The Alameda County Public Health Department sends out Health Alerts, Advisories, and Updates regarding communicable disease outbreaks, immunization updates, and other public health concerns to Alameda County clinicians and other partners. See recent releases below.

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ADVISORY: provides important information for a specific incident or situation; may not require immediate action.

September 19, 2023


Staff Masking Required in Higher-Risk Healthcare Settings beginning November 1st

The fall and winter of 2022-2023 saw substantial waves of RSV, flu and COVID-19, and a similar pattern is expected this year. To combat the spread of these viruses to vulnerable patients and residents and minimize the associated risk of severe illness and death, Staff and other workers in specified Health Care Facilities (HCFs) in Alameda County are required to wear high-quality, well-fitting masks in patient care areas from November 1, 2023 through April 30, 2024, regardless of vaccination status (see attached Order). Alameda County is aligning with health jurisdictions across the Bay Area in implementing this policy. HCFs in the City of Berkeley are NOT covered by this Order and should follow City of Berkeley guidance.

The following HCFs are covered by this Order: General Acute Care Hospitals, Long Term Acute Care Hospitals, Psychiatric Hospitals, Skilled Nursing Facilities, Dialysis Centers, and Infusion Centers.

This Order does not require patients, residents, or visitors to wear masks, although masks are strongly recommended for everyone in all health care settings, including Staff in health care settings not covered by this Order.

Order No. 23-02 (requiring Staff in Skilled Nursing Facilities (SNFs) to wear masks in patient care areas) that went into effect on April 3, 2023 remains in effect at this time.

Order No. 20-16b (requiring Health Care Workers in specified facilities to receive annual flu vaccinations or wear masks) is suspended, effective September 20, 2023 at 12:01 a.m. in Alameda County. The Order remains in effect in the City of Berkeley at this time.

Please see Order No. 23-03 for detailed information.

September 11, 2023


Update 2 Penicillin G Benzathine Shortage, September 6 2023

This health advisory is to provide updates on the ongoing, nationwide shortage of penicillin G benzathine (Bicillin® L-A), first reported on April 26, 2023. Alameda County released a health advisory April 28 on this shortage. Pfizer is the sole supplier of Bicillin® L-A, and currently anticipates that the shortage will not be resolved until quarter 2 of 2024. Alameda County Public Health Department (ACPHD) has not been informed of shortages, but healthcare systems in San Francisco have reported critical shortages of penicillin G benzathine.

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.

Given the ongoing shortages, it is important supplies be used to treat patients for whom there is no alternative regimen or those unable to adhere to a multiday course of oral treatment. Other intramuscular formulations of penicillin (e.g. Bicillin® C-R) are not acceptable alternatives for the treatment of 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.

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

September 01, 2023


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

Please see the Health Advisory for detailed information.

August 25, 2023


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 within 1 business day.

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

July 10, 2023


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


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


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


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


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


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


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


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.

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