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Crews have started sanitizing streets, sidewalks and gutters in San Diego to try to combat a hepatitis A outbreak among the city’s homeless population.

Amid an outbreak across San Diego County that health officials say has led to 16 deaths and nearly 300 hospitalizations, workers were power-washing areas in downtown San Diego earlier this week with water laced with chlorine and bleach, the San Diego Union-Tribune said.

San Diego Mayor Kevin Faulconer said measures to try to curb the spread of the deadly disease would include administering free vaccinations, installing hand-washing stations and implementing sanitation procedures on the streets.

“We must continue to work collaboratively to stop this crisis and save lives,” he said.

San Diego County’s Health and Human Services Agency said the majority of the 421 reported cases relating to the hepatitis A outbreak across the county were among the homeless and drug users. There were 5,619 people reported homeless in San Diego this year, 3,231 of whom were living on the streets, said the Regional Task Force on the Homeless.

Hepatitis A, which is a highly contagious liver infection caused by a virus, is spread person-to-person typically through poor sanitation practices.

The Centers for Disease Control and Prevention said that since the introduction of a vaccine in 1995, hepatitis A infections have declined by 95 percent. Symptoms include fever, jaundice, joint pain, nausea, vomiting and abdominal pain.

The city of San Diego said it would keep 14 restrooms open 24 hours a day in Balboa Park, where many of the city’s homeless stay, according to the San Diego Union-Tribune. In addition, 40 hand-washing stations were installed in areas where the city’s homeless gather, according to local news reports.

Crews will clean the streets again Wednesday and Friday, and then again every other week to attempt to control the outbreak.