Health Alerts

June 25, 2015

Update

Ebola Virus Disease

The ongoing Ebola epidemic in West Africa that started last year is the largest in history, and continues to affect the countries of Guinea and Sierra Leone.  Liberia was declared free from Ebola virus transmission by the World Health Organization on May 9, 2015.  In the US, the Centers for Disease Control and Prevention (CDC) has not declared Liberia Ebola free, but classifies Liberia as a country with former widespread transmission and current, established control measures. Effective June 17, 2015, the CDC changed its monitoring procedure for Liberian travelers from public health active monitoring to traveler self monitoring.  Travelers from Liberia will continue to be screened in the 5 east coast airports they must pass through to enter the US.  CDC will continue to notify California Department of Public Health (CDPH) and local health departments of travelers arriving in our jurisdictions for informational purposes.  Alameda County is no longer actively monitoring travelers from Liberia.

CDC, CDPH, and Alameda County Public Health Department recommends that healthcare providers:

• Should conduct thorough histories that include: health status, travel, and exposures.
• Should assess travel history for any possible infectious disease exposures (e.g., MERS-CoV, malaria) and not focused only on Ebola-affected countries.
• Should use clinical judgment to evaluate patients based on those histories and their symptoms.
• Should implement infection control measures as appropriate to travel history and clinical presentation.
• Follow standard protocols for patient care (e.g., medical equipment and procedures, infection control, laboratory testing)
  • If the patient reports travel from Liberia and no travel into Guinea and Sierra Leone – no Ebola-specific precautions are required.
• Should continue to report suspect cases of any potential high risk infectious disease to Alameda County Public Health Department Acute Communicable Disease at 510-267-3250.

• ACPHD Ebloa Page
• CDPH Ebola Page
• CDC Ebola Page

June 11, 2015

Update

Middle Eastern Respiratory Syndrome Coronavirus (MERS CoV)

In light of the recent largest outbreak of MERS-CoV outside of the Arabian Peninsula in Korea, the CDC has issued Health Advisory including an update of the criteria for a Patient Under Investigation for MERS-CoV to add – “A history of being in a healthcare facility (as a patient, worker, or visitor) in the Republic of Korea within 14 days before symptom onset.” Only two patients in the U.S. have ever tested positive for MERS-CoV infection, both in May 2014, while more than 500 have tested negative.

The CDC has also issued updated Interim Infection Prevention and Control Recommendations for Hospitalized Patients with Middle East Respiratory Syndrome Coronavirus (MERS-CoV). This updated guidance continues to recommend standard, contact, and airborne precautions. In addition, the updated infection control guidance emphasizes additional elements of infection prevention and control programs that should be in place to prevent the transmission of any infectious agents including respiratory pathogens such as MERS-CoV in healthcare settings.

CDC continues to closely monitor the MERS situation globally and work with partners to better understand the risks of this virus, including the source, how it spreads, and how infections might be prevented. CDC recognizes the potential for MERS-CoV to spread further and cause more cases globally and in the U.S. We have provided information for travelers and are working with health departments, hospitals, and other partners to prepare for this.

• CDC MERS-CoV Health Advisory
• Centers for Disease Control MERS-CoV page

May 22, 2015

Advisory

Carbapenem-Resistant Enterobacteriaceae (CRE)

Carbapenem-Resistant Enterobacteriaceae (CRE) are untreatable or difficult to treat multidrug-resistant organisms that have developed high levels of resistance to carbapenems, a class of antibiotics that includes doripenem, ertapenem, imipenem and meropenem. Risk factors for CRE colonization or infection include open wounds, presence of indwelling devices including endotracheal tubes, multiple co-morbidities, and high antimicrobial use. Long-term acute care (LTAC) hospitals have the greatest prevalence of patients with CRE-colonization or infection as a result of receiving and caring for patients who have many CRE risk factors and a history of lengthy hospitalizations.

Multiple clusters and outbreaks of CRE have been increasingly recognized in recent years in Northern California acute and long-term care facilities, including facilities in Alameda County. CRE are highly transmissible in healthcare settings and both infected and colonized patients can serve as reservoirs for transmission. Early recognition and prompt implementation of infection control precautions are critical to control the spread of CRE in our region.

• Full ACPHD Health Advisory
• ACPHD CRE page
• California Department of Public Health CRE Page
• Centers for Disease Control CRE Page

February 20, 2015

Advisory

Measles Cases in Alameda County and California

As of February 20, Alameda County Public Health Department (ACPHD) has confirmed 6 cases of measles in 2015 and is investigating other suspect cases, and California has confirmed 123 cases. Measles is very infectious, and airborne transmission can occur in crowded settings. Think of measles in patients with a fever and rash, especially with a history of travel or exposure to returning travelers or measles patients. Although most measles cases occur in unvaccinated patients, cases have occurred in patients who reported a history of MMR vaccination.  All Alameda County residents should ensure they are immune or have been vaccinated against measles.

Think of measles in patients with a fever and rash, especially with a history of travel or exposure to returning travelers or measles patients. Although most measles cases occur in unvaccinated patients, cases have occurred in patients who reported a history of MMR vaccination.

• ACPHD Health Advisory – Feb. 20, 2015
• CDPH Health Advisory - Feb. 20, 2015
• ACPHD Measles Page
• CDPH Measles

January 16, 2015

Advisory

Measles Cases in Alameda County and California

As of January 16, Alameda County Public Health Department (ACPHD) has confirmed 4 cases of measles in 2015 and is investigating other suspect cases. The State of California has confirmed 33 recent cases. An outbreak of measles from exposures associated with visits to Disney theme parks in December 17-20th, 2014 has resulted in 28 cases throughout California, including in Alameda County. Five additional cases have no identified common exposures with the outbreak. Cases involve both children and adults, ages 7 months to 59 years old, including 15 unimmunized individuals. A small number of cases were previously immunized. Measles is very infectious, and airborne transmission can occur in crowded settings. Outbreaks in California typically involve infected international visitors or unimmunized persons traveling overseas in areas where large measles outbreaks are occurring, followed by local spread. All Alameda County residents should ensure they are immune or have been vaccinated against measles

Think of measles in patients with a fever and rash, especially with a history of travel or exposure to returning travelers or measles patients. Although most measles cases occur in unvaccinated patients, cases have occurred in patients who reported a history of MMR vaccination.

• ACPHD Health Advisory – January 16, 2015
• ACPHD Measles Page
• CDPH Measles

January 07, 2015

Advisory

Measles Cases in Alameda County and California

As of January 8, 2015, Alameda County Public Health Department (ACPHD) has confirmed one case of measles in 2015, and is investigating two additional suspect cases. These cases were likely exposed during a visit to Disneyland or Disney California Adventure Park 12/17-12/18/14. As of 1/6/15, an additional six cases have been confirmed in California with similar exposure, and three others are under investigation in CA and Utah. All patients reported visiting Disneyland or Disney California Adventure Park in Orange County, California between December 15th and December 20th, 2014. Confirmed CA cases range in age from 8 months to 21 years. Of the seven confirmed CA cases, six cases were unvaccinated for measles (two were too young to be vaccinated, and one had received appropriate two doses of MMR vaccine). Several large contact investigations are ongoing. It is likely that a person infectious with measles was at Disneyland or Disney California Adventure Park on these dates. However since persons can be infectious with measles for 9 days we cannot rule out the possibility of additional exposure dates or venues.

Think of measles in patients with a fever and rash, especially with a history of travel or exposure to returning travelers or measles patients. Although most measles cases occur in unvaccinated patients, cases have occurred in patients who reported a history of MMR vaccination.

• CDPH Health Advisory – January 7, 2015
• CDPH Measles Press Release- January 7, 2015
• Alameda County Public Health Department - Measles

October 29, 2014

Advisory

Ebola Virus Disease

West Africa continues to experience the largest known outbreak of Ebola Virus Disease, with high case fatality rates, in three countries: Liberia, Guinea and Sierra Leone. Spread of Ebola was contained in Nigeria, and it has been declared Ebola-free by the World Health Organization. A small number of Ebola cases continue to be diagnosed in travelers returning from West Africa to the United States, and two cases of Ebola were diagnosed in health care workers who cared for a patient with Ebola while he was critically ill in Texas. To date, other persons with a known exposure to confirmed cases in the US have not developed Ebola. As of 10/11/14, CDC is screening all travelers coming into the US from the three impacted countries, and notifying local health departments in their final destination of their arrival. Alameda County Public Health Department (ACPHD) is actively monitoring travelers arriving from these 3 countries with widespread Ebola transmission, including health care workers, for 21 days after date of departure from West Africa. All healthcare providers, including those in primary care and other outpatient settings, should be prepared to identify and temporarily isolate a patient presenting with fever and recent travel from one of the Ebola-affected areas. Early recognition and appropriate infection control precautions continue to be critical for disease control.

• ACPHD Health Advisory
• ACPHD Ebola Page
• CDPH Ebola Page
• CDC Ebola Page

October 14, 2014

Advisory

Enterovirus D68 (EV-D68) Respiratory Illness & Acute Flaccid Paralysis Surveillance

As of September 30, 2014, 472 cases of EV-D68 have been confirmed in 41 states, including seven cases in California: six in southern California residents, and one case has been identified in northern California. In addition, the Centers for Disease Control & Prevention (CDC) are investigating a cluster of pediatric patients hospitalized with acute flaccid paralysis and spinal cord lesions in Colorado; the possible linkage of these to the respiratory illness outbreak is still under investigation. Some of the Colorado cases with neurologic illness had respiratory specimens test positive for EV-D68.

• ACPHD Health Advisory
• CDC Enterovirus D68 Page

October 08, 2014

Advisory

Ebola Virus Disease

The first case of Ebola Virus Disease (Ebola) diagnosed in the United States (US) was confirmed by the Centers for Disease Control and Prevention (CDC) on 9/30/14 and occurred in a traveler from Liberia to Dallas, Texas. The patient fell ill on 9/24/2014, sought medical care at a Dallas hospital on 9/26/14 and was released despite a reported history of recent travel to Liberia. On 9/28/14, he returned to the same hospital and was admitted for treatment. The CDC issued a Health Advisory on 10/2/14 to advise clinicians to identify, isolate, and immediately report suspected Ebola cases to their local health department. Early recognition and appropriate infection control precautions are critical for disease control.

• ACPHD Health Advisory
• CDPH Ebola Page
• CDC Ebola Page

August 19, 2014

Update

Ebola Virus and West Nile Virus Update

There is currently a large outbreak of Ebola Virus Disease (EVD) in the West African countries of Guinea, Sierra Leone, Liberia, and most recently, Nigeria. As of August 19, the World Health Organization has reported a cumulative total of 2240 suspect and confirmed cases and 1229 deaths. CDC has advised travelers to avoid all non-essential travel to Guinea, Sierra Leone, and Liberia, and has issued a lower level alert for Nigeria. As of August 19, 2014, there are no EVD cases acquired in the United States. While the risk of importation of Ebola into the United States is considered to be very low, Alameda County Public Health Department (ACPHD) is working with the California Department of Public Health (CDPH) to prepare in the event that a returning traveler from these countries develops illness that may be concerning for EVD. Early identification of such cases and prompt infection control implementation will be key components to containment and prevention of spread.

As of August 13, 2014, Alameda County reported 51 dead birds and 10 mosquito pools positive for West Nile Virus (WNV); this is an unusually high number and already higher than all prior years. Mosquito Abatement has undertaken precautions to treat mosquitoes in areas where activity is highest in Livermore. There are currently no reported symptomatic cases of human WNV in Alameda County this year, and there are 57 reported human cases in CA from 36 jurisdictions.

• Ebola Virus and WNV Update
• CDPH Ebola Page
• CDC Ebola Page

June 10, 2014

Update

Middle Eastern Respiratory Syndrome Coronavirus (MERS CoV)

The CDC had previously reported on May 17, 2014 that an individual from Illinois who had extended face-to-face contact with the Indiana case had become infected with MERS CoV but had no symptoms. After further laboratory testing on May 28, the CDC announced that they have now concluded that the Illinois resident was not infected with MERS CoV

• ACPHD Health Update
• MERS-CoV Patient Alert Poster

May 22, 2014

Advisory

Middle Eastern Respiratory Syndrome Coronavirus (MERS CoV)

As of May 2, 2014, the CDC confirmed that the first case of Middle Eastern Respiratory Syndrome Coronavirus (MERS CoV) has been reported in a US citizen in Indiana. On May 11 a second case was confirmed in Florida. The cases are unrelated. Both were healthcare workers who had returned from the Middle East. On May 16, 2014 the first domestic secondary case was reported in Indiana. This case was exposed to the first case and remains asymptomatic, but lab testing indicates exposure and immune response to MERS-CoV. The CDPH and CDC have provided guidelines for healthcare providers.

• ACPHD Health Advisory
• CDPH MERS CoV page
• CDC MERS Cov page