SAN DIEGO >> Streets in San Diego will be power-washed every other week and hand-washing stations are being installed where homeless people congregate under a plan to combat a deadly outbreak of hepatitis A, according to the mayor’s office.

San Diego County officials earlier this month declared a public health emergency because of the spread of the liver disease that has killed 15 people and hospitalized 300 more.

The region’s homeless population, which often lacks adequate access to restrooms or showers, has been hit the hardest since the outbreak started last November.

Mayor Kevin Faulconer’s office on Friday responded to a letter from county government asking the city to move forward with specific sanitation actions.

The county a week earlier gave the city five business days to respond with a plan for remedying what it called a “fecally contaminated environment” downtown.

The county will soon expand its efforts to other cities in the region, where the hepatitis A outbreak has now produced nearly 400 confirmed cases.

Crews will use bleach-spiked water to pressure wash outdoor surfaces that may have feces, blood or bodily fluids. The virus lives in human feces and spreads if people who have used the bathroom do not properly clean their hands.

The county moved forward with its own contractor, who installed 40 hand-washing stations in areas where the homeless often gather.

There are plans, according to the city’s letter, to add more stations starting this week, the San Diego Union-Tribune reported (http://bit.ly/2y0hkuT ).

In addition to regularly pressure-washing dirty city right of ways, the county also asked the city to “immediately expand access to public restrooms and wash stations within the city limits that are adjacent to at-risk populations.”

Additional San Diego police escorts will also be provided for the county’s mobile vaccination teams and expanded vaccination clinics will be opened at public libraries, the newspaper said.

Vaccinations and education were San Diego County’s main previous preventative strategies. Thousands of doses of vaccine were distributed, but infection rates have not slowed much.

The new sanitation efforts were inspired by a prior campaign in Los Angeles, home to tens of thousands of homeless.