Add 20 more cases and 22 more hospitalizations to San Diego County’s ever-growing hepatitis A outbreak.

Tuesday afternoon the county Health and Human Services Agency raised the number of the outbreak’s confirmed cases to 481 from 461 and hospitalizations to 337 from 315. The death count associated with the outbreak, which started in November 2016, remained at 17 for a second straight week.

For the last two weeks, the health department has reported having more than 40 cases under investigation awaiting confirmation from the U.S. Centers for Disease Control and Prevention that they suspect are caused by the same unique strains associated with other outbreak cases.

No information on the number of cases under investigation was available Tuesday. All of those who have died during the outbreak have had underlying medical conditions such as liver disease. Most were also homeless and/or drug users.

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