MIAMI, FLORIDA - Officials have declared a public health emergency over the rising number of hepatitis A cases in Florida, the latest part of the country dealing with outbreaks of the liver disease.

Florida Surgeon General Scott Rivkees declared an emergency Thursday to allow the state to spend more on testing and treatment, saying Florida has had more than 2,000 cases since the beginning of the year compared with 548 all of last year. Most have been in central Florida, and health officials are still investigating the sources.

“We urge vaccination and stress the importance of washing your hands regularly,” Florida Lt. Gov. Jeanette Nunez said in a tweet .

Verna Vasbinder prepares her new bunk in the city's new Temporary Bridge Shelter for the homeless as her dog, Lucy Lui, looks on, Dec. 1, 2017, in San Diego. The first of three shelters opened Friday, which will eventually provide beds for up to 700
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The U.S. city of San Diego has opened the first of three large tents that together will house 700 homeless people in an effort to contain an outbreak of hepatitis A that is being spread among the homeless population. About 20 people made the tent their temporary home Friday. The first tent erected will house 350 single men and women.

Philadelphia also declared an emergency Thursday, and Mississippi officials announced an outbreak in their state earlier in the week. The Centers for Disease Control and Prevention says Kentucky has had 4,793 cases since an outbreak there in 2017; since 2018, Ohio has had 3,220 and West Virginia 2,528.

Hepatitis A is a virus that infects the liver and is spread through food, water and objects tainted by feces, or through close contact. Its flulike symptoms, if they occur, usually last about two months. It had been considered a disease that was fading away, thanks in part to vaccines available since 1995. As recently as 2015, fewer than 1,400 cases were reported nationwide.

But three years ago, a wave of outbreaks among homeless people and illicit drug users began appearing in the U.S. More than two dozen states have reported such outbreaks since then, with more than 22,500 cases, including 221 deaths. Vaccines have typically been administered to children, but many of the new cases have been in adults.

Florida had 65 new cases in the past two weeks alone, bringing the total to 2,034, state officials said. That compares with 548 last year and 276 cases in 2017.

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Dr. Eugene Schiff, director for liver diseases at the University of Miami Miller School of Medicine and former epidemic intelligence service officer for CDC, told The Associated Press that the disease is likely spreading in Florida among homeless and unvaccinated people. He said intravenous drug users, men who have sex with men and the homeless are at a higher risk for the illness.

“Homelessness is a big issue throughout the country and in Florida, and they are at higher risk to spread hepatitis A around,” Dr. Schiff said. “It is more epidemic in the homeless community.”

But he noted that the vaccine protects people against the disease: “This is entirely preventable. It is not that this is a virulent strain, there is just a larger risk if people haven’t been vaccinated.”