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San Diego’s hepatitis A outbreak added another death Tuesday, pushing the total to 19 as the number of confirmed cases passed 500.

Updated numbers released by the county Health and Human Services Agency come as a massive effort around vaccination, sanitation and public education continues to try and stop the largest surge of the viral disease since the vaccine for hepatitis A was approved in the late 1990s.

With last week’s total number of cases at 490, the latest reported increase to 507 may make it seem as if the outbreak continues to grow, but, because of the way that the public health department is tallying the outbreak, it is difficult to say whether that’s the case.

Last week, in a report to the San Diego County Board of Supervisors, Dr. Wilma Wooten, the county’s public health officer, said that her department had 47 cases under investigation. Those cases don’t get added to the outbreak totals until testing by the U.S. Centers for Disease Control and Prevention in Atlanta confirms that they were caused by the same strains of hepatitis A that have caused other outbreak cases.

Read the full story on LATimes.com.