Health officials are worried that a huge hepatitis outbreak plaguing San Diego could spread to Los Angeles County.

Health officials say LA's homeless population is at risk after more than 400 people, many of whom are transients, contracted hepatitis A in San Diego. Sixteen people have died there, but while there have been only eight cases in Los Angeles, at least two of the people with the disease moved up from San Diego to LA, according to the Los Angeles County Department of Public Health.

Hepatitis A is a virus spread through fecal matter when people do not properly wash their hands. It can also spread through sexual contact and contaminate food.

"We worry that you just need one case in the setting of poor hygiene, poor sanitation and questionable practices in terms of washing hands and where they're procuring food, and now you have a large population that can get infected," said Suman Radhakrishma, a doctor at Dignity Health California Hospital.

LA County public health officials have stepped up the cleaning of Skid Row, using bleach mixture to try and prevent a local hepatitis outbreak. Outreach workers are also educating transients about how the virus is spread and encouraging them to get vaccinated at free clinics.

Signs of Hepatitis A:

Flu-like symptoms

Dark urine

Body aches

Jaundice (yellowing of the skin or eyes)

It's not how you start, it's how you finish.

Chris Taylor hit an inside-the-park home run to start the game, but Clayton Kershaw surrendered a grand slam late, as the Philadelphia Phillies upset the Los Angeles Dodgers, 4-3, on Monday night at Citizens Bank Park. 

Taylor broke out of his most recent 0-for-15 slump with a little bit of luck from the outfielder guard rail as he hammered the second pitch of the game off the rail in left-center and the ball ricocheted into left field and away from two Phillies outfielders allowing CT3 to easily run around the bases for a leadoff, stand-up, inside-the-park home run.

Taylor rounded the bases in a speedy 15.40 seconds, the third fastest trip around the bases this season. The inside-the-park home run was also the first for the Dodgers since Aug. 20, 2011 at Coors Field when Trent Oeltjen did it for the Boys in Blue.

To come full circle, according to ESPN Stats and Info, it was the first leadoff inside the park home run for the Dodgers since current manager Dave Roberts did it on Aug. 9, 2003.

The creative home run was also Taylor's 20^th of the season, making him the fifth Dodger with 20 or more home runs this season.

Five different players ties the franchise record set in 1979 and 2000, and the current team could break the record if Yasmani Grandal goes deep one more time before season's end as the catcher is currently stuck on 19 long balls this season.

The Dodgers went back-to-back in the first inning as third baseman Justin Turner crushed a curveball from Nick Pivetta three pitches later to give the Dodgers an early 2-0 lead.

"We got ahead early, but those guys hung in there and got the big hit when they needed it," Dodgers' manager Dave Roberts told reporters after the game. "It was a surprise to all of us. He [Kershaw] usually finds a way to make that pitch to get out of the inning."

Kershaw cruised through the first five innings of the game before he ran into trouble in the bottom of the sixth.

"I thought he pitched really well tonight," continued Roberts. "In that sixth inning, that leadoff walk got him, and then another walk."

Kershaw uncharacteristically walked a pair of Phillies hitters around a single by Freddy Galvis and was just one pitch away from getting out of the inning unscathed.

"Obviously we were being careful with Hoskins," said catcher Austin Barnes of the walk to Rhys Hoskins that loaded the bases. "He [Kershaw] left it over the plate and he [Altherr] made us upay for it."

Unfortunately, that pitch was not what he wanted as he hung a slider over the heart of the plate to Aaron Altherr and the Phillies' left-fielder hit a game-winning grand slam off the three-time Cy Young Award winner.

Hoskins works 7-pitch, 2-out walk.

Altherr crushes grand slam.

Baseball is a beautiful game. pic.twitter.com/LuITmoXruS

— CSN Philly (@CSNPhilly) September 19, 2017

"It was just a bad slider," said a visibly frustrated Kershaw after the game. "I made some bad pitches. I probably should have pitched better."

It was the first grand slam allowed in Kershaw's career, and the one mistake was all it took for Kershaw (17-4) to get the loss, allowing all four runs to come on one pitch, scattering four hits with two walks (both in the 6^th inning) with six strikeouts in six innings.

"We had the lead and I blew it and we lost," Kershaw said matter-of-factly. "Need to go back to the drawing board and get ready for the next one."

Despite allowing two home runs to the first two batters of the game, Pivetta (6-10), got the win, beating Kershaw by allowing just two runs on four hits with two walks and eight strikeouts in six innings.

Curtis Granderson broke out of a bad slump with a solo home run in the top of the ninth for his 24^th home run of the season. All three Dodger runs came on solo home runs.

Curtis Granderson Solo Homerun pic.twitter.com/IWpLDMGSAx

— Dodgers (@DodgersVideos) September 19, 2017

Hector Neris gave up the homer to Granderson, but struck out the side in the ninth to earn his 22^nd save of the season.

The Dodgers Magic Number remains at four, but could be lowered if the Arizona Diamondbacks lose to the San Diego Padres later in the evening. 

Up Next:

Yu Darvish takes the mound on Tuesday opposite RHP Aaron Nola in the second game of a four-game series. First pitch is scheduled for 4:05PM PST.

A BMW was engulfed in flames in what investigators are calling a "suspicious" car fire. Ted Chen reports for the NBC4 News at 6 on Monday, Sept. 18, 2017.

The group of protesters oppose the construction of those massive tunnels to bring water from Northern California down south and they worry how much of the cost will be passed down to rate payers. Patrick Healy reports for the NBC4 News at 5 on Monday, Sept. 18, 2017.

Major national airlines have warned travelers of possible flight cancellations and delays as Category 5 Hurricane Maria made landfall Monday in the Caribbean. 

Delta, Southwest and American airlines announced there would be no change fees if a flight was impacted by Hurricane Maria. All three airlines are updating their websites with the latest details on their flights. 

Regional airlines in the Caribbean have also canceled or delayed their flights. 

Maria grew into an "extremely dangerous" Category 5 storm with maximum sustained winds of 160 mph on Monday as it barreled onto the island of Dominica in the eastern Caribbean.

Maria could hit Puerto Rico and the Virgin Islands Tuesday night and Wednesday.

President Donald Trump approved an emergency declaration for the island and ordered Federal Emergency Management Agency to assist the commonwealth. The declaration authorizes FEMA to coordinate all disaster relief efforts in Puerto Rico. 

A Laguna Niguel softball coach, who was also a UC Irvine board member, made his first appearance in a Santa Ana courtroom Monday on charges of molesting two 10-year-old girls.

Glen Thomas Kauffman, 53, of Laguna Niguel, was charged Thursday with two counts of lewd acts on a child younger than 14, according to the Orange County District Attorney's Office. He also faces a sentencing enhancement for multiple victims.

Kauffman is accused of molesting one of the girls multiple times and once with another, according to prosecutors. The sexual assaults are alleged to have taken place between August 2014 and August 2017, prosecutors said.

Kauffman's status with UCI is under review.

"UCI is reviewing this situation and will comment when appropriate," said UCI spokesman Tom Vasich. "Mr. Kauffman's board membership is currently on hiatus."

Kauffman's arraignment was rescheduled for Sept. 25.

A Pieology restaurant employee was fired after allegedly typing an anti-police message on a Torrance officer's receipt on Thursday.

A Facebook post shared Monday to Facebook denounced the message that read "F--- The Cops" on the unnamed officer's take out receipt.

The post reads in full: "I want to share this with everyone to show the unprovoked hatred that my husband and his partners deal with everyday. This is not the type of business that I want to see in the city where I live. My husband's partner was just trying to get a quick bite to eat in the middle of a busy shift and this is what he received. Needless to say we will never eat at Pieology ever again. I hope you all will help support our police and share this both near and far. It is NOT ok to treat our officers like this."

The Facebook post has since been shared more than 7,000 times and has garnered more than 2,000 comments.

The pizzeria apologized on behalf of the entire Pieology family for this "upsetting situation" in a statement shared with NBC4.

"The actions of this employee do not in any way reflect the thoughts of Pieology, and we have taken swift and serious action to rectify the situation, including terminating the offending employee. We have the utmost respect and gratitude for the men and women who keep our communities safe, and have no tolerance for hateful language or actions. This location in Torrance is a heartfelt supporter of all men and women in uniform, especially the brave first responders, and shows its support with a discount for all uniformed police, firefighters and military members."

A woman lay dead inside a Santa Ana apartment for hours Monday as police consulted with drug lab experts to determine if the home was safe to enter.

A man called police about 3 a.m. to report that a woman was "hurt and needed medical attention" at 215 S. Birch St., according to Santa Ana police Cpl. Anthony Bertagna. The home is known to police for drawing multiple complaints regarding narcotics and other disturbances.

When officers arrived, "they could see her lying on the ground and forced entry into the residence and found her to be deceased with a male next to her," Bertagna said.

Police took the man, who is in his 30s, in for questioning. The victim was in her 50s, according to Bertagna, who said both lived at the Birch Street home.

"At this point it appears to be a homicide," based on her injuries, Bertagna said. "We're looking into the possibility that the caller was different than the person detained," he said.

The home has drawn numerous calls for police service, Bertagna said.

"We come to this location on a regular basis for narcotics and disturbance calls," he said.

The woman's body was still inside the apartment after hazmat crews left the scene, with officials trying to determine if they were dealing with a meth lab as they continued their investigation.

Some companies are so set on having workers who know just how their computer systems work that they're partnering with schools to start or invest in job training programs of their own, NBC News reported.

Call it "new collar" jobs, as opposed to white collar and blue collar. They require some specialized education to get the job, but not a four-year degree.

For example, Delta has partnered with 37 aviation maintenance schools to help shed light on the often-technical aviation maintenance technician job. A company executive said that the curriculum required by the Federal Aviation Administration is "very generic" and that it takes at least a year of working at Delta even with certification to be able to sign off on anything as an AMT.

Nationwide, there were 6.2 million job openings at the end of June, a record high, and many of these openings are "new collar jobs that are unfilled as a result of an unskilled and under-skilled workforce," said Eugene Giovannini, chancellor at Tarrant County College in Texas.

Five football players at a Christian college in suburban Chicago face felony charges over the alleged hazing of a freshman teammate last year, authorities confirmed.

A judge issued arrest warrants Monday for Wheaton College students James Cooksey, Kyler Kregel, Benjamin Pettway, Samuel TeBos and Noah Spielman. Prosecutors charged the five players with aggravated battery, mob action and unlawful restraint.

Spielman is the son of former NFL star Chris Spielman. An attorney for the Ohio State linebacking great said the family is surprised by the charges and called the allegations against his son "inaccurate and sensationalized."

"Chris and his family were shocked to hear of these charges after an investigation by Wheaton College exonerated these gentlemen over one year ago," the statement read. "The initial print reporting has been inaccurate and sensationalized as Noah has, and will, cooperate with authorities moving forward in the legal process."

Attorney information for the other students was not immediately available.

Police said the victim was "taken forcefully from his dorm room, restrained against his will" and left in a baseball field with multiple injuries.

The victim told police he was in his dormitory room in March 2016 when the players tackled and duct taped the freshman, put a pillowcase over his head and threw him in a vehicle, the Chicago Tribune reported, citing court documents describing the victim’s statements to investigators. The student told investigators they attempted to sodomize him with an object and dumped his half-naked and beaten body in an off-campus field.

The freshman ultimately took himself to a hospital with muscle tears in both shoulders and various bruises and scratches, the Tribune reports. Police said the freshman's injuries were "confirmed by medical experts."

The publication said it obtained the records after the Wheaton Police Department declined this year to release the report under the state’s Freedom of Information Act. The Tribune did not say how it obtained the report.

The victim withdrew from the school not long after, according to the publication. 

He told the Tribune in a statement that the incident "has had a devastating effect on my life."

The college said in a statement late Monday night that it conducted its own investigation into the hazing claims, which "resulted in a range of corrective actions," though it could not specify what those actions were. 

"The conduct we discovered as a result of our investigation into this incident was entirely unacceptable and inconsistent with the values we share as human beings and as members of an academic community that espouses to live according to our Community Covenant," the statement read. "We are profoundly saddened that any member of our community could be mistreated in any way."

Wheaton College has one of the top-ranked Division 3 football programs in the nation.

Police said it is the first serious hazing incident that has been reported from the school.

"They're very serious charges," said Chief Jim Volpe. "They'll be answering to felony charges." 

A varsity member of the school's football squad told NBC 5 the team was scheduled to have a meeting to discuss the charges against their teammates after a game Monday night.

Students at the private Christian college told NBC 5 they're disappointed to hear the accusations.

"I was just in the student center and there's a post on the wall that says: 'You know it has been a year since this happened, why haven't we heard about anything?'" said Wheaton College senior Drew English. "There's an anti-hazing policy in the student handbook — that's supposed to protect against things like this."

The DuPage County Prosecutor's Office said the players could turn themselves in as early as Tuesday morning during bond court. Their bond has been set at $50,000. 

"We expect that they will turn themselves in within a very reasonable time, according to our discussions with them," Volpe said. 

Read the college's full statement below:

"Wheaton College aspires to provide an educational environment that is not only free of hazing, but practices our values as a Christian community. As such, we are deeply troubled by the allegations brought by law enforcement against five members of our football team. When this incident was brought to our attention by other members of the football team and coaching staff in March 2016, the College took swift action to initiate a thorough investigation. Our internal investigation into the incident, and our engagement with an independent, third-party investigator retained by the College, resulted in a range of corrective actions. We are unable to share details on these disciplinary measures due to federal student privacy protections.

"The College has fully cooperated with law enforcement in their investigation. To not impede the law enforcement investigation, the College was bound by confidentiality and unable to share more information until now.

"The conduct we discovered as a result of our investigation into this incident was entirely unacceptable and inconsistent with the values we share as human beings and as members of an academic community that espouses to live according to our Community Covenant. We are profoundly saddened that any member of our community could be mistreated in any way. This incident has prompted our Board of Trustees to engage outside experts to lead a campus-wide review of the level of effectiveness of our anti-hazing policy and of the culture around how students treat one another in our campus communities, athletic teams, and organizations. Wheaton remains committed to providing Christ-centered development programs and training to all our students.

"In 2014, we revised our anti-hazing policy and improved our training protocols to include a formal review of our anti-hazing policy with all student athletes every year, with required student signatures; we also require annual training for residence assistants who are responsible for residence hall activities. Despite these deeply troubling charges, we have experienced positive changes on campus, including rapid responses from campus leaders to reports of hazing or other inappropriate behavior and effective disciplinary review."

More than 70 members of the Los Angeles Fire Department returned home after a weeks-long mission to help victims affected by Hurricane Harvey and Hurricane Irma.

The weary first responders spent 11 days helping the victims of Hurricane Harvey and another 13 days assisting those affected by Hurricane Irma. They returned to Station 88 in Sherman Oaks with loving applause, warm greetings and cheering family and friends.

Beverly White reports for the NBC4 News at 11 on Monday, Sept. 18, 2017.

Surveillance video supports an Oakland woman's report last week that a would-be robber handed her a threatening note, according to BART police.

The woman, Julie Dragland, said she boarded a train in Daly City and was heading home to Dublin when a person in dark clothing climbed onto the train in downtown San Francisco and thrust a note at her. She said she faked a seizure to thwart the would-be robbery. 

The note read: “There are 2 guns pointed at you now. If you want to live, hand back your wallet + phone NOW + do not turn around and be descreet [sic]. Do not turn around until after you have left Civic Center + you will live.”

BART police Deputy Chief Lance Haight said Monday video from the train shows the suspect was seated behind the victim, who was sitting alone. The suspect, who was also alone, is then seen reaching over the victim’s shoulder, which is when the suspect may have dropped the note, Haight said.

Dragland immediately pretended she was having a seizure. In response, the alleged suspect disembarked at the Powell Street BART station.

There is no indication from the video the suspect was armed with any weapons.

The victim said she was shaken up and will no longer sit on a BART seat with its back to other chairs behind it. Dragland, however, won’t let the frightening encounter stop her from riding BART trains altogether.

Dragland doesn’t plan to press charges if the suspect is caught.

BART is investigating the alleged crime and poring over surveillance footage. Although there were roughly 15 people in the BART train car, no one else reported the incident, police say.

T-Mobile and Sprint are in active talks about a merger, though negotiators are still weeks away from finalizing a deal to unite the nation's No. 3 and No. 4 wireless carriers, people close to the situation told CNBC.

T-Mobile parent Deutsche Telekom would emerge as the majority owner in the stock-for-stock merger. Sprint's parent company is Softbank.

The companies declined to comment on the report.

A big factor looming over a possible deal is the risk of rejection by antitrust regulators.

With decision time approaching for water districts being asked to fund the most expensive water project in California history, the head of California's largest water wholesaler Monday warned there is no room for subsidies or withdrawal from participation.

"All of us have to work together to make this work, and all of us need to pay our share," said Jeff Kightlinger, general manager of the Southern California Metropolitan Water District (MWD).

"California WaterFix" would address a weak link in the state's aqueduct system by going underground and building more than 30 miles of massive tunnels for transporting water. The state water project, which draws on snowmelt from the Northern Sierra, provides about one-third of California's water.

Though drought is still a fresh memory in California, opponents and skeptics have raised concerns about the estimated $17 billion cost, and how that will be divvied up. Historically, urban users have paid more for gallons delivered by the state water project than farm users.

There have also been indications that some agricultural water districts -- in particular those that hold senior water rights -- will be reluctant to pay the the full amount of their apportioned share of the total cost.

A key bellweather could come Tuesday when a major San Joaquin Valley agricultural water district, Westlands, will consider its participation in California WaterFix. At an August meeting, several board members expressed reservations about the projected cost.

Also Tuesday, a Los Angeles City Council Committee will consider the project's economics.

WaterFix would tackle what has been a problem since development of the state water project first began more than half a century ago during the administration of Pat Brown, the current governor's late father.

Northern California snowmelt destined for the California Aqueduct must traverse the delta of the Sacramento and San Joaquin Rivers at the east end of the San Francisco Bay. Consisting of waterways between hundreds of islands and earthen levees, the delta is environmentally fragile, and the pumping required to move the fresh water plays havoc with water flows and kills fish.

During his first tenure as governor in the 1970-80's, Gov. Jerry Brown championed a "peripheral canal" what would carry water around the delta. Voters rejected that in 1982. Since returning to the state capital, Brown re-envisioned the peripheral canal as twin tunnels that would stretch 30-plus miles beneath the delta.

The proposal is characterized as a way to increase reliability, though it is also expected to allow a fractional increase in the amount of water that can be delivered.

The MWD has been a powerful advocate for the twin tunnel plan. But Kightlinger made it clear MWD needs allies, and is not inclined to pay more than its share to get the project built. MWD believes its portion of the cost should equal the percentage of of water it is to receive.

"This is not going to be a subsidy," Kightlinger said.

Los Angeles has four representatives on the MWD board, which on October 10 is expected to vote on proceeding with the project.

A study prepared by the Los Angeles office of public accountability/ratepayer advocate projects the additional cost for a median household would likely be $1.73 per month, though it could range from a low of 87 cents to a high of $4.31.

"The WaterFix is affordable to City single family residence households," the report concluded. 

Twin Tunnel opponents who demonstrated Monday at City Hall expressed skepticism of the ratepayer advocate's numbers.

"A lot of people cannot afford their water bills now, and the cost will go up exponentially," said Conner Everts of the Southern California Watershed Alliance.

The demonstrators urged city leaders to direct the city's MWD appointees to vote against the twin tunnels. Some demonstrators also carried signs urging the city not to retain ratepayer advocate Fred Pickel. He defended the report, and said that previous actions by his office had delayed the imposition of rate increases and saved the city's ratepayers millions of dollars.

Pickel was set to appear at Tuesday's meeting of the City Council Energy, Climate Change and Environmental Justice Committee, to answer questions about the report.

Opponents of the twin tunnels and any rate increases favor alternative approaches to stretching water resources, such as increased conservation and recycling.

As it was Monday, MWD joined the Sanitation Districts of Los Angeles County in announcing commitment to a Regional Recycled Water Program.

"We want to be more efficient, to do more with less," said Kightlinger. When built out, the facility could produce enough waterto serve the needs of 350,000 homes, Kightlinger said, but that amount represents only 10 percent of what is expected to flow south through the twin tunnels.

"We want to be more efficient, to do more with less," said Kightlinger. "But you still have to have that backbone supply, that imported water from Northern California." 

A magnitude-3.6 earthquake rattled parts of Los Angeles late Monday.

The earthquake hit at 11:20 p.m., centered northwest of Westwood, the USGS reported. Hundreds of Southern Californians reported weak to light shaking from inland areas to the coast, according to the USGS.

There were no reports of damage or injuries.

Look, we get it, and it's completely understandable.

When the mornings grow a tad crisper, and the weather starts to don its true fall feel, a person longs to stay tucked up, under the toasty blankets of their bed, for just a little longer each day.

So it goes, apparently, with the Titan Arum, or Amorphophallus titanum, or, most popularly, the Corpse Flower.

This stinker of a special specimen, a rare and talked-about bloom of headline-making proportions, is now on display at the San Diego Botanic Garden in Encinitas.

But the four-foot-tall flower, which is famed for its "deathly" smell, wasn't yet open when it arrived at the plant-filled property in early September. Staffers guessed it might open over the middle weekend of September, perhaps on the 16th or 17th, thus sending its rotting smell to nearby noses, but, alas: This reticent flower didn't budge.

The "cooler weather" over the weekend slowed the Corpse Flower's roll, and those dramatic outer fronds didn't open up as had been hoped.

But hopes were beautifully met on the evening of Monday, Sept. 18 when the stately but whiffy wonder began to finally work its nose-testing magic.

It's now open, in other words, and will stay stinky for "two to three days."

If you're curious about this singular flower-observing experience, you best hightail it, gently and dutifully observing all posted laws, to Encinitas straightaway, especially if you've never had a chance to smell a flower that is redolent of "Limburger cheese, filthy socks, rotting flesh, and dirty diapers with a dash of sickly sweetness..."

So many feelings here. Repulsion, yes, but fascination wins out.

To find out more about this particular Corpse Flower's journey to San Diego Botanic Garden, click. To keep tabs on the all-too-brief bloom, follow the SDBG on Facebook.

If Donald Trump backs out of the 2015 nuclear deal with Iran, "no one will trust America again," Iran's president, Hassan Rouhani, told NBC News.

The move would also leave Iran free to resume work on expanding its nuclear capabilities, Rouhani said in the interview, which took place shortly before Trump's first speech to the United Nations General Assembly Tuesday.

Trump called Tehran a "murderous regime" and hit out at the deal, which was agreed between Iran and six world powers, the United States included.

"Every word was analyzed many times by countries involved before its ratification, so if the United States were to not adhere to the commitments and trample upon this agreement, this will mean that it will carry with it the lack of subsequent trust from countries towards the United States because the greatest capital that any country has is trust and credibility," Rouhani told "NBC Nightly News" anchor Lester Holt.

Talking like a pirate?

Throwing a couple of "arrrrr"-type interjections and a "matey" or two and you're halfway there. If you know a sea shanty? Then consider yourself a master of the artform.

Or, we mean, the arrrrrtform.

Tuesday, Sept. 19 is Talk Like a Pirate Day, and even if you don't have a parrot pal, the kind of chatty co-observer who can sit on your shoulder all day as you go about your work and errands, you can still bellow "thar she blows!" at various sights, like the stoplight finally turning green at that one busy intersection on your way home.

If you're near Santa Monica Pier on Sept. 19, at the beach, around the northwest corner of Parking Lot 1, you'll spy more pirate-y high jinks: Disney's "Pirates of the Caribbean: Dead Men Tell No Tales" debuts on digital on Sept. 19, and, to celebrate the movie-tastic moment, The Black Pearl will magically appear not far from the sand.

Well, hold up: It's a replica of the famous "Pirates of the Caribbean" ship, and not to scale, standing at 1/3 of the size of the film boat. You may see roaming pirates in costume, and sea-worthy happenings in the vicinity of the replica.

And there's a photo area if you want to snap a picture of the Pearl to share with your pirate-talkin' buds.

Should you desire the rollicking cinematic adventure on Blu-ray, hold onto your tri-corner hat: The debut date is set for Tuesday, Oct. 3.

One of the worst Hepatitis A outbreaks in San Diego County history is likely to continue for up to six months and lead to more victims, health experts said Tuesday. County and city officials also suggested not everyone needs to get a vaccine. 

Since the outbreak was identified in early March, 16 people have died. Two other deaths are being investigated as possibly connected to the outbreak.

There have been 444 confirmed cases with an additional 44 cases that are considered suspicious. Officials said 305 people have been hospitalized for Hepatitis A virus. To compare, there were 181 cases in California in 2015 with just 22 in San Diego.

Given the incubation period of 15 to 50 days, health officials expect the outbreak to continue an additional six months.

"Based on history, prior to the availability of the vaccine in the late 1990s, we expect this outbreak will last longer, and will likely have an additional number of further cases," said Dr. Nick Yphantides, San Diego County's chief medical officer.

Most of the cases have been from downtown San Diego, El Cajon, Santee, La Mesa, and the adjacent unincorporated areas, county officials said.

"This is personal, this is our community, and we will protect it,” said San Diego Mayor Kevin Faulconer as he unveiled a new media campaign he called "Vaccination, Sanitation & Education."

Officials want the public to know not everyone needs a vaccine.

The following occupational groups must be vaccinated: fire, emergency, law enforcement personnel, food handlers, health care personnel and professionals, service workers working directly with the homeless population, and individuals working directly in substance abuse treatment programs, and public transit workers.

Information on upcoming changes to get the vaccine can be found by calling 211 or www.211SanDiego.org.

Since 2006, children have received the Hepatitis A vaccine in accordance with school immunization requirements. 

Over 22,000 vaccinations have been performed by county health officials so far. Of these, 15,000 people were in a high-risk category, homeless, drug users.

The officials said 1,400 hygiene kits have been distributed, largely in the downtown area.

San Diego County Supervisor Ron Roberts said the first sign of something wrong was apparent in late February or early March.  He said the county and city have been ramping up efforts to deal with an outbreak ever since.

Public nurses have been sent into areas of the county to reach transients and other people who may not have seen the warnings and alerts on local media, Roberts said. 

“Vaccination and hygiene are the strongest things we can do,” Roberts said.

The most vulnerable are those living on the streets.

They’re most concerned for at-risk community – homeless, intravenous and illicit drug users, men who have sex with men, people who have sexual contact with someone who has the virus, people with a chronic liver disease, and individuals who have clotting factor disorders, Yphantides said.

Of the 444 confirmed Hepatitis A cases in San Diego County: 34 percent have occurred in individuals who are both homeless and IV or illicit drug users; 17 percent have occurred in individuals who are homeless only; 13 percent in individuals who are illicit or IV drug users only; 24 percent are neither homeless nor illicit drug users – but many of these cases have some relationship with individuals who are in an at-risk population; remaining 12 percent – no available records to classify accordingly.

Of the 16 deaths: officials had access to the personal history available on 15 of them. Those victims had underlying medical conditions, officials said. All but one was either homeless or/and an IV/illicit drug user.

The homeless outreach team with the City of San Diego and vaccination teams with the county have added public health nurses to administer the shots. They walk the river bed to vaccinate the homeless population living there.

"A big percentage of the people who have been victims of the Hepatitis A outbreak have been drug users or homeless people and we have both living along the river bed,"  said Sarah Hutmacher with San Diego River Park Foundation. 

Workers and volunteers with the organization pick up trash along the river. They encounter everything, including human waste and needles, both of which can spread Hepatitis A.

"It's very, very common for us to encounter places where you find human waste, toilet paper, stuff like that," Hutmacher said.

The San Diego River stretches across areas like Santee, Mission Valley and then out to the ocean at Ocean Beach dog beach. The virus can live in standing water for months. 

Of the 22,966 vaccines given by the county, 10,332 of those were given to at-risk population via field events, foot teams going out into at-risk remote places, mass vaccination clinics.

An additional 12,436 vaccines were given by community partners including clinics and pharmacies.

People who were known to have been exposed to the virus received the remaining 198 vaccines.

"We’re not recommending all adults get vaccinated for Hep A," said Yphantides. 

He added that a member of the general population who is concerned has the right to pursue getting the vaccine from his or her own medical provider.

Dr. William Tseng with the San Diego County Medical Society said the prescription is simple - wash your hands. 

"Remember what our moms used to tell us, what our teachers used to tell us – wash your hands," Tseng said. "Wash your hands. Say it 100 times, say it different ways."

The county sent out an alert to the public last week about possible contamination at World Famous restaurant in Pacific Beach. The restaurant has since been thoroughly cleaned.

Some diners, like Suzzette Haack, hope the news won't hurt business.

"It is not fair to the business. They don't deserve this or the reputation. They have a stellar reputation in the community," she said. 

As of now, it is the only restaurant in the county with this warning.

The county will only notify the public if a person who handles food and drinks at a local restaurant tests positive for the virus. But managers, hostesses, and even dishwashers are not included.

A magnitude 7.1 earthquake struck Mexico Thursday in the state of Puebla, which is about 80 miles southeast of Mexico City. This latest quake comes less than two weeks after an 8.1 earthquake hit the country, killing nearly 100 people.