Fourteen people have died from an outbreak of hepatitis A in San Diego, and experts believe it to be the deadliest outbreak of the disease in the US in decades, the Guardian has learned. In large part, the victims were homeless people who have had to contend with a lack of 24-hour public restrooms, even though hand-washing is one of the best defenses against infection.

The number of cases has exceeded other large outbreaks, said a Centers for Disease Control (CDC) spokesperson, and is “likely the most deaths in an outbreak in the US in the past 20 years”, the period in which the CDC has operated its electronic reporting system. In 2003, three people died and at least 124 were hospitalized after eating contaminated salsa at a Pennsylvania restaurant. In 2013, 69 people across 10 states were hospitalized after eating contaminated pomegranate seeds.

Yet in San Diego, 264 people have been hospitalized, roughly 70% of them homeless, in an outbreak that began last November, according to local health officials. Nine of the 14 deaths have occurred since mid-July. The virus, which impairs liver function, causing jaundice, fatigue, joint pain and, in the most serious cases, death, is largely spread through food or water contaminated by fecal matter. Hepatitis A has a long incubation period – up to 28 days – which means people can spread the disease before they’re aware they’re infected.(theguardian)…[+]