SAN DIEGO — Cases of hepatitis A continue to grow in San Diego County, with an additional three cases of the virus confirmed last week by health officials.

The additional reported cases bring the total number up to 28 in the county between Jan. 10 and May 6. At least one death has been recorded, as well as 18 hospitalizations due to the virus, according to health officials.

All have been transited from person-to-person and are not connected to the outbreak last year linked to frozen strawberries.

A majority of the cases this year so far — about 18 — have been among people experiencing homelessness, including the one death.

According to health officials, the County typically reports about two cases of the virus per month, while a single positive was recorded among the region’s unhoused population last year.

At this time, the uptick in cases is not considered an outbreak, as that would require at least three connected cases. While no outbreak location has been identified, health officials say they are already working to prevent further spread of the disease.

On Monday, the Health and Human Services department has issued a California Health Alert Network advisory, warning about the spread and providing updated guidance to healthcare practitioners.

Since the county began monitoring the uptick in February, health officials have also stepped up vaccination and education outreach efforts, particularly among groups like the unhoused who are considered to be most at-risk from the disease.

“We’re expanding ongoing efforts to reach the homeless community because this is a setting where cases could spread more quickly,” said county public health officer, Dr. Wilma Wooten. “We need all of our partners, from shelter operators, cities and the healthcare systems, to join us in this response.”

About 126 vaccination events have taken place since February, health officials said, and another 18 are scheduled to take place this month.

In addition, three outreach teams have been deployed twice a week to provide vaccinations and other resources to encampments, focused in downtown San Diego.

However, lack of convenient access to bathrooms or handwashing continue to pose a major vulnerability for populations like the unhoused when it comes to hepatitis A mitigation.

Earlier this month, county officials sent a letter requesting all cities in the region to place additional portable bathrooms and handwashing stations at encampments for unhoused residents to use.

The City of San Diego, the largest in the county, told FOX 5 in a statement that they added an additional 10 stations at locations across the city in late March and early April, but have not added additional portable restrooms despite the county’s request.

The last major hepatitis A outbreak in San Diego County was from 2016 to 2018, impacting mostly the unhoused and people who use illicit drugs. About 592 probable or confirmed cases were reported during the outbreak, as well as 20 virus-related deaths.

San Diego County encourages those at risk for a hepatitis A infection to get vaccinated if they have not already as part of childhood immunizations.

According to the Centers for Disease Control and Prevention, those groups include international travelers, men who have sex with men, people who use illicit drugs, individuals experiencing homelessness, anyone with occupational risk for exposure and people with chronic liver disease or HIV.

FOX 5’s Christelle Koumoué contributed to this report.