New Hepatitis A cases linked to statewide outbreak put county officials on alert.

Employees, remember to wash those hands.

The number of Hepatitis A cases related to the statewide outbreak that's so far killed 20 people in San Diego County has risen in Monterey County from one to four in the last two weeks.

When the first case was discovered in a homeless individual in Chinatown in Salinas around Nov. 7, Monterey County Health officials quickly acted by vaccinating all the person's close contacts.

More than 700 doses of the vaccine were made available to high risk individuals and those who work with the homeless in Chinatown and other areas of the county, according to Dr. Edward Moreno, the county's health officer and director of public health.

Vaccinations will be available to the public nearly every weekday in December at various locations. 

The Montage Health Mobile Clinic will have them at their weekly Seaside clinic on Thursday afternoons, and Clinica de Salud del Valle de Salinas, a nonprofit organization that operates clinics in rural areas, will also be administering the vaccines.

Salinas officials cleared more than 20 tons of rubbish from Chinatown streets on Nov. 16, in an effort to stem further transmission of the disease, says Don Reynolds, the city's interim public works director.

Following instructions from county environmental health officials, he says a contractor spray-misted a bleach solution onto sidewalks, streets and gutters.

What Reynolds says remains unclear is just how serious the outbreak is and how much the city will need to be involved in subsequent clean-ups and treatments. 

Reynolds says Chinatown cleanups are costly, requiring the help of multiple city departments, including law enforcement. After the Thanksgiving holiday he plans on meeting with county officials to determine next steps, if any are needed.

"It's brand new to us," he says.

At this point the four cases in Monterey County are considered a "local transmission" and not an outbreak, says Moreno.

The good news: The rate of transmission has so far not been as aggressive as in other counties.

Besides having to worry about Hepatitis A spreading among the homeless community and those who work with the homeless, there's also a concern about restrooms frequented by the public, like in parks, schools and restaurants.

Hepatitis A spreads after contact with infected feces, which makes bathrooms a prime hot spot for transmission.

Careful hand washing can help stop the disease's spread, but cleaning facilities is also important. The county recommends bathrooms and food preparation surfaces be disinfected several times a day.

Detailed disinfecting instructions are included on the county's website.