Health Alerts

September 01, 2023

Advisory

Outbreak of Shigellosis likely associated with a Conference at a Hotel Venue in Downtown Los Angeles, August 21-24, 2023

Alameda County Public Health Department, in coordination with the California Department of Public Health (CDPH), is investigating an outbreak of shigellosis likely associated with a union delegate conference held at a hotel venue in downtown Los Angeles from August 21-24, 2023. The event included an estimated 300+ attendees from across California. As of August 31, 2023, CDPH is reporting six shigellosis cases from four California local health jurisdictions among event attendees, including Alameda County residents. At least three/six cases were PCR+ for Shigella; culture and additional subtyping are pending. Known illness onset dates were on 8/25/23; at least two patients have been hospitalized. As of September 1, 2023, Alameda County is reporting three shigellosis cases to CDPH, all of whom attended this event.

To report cases to Alameda County Public Health Department, complete and indicate on the CMR report “LAC Conference Outbreak”. Fax the completed CMR to (510)273-3744 or email acutecd@acgov.org.

Please see the Health Advisory for detailed information.

August 25, 2023

Advisory

Infections with Aeromonas spp. in Participants of a Tough Mudder Endurance event August 19-20, 2023 in Sonoma, CA

On August 24, 2023, Sonoma County issued a Health Alert and Media Advisory regarding a Tough Mudder Endurance event that took place on August 19-20th, 2023 in Sonoma, CA. Multiple event participants reportedly developed symptoms of rash with fever, myalgias, nausea/vomiting or respiratory symptoms, often 24 hours after exposure to mud at the event. Culture results implicate a pan-sensitive Aeromonas species. Prompt evaluation of any symptomatic patients is strongly recommended, and empiric antibiotic treatment, until culture results are obtained, should be strongly considered.

To report cases to Alameda County Public Health Department, complete and submit CMR reporting as "Unusual/Other" with a note that the patient participated in the Tough Mudder event. Fax the completed CMR to (510)273-3744 or email acutecd@acgov.org within 1 business day.

Please see the Health Advisory for detailed information, including actions requested of clinicians.

July 10, 2023

Advisory

Locally Acquired Malaria Cases Identified in the United States

The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory to share information and notify clinicians, public health authorities, and the public about:

1. Identification of locally acquired malaria cases (P. vivax) in two U.S. states (Florida [4] and Texas [1]) within the last 2 months,
2. Concern for a potential rise in imported malaria cases associated with increased international travel in summer 2023, and
3. Need to plan for rapid access to IV artesunate, which is the first-line treatment for severe malaria in the United States.

June 01, 2023

Advisory

Outbreak of Suspected Fungal Meningitis in US

Among Patients who Underwent Surgical Procedures under Epidural Anesthesia in Matamoros, Mexico

The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network Health Advisory about an outbreak of suspected fungal meningitis among U.S. patients hospitalized in Texas after undergoing cosmetic procedures underepidural anesthesia in the city of Matamoros, state of Tamaulipas, Mexico. It is currently unknown which organism(s) is causing the outbreak. A fungal etiology is suspected based on elevated cerebrospinal fluid (CSF) levels of the fungal biomarker(1,3)-beta-D-glucan in at least one patient. As of May 12, 2023, five patients have been diagnosed with suspected fungal meningitis; all have been hospitalized, and one has died. All these patients received epidural anesthesia and underwent cosmetic procedures. Affected patients underwent procedures in at least two clinics in Matamoros, Mexico, including River Side Surgical Center and Clinica K-3. Other facilities might be identified through further investigation.

Healthcare providers and the public should be aware that patients who underwent medical or surgical procedures under epidural anesthesia in Matamoros, Mexico, and who have developed signs or symptoms of possible meningitis (e.g., fever, headache, stiffneck, nausea, vomiting, photophobia, altered mental status) should promptly seek evaluation by a healthcareprovider and convey that medical history.

May 23, 2023

Advisory

Mpox Updates May 2023

The purpose of this health advisory is to provide updated information to Alameda County health care providers regarding monkeypox cases, testing, and vaccination.

In Alameda County and the United States, cases of mpox (formerly monkeypox) have declined since peaking in August 2022, but the outbreak is not over. Ongoing community transmission in the United States and internationally is occurring. CDC and local partners are investigating a cluster of mpox cases in the Chicago area. As the summer months and celebrations surrounding LGBTQ PRIDE approach, now is the best time to get vaccinated and complete the two-dose mpox vaccine series.

Please see Health Advisory for detailed information, including actions requested of clinicians.

April 28, 2023

Advisory

Benzathine penicillin G (Bicillin L-A®) Shortage

On April 16, 2023, the American Society of Health-System Pharmacists (ASHP) announced a Penicillin G Benzathine shortage (Bicillin L-A® or “BIC”). Benzathine penicillin G (Bicillin L-A®) is the recommended treatment for syphilis and the only recommended treatment for pregnant women infected with, or exposed to, syphilis. Other formulations of penicillin, including Bicillin C-R, are not acceptable alternatives to Bicillin L-A® for syphilis treatment. The manufacturer anticipates the issue will be resolved in the next two months.

Please see Health Advisory for detailed information, including actions requested of clinicians.

April 12, 2023

Advisory

Xylazine Risk with Drug Use

Xylazine is a non-opioid veterinary sedative being detected in combination with fentanyl and other substances in a rising number of overdose deaths, particularly in the northeastern United States but also now in two Bay Area health jurisdictions.

Please see Health Advisory for detailed information on xylazine health risks for clinicians and providers serving people who use drugs.

April 06, 2023

Advisory

Marburg Virus Disease (MVD) Outbreaks in Equatorial Guinea and Tanzania

The Centers for Disease Control and Prevention (CDC) is issuing a Health Alert Network (HAN) Health Advisory to inform clinicians and public health departments in the United States about two confirmed outbreaks of Marburg virus disease (MVD)—one in Equatorial Guinea and one in Tanzania. Currently, there is no evidence to suggest that these two outbreaks are related; most experts agree that these represent two independent animal-to-human spillover events. To date, no confirmed cases of MVD related to these outbreaks have been reported in the United States or other countries outside Equatorial Guinea and Tanzania. This Health Advisory provides information about these outbreaks to increase awareness of the risk of imported cases in the United States.

Please review CDC'S Health Advisory for additional background, recommendations, and clinical and infection control resources.

March 08, 2023

Advisory

Increase in Extensively Drug-Resistant Shigellosis

Public health authorities are monitoring an increase in extensively drug-resistant (XDR) Shigella infections (shigellosis) reported via ongoing surveillance. Shigellosis is an acute enteric infection that is an important cause of domestically acquired and travel-associated bacterial diarrhea in the United States. Shigella bacteria are transmitted by the fecal-oral route, directly through person-to-person contact including sexual contact, and indirectly through contaminated food, water, and other routes. Historically, shigellosis has predominantly affected young children (age 1–4 years) in the United States. More recently, public health has observed an increase in antimicrobial-resistant Shigella infections among adult populations especially:

• Gay, bisexual, and other men who have sex with men (GBMSM)
• People experiencing homelessness
• International travelers
• People living with HIV

Please review the health advisory for additional background and recommendations for clinicians and laboratories.

March 03, 2023

Advisory

Measles Exposure and Outbreak Alert

The CDC has issued an advisory regarding measles detected in Kentucky, with concerns regarding possible exposure at a large gathering of over 20,000 people. Measles is a highly contagious, airborne transmissible viral illness and can spread quickly. There have been recent sporadic cases of measles associated with travel and outbreaks of measles nationally. Alameda County Public Health Department is sending this advisory to inform vigilance and action to support early detection, as well as clinical and public health containment measures.

Clinicians are requested to:

1. Consider/suspect measles in patients with a rash and fever ≥101°F (38.3°C) regardless of travel history.
2. Prepare your facility for the possibility of patients with measles.
3. Report suspected measles cases immediately, while the patient is still in your office to ACPHD Acute Communicable Disease Section by phone at (510) 267-3250; after hours call (925) 422-7595 and ask for the Public Health On-call Duty Officer. CALL, DO NOT FAX.

Please review the CDC Health Advisory for additional background and full recommendations and resources.

February 23, 2023

Advisory

Emergence of Candida auris

Emergence of Candida auris in Healthcare Facilities in Northern California and Increase in Incidence of Carbapenemase-Producing Organisms

Alameda County Public Health Department (ACPHD) is notifying healthcare providers of the identification of a patient with Candida auris (C. auris) colonization in our jurisdiction in January 2023 transferred from an Acute Care Hospital in Contra Costa County. The patient was identified upon admission screening and had no known risk factors or exposures in healthcare facilities outside of Northern California. Due to the presence of C. auris locally, ACPHD encourages healthcare facilities to screen patients on admission from any long-term acute care hospital (LTACH), subacute/ventilator-equipped skilled nursing facility (vSNF) and any healthcare facility in Nevada state.

Please see full health advisory for detailed information.

February 07, 2023

Advisory

Information to Healthcare Providers on Doxy-PEP

There is a new opportunity for prevention of sexual transmitted infections (STIs) for Alameda County residents called doxycycline post-exposure prophylaxis, or doxy-PEP.   This letter provides provisional guidance to healthcare providers on this strategy. As new information becomes available this guidance may be modified. Doxy-PEP is doxycycline 200 mg taken within 72 hours of sex (preferably within 24 hours of sex).

• Healthcare providers should counsel gay men and other men who have sex with men, and transgender people regarding doxy-PEP as a part of comprehensive sexual health counseling.
• Gay men and other men who have sex with men and transgender people who have had a recent STI and who are not taking HIV PrEP should be counseled about HIV PrEP and new long-acting formulations (cabotegravir).
• Adult gay men and other men who have sex with men, and transgender women who are interested in doxy-PEP and who have had a recent STI (chlamydia, gonorrhea or syphilis in the last year), or who are taking HIV PrEP, or who have had more than 1 oral or anal condomless sex partner in the last year, or who are people living with HIV, should be offered doxy-PEP.
• Doxycycline can be taken as often as every day, depending on frequency of sexual activity, but individuals should not take more than 200 mg within a 24-hour period.

For any questions, please reach to Alameda County Public Health, SexualHealth@acgov.org or 510-267-3220