Health officials in San Diego have scrambled for months to contain an outbreak of hepatitis A — vaccinating more than 19,000 people, putting up posters at bus stations and distributing hand sanitizer and cleansing wipes.

Despite those efforts, 16 people have died of the highly contagious virus in San Diego County and hundreds have become ill in what officials say is the nation’s second-largest outbreak of hepatitis A in decades.

Earlier this month, San Diego officials declared a public health emergency.

Though Los Angeles has so far escaped an outbreak, public health officials are hoping to head off a similar emergency. They say the virus could easily spread to Los Angeles because of its proximity to San Diego and the region’s large homeless population.

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