Health Alerts

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.

March 18, 2024

Alert

Measles cases on the rise!

A rise in cases of Measles across the U.S., including in California, is being reported by CDC and CDPH. Alameda County Public Health Department (ACPHD) is urging all healthcare facilities and clinicians to be on alert and to consider measles in persons presenting with a febrile rash illness. Please review this full health advisory for recommendations.

Please be advised that Measles is an immediately reportable condition per Title 17 Section 2500 of the California Code of Regulations. A suspect case of Measles must be immediately reported by telephone to the local health jurisdiction. Delays in reporting can result in delayed diagnosis and on-going transmission.

To report a case or suspect case of measles in Alameda County, please call ACPHD’s Acute Communicable Diseases Section at 510-267-3250 (Option 2), 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.

Clinicians and healthcare settings are encouraged to use this Measles Info Sheet from the American Academy of Pediatrics or a similar resource to ensure awareness and implementation of immediate isolation, communication and coordination, especially among staff working in urgent care centers and emergency rooms.

February 16, 2024

Advisory

Cluster of Shigellosis and Shigellemia Cases

The Alameda County Public Health Department has detected an increase in reports of infections due to Shigella bacteria species in Alameda County, including cases of bacteremia known as shigellemia. These cases have mainly occurred among residents of Board and Care facilities and persons experiencing homelessness (PEH); some patients also have a history of drug use. In these recently reported cases, most patients have required antibiotics, and some have required hospitalization. Associated isolates have been susceptible to fluoroquinolones and carbapenems.

Healthcare professionals are urged to be vigilant for possible cases of Shigella infection, to report cases to their local health department, and to educate patients and communities at increased risk about prevention and transmission. Due to recent reports of shigellemia, clinicians are advised to have a low threshold for conducting both blood and stool cultures for suspected cases. Importantly, clinicians must request susceptibility testing against all the common antibiotics used to treat Shigella if cultures are positive. In addition, providers are reminded to submit Shigella isolates to the Alameda County Public Health Laboratory (ACPHL) for further testing.

Please refer to the Health Advisory for more information.