20 more cases and 22 more hospitalizations to San Diego County’s ever-growing hepatitis A outbreak.

Tuesday afternoon the county Health and Human Services Agency raised the number of the outbreak’s confirmed cases to 481 from 461 and hospitalizations to 337 from 315. The death count associated with the outbreak, which started in November 2016, remained at 17 for a second straight week.

For the last two weeks, the health department has reported having more than 40 cases under investigation awaiting confirmation from the U.S. Centers for Disease Control and Prevention that they suspect are caused by the same unique strains associated with other outbreak cases.

No information on the number of cases under investigation was available Tuesday. All of those who have died during the outbreak have had underlying medical conditions such as liver disease. Most were also homeless and/or drug users.

Vaccination events continue throughout the city as public health officials focus on those at the highest risk of infection such as health and safety workers and those who work with homeless outreach organizations and food service workers.

Hepatitis A infection is seldom fatal unless other complications, such as liver disease or an autoimmune disorder, are already present.

The hepatitis A virus is shed in human feces and transmitted when a person accidentally comes in contact with fecal matter. Proper hygiene — hand-washing with soap and warm water for at least 20 seconds after using the bathroom — is sufficient to kill the virus, though alcohol-based hand sanitizer may not be effective. Hepatitis A symptoms include jaundice (yellowing of the skin and the whites of the eyes), abdominal pain, fatigue, diarrhea, vomiting and nausea.

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Evangelist Dina Amelia Kalmeta is the Founder and CEO of Your New Life in Christ Ministries - CWW7NEWS. Evangelist Dina reports on world events as they pertain to Bible Prophecy. Before Your New Life in Christ Ministries, Evangelist Dina served as a Leader for INCHRIST NETWORK leading teams online and spreading the Gospel of Jesus Christ. Her mission today is to bring hard evidence that what is taking place in the world isn't just coincidence, but indeed proof that the last days the Bible warned us about are upon us right now.