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An outbreak waiting to happen: Hepatitis A marches through San Diego’s homeless community

A hepatitis A outbreak has stricken 481 people and killed 17 in San Diego, and it could get worse because of the challenges of dealing with the homeless population.

SAN DIEGO — The hepatitis A outbreak now roiling this well-heeled, coastal city may have had its roots in a baseball game — when the city cleaned up for the 2016 All-Star Game by pushing its homeless out of the touristy areas downtown and into increasingly congested encampments and narrow freeway onramps just east of downtown. The lines of tents stretched for blocks.

At the same time, the city was locking and removing bathrooms to help control the rampant drug and prostitution trade they’d spawned. Hepatitis A is transmitted through contact with feces from an infected person, and in close, unsanitary conditions, the highly contagious virus can spread explosively. So it was only a matter of time, experts say, before cases would surge among the homeless.

“I’m not so much surprised it occurred, but surprised it didn’t occur earlier,” said Dr. Robert Schooley, who chairs the division of infectious diseases at the University of California, San Diego, and currently serves as an informal health adviser to the city’s mayor. “In some ways, it was the perfect storm.”

Read more: San Diego will power wash streets amid hepatitis outbreak

Today, the tents are gone. There are clusters of newly installed portable toilets open and guarded 24 hours a day. More than 60 new hand-washing stations dot the city. Workers in hazmat suits

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