San Diego County and city officials delayed taking specific actions to address the community's hepatitis A outbreak for months, as infections and deaths mounted, according to public records obtained by The San Diego Union-Tribune.
Here are six things to know.
1. Officials launched an investigation into the outbreak in early 2017. As of Sept. 19, officials have tallied more than 440 cases of hepatitis A, 305 hospitalizations and 16 deaths in San Diego County. The vast majority of those affected by the outbreak have either been homeless, illicit drug users or both.
2. Emails released by county spokesman Michael Workman to the Union-Tribune suggest the city declined opportunities for the installation of portable toilets and wash stations to curb the spread of hepatitis A. The virus is primarily transmitted through contact with the fecal matter of infected individuals, which can contaminate food and water.
"May 4 we proposed the wash stations and city said no," Mr. Workman told the publication. "Two weeks later we offered to pay for them, still no … June 28 they said they'll consider a permit process but want us to pilot first on our properties."
3. Greg Block, a spokesman for San Diego Mayor Kevin Faulconer, R, told the Union-Tribune the city did not turn away wash stations. He said the city deferred to the county to handle the outbreak response because the county has more public health experience.
"The county is our public health agency," Mr. Block told the newspaper. "They have the expertise on public health matters that the city does not. As a result, we take our direction on public health issues from them."
4. City and county officials also spent weeks discussing the dissemination of posters for a hepatitis A public relations campaign. The outbreak was first identified in March. Posters were first discussed in June and displayed in the community in August.
5. The outbreak was declared a public health emergency Sept. 1, and officials have now equipped areas with high concentrations of homeless residents with portable hand-washing stations. Additionally, street cleaning crews washed the city streets with bleach-spiked water.
6. The San Diego hepatitis A outbreak is the worst in the United States since the 1990s, according to the Union-Tribune.
More articles on infection control:
Top 10 infection control stories, Sept. 18-22
6 children hospitalized in Wisconsin E coli outbreak
Flint's Legionnaires' outbreak likely killed more people than reported, says expert