SACRAMENTO (CBS13) — Sacramento County health officials have announced new steps to combat a health scare that’s reached the epidemic stage in Southern California.

The outbreak of Hepatitis A, a highly contagious liver disease, can be worsened by poor sanitation or close personal contact with someone infected by the virus.

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The disease has been fairly rare in the United States since a vaccine was developed around 20 years ago. Counties like Sacramento may see a few cases per year, but late last fall it began spreading wildly through San Diego and Santa Cruz and hasn’t stopped.

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State health officials are now urging counties yet to be affected to prepare for the disease by vaccinating the homeless and those that work with them. The disease is spread primarily through poor hygiene — a chronic problem among those without access to soap, water, and toilet facilities. It’s also spread through heavy drug use.

“You have people running around the streets sometimes and maybe the clothes are dirty, they have been defecated on, they’ve been urinated on, or they just haven’t been cleaned…and whenever you have a condition like that, you have a petri dish for all kinds of things including Hep A,” said Pastor Tim Lane.

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That’s why the county health effort will start at health clinics for the homeless like the Mercy Clinic at Sacramento’s Loaves and Fishes. It’ll start first with vaccines, and with cooperation from the city, bring better sanitation to the street population.

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But it’s not simply a problem among the homeless. In San Diego, more than 400 cases of Hepatitis A have been diagnosed. The number is much higher in much smaller Santa Cruz where 16 people have died.

Because of how contagious the disease is, it can be contracted in ways that might not expect, such as contact with a parking meter, a gas pump or an ATM. And the symptoms aren’t pleasant; they include nausea, vomiting, and joint pain. Rest and hydration are usually prescribed as symptoms run their course in a couple of weeks. But the elderly and those with liver problems can face more serious symptoms and even death.

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Rest and hydration are usually prescribed as symptoms — typically lasting a couple of weeks — run their course. The elderly and those with liver problems can face more serious symptoms and even death.