Health Alerts

March 12, 2025

Advisory

Expanding Measles Outbreak in the United States and Guidance for the Upcoming Travel Season

The purpose of this advisory is to share the CDC HAN from 3/7/25 about a measles outbreak in Texas and New Mexico, emphasizing the importance of being up-to-date on MMR vaccination. As of March 6, 2025, a total of 222 measles cases had been reported by twelve U.S. jurisdictions this year, including California. Most of the 222 cases are among children who had not received the MMR vaccine.

Per Title 17, cases of measles or suspect measles must be immediately reported by telephone, while the patient is still present if possible, to ACPHD at 510-267-3250 (M-F 8:30-5PM). After hours and on weekends, please call the Alameda County Fire Dispatch at 925-422-7595 and ask to speak with the Public Health Duty Officer on-call. Delays in reporting can result in delayed diagnosis and on-going transmission. 

ACTIONS REQUESTED OF CLINICIANS 

1. Consider measles as a diagnosis in anyone with fever (≥101°F or 38.3°C) and a generalized maculopapular rash with cough, coryza, or conjunctivitis who has recently traveled internationally, or domestically to a region with a known measles outbreak, or has other known or suspected exposure to measles. See also the Clinical Provider Flowsheet.
2. Isolate patients with suspected measles immediately, ideally in a single-patient airborne infection isolation room (AIIR), or in a private room with a closed door until an AIIR is available. Patients with suspected measles should not remain in the waiting room or other common areas of a healthcare facility.
3. Collect respiratory swab (NP or OP (OP preferred)) AND urine for measles PCR testing at the Alameda County Public Health Lab with approval from ACPHD. When directed, serum samples for Measles IgM/IgG should be collected and routed to the California Department of Public Health-Viral and Rickettsial Disease Lab (VRDL). Do NOT use commercial laboratories for suspect measles cases. For detailed instructions, please see ACPHD’s Measles Testing & Specimen Routing Procedures document.
4. Ensure ALL U.S. residents older than age 6 months without evidence of immunity who are traveling internationally or to an area of the U.S. with an ongoing outbreak, receive MMR vaccine prior to departure. 
   1. Infants 6 through 11 months of age should receive one dose of MMR vaccine before departure (dose 0). These infants will still need two additional doses of MMR after 1 year of age per the ACIP vaccination schedule.
   2. Children 12 months of age or older should receive two doses of MMR vaccine, separated by at least 28 days.
   3. Teenagers and adults without evidence of measles immunity should receive two doses of MMR vaccine separated by at least 28 days.
   4. For those with adequate documented immunity, additional doses of MMR are not recommended given the level of vaccination in our community and high effectiveness of two doses of vaccine.  

For more detailed guidance, please see the full HAN and Clinical Overview of Measles (CDC) 

February 28, 2025

Advisory

Influenza-Associated Encephalopathy and Encephalitis in Children

This purpose of this Health Advisory is to inform clinicians about reports of pediatric influenza-associated encephalopathy and encephalitis (IAE), including four deaths nationally from acute necrotizing encephalopathy (ANE), a severe form of IAE. Centers for Disease Control and Prevention (CDC) has requested that local public health be notified about these conditions.  

ACTIONS REQUESTED OF CLINICIANS   

• At every opportunity, strongly recommend and administer influenza vaccine to all patients at least 6 months of age. 
• Initiate early antiviral treatment for patients of any age who are at increased risk for influenza-associated complications. 
• Consider IAE or ANE in pediatric patients who present with persistent fever and altered mental status. CSF may show normal WBCs with elevated protein. Providers should:   
  
  • Test for influenza. Retain and submit positive specimens to Alameda County Public Health Laboratory for subtyping and sequencing. 
  • Hold serum and CSF for possible further testing.  
  • Voluntarily report all suspected or confirmed IAE or ANE cases that have occurred since October 1, 2024 and meet the following criteria to Alameda County Public Health at (510) 267-3250: 
    • Age <18 years 
    • Admitted to an acute care hospital or pronounced dead in an emergency department between October 1, 2024, and May 30, 2025 
    • Laboratory-confirmed influenza virus infection within 14 days preceding hospital presentation, during hospitalization, or in respiratory specimens collected post-mortem
    • Documented neurologic abnormalities (meets one or more of the following):
      
      • Diagnosis of encephalopathy or encephalitis 
      • Neurologic signs or symptoms including but not limited to seizures, altered mental status, delirium, decreased level of consciousness, lethargy, hallucinations, or personality changes lasting >24 hours 
      • Neuroimaging abnormalities such as brain edema, brain inflammation, or brain lesions 
      • Electroencephalogram abnormalities 
      • Abnormal brain autopsy findings, if available, for children who died 
• Report laboratory-confirmed influenza-associated fatal pediatric cases (<18 years) to Alameda County Public Health at acutecd@acgov.org as soon as possible. 
  
  

For more information, please review the complete advisory. 

February 06, 2025

Advisory

Ebola Outbreak Caused by Sudan Virus in Uganda

The Centers for Disease Control and Prevention (CDC) has issued a Health Alert Network (HAN) Health Advisory about a recently confirmed outbreak of Ebola disease in Uganda caused by the Sudan virus. Currently, no suspected, probable, or confirmed Sudan virus disease (SVD) cases related to this outbreak have been reported in the United States, or outside of Uganda. However, as a precaution and because there are other viral hemorrhagic fever (VHF) outbreaks in East Africa, CDC is sharing best practices for clinical laboratories and healthcare workers. Recommendations for Clinical Laboratory Biosafety can be found in the full advisory: https://www.cdc.gov/han/2025/han00521.html

Recommendations for Clinicians (see full Advisory for complete list):

• Systematically assess patients with compatible symptoms for exposure risk and the possibility of VHFs including SVD through a triage and evaluation process including a travel history. 
• Include SVD in the differential diagnosis for an ill person who has been to an area with an active SVD outbreak in the past 21 days, AND who has compatible symptoms (e.g., fever, headache, muscle and joint pain, fatigue, loss of appetite, gastrointestinal symptoms, or unexplained bleeding), AND who has reported epidemiologically compatible risk factors like one or more of the below, within the 21 days before symptom onset:
  • Had direct contact with a symptomatic person with suspected or confirmed SVD (alive or dead), or with any objects contaminated by their body fluids.
  • Experienced a breach in infection prevention and control precautions that resulted in the potential for contact with body fluids of a patient with suspected or confirmed SVD.
  • Participated in any high-risk activities while in an area with an active SVD outbreak (see full Advisory for list)
• Isolate and manage patients with exposure risks and symptoms compatible with SVD in a healthcare facility using appropriate PPE until receiving a negative SVD test result on a sample collected ≥ 72 hours after symptom onset. If a sample collected is <72 hours after symptom onset and is negative, the patient should remain isolated in the healthcare facility and another test should be performed on a new sample taken ≥ 72 hours after initial symptom onset. Routine laboratory testing to monitor the patient’s clinical status and diagnostic testing for other potential causes of the patient’s illness should be pursued while SVD testing is underway. SVD diagnostic testing should not be delayed while awaiting results of other diagnostic testing.
  • Contact ACPHD immediately at (510) 267-3250, M-F 8:30-5PM. After hours and on weekends, please call (925) 422-7595 and ask to speak with the Public Health Duty Officer on call. 

December 09, 2024

Advisory

Detection of Highly Pathogenic Avian Influenza (HPAI) A (H5N1) Virus in Alameda County

Alameda County Public Health Department (ACPHD) is issuing this Health Advisory to share information and notify clinicians, public health authorities, and the public about influenza A (H5N1), or bird flu. There are ongoing outbreaks of influenza A (H5N1) in dairy cattle and poultry farms in other counties in California. As of December 9, 2024, there are 58 confirmed human cases in the United States, with 32 cases reported in California. The current public health risk for influenza A (H5N1) infection remains low.

1. Information on the influenza A (H5N1) case in an Alameda County resident.
2. Clinicians are asked to consider influenza A (H5N1) in patients with upper respiratory symptoms and exposure to sick/dead birds, wildlife or domesticated animals or exposure to unpasteurized (raw) milk or milk products.
3. If bird flu is suspected, clinicians should call Alameda County Department of Public Health (510) 267-3250.
4. Evaluation and Testing for Human Avian Influenza A (H5N1) Infection

See H5N1 Health Advisory

November 08, 2024

Advisory

Increase in Pertussis Cases

More than 60 confirmed or probable cases of Pertussis have been reported in Alameda County during the 2024-2025 school year, along with multiple high school outbreaks. This is an increase compared with recent years. No hospitalizations have been reported. Despite high vaccination rates in our community, any person who has Pertussis-like symptoms should avoid taking care of or spending time with pregnant persons or infants, as Pertussis can cause severe illness or, in rare instances, death. A person infected with Pertussis is considered contagious for 21 days after the onset of cough or until 5 days of antibiotics have been completed.  

ACTIONS REQUESTED OF CLINICIANS:

• Suspect Pertussis early in a person with cold-like symptoms and cough if there is a history of exposure to a Pertussis case. Also consider Pertussis if the cough is persistent (≥2 weeks), paroxysmal, or accompanied by post-tussive vomiting. 
• Provide Post-Exposure Prophylaxis (PEP) if high-risk contacts are identified. These include pregnant persons in 3rd trimester, infants, household or occupational contacts of infants, and persons with underlying conditions, such as moderate to severe asthma or immunocompromising conditions, who may experience severe disease.  
• When testing persons with Pertussis symptoms, treat empirically with antibiotics and exclude from exposure to high-risk contacts, school or the workplace pending test results, so as not to expose additional persons.
• If your patient tests positive for Pertussis, advise isolation until 5 days of antibiotics have been completed OR ≥3 weeks have elapsed since cough onset.  
• Provide Tdap booster to pregnant persons in the third trimester of every pregnancy. 
• If you have any questions, please call the Acute Communicable Disease Section at the Alameda County Department of Public Health, Monday through Friday from 8:30 am - 5:00 pm at (510) 267-3250.

See Pertussis Health Advisory

October 09, 2024

Advisory

First Marburg Virus Disease Outbreak in the Republic of Rwanda

The purpose of this advisory is to share a CDC HAN from 10/3/24 about Rwanda’s first confirmed outbreak of Marburg virus disease (MVD). There were 56 cases and 12 deaths reported as of October 8, 2024, including at least 19 cases in healthcare workers. No confirmed cases of MVD related to this outbreak have been reported in the United States or other countries outside of Rwanda to date. Currently, the risk of MVD in the United States is low; however, clinicians should be aware of the potential for imported cases.

Please review the HAN for a full list of recommendations for clinicians, including infection prevention considerations. Contact ACPHD immediately (510-267-3250 M-F 8:30-5PM or 925-422-7595 after hours and on weekends) about any patient who has been to an area with an active MVD outbreak in the past 21 days, AND who has compatible symptoms (e.g., fever, headache, muscle and joint pain, fatigue, loss of appetite, gastrointestinal symptoms, or unexplained bleeding), AND has reported epidemiologically compatible risk factors within the 21 days before symptom onset including direct contact with a symptomatic person with suspected or confirmed MVD, or with any objects contaminated by their body fluids.

Recommendations for Infection Prevention and Control Measures in Hospitals

• Employ a combination of infection prevention and control measures to prevent transmission of MVD in hospitals. These infection prevention and control measures include, but are not limited to:
  • Isolating patients in a private room with a private bathroom or covered bedside toilet if MVD is suspected. Dedicated medical equipment (preferably disposable, when possible) should be used for the provision of patient care.
  • Following separate PPE guidance for managing clinically stable and clinically unstable patients.
  • Ensuring that healthcare workers caring for patients with VHFs have received comprehensive training and demonstrated competency in performing VHF-related infection control practices and procedures.
  • For additional measures, please review the HAN.
• Know that healthcare personnel can be exposed through contact with a patient’s body fluids, contaminated medical supplies and equipment, or contaminated environmental surfaces. Splashes to unprotected mucous membranes (e.g., the eyes, nose, or mouth) are particularly hazardous.
• Minimize procedures that can increase environmental contamination with infectious material, involve handling of potentially contaminated needles or other sharps, or create aerosols.

September 30, 2024

Advisory

Staff Masking Required in Higher-Risk Healthcare Settings beginning November 1st

The fall and winter of 2023-2024 saw substantial waves of RSV, flu and COVID-19, and a similar pattern is expected this year. To combat the spread of these viruses to vulnerable patients and residents and minimize the associated risk of severe illness and death, Staff and other workers in specified Health Care Facilities (HCFs) in Alameda County, including the City of Berkeley, are required to wear high-quality, well-fitting masks in patient care areas from November 1, 2024 through March 31, 2025, regardless of vaccination status (see Order). Alameda County and the City of Berkeley are aligning with many health jurisdictions across the Bay Area in implementing this policy.  

The following HCFs are covered by this Order: General Acute Care Hospitals, Long Term Acute Care Hospitals, Psychiatric Hospitals, Skilled Nursing Facilities, Dialysis Centers, and Infusion Centers.  

This Order does not require patients, residents, or visitors to wear masks, although masks are strongly recommended for everyone in all health care settings, including Staff in health care settings not covered by this Order.  

Order No. 20-16b (requiring Health Care Workers in specified facilities to receive annual flu vaccinations or wear masks), which was suspended last year, has now been rescinded.

September 24, 2024

Advisory

Increased Oropouche Virus Activity and Associated Risk to Travelers

A CDC HAN from 8/16/24 about the increase in Oropouche virus disease originating from endemic areas in the Amazon basin and new areas in South America and the Caribbean was distributed. As of September 17, there were 74 travel-associated cases in the U.S. in 2024, including one in California. Recommendations for healthcare providers include: 

• Consider Oropouche infection in a patient who has been in an area with documented or suspected Oropouche virus circulation within 2 weeks of initial symptom onset (as patients may experience recurrent symptoms). 

• Report any suspected Oropouche infection to the ACPHD immediately at (510) 267-3250, M-F 8:30-5PM. After hours and on weekends, please call (925) 422-7595 and ask to speak with the Public Health Duty Officer on call. 

• Rule out dengue virus infection in travelers with suspect Oropouche virus infection. 

• Inform pregnant people of the possible risks to the fetus when considering travel to areas with reported Oropouche virus transmission. Pregnant people are currently recommended to reconsider non-essential travel to Cuba or other areas with a Level 2 Travel Health Notice.  

• Be aware that people who may be at higher risk for complications or severe disease include pregnant people, older adults, and people with underlying medical conditions. 

• Direct all travelers going to areas with Oropouche virus transmission to use measures to prevent insect bites during travel and for 3 weeks after travel.

September 10, 2024

Advisory

Detection of highly pathogenic avian influenza (HPAI) A(H5N1) in California dairy cattle

A CAHAN from 9/4/24 about the detection of avian influenza A(H5N1) in cows at three California dairies located in the Central Valley is being distributed. Below are some reminders for Alameda County healthcare providers (HCPs): 

• HCPs should consider H5N1 in persons with acute respiratory symptoms and/or conjunctivitis AND recent exposure to animals suspected or confirmed to have avian influenza.
• Providers in Alameda County should immediately report any suspected avian influenza infections to ACPHD at 510-267-3250 (M-F 8:30-5PM). After hours and on weekends, please call 925-422-7595 and ask to speak with the Public Health Duty Officer on call.
• Testing of respiratory and conjunctival specimens for avian influenza is only available at public health laboratories and requires coordination with ACPHD.
• Antiviral treatment is recommended for patients suspected or confirmed to have H5N1 infection.
• Healthcare providers should follow standard, contact, and airborne precautions when caring for patients suspected of having H5N1 infection.   
• Continue to follow the enhanced surveillance guidance shared in a previous CAHAN (6/12/24). 

August 16, 2024

Alert

Clad I Mpox Increased Infections: Recommendations for California Health Care Providers

This Health Alert is to update providers on Clade I mpox.  Clade I mpox infections have continued to increase in the Democr​atic Republic of the Congo (DRC) and there have been confirmed cases in neighboring countries; a case was recently detected in Sweden. At this time, there have been no cases reported in the U.S. The WHO has declared this outbreak a public health emergency of international concern.

• Clade I mpox is associated with increased transmissibility and fatality rates when compared to the currently circulating clade II mpox in the US.
• Medical countermeasures used in the ongoing global outbreak, including the mpox vaccine, and antiviral medications (Tecovirimat (TPOXX)) are anticipated to be effective for clade I mpox.
  • Continue to recommend mpox vaccination (JYNNEOS) for those who may be at risk and ensure patients complete the 2-dose vaccine series.
  • Ask all patients with mpox-like illness about: 1) recent travel to DRC or neighboring countries (e.g. Burundi, Kenya, Rwanda and Uganda); 2) being a close contact to travelers returning from DRC or neighboring countries within the prior 21 days; and 3) being a contact to someone with mpox clade I illness. See here for updates on the location of cases of Clade I related to the outbreak, as this is changing.
  • If the patient with mpox-like illness or close contacts have had recent travel to DRC or neighboring countries:
    • Notify ACPHD by contacting sexualhealth@acgov.org
    • Test for mpox using appropriate infection control practices and a routine test kit; submit a specimen for clade-specific testing to CDPH.
      • Instructions on how to send a specimen to CDPH can be found here: VRDL Test Page - Monkeypox Virus PCR (ca.gov)

Reference:  CAHAN:  Update on Clade I Mpox Geographical Spread in Africa: Recommendations for California Health Care Providers

If you were forwarded this message and would like to receive future communications from ACPHD directly, please register yourself for our AC Alert system here. 

July 23, 2024

Advisory

Critical shortage of Becton Dickinson (BD) BACTEC™ blood culture media bottles

On July 23, 2024, the Centers for Disease Control and Prevention (CDC) issued a Health Alert Network (HAN) Health Advisory to inform healthcare providers, laboratory professionals, and healthcare facility administrators of a critical shortage of Becton Dickinson (BD) BACTEC™ blood culture media bottles. This shortage has the potential to disrupt patient care by leading to delays in diagnosis, misdiagnosis, or other challenges in the clinical management of patients with certain infectious diseases. Facilities affected by this shortage should immediately begin to assess their situations and develop plans and options to mitigate the potential impact of the shortage on patient care.

For a full list of recommendations, please see the attached Health Advisory.

If you were forwarded this message and would like to receive future communications from ACPHD directly, please register yourself for our AC Alert system here.  

April 29, 2024

Advisory

Adverse Effects Linked to Counterfeit or Mishandled Botulinum Toxin Injections

The Centers for Disease Control and Prevention (CDC), the U.S. Food and Drug Administration (FDA), and state and local partners are investigating 22 people from 11 states who reported adverse effects after receiving injections with counterfeit botulinum toxin, or injections administered by unlicensed or untrained individuals or in non-healthcare settings, such as homes or spas. The California Department of Public Health (CDPH) received reports of two California residents who are included in the investigation; one reported purchasing counterfeit “Botox" on the internet. Both patients received injections in non-health care settings.

Botulism is a medical emergency and requires immediate medical and public health response.[BOLD previous sentence] Clinicians must immediately report any patients with suspected botulism to Alameda County Public Health Department (ACPHD) who will then coordinate with CDPH to authorize botulism antitoxin (BAT) release if appropriate. To reach ACPHD, call 510-267-3250 (Option 2), M-F 8:30AM-5PM. After hours and on weekends, ask for the ACPHD Duty Officer on call at 925-422-7595.

For more information, please see the full CDC Health Advisory.