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SAN DIEGO (AP) — The city of San Diego issued citations and cleared a downtown street where hundreds of homeless people regularly camp during ongoing efforts to sanitize neighborhoods to control the spread of hepatitis A.

Officers are asking homeless people to leave the street and nearby blocks where tarps and tents have regularly lined sidewalks and an area near a freeway onramp, police Lt. Scott Wahl said Wednesday. Those who refuse are given citations and those who resist further are arrested. Police over the past two weeks have been issuing about 50 citations a week — up from 30 a week before the crackdown, Wahl said.

He said he did not have figures on how many have been arrested. Some, he said, have been taken to mental health services if they showed signs of distress.

The crackdown was necessary to increase the effectiveness of cleaning efforts that include the power-washing of streets and installation of hand-washing stations, Wahl said. San Diego County is battling an epidemic of hepatitis A, a contagious liver disease that has killed 17 people and infected 461 people, including more than 300 who had to be hospitalized.

“The problem is we’re not yet on top of this outbreak, and we cannot have people going back in and re-infecting areas we’ve just cleaned,” Wahl said. “The vast majority of the homeless who were there have complied when asked to leave. But if they don’t, people will be cited. This is about saving lives.”

The region’s homeless population, which often lacks adequate access to restrooms or showers, has been hit the hardest since the outbreak started last November.

It was unclear where the homeless people who were along the downtown street have gone. Many suspected they scattered to other parts of the city.

Bob McElroy of the nonprofit Alpha Project said he’s working on opening a camping area in the short-term and providing small tents for 200 people near downtown, along with restrooms and showers and washing facilities. His organization along with two other service providers for the homeless are also working with the city to erect three massive commercial-grade tents starting in December that would house hundreds.

Hepatitis A spreads when someone comes in contact with an infected person’s feces, sometimes when hands are not properly washed after going to the bathroom or changing diapers and the virus is then spread through food or objects. It can also be spread through sex or by sharing drug paraphernalia.

Health officials say the incubation period ranges from 15 to 50 days, and symptoms include fever, malaise, dark urine, anorexia, nausea and abdominal discomfort, followed by jaundice.

San Diego County public health nurses have been teaming up with police and visiting areas where the homeless are camped to offer vaccinations against Hepatitis A. The city also has been installing restrooms and washing stations in areas frequented by the homeless.