SAN DIEGO–A fifth person has died as a result of the hepatitis A outbreak in San Diego county, the County Health and Human Services Agency said Wednesday.

About 161 people have been hospitalized with the disease. There is a total of 228 hepatitis A cases reported in the San Diego county area.

The illness strikes homeless individuals or illicit drug users. One in five people also have hepatitis C, according to the health agency.

Hepatitis A is most commonly spread person-to-person through the fecal-oral route. Public health investigators are continuing to evaluate cases, but so far no common food, drink or drug source has been identified as a contributing cause to this outbreak.

“It is imperative that anyone at risk for hepatitis A get vaccinated,” said Wilma Wooten, M.D., M.P.H., County public health officer. “We cannot stress this enough – get vaccinated and make sure you wash your hands after going to the bathroom.”

Symptoms of hepatitis A include jaundice (yellowing of the skin and eyes), fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, and light-colored stools.  Symptoms usually appear over a number of days and last less than two months.  However, some people can be ill for as long as six months. Hepatitis A can sometimes cause liver failure and even death.

The best way to prevent hepatitis A is by getting vaccinated. The hepatitis A vaccine became available in 1995 and is recommended as part of the routine childhood vaccination schedule. However, many adults have not been vaccinated and may be susceptible to the hepatitis A virus.

For general information on hepatitis A, visit the HHSA hepatitis website where data are updated routinely. A hepatitis A fact sheet is also available.