Health Alerts

January 19, 2022

Advisory

Prioritization of COVID-19 CMR Reporting

The increase of COVID-19 cases in Alameda County caused by the Omicron variant of SARS-CoV-2 is creating a substantial burden on communities, health care systems, and providers. Alameda County is closely monitoring the situation. Submission of Confidential Morbidity Reports (CMRs) for COVID-19 cases is required by state regulation but may be challenging during periods of high case volume.

Until further notice, clinical providers in Alameda County should prioritize submission of CMRs for patients with COVID-19 that have been hospitalized or have died. CMRs for other COVID cases should continue to be submitted as capacity allows. Multi-System Inflammatory Syndromes in Children (MIS-C) is required to be reported separately, and should continue to be prioritized for CMR submission. Laboratories must continue to report positive and negative results via Electronic Laboratory Reporting (ELR) or by fax.

Please see the full health advisory for details, including actions requested of clinicians and additional resources.

December 28, 2021

Advisory

Changes to J&J Guidance and CDPH Booster Requirements

Due to the risk of Thrombosis with Thrombocytopenia Syndrome (TTS), a rare but serious adverse event, the CDC now recommends the use of mRNA vaccines over the Janssen/J&J vaccine for all vaccine-eligible persons. Vaccine providers should start the two-dose mRNA vaccine series even if there is uncertainty about how the patient will receive their second dose; setting alone should not be a reason to offer the J&J vaccine. However, J&J may be offered in some situations as described below:

• When there is a contraindication to mRNA vaccines (e.g., severe allergic reaction after a previous dose or to a component of an mRNA vaccine)
• When a person would otherwise remain unvaccinated for COVID-19 due to limited access to vaccines.
• When a person wants to receive J&J despite the safety concerns identified

 For more information, please review the CDC’s Interim Clinical Considerations.

As Omicron spreads, it is important that providers encourage all eligible patients to get a booster, especially those over 50 or those with significant underlying health conditions.

For more information, please see PDF.

December 28, 2021

Alert

CAHAN Disease Notification - CDPH Health Alert - Authorization of Paxlovid

On December 22, 2021, the U.S. Food and Drug Administration (FDA) issued an emergency use authorization (EUA) for Pfizer’s Paxlovid (nirmatrelvir tablets and ritonavir tablets, co-packaged for oral use) for the treatment of mild-to-moderate COVID-19 in adults and pediatric patients (12 years of age and older weighing at least 40 kilograms).

The federal government will be allocating Paxlovid to states, and the California Department of Public Health (CDPH) will allocate Paxlovid to jurisdictions based on new COVID-19 cases and an equity measure. Given the limited amount of Paxlovid available, product scarcity is expected. The attached Health Alert outlines suggested prioritization of patients for Paxlovid and ethical considerations in settings of limited availability.

On December 23, 2021, the FDA issued an emergency use authorization (EUA) for Merck’s molnupiravir for the treatment of mild-to-moderate COVID-19 in adults. More information about the allocation of molnupiravir is coming soon.

For clinical questions, please contact Arnie Spanjers, MD, at arnie.spanjers@acgov.org

For allocation questions, please contact Cynthia Frankel, RN, MN at cynthia.frankel@acgov.org

• CDPH Health Alert

December 01, 2021

Alert

SARS-CoV-2 virus variant of concern B.1.1.529 (Omicron)

• ACPHD Health Alert
• CDPH Health Advisory
• CDC Health Alert

November 30, 2021

Advisory

Increasing Influenza A (H3N2) Activity

On November 24, 2021, The Centers for Disease Control and Prevention (CDC) issued a Health Alert Network (HAN) Health Advisory about increased influenza A(H3N2) activity that could mark the beginning of the 2021-2022 influenza season. The purpose of this HAN Health Advisory is to:

1. Remind public health practitioners and clinicians to recommend and offer the current seasonal influenza vaccine to all eligible persons aged six months and older (Flu vaccine and COVID-19 vaccine can be given at the same visit).
2. Remind clinicians to consider testing for both influenza virus and SARS-CoV-2 in patients with influenza-like illness (ILI).
3. Advise clinicians that antiviral treatment is recommended as early as possible for any patient with confirmed or suspected influenza who is: a) hospitalized; b) at higher risk for influenza complications; or c) developing progressive illness. In patients with suspected influenza, decisions about starting antiviral treatment should not wait for laboratory confirmation of influenza, however COVID-19 should be excluded if a rapid assay is available.
4. Remind public health practitioners and clinicians to consider mitigation measures including antiviral post-exposure prophylaxis during influenza outbreaks in institutions (e.g., long-term care facilities, university dormitories) in the setting of co-circulation of SARS-CoV-2.
5. Remind the public to use non-pharmaceutical interventions (NPI) or everyday preventive actions, in addition to getting a flu vaccine. Everyday preventive actions include staying home when sick, covering coughs and sneezes, and washing hands often.

Please review the full health advisory for detailed recommendations on testing, treatment, post-exposure prophylaxis, public education and additional resources for clinicians.

November 29, 2021

Advisory

Legionella Amidst Reopening of Businesses & School Facilities

Legionella bacteria are aerobic, gram negative, intracellular pathogens found in water and soil, generally in small numbers insufficient to cause disease.

Legionellosis refers to any clinical syndrome associated with Legionella infection, and can present as Pontiac fever, which is an acute, self-limited febrile illness as well as the more severe Legionnaire’s disease which refers to pneumonia. Even during outbreaks, only a minority of people develop disease, and associated risk factors include age>50, smoking history, and underlying medical conditions such as chronic lung disease, cardiovascular disease, kidney or liver failure, diabetes, malignancy, and immune system disorders. More recently, there have also been increasing cases of Legionella co-infections in patients diagnosed with COVID-19.

Please see the full health advisory for a situation update and action requested of clinicians.

November 22, 2021

Advisory

COVID-19 Vaccine Booster Eligibility

On Friday, November 19^th, the CDC expanded COVID-19 vaccine booster eligibility to all adults. This aligns with CDPH’s letter released on November 9^th, which emphasizes that no one seeking a booster dose should be turned away if:

• The patient is 18 or over AND has met the 6-month original vaccination series time period for the Moderna or Pfizer vaccine OR it has been at least 2 months since their J&J vaccine

It is recommended that healthcare providers proactively outreach to all patients who are eligible for a booster with information about their eligibility, locations for receiving booster doses, and instructions for how to make an appointment/walk-in. In addition, providers should not miss any opportunity to vaccinate the unvaccinated or provide boosters, by offering vaccine during routine or nonroutine visits to medical offices, clinics, pharmacies, and hospitals.

For more information about helping patients choose the appropriate booster type, please see the CDC’s Interim Clinical Considerations. For information about providing booster doses to those patients who received their primary series with a vaccine not authorized in the U.S. OR as part of a clinical trial, please see the CDC’s Emergency Use Instructions.

October 04, 2021

Advisory

COVID-19 Vaccination for Pregnant People to Prevent Serious Illness, Deaths, and Adverse Pregnancy Outcomes

The Centers for Disease Control and Prevention (CDC) recommends urgent action to increase COVID-19 vaccination among people who are pregnant, recently pregnant (including those who are lactating), who are trying to become pregnant now, or who might become pregnant in the future. CDC strongly recommends COVID-19 vaccination either before or during pregnancy because the benefits of vaccination outweigh known or potential risks.

In addition to the risks of severe illness and death for pregnant and recently pregnant people, there is an increased risk for adverse pregnancy and neonatal outcomes, including preterm birth and admission of their neonate(s) to an intensive care unit (ICU). Other adverse pregnancy outcomes, such as stillbirth, have been reported.

• ACPHD Health Advisory
• CDC Health Advisory

September 29, 2021

Advisory

Respiratory Syncytial Virus and Influenza Activity and Guidance for Clinicians

Respiratory syncytial virus (RSV) and other respiratory viruses besides SARS-CoV-2 are circulating in California causing potentially serious illnesses in infants and older adults. Testing for influenza and RSV is recommended, and testing for other respiratory pathogens should be considered, especially in patients with respiratory illnesses who test negative for SARS-CoV-2. Continue to vaccinate patients 6 months and older against influenza. Influenza vaccine and COVID-19 can be co-administered. Encourage parents and caregivers to keep young children with acute respiratory illnesses out of childcare, even if they have tested negative for SARS-CoV-2. Discourage health care personnel, childcare providers, and staff of long-term care facilities from working while acutely ill, even if they have tested negative for SARS-CoV-2.

• CDPH Health Advisory

September 28, 2021

Advisory

Increases in Availability of Cannabis Products Containing Delta-8 THC

On September 14, 2021, the CDC issued a health advisory notice in response to the increase in availability of enhanced delta-8 tetrahydrocannabinol (THC) cannabis products and the rise of serious adverse health events (e.g., vomiting, hallucinations, and loss of consciousness) that occurred after ingesting the enhanced delta-8 THC products. While delta-8 THC naturally contains less THC, the chemical property responsible for creating the “high” feeling that consumers experience when ingesting traditional delta-9 THC products, delta-8 THC products are now being synthetically enhanced or altered by some manufacturers to contain higher levels of THC.

Recently, these practices have led to serious adverse health events, including among pediatric patients younger than 18 years old. These products have not been approved by the FDA. Retailers/consumers are advised to research delta-8 products thoroughly before selling and/or consuming them.

Additional information about the delta-8 and the serious adverse health events can be found below:

• CDC Health Advisory
• FDA 5 Things to Know about Delta-8 THC

September 21, 2021

Advisory

Maintain Vigilance for Vaccine Preventable Diseases

Due to the need for evacuation, individuals from Afghanistan are being resettled in the United States including California. The Alameda County Public Health Department (ACPHD) asks clinicians caring for this vulnerable community to remain vigilant for signs and symptoms of measles, polio, and other vaccine-preventable diseases such as mumps, varicella and pertussis among persons recently resettled from Afghanistan. Clinicians are urged to contact the local health department to report suspected cases of these vaccine-preventable diseases.

See advisory for additional details, guidance, and recommendations.

• ACPHD Health Advisory
• Guidance for Clinicians Caring for Individuals Recently Evacuated from Afghanistan (CDC Health Advisory)y

September 15, 2021

Advisory

Health Recommendations for Asylees and Refugees

After recent evacuation, individuals from Afghanistan are being resettled in the United States. The California Department of Public Health (CDPH) asks that clinicians remain vigilant for signs and symptoms of measles, polio, and other vaccine-preventable diseases such as mumps, varicella and pertussis among persons in California who were recently in Afghanistan. Clinicians are urged to contact their local health department to report suspected cases of these vaccine-preventable diseases.

• Health Screening Guidelines for Physicians Who Serve Asylees (CDPH)
• Health Recommendations and Considerations for Arrivals from Afghanistan (US Department of Health and Human Services)