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Report failures in response to the San Diego Hepatitis A outbreak

The outbreak killed 20 and made 577 people ill between November 2016 and October 2017.

The review, titled "The Hepatitis A Epidemic in San Diego: (Mis) Managing a Public Health Crisis," criticizes to the county and the city due to inadequate coordination that delayed sanitary procedures that could have diminished the spread of the disease, especially among the homeless population.

The report "correctly points out that there really was not a playbook to deal with what was an unprecedented health crisis", San Diego Ms Kevin Faulconer said

"It is clear that it was necessary to improve coordination and communication when the outbreak was identified for the first time and there were many lessons that will help us move forward, "said the mayor. "The most important lesson is that our community can not postpone difficult decisions about homelessness because it makes the problem worse."

The Centers for Disease Control and Prevention says that Hepatitis A is a preventable disease of the liver and can be prevented with vaccines by a virus. It is usually transmitted from person to person or by consuming contaminated food or water. Symptoms include fatigue, poor appetite, stomach pain, nausea and jaundice.

The 20-page report praised officials for effectively contacting residents at risk and getting vaccinated, according to the San Diego Union-Tribune. Among the recommendations in the report are updating the county's emergency operations plan, establishing clear lines of authority and designating a medical professional to report directly to the mayor.

He also recommends building safer bathrooms and hand-washing stations in homeless areas where people congregate.

Officials vaccinated more than 100,000 people, installed dozens of hand washing stations and cleaned the streets with a solution of bleach to contain the virus that lives in the feces. The emergency ended in January.

The mayor said the city is carrying out a massive expansion of services for the homeless that includes building shelters and adding new bathrooms.

The grand jury, comprised of 19 retired professionals, interviewed administrative staff from the county's health and human services agency, high-level management of several local cities and police personnel throughout the region before drawing their conclusions, said the newspaper.

Written reports, including local media accounts, professional medical documents and internal emails were also examined.

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