Health officials in San Diego tallied another death linked to a massive hepatitis A outbreak on Tuesday, bringing the total number of fatalities to 19. The updated data also saw an increase in the number of San Diego’s confirmed cases, with the total now surpassing 500, the Los Angeles Times reported.

The outbreak has spread to other Los Angeles counties and prompted Gov. Jerry Brown to declare a state of emergency last week in order to provide easier access to vaccines. It is the largest person-to-person outbreak recorded since the vaccine was introduced in 1996.

“This outbreak is different than any other we have seen in the United States in the past decade,” Matt Zahn, medical director of epidemiology at the Orange County Health Care Agency, told ABC News. “Previously we have seen outbreaks that are foodborne, with a direct exposure to that food course. Ongoing person-to-person spread is really not something we’ve seen in recent years.”

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The outbreak has largely affected the homeless population and illicit drug users, with health officials moving to sanitize downtown San Diego streets in an effort to wash away infected feces and bodily fluids.

Paramedics were also authorized to administer vaccines in an effort to stop the disease from spreading further.

Related: Seven Sneaky, Subtle Signs of Liver Disease

“The key is to bring the vaccination directly to the communities at risk,” Zahn told ABC News. “This population is not easy to reach, so we make interventions to bring it to them. San Diego has done a marvelous job to have their staff go out to the homeless community, individual by individual, and offer the vaccine.”

Hepatitis A can cause fever, fatigue, abdominal pain, nausea, and vomiting. While it does not typically prove fatal, it can kill those with compromised livers or weakened immune systems.

This Fox News article is used by permission.

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