SAN DIEGO — A slight increase in hepatitis A cases prompted city officials to expand handwashing stations throughout San Diego for unhoused individuals, but have not added additional bathrooms to prevent the virus’ spread — despite a request from the county.

San Diego County health officials have been monitoring the uptick since earlier this year, when five cases and one death were confirmed in the region between Jan. 10 and Feb. 6.

Since then, there have been 24 infections of the virus confirmed by the county, including 18 hospitalizations. At least eight cases were reported in March and seven in April.

Almost all the cases were among the homeless population, according to San Diego County deputy public health officer Dr. Cameron Kaiser.

Homeless San Diegans are considered a greater risk for a hepatitis A infection, as the virus is closely associated with contaminated water or food, poor sanitation and hygiene.

At this time the uptick in cases is not considered an outbreak, according to Kaiser. To date, two of the cases were connected, but he said it takes three related infections to be considered an outbreak.

“We are not waiting for this to become an outbreak,” Kaiser told FOX 5. “We want to make sure that people have the tools they need to not get sick.”

That prompted the county to request additional portable restrooms be placed throughout the City of San Diego, as well as hand-washing stations for unhoused residents to use.

In a statement to FOX 5, San Diego officials say 10 additional stations have been added across the city in late March and early April, bringing the current total available to 33.

However, there are so far no additional portable restrooms added, per the county’s request.

According to the emailed statement, some portable restrooms are already provided at key locations identified by the city.

“Hand washing stations promote hygiene and sanitation and, combined with ongoing vaccination efforts in city shelters, can help prevent the transmission of hepatitis A,” the statement continued.

Homeless advocate Michael McConnell says that additional bathrooms are needed to help keep the virus from spreading among the homeless population as cases rise. He told FOX 5 that he doesn’t understand why the city isn’t willing to make a move.

“Unfortunately, it doesn’t really seem like the city is very concerned about it the county has given directions to put out additional bathrooms and they just refuse to do it,” said McConnell.

“The good thing is that a lot of people are vaccinated,” he continued, “but the fact of the matter is we don’t have places for people to go out here.”

For now, county health officials are keeping a close eye on hepatitis A cases to prevent another outbreak similar to the one from 2016 to 2018 that impacted nearly 600 residents.

“Because it is hard to predict, we are taking it seriously,” said Dr. Kaiser “We don’t want things to snowball.”

“We have county foot teams in encampments and shelters making sure people know the risks to them, giving them hygiene kits to reduce the risk of transmission.”