Health Alerts

May 19, 2022

Advisory

Homemade Infant Formula to Infants

On May 13th, the California Department of Public Health issued a Health Advisory on the current infant formula shortage which includes helpful recommendations for families. The California Department of Public Health/Women, Infants and Children Division (CDPH/WIC) is monitoring reports of widespread low-stock situations, outages, and rationing of powdered infant formula in California.

Actions requested of clinicians:

• Please remind families that they should not excessively dilute formulas or attempt to make their own infant formulas at home.
• WIC staff are encouraging families to consult with their pediatrician before making any substitutions, especially for infants requiring a specialized or therapeutic formula. Healthcare providers who provide care for children in critical need of a particular specialty formula should contact Abbott directly to request the product by calling 1-800-881-0876 or visiting their formula information and product request form.

April 29, 2022

Advisory

Bebtelovimab + Evusheld appointments available at Total Infusion!

We are pleased to announce that Total Infusion remains open to administer both Bebtelovimab (provider and patient referrals) and Evusheld (provider referrals only). The appointment page can be found here: https://totalinfusion.com/book-an-appointment/ or you can call (510) 878-9528 with questions.

For general questions about treatment,please contact Arnie Spanjers, MD, Alameda County Public Health Department at arnie.spanjers@acgov.org

April 26, 2022

Advisory

Recommendations for Adenovirus Testing and Reporting of Children with Acute Hepatitis of Unknown Etiology

The CDC and the California Department of Public Health (CDPH) have issued a health advisory regarding a cluster of pediatric cases of hepatitis associated with Adenovirus type 41. Clinicians are requested to report cases of children that meet the following criteria to the local health department within one business day.

Reporting criteria:

Children <10 years of age with elevated aspartate aminotransferase (AST) or alanine aminotransferase (ALT) (>500 U/L) AND who have an unknown etiology for their hepatitis (with or without any adenovirus testing results, independent of the results) since October 1, 2021

To report cases to Alameda County Public Health Department, contact the Acute Communicable Disease (ACD) Section

By phone: at 510-267-3250 option 2, Monday –Friday 8:30am through 5PM.

By secure email: acutecd@acgov.org

April 25, 2022

Advisory

Availability and Use of Treatments for Outpatients with Mild to Moderate COVID-19

The Centers for Disease Control and Prevention (CDC) issued a Health Alert Network (HAN) Health Advisory to provide an update about the availability and use of recommended therapies for COVID-19 and to advise against using unproven treatments that have known or potential harms for outpatients with mild to moderate COVID-19.  

For patients with mild to moderate COVID-19 who are not hospitalized and who are at increased risk for severe COVID-19 outcomes, several treatment options, including antiviral medications and monoclonal antibodies, are now widely available and accessible. Please see the Health Advisory for full details and note the following: 

• Total Infusion will no longer be able to provide monoclonal antibody therapy after Friday, April 29^th.
• COVID-19 Outpatient Therapeutics + Pre-Exposure Prophylaxis webinar
• Patient flyer: Know Your Treatment and Prevention Options for COVID-19
• CDC’s DON’T DELAY: TEST SOON AND TREAT EARLY (cdc.gov)
• CDPH Toolkit COVID-19 Treatments Toolkit (ca.gov)
• ACPHD therapeutics website

For general questions about treatment, please contact Arnie Spanjers, MD, Alameda County Public Health Department at arnie.spanjers@acgov.org  

April 01, 2022

Advisory

CAHAN: Use of Outpatient COVID-19 Therapeutics in California

On March 30th, the California Department of Public Health (CDPH) issued this alert on the use of outpatient COVID-19 therapeutics in California. As supply of therapeutics has increased and overall COVID-19 cases have decreased across California, there is no longer a limited supply of COVID-19 therapeutic treatments in most locations. As of this writing, all outpatients with mild to moderate COVID-19 who are at risk for disease progression should be offered treatment if eligible based on the product Emergency Use Authorizations (EUAs). Treatment should be offered regardless of vaccination status and because of the predominance of the Omicron sub-variant BA.2, sotrovimab is no longer authorized for use in California. This Health Alert also includes information on the new Test to Treat Locator. 

Please see the updated Alameda County Health Advisory. You are also encouraged to view yesterday’s webinar, COVID-19 Outpatient Therapeutics + Pre-Exposure Prophylaxis, with Dr. Nicholas Moss, Alameda County Health Officer, and Dr. John Openshaw. Dr. Openshaw is an infectious disease physician and researcher who leads the COVID-19 Clinical Team at the California Department of Public Health. He is on the faculty at Stanford University School of Medicine and regularly sees adult infectious disease patients in San Mateo and Santa Clara Counties. To learn more about COVID-19 drug-drug interactions, please check out the Liverpool COVID-19 Drug Interaction Tool. 

For questions regarding the distribution of COVID-19 outpatient therapeutic products within ALCO, please contact Cynthia Frankel, RN, Alameda County Therapeutics Distribution Lead at cynthia.frankel@acgov.org. For clinical questions about COVID-19 therapeutics, please contact Arnie Spanjers, MD, Alameda County Public Health Department at arnie.spanjers@acgov.org  

March 31, 2022

Advisory

Outpatient Therapies for the Treatment and Prevention of COVID-19 in High-Risk Patients

The purpose of this Health Advisory is to inform clinicians in Alameda County about the availability of outpatient therapies for high-risk patients with 1) mild to moderate COVID-19 illness who are not yet hospitalized; or 2) ongoing risk of exposure to COVID-19. When resources are limited, therapy should be prioritized for patients who are at the highest risk of progressing to severe COVID-19, as described in the NIH Panel’s interim statement. As availability increases, it may be possible to offer available therapies to all eligible patients. 

Recent updates to the Health Advisory include:

• New NIH treatment guidelines released
• Change in Sotrovimab window of therapy from within 10 days to within 7 days of symptom onset
• Change in dose of Evusheld; additional dose recommended for those who got smaller first dose
• Addition of Bebtelovimab as a recommended mAB therapy
• Remdesivir available for outpatient treatment of children and adults
• Therapeutic locator websites available
• Federal Test to Treat initiative launched 

Please also visit our COVID-19 website. For questions regarding the distribution of COVID-19 outpatient therapeutic products within ALCO, please contact Cynthia Frankel, RN, Alameda County Therapeutics Distribution Lead at cynthia.frankel@acgov.org. For clinical questions about COVID-19 therapeutics, please contact Arnie Spanjers, MD, Alameda County Public Health Department at arnie.spanjers@acgov.org  

February 28, 2022

Advisory

FDA Revises Evusheld Dosing in EUA

The FDA has revised the EUA for Evusheld (tixagevimab co-packaged with cilgavimab) to increase the initial dose to 300 mg of tixagevimab and 300 mg of cilgavimab. Patients who have already received the previously authorized dose (150 mg of tixagevimab and 150 mg of cilgavimab) should receive an additional dose of 150 mg of tixagevimab and 150 mg of cilgavimab as soon as possible. Evusheld is authorized for use as pre-exposure prophylaxis (PrEP) for prevention of COVID-19 in certain adult and pediatric patients (12 years of age and older weighing at least 40 kg).

Based on the most recent available data, a higher dose may be more likely to prevent infection by Omicron subvariants BA.1 and BA.1.1 than the originally authorized Evusheld dose. Please also review our recent Health Advisory, Outpatient Therapies for the Treatment and Prevention of COVID-19 in High-Risk Patients, regarding the availability of therapeutics for patients with 1) mild to moderate COVID-19 illness who are not yet hospitalized; or 2) ongoing risk of exposure to COVID-19. Information is also available on our COVID-19 website.

For questions regarding the distribution of COVID-19 outpatient therapeutic products within ALCO, please contact Cynthia Frankel, RN, Alameda County Therapeutics Distribution Lead at cynthia.frankel@acgov.org. For clinical questions about COVID-19 therapeutics, please contact Arnie Spanjers, MD, Alameda County Public Health Department at arnie.spanjers@acgov.org.

February 24, 2022

Advisory

UPDATE: COVID-19 CMR Reporting

COVID-19 CMR Reporting Updates

Actions: Health Care Providers in Alameda County should submit COVID-19 Confidential Morbidity Reports (CMRs) within 24 hours on patients with SARS-CoV-2 infection that have been hospitalized or have died. Providers should continue to report on patients with Multi-System Inflammatory Syndromes in Children (MIS-C).  Healthcare facilities should continue to report weekly COVID-19 cases to CDPH as per AFL 21-25. Laboratories must continue to report positive and negative results via Electronic Laboratory Reporting (ELR) or by fax within 24 hours.

ACTIONS REQUESTED OF CLINICIANS:

1. Health Care Providers in Alameda County should submit CMRs within 24 hours on patients with SARS-CoV-2 infection that have been hospitalized or have died.
2. Continue to submit CMRs on patients with MIS-C and all non-COVID-19 Title 17 reportable conditions.

Additional Resources:

Order of the State Public Health Officer: Revision of Mandatory Reporting of Covid-19 Results by Health Care Providers

Alameda County Public Health Department CMR-D (COVID) reporting:

Email: COVIDreport@acgov.org
Fax: (510) 273-3944
For non-urgent concerns, email nCoV@acgov.org

February 22, 2022

Advisory

Update on Distribution and Patient Prioritization for Evusheld

The purpose of the CAHAN is to inform clinicians that: 

1. Evusheld is now being directly allocated to local health jurisdictions similar to the other federally allocated COVID-19 therapeutics. Evusheld received an emergency use authorization (EUA) for pre-exposure prophylaxis (PrEP) against COVID-19 on December 8, 2021. Healthcare facilities that would like to acquire product should contact Cynthia Frankel (see below).
2. Overall weekly supplies of Evusheld distributed from HHS have remained relatively consistent. However, product scarcity is still possible, especially as the number of sites administering this treatment increases. In cases where supply is limited by supply or logistical constraints, providers should follow NIH treatment guidelines.  

Please also review our recent Health Advisory, Outpatient Therapies for the Treatment and Prevention of COVID-19 in High-Risk Patients, regarding the availability of therapeutics for patients with 1) mild to moderate COVID-19 illness who are not yet hospitalized; or 2) ongoing risk of exposure to COVID-19. Information is also available on our website at https://covid-19.acgov.org/antibody-treatment 

For questions regarding the distribution of COVID-19 outpatient therapeutic products within ALCO, please contact Cynthia Frankel, RN, Alameda County Therapeutics Distribution Lead at cynthia.frankel@acgov.org 

For clinical questions about COVID-19 therapeutics, please contact Arnie Spanjers, MD, Alameda County Public Health Department at arnie.spanjers@acgov.org  

February 14, 2022

Advisory

UPDATE! COVID-19 Vaccine Booster Eligibility

On Friday, February 11th, the CDC updated its guidance for COVID-19 vaccination for people who are moderately or severely immunocompromised:

• Immunocompromised persons who have completed a primary series of an mRNA vaccine (Pfizer or Moderna) are recommended to receive an mRNA booster dose 3 months (instead of 5 months) after the last primary dose.
• Immunocompromised persons who have received a single J&J COVID-19 vaccine should receive one additional dose of an mRNA COVID-19 vaccine and one booster dose (preferably mRNA) for a total of 3 vaccine doses.

The CDC also clarified that immunocompromised persons who have completed their primary series of 3 mRNA doses should receive an mRNA vaccine booster dose—to make a total of 4 doses.

Also, for those who previously received passive COVID-19 antibody products, the CDC no longer recommends a waiting period prior to COVID-19 vaccination.

• Summary of key messages from the CDC related to these updates
• Alameda County’s full health advisory

February 03, 2022

Advisory

Ivermectin + Therapeutics Changes for Outpatient Treatment of Mild to Moderate COVID-19

On February 1, 2022, the CDC shared the following COCA Now: Ivermectin Products are Not Approved by FDA to Prevent or Treat COVID-19. Clinicians should be aware of the symptoms associated with ivermectin overdose, including:

• Gastrointestinal symptoms such as nausea, vomiting, and diarrhea
• Low blood pressure
• Neurologic effects such as decreased consciousness, confusion, hallucinations, central nervous system depression, seizures, coma, and death

Ivermectin may also increase sedative effects of other medications such as benzodiazepines and barbiturates.

On February 2, 2022, CDPH released the following health alert: CaHAN (Omicron Variant Update: Therapeutics Changes for Outpatient Treatment of Mild to Moderate COVID-19)

For questions regarding the distribution of COVID-19 outpatient therapeutic products within ALCO, please contact Cynthia Frankel, RN, Alameda County Therapeutics Distribution Lead at cynthia.frankel@acgov.org

For clinical questions about COVID-19 therapeutics, please contact Arnie Spanjers, MD, Alameda County Public Health Department at arnie.spanjers@acgov.org

For the full health advisory, please see ACPHD's Health Advisory.

January 28, 2022

Advisory

Outpatient Therapies for the Treatment and Prevention of COVID-19 in High-Risk Patients

The purpose of this Health Advisory is to inform clinicians in Alameda County about the availability of outpatient therapies for high-risk patients with 1) mild to moderate COVID-19 illness who are not yet hospitalized; or 2) ongoing risk of exposure to COVID-19. When resources are limited, therapy should be prioritized for patients who are at the highest risk of progressing to severe COVID-19, as described in the NIH Panel’s interim statement.

Please see the full health advisory full details and visit our COVID-19 website.

For questions regarding the distribution of COVID-19 outpatient therapeutic products within ALCO, please contact Cynthia Frankel, RN, Alameda County Therapeutics Distribution Lead at cynthia.frankel@acgov.org

For clinical questions about COVID-19 therapeutics, please contact Arnie Spanjers, MD, Alameda County Public Health Department at arnie.spanjers@acgov.org