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SAN DIEGO — San Diego County could have reduced the risk of the spread of hepatitis A last year with better organization and hastened vaccination efforts, according to a report released Thursday by California State Auditor Elaine Howle.

According to the report, the county failed to set appropriate targets to vaccinate at-risk county residents and did not determine the amount of resources such as nurses that would be needed to fulfill vaccination efforts. While an average of 20 new hepatitis A cases were confirmed each week from May to mid-September 2017, vaccinations only increased significantly by September.

According to the auditor’s report, vaccinations in September and October totaled more than 41,000 compared to about 7,700 in August. The spike in vaccinations led to a decrease in new cases, suggesting that the county could have limited the outbreak earlier in the year.

The city and county of San Diego also failed to improve sanitation conditions in a timely manner, failing to increase access to hand-sanitizing stations and public restrooms until September 2017. According to the audit, such dysfunction was due to the county’s failure to inform the city of San Diego how severe the outbreak became.

“While I am still evaluating the extremely thorough report from the State Auditor, one thing is clear: lives could have been saved,” said Assemblyman Todd Gloria, D-San Diego. “We now know that the county and the city could have planned better and acted sooner to contain the spread of this disease. Unfortunately, that was not done until it was too late.”

Howle’s office suggested multiple recommendations to the city and county to improve their responses to public health outbreaks. The auditor’s office advised the county to update its emergency operations plan by April 30, 2019, share relevant data with its local jurisdictions and come to an agreement with the city of San Diego by March 31, 2019 to clarify how each entity should respond to future public health problems.

Howle’s office also advised the city to examine its actions during the outbreak prior to the emergency declaration on Sept. 1, 2017. The city is then recommended to fix any weaknesses found during the review.

“We agree with the recommendations, particularly that the city and county should strengthen their relationship as it relates to responding to regional emergencies,” city COO Kris Michell said. “We look forward to working in partnership with the county on this recommendation.”

The San Diego County Board of Supervisors also weighed in on the audit’s findings.

“More important than pointing fingers and laying blame, is taking the lessons learned from this incident and using them to be better prepared for future health emergencies,” Chariwoman Kristin Gaspar said in a statement.

The City currently has three locations for portable restrooms that remained after the Hepatitis A emergency ended, according to Tracy Cambre Morales, Deputy Director with the City of San Diego’s Communication Department.

The County identified 11 of the 82 hand washing stations as “high usage.”

“The City has kept those 11 hand washing stations in operation since January 2018,” Morales wrote in an emailed response to FOX 5. “The City also issued a post-emergency sidewalk sanitation contract similar to the one used during the emergency and those sidewalk sanitations continue today.”