The death toll continues to climb.

The county Health and Human Services Agency updated its hepatitis A outbreak numbers which inluded an additional death to bring the total to 19 and increased the number of cases to more than 500 at 507.

Efforts are underway to vaccinatate, sanitize and educate the public on the crisis.

Dr. Wilma Wooten, the county’s public health officer, said last week that her department had 47 cases under investigation. Those cases though don’t get added to the outbreak totals until testing by the U.S. Centers for Disease Control and Prevention confirms the strain.

Last week Governor Jerry Brown declared a state of emergency to combat the virus. Brown's proclamation allows the state to buy vaccines directly from manufacturers and distribute them.

California has distributed 81,000 federally-funded vaccine doses since the outbreak began and local jurisdictions have acquired more but the supply is insufficient, Chavez said.

California is experiencing the largest hepatitis A outbreak in the United States transmitted from person to person — instead of by contaminated food — since the vaccine became available in 1996. The state says the majority affected are homeless, using drugs or both.