SAN DIEGO — Public health authorities say a fifth person has died during San Diego County’s ongoing hepatitis A outbreak.

Officials say the outbreak that started last November has grown among the region’s homeless population.

The Union-Tribune reported Wednesday ( ) there have been 228 confirmed infections, including 161 people who had to be hospitalized.

Hepatitis A, an infectious disease of the liver, can be prevented through vaccination — and that has been the main strategy for health officials trying to stop the spread.

The newspaper says it’s the state’s largest hepatitis A outbreak in two decades.

Information from: The San Diego Union-Tribune,