Health Alerts

October 17, 2025

Advisory

Community Spread of Clade I Mpox Within California

CDPH/Health Advisory - October 17, 2025 – The California Department of Public Health (CDPH) would like to alert healthcare providers, local health jurisdictions and laboratories about three unrelated clade I mpox cases, which have been confirmed in Southern California with no history of recent international travel. Public health investigation indicates that community transmission of clade I mpox is occurring in California. Persons at increased risk of mpox should be encouraged to be vaccinated.  Mpox testing should be considered for patients with compatible signs and symptoms (PDF), regardless of vaccination status or previous infection.

See CDPH Health Advisory

October 15, 2025

Advisory

Masking Recommendations for Staff and Visitors in Licensed Health Care Facilities When Respiratory Viruses Circulate

To prevent the spread of respiratory viruses, such as COVID-19, Influenza (flu), and Respiratory Syncytial Virus (RSV), to vulnerable patients and residents, and to minimize the associated risk of severe illness and death among these persons, the Health Officers of Alameda County and the City of Berkeley strongly recommend that staff and visitors in patient care areas of licensed health care facilities in Alameda County, including the City of Berkeley, wear high-quality, well-fitting masks, regardless of vaccination status, during winter respiratory virus season (November 1 to March 31) and other times of increased respiratory virus circulation. Please see the attached Health Advisory for additional information.

This guidance replaces the expired joint Alameda County and City of Berkeley Health Officer Order requiring staff masking in licensed health care facilities during the 2024-25 winter respiratory virus season.

October 02, 2025

Advisory

Health Officer Order for Reporting Carbapenem-Resistant Organisms (CROs)

This is a message from the Alameda County Public Health Department.

The Alameda County Health Officer Order dated June 13, 2017, requiring health care providers and clinical laboratories to report all cases of carbapenem-Resistant Enterobacterales (CRE) to Alameda County Public Health Department (ACPHD) and submit associated specimens to Alameda County Public Health Laboratory (ACPHL) is hereby rescinded and replaced with this order, effective November 3, 2025:

Providers must report CRO cases meeting the following criteria to ACPHD:

• For CRE: resistance to any carbapenem antimicrobial, with a MIC of ≥ 4 µg/ml for doripenem, imipenem, or meropenem; or MIC ≥ 2 µg/ml for ertapenem; OR
• For carbapenem-resistant Acinetobacter Baumannii (CRAB): resistance to any carbapenem antimicrobial, with a MIC of ≥ 8 µg/ml for doripenem, imipenem, or meropenem OR
• For carbapenem-resistant Pseudomonas aeruginosa (CRPA): resistance to any carbapenem antimicrobial, with a MIC of ≥ 8 µg/ml for doripenem, imipenem, or meropenem AND nonsusceptible (intermediate or resistant MIC ≥ 16 µg/ml) to cefepime or ceftazidime, or, resistant to ceftolozane/tazobactam (MIC ≥ 16/4μg/ml); OR
• For any CRO: Documented carbapenemase production, demonstrated using a phenotypic CLSI-endorsed or FDA cleared test (modified Hodge, Carba-NP, metallo-β-lactamase, etc.); OR
• For any CRO: demonstrated to possess a carbapenemase gene (such as KPC, NDM, VIM, IMP, OXA-48-type) using a CLSI-endorsed or FDA cleared test (Carba-R, PCR, Whole Genome Sequencing, etc.) 

Laboratories must submit CRO microbiologic isolates meeting the following criteria to ACPHL:

• The isolate is CRAB, regardless of carbapenemase test results OR
• The isolate has not already undergone carbapenemase testing at a facility or commercial laboratory OR
• The isolate had a positive phenotypic test, but a specific carbapenemase was not identified OR
• The isolate is pan-nonsusceptible (intermediate or resistant to all drugs tested to date) OR
• The isolate is specifically requested by the public health department OR
• The isolate belongs to an Alameda County resident residing in a LTCF or SNF

Please refer to Carbapenem-Resistant Organisms (CROs) for additional information and direct questions to acutecd@acgov.org.

September 04, 2025

Advisory

Alameda County Mpox Updates

There has been a recent increase in mpox in Alameda County, as well as other areas in the San Francisco Bay Area (CDPH Health Advisory).   In Alameda County, we have had a 4-fold increase in mpox cases (from 3 cases to 12 cases) since July 2025.  

Mpox is characterized by a diffuse or localized rash; the rash can be preceded by a prodrome or other symptoms such as fever, malaise, or lymphadenopathy. Mpox is usually transmitted by close and sustained physical contact.  Mpox has two clades; the large global mpox outbreak in 2022 was caused by Clade II mpox and it is still circulating in the US.  Clade I mpox is primarily occurring outside the United States. JYNNEOS vaccine (mpox vaccine) prevents both clades.  One dose of the vaccine has 36-75% efficacy, and two doses has 66-89% efficacy for prevention of mpox.

See Mpox Updates Health Advisory

Actions requested of Providers: 

• Test for mpox when a patient presents with new rash and other symptoms (compatible signs and symptoms (PDF)). 
• Recommend mpox vaccination for persons at risk, and a second dose for anyone who has not completed the 2-dose series. Getting more than 2 doses (“booster”) is not recommended. Anyone who thinks they need the vaccine should get it. 
• Vaccines are available at many chain pharmacies and certain clinics—see Mpox Vaccine Locator.  JYNNEOS (mpox) vaccine will also be available with limited supply at Oakland PRIDE (9/7), Oakland LGBTQ center, and Steamworks (9/5, 9/6, 9/9). 
• Ensure persons know the signs and symptoms of mpox illness so they are evaluated and tested in a timely way if they are symptomatic.  
• Submit a confidential morbidity report (CMR) to Alameda County Public Health Department for suspect and confirmed cases of mpox that reside in Alameda County.  
• Ask about planned travel and recommend mpox vaccine for those at risk.  
• For persons with suspect mpox that have had recent travel to specific locations or exposure to someone with known mpox Clade I, test for mpox Clade I.  Contact Alameda County Public Health Department at sexualhealth@acgov.org and follow the procedures for testing for Clade I mpox by sending the test to VRDL.    

Resources: 

• Mpox updates Alameda County Public Health Department https://mpx.acgov.org/ 
• Bavarian Nordic: Mpox Vaccine Locator 
• California Prevention Training Center | Mpox Clinical Recognition & Testing Overview (PDF)  
• CDC Updates on Tecoviromat  [+Tecovirimat (TPOXX) for Treatment of Mpox | Mpox | CDC+|https://www.cdc.gov/mpox/hcp/clinical-care/tecovirimat.html] 
• CDPH | Local Health Department Communicable Disease Contact List 
• CDPH | Mpox Treatment Information for Providers 
• CDPH | Provider and Health System Access to Commercially Available JYNNEOS Vaccine in California (PDF) 
• CDPH | Health Advisory: First Clade I Mpox Case Confirmed in California and the United States in a Returned Traveler (11/19/2024) 
• CDPH VRDL (for clade I testing): 510-307-8585 or VRDL.Submittal@cdph.ca.gov 
• CDC Poxvirus and Rabies Branch | poxvirus@cdc.gov or after hours via the CDC Emergency Operations Center (EOC) at (770) 488-7100 
• CDC | Mpox Vaccination 
• CDC | Clinical Features of Mpox 
• CDC | Safer Sex, Social Gatherings, and Mpox 
• CDC | Clade I Mpox Outbreak Originating in Africa

August 28, 2025

Advisory

Letter to Healthcare Providers Regarding Title 17 Section 2500 California Code of Regulations Updates

California Department of Public Health (CDPH), in consultation with the California Conference of Local Health Officers (CCLHO), recently updated Title 17 Section 2500 of the California Code of Regulations. For more information, please refer to CDPH Reportable Diseases and Conditions. 

The following conditions have been added and are now required to be reported to the local health department:  

• Melioidosis – report immediately by telephone  
• Cronobacter sakazakii infections in infants less than one year of age – report within one working day  
• Multisystem inflammatory syndrome in children (MIS-C) – report within one working day  
• Silicosis – report within seven calendar days  

The following conditions have been renamed or modified:  

• Neisseria meningitidis (invasive disease), previously appeared as meningococcal infection  

• Coronavirus disease 2019 (COVID-19) (hospitalizations only) via the National Healthcare Safety Network (NHSN). Previously all cases were reportable and appeared as Coronavirus disease 2019 (COVID-19).  COVID-19 outbreaks also remain reportable in all settings with specific thresholds: Reporting Requirements | COVID-19 | Alameda County Public Health

The following conditions have a change in the reporting timeframe:  

• Brucellosis, human – report within one working day, previously was immediately reportable  
• Cyclosporiasis – report within one working day, previously was seven working days  
• Hemolytic uremic syndrome – report within one working day, previously was immediately reportable  
• Legionellosis – report within one working day, previously was seven working days  
• Shiga toxin detected in feces – report within in one working day, previously was immediately reportable Additionally, Section 2500 now requires healthcare providers to include the patient’s hospitalization status, if known, when reporting to public health. 

Additionally, Section 2500 now requires healthcare providers to include the patient’s hospitalization status, if known, when reporting to public health.  

August 15, 2025

Update

Outbreak of Candida auris at an Alameda County Acute Care Hospital Has Ended

Alameda County Public Health Department (ACPHD) has been working with Wilma Chan Highland Hospital (HH) in Oakland to investigate and control an outbreak of Candida auris (C. auris) among adult patients admitted to the intensive care unit (ICU), step-down unit (SDU) and medical/surgical units. ACPHD no longer considers HH in active outbreak and will continue surveillance monitoring. Therefore, additional screening measures that were recommended for healthcare facilities accepting patients from HH may cease. In coordination with ACPHD, HH was able to implement aggressive measures to control the outbreak and prevent further transmission. In addition to addressing opportunities to improve general infection control measures, HH has been conducting bi-weekly unit-based screening of patients in affected units and screening of patients upon discharge to lower levels of care.

Patients should not be denied admission or transfer due to colonization, infection, or a pending screening result for C. auris. Furthermore, all healthcare facilities should follow the C. auris testing recommendations outlined in the California Department of Public Health (CDPH) June 9, 2025 Health Advisory Ongoing Transmission of Candida auris in Healthcare Facilities in Northern and Central California.

• ACPHD C. auris Health Update

July 21, 2025

Advisory

CDPH Mycoplasma pneumoniae Infections Among Children and Adolescents During Fall and Winter Respiratory Illness Season

On July 9, 2025, CDPH issued a CAHAN reporting an inc​​reasin​g number of respiratory infections in children due to Mycoplasma pneumoniae (M. pneumoniae) since March 2025.  

• CDPH has received reports of increasing numbers of children hospitalized with M. pneumoniae infections from March through June 2025 at hospitals in the San Francisco Bay Area and the San Joaquin Valley, including Alameda County. California does not perform routine surveillance for M. pneumoniae; as such, systematic statewide data is not available.
• National trends of M. pneumoniae infections do not currently mirror the increase in cases reported in California counties.
• CDPH Viral and Rickettsial Disease laboratory (VRDL) has been partnering with the CDC to facilitate azithromycin resistance testing for M. pneumoniae positive respiratory specimens. To date, no increase in azithromycin resistance has been detected in California. 
• Providers should consider testing for M. pneumoniae infection in children with community acquired pneumonia or other respiratory illnesses, especially those who aren't clinically improving on antibiotics ineffective against M. pneumoniae, such as amoxicillin or other beta-lactams.  

For more information, please see this PDF from CDPH.

July 21, 2025

Alert

Penicillin G Benzathine (Bicillin® L-A) Voluntary Recall and Shortage

July 17, 2025

SITUATION:

On July 10, 2025, Pfizer, the manufacturer of penicillin G benzathine (Bicillin® L-A), issued a voluntary recall of affected product lots due to particulates identified in the syringes during visual inspection. This includes both 1.2 million units/2 mL and 2.4 million units/4 mL prefilled syringes distributed from December 11, 2023 – June 24, 2025.

Please check your Bicillin stock immediately as affected lots (see below) should be discontinued. You can find more information about credit reimbursement for returned affected lots in Pfizer’s Bicillin® L-A  recall notification.

In response to this recall and as Pfizer is the only manufacturer of Bicillin® L-A, the FDA anticipates a limited supply of Bicillin® L-A 1.2 and 2.4 million units doses with no estimated recovery date. 

Bicillin® L-A is the only acceptable treatment for pregnant people infected with or exposed to syphilis and should be prioritized for babies exposed to syphilis in utero.

Utilizing Pfizer’s Medical Request Process, providers and pharmacy directors who no longer have wholesale or hospital system access to Bicillin® L-A can submit a medical request form for patients who can only receive Bicillin® L-A due to the risk of congenital syphilis.

Doxycycline is an acceptable alternative for non-pregnant adults with primary, secondary, or early and late latent syphilis, and for those who have been exposed to a patient with infectious syphilis. Limited data support ceftriaxone as an effective therapy option for the treatment of primary and secondary syphilis, and neurosyphilis, in non-pregnant adults.

Extencilline and Lentocilin were approved by FDA for temporary importation due to prior shortages and remain available.

Other intramuscular formulations of penicillin (e.g. Bicillin C-R) are not acceptable alternatives for the treatment of syphilis.

ACTIONS REQUESTED OF HEALTHCARE PROVIDERS:

1. Check your Bicillin stock immediately as affected lots (see below) should be discontinued.
2. Use penicillin G benzathine (Bicillin® L-A) for:
   • Pregnant people with syphilis infection or exposure
   • Infants exposed to syphilis in utero
   • Non-pregnant adults with syphilis of any stage who have a contraindication to doxycycline
   • Non-pregnant adults with syphilis of any stage who are unlikely to adhere to a multi-day doxycycline regimen, for example people without a safe space to store medications, or who have shown difficulties in adhering to other medications.
3. Use doxycycline for syphilis treatment in non-pregnant adults and those without other reasons to use Bicillin® L-A
   • Use doxycycline 100 mg PO BID x 14 days for the treatment of primary, secondary and early latent syphilis, and for those exposed to syphilis.
   • Use doxycycline 100 mg PO BID x 28 days for the treatment of non-pregnant adults with late latent syphilis.
4. Use alternative antimicrobials to treat group A strep pharyngitis and for primary rheumatic fever prophylaxis, e.g., penicillin V, amoxicillin, and azithromycin.
5. Monitor your inventory of penicillin G benzathine. Please notify ACPHD SexualHealth@acgov.org of shortage(s) or low inventories of Bicillin ® L-A. ACPHD has a limited supply of Bicillin® L-A that may be available for the treatment of prioritized cases. Requests for Bicillin® L-A should indicate the purpose, and be submitted to ACPHD SexualHealth@acgov.org.

RESOURCES:

• Pfizer announces urgent recall of Bicillin L-A, affected lot numbers below:
  
• Pfizer Bicillin Supply Update – July 2025
• FDA on Bicillin L-A shortage and availability of Extencilline
• Extencilline Ordering and Administration Instructions
• CDC STI Treatment Guidelines for Syphilis
• CDPH Health Advisory - Bicillin® L-A (Benzathine Penicillin G) Shortage – June 2023
• CDPH: Alternative therapies for the treatment of syphilis in non-pregnant adults
• SFDPH Bicillin LA Recall and Shortage Health Alert

June 24, 2025

Advisory

CDPH Influenza A Subtype Testing Guidance: Continued Surveillance During the Summer Months

On June 11, 2025, CDPH issued a CAHAN urging healthcare providers to maintain awareness of potential H5N1 infection during the summer months. Continued influenza testing and subtyping all flu A positives over the summer is key to maintaining visibility of the flu A subtypes circulating in the community, and for enhanced detection of novel influenza cases. 

Healthcare providers should: 

• Continue to test for influenza in patients with respiratory illness and exposure risk factors for H5N1, and if positive for flu A, arrange for subtyping at Alameda County Public Health Laboratory (ACPHL).
• Continue to test for influenza in hospitalized patients with severe respiratory illness (particularly those in the ICU) regardless of exposure history and arrange for all flu A positive specimens to be sent to a clinical or commercial lab, or to ACPHL for subtyping.
• Report suspected cases of novel influenza, particularly H5N1, to ACPHD based on symptoms and relevant exposure, OR if a flu A test was positive, and subtyping was attempted but did not identify a seasonal flu A subtype (this includes unsubtypeable results). Please call 510-267-3250 from M-F 8:30-5PM. After hours and on weekends, call the Alameda County Fire Dispatch at 925-422-7595 and ask to speak with the Public Health Duty Officer on-call.
• In patients with both respiratory illness and conjunctivitis, please test for influenza even in the absence of avian flu risk factors.

Clinical and commercial laboratories should:

Report any samples that are flu A positive and for which subtyping was attempted but did not identify a seasonal flu A subtype to ACPHD and urgently direct these samples to ACPHL.

From June through September 2025, submit flu A positive samples that were not subtyped in clinical or commercial laboratories to ACPHL for subtyping.

June 09, 2025

Advisory

Ongoing Transmission of Candida auris in Healthcare Facilities in Northern and Central California

As an update to the March 2023 Health Advisory describing the emergence of Candida auris (C. auris) in Northern California, the California Department of Public Health (CDPH) and local public health partners are alerting health care providers of an increase in C. auris cases identified across Northern and Central California.

In addition, there has been ongoing transmission in acute care hospital and long-term acute care hospital (LTACH) settings in the Bay Area and Central Valley since November 2024, with more spread likely in the region than has been identified to date.

Patients and residents who have had prolonged admission in healthcare settings, particularly high-acuity care settings including LTACHs, ventilator-equipped skilled nursing facilities (vSNFs) and high-acuity ACH units (e.g., intensive care units (ICUs)), are at highest risk of C. auris and other multidrug-resistant organism (MDRO) colonization and infection.

June 9, 2025 CDPH Health Update to Healthcare Professionals

May 20, 2025

Advisory

Transmission of Candida auris at an Alameda County Acute Care Hospital

Alameda County Public Health Department (ACPHD) is investigating transmission of Candida auris (C. auris) among patients at Highland Hospital (HH) in Oakland. To date, five cases of C. auris colonization have been identified from multiple adult inpatient units at HH. The HH Emergency Department and Labor & Delivery Unit are not currently affected. Contact tracing and additional point prevalence surveys (PPS) are being conducted. No transmission of C. auris has been documented in any other local facility at this time. ACPHD is notifying local health care facilities to inform actions to prevent further spread (see attached Health Advisory).

ACTIONS REQUESTED OF LOCAL HEALTH CARE FACILITIES

1. For General Acute Care Hospitals and Long-term Acute Care Hospitals, conduct an admission screen for C. auris of patients from any adult inpatient unit from Highland Hospital (excluding Labor & Delivery and patients seen only in the Emergency Department), and place patients on empiric Contact Precautions until the admission screen results negative.
2. For Skilled Nursing Facilities (SNF) and vSNFs admitting patients from Highland Hospital (excluding Labor & Delivery and patients seen only in the Emergency Department), place patients on empiric Enhanced Barrier Precautions until you receive negative screening results for C. auris. Discharge screening will be conducted by Highland Hospital and communicated to receiving facilities.
3. Retrospective testing of patients admitted from HH since early March may be considered. Facilities will be notified if additional testing is required for patients epidemiologically linked to newly identified C. auris colonized cases.
4. Review previous recommendations for C.auris: Health Advisory Feb 23, 2023.

ACTIONS REQUESTED OF CLINICAL AND REFERENCE LABORATORIES

1. Identify all Candida isolates from sterile sites, if it is the only organism isolated.
2. For Candida isolated from non-sterile sites (e.g., urine), consider speciating isolates from patients at highest risk for C. auris.
3. Report C. auris identification to ACPHD within one working day; follow reporting instructions outlined in Candida auris Health Advisory Feb 23, 2023.

May 07, 2025

Advisory

Congenital Syphilis Health Advisory

This Health Advisory is to update providers on congenital syphilis. Alameda County’s congenital syphilis rate increased 218% between 2019 and 2023. Congenital syphilis is preventable with routine screening and timely treatment of syphilis in pregnant persons. More information on this review can be found here.

Congenital Syphilis Health Advisory

Actions Requested of Clinicians:

• Complete and Fax to 510-268-2036 a Confidential Morbidity Report (CMR) and associated medical records to ACPHD within one working day for all suspected and confirmed cases of syphilis. Include pregnancy status and treatment information.
• Screen all sexually active people ages 15-44 years for syphilis at least once, regardless of gender identity or sexual orientation.
• Conduct a pregnancy test for anyone with confirmed syphilis who is capable of becoming pregnant.

For Pregnant Patients:

• Screen all pregnant persons for syphilis three times: (1) at first prenatal encounter (ideally during the first trimester); (2) early in the third trimester (ideally at 28 weeks gestation); and (3) again at delivery.
• Prior to discharge, Emergency Departments should either conduct a syphilis test for all pregnant patients or verify that documented syphilis screening results from the current pregnancy are available.
• If clinically indicated, provide empirical treatment for syphilis while awaiting confirmatory testing for patients with preliminary positive treponemal or non-treponemal test results. Note: In pregnant persons, syphilis treatment must be initiated at least 30 days before delivery to prevent congenital syphilis.
• Ensure that syphilis treatment regimen is appropriate for the stage of syphilis, and that doses are being administered on the proper schedule (see CDC Syphilis During Pregnancy Guidelines). Note: For unknown duration or late latent syphilis, optimal treatment in pregnancy is 3 doses of benzathine penicillin G with an interval of 7 days between doses. If treatment occurs with more than 8 days or less than 6 days between doses, the full treatment course should be restarted.
• Educate pregnant patients with syphilis on the importance of completing the treatment regimen.

For any questions, please contact the ACPHD Sexual Health team Monday through Friday, 8:30 AM – 5:00 PM, at (510) 267-3250 or email us at SexualHealth@acgov.org.