In Diego County has reported a 20th person has died from a Hepatitis A outbreak — the worst of its kind in the United States in 20 years. Dr. Eric McDonald, chief of the county’s Epidemiology and Immunization Services Branch, told the San Diego Union Tribune that a 67-year-old man who appeared to be recovering suddenly relapsed and died on Oct. 26. More than 530 people have fallen ill and more than 360 have been hospitalized since November 2016. Most of the deaths have been among the homeless population. The contagious, liver-damaging illness lives in fecal matter. California Gov. Jerry Brown last month declared a state of emergency to allow the state to buy vaccines directly from manufacturers and distribute them. San Diego County has vaccinated more than 90,000 people in recent months.