The death toll in a hepatitis A outbreak plaguing California has risen to 19, authorities say. More than 500 people, most of them in San Diego’s homeless population, have been infected since last November in the second-largest U.S. outbreak of the disease in the past 20 years. Cases have also been reported in Santa Cruz, Los Angeles, and San Francisco. Authorities in San Diego have gone so far as to disinfect city streets with bleach and set up public hand-washing stations in a bid to contain the virus. The liver disease is usually spread through fecal matter and flourishes in unsanitary conditions.