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.

April 29, 2024


Adverse Effects Linked to Counterfeit or Mishandled Botulinum Toxin Injections

The Centers for Disease Control and Prevention (CDC), the U.S. Food and Drug Administration (FDA), and state and local partners are investigating 22 people from 11 states who reported adverse effects after receiving injections with counterfeit botulinum toxin, or injections administered by unlicensed or untrained individuals or in non-healthcare settings, such as homes or spas. The California Department of Public Health (CDPH) received reports of two California residents who are included in the investigation; one reported purchasing counterfeit “Botox" on the internet. Both patients received injections in non-health care settings.

Botulism is a medical emergency and requires immediate medical and public health response.[BOLD previous sentence] Clinicians must immediately report any patients with suspected botulism to Alameda County Public Health Department (ACPHD) who will then coordinate with CDPH to authorize botulism antitoxin (BAT) release if appropriate. To reach ACPHD, call 510-267-3250 (Option 2), M-F 8:30AM-5PM. After hours and on weekends, ask for the ACPHD Duty Officer on call at 925-422-7595.

For more information, please see the full CDC Health Advisory.

February 16, 2024


Cluster of Shigellosis and Shigellemia Cases

The Alameda County Public Health Department has detected an increase in reports of infections due to Shigella bacteria species in Alameda County, including cases of bacteremia known as shigellemia. These cases have mainly occurred among residents of Board and Care facilities and persons experiencing homelessness (PEH); some patients also have a history of drug use. In these recently reported cases, most patients have required antibiotics, and some have required hospitalization. Associated isolates have been susceptible to fluoroquinolones and carbapenems.

Healthcare professionals are urged to be vigilant for possible cases of Shigella infection, to report cases to their local health department, and to educate patients and communities at increased risk about prevention and transmission. Due to recent reports of shigellemia, clinicians are advised to have a low threshold for conducting both blood and stool cultures for suspected cases. Importantly, clinicians must request susceptibility testing against all the common antibiotics used to treat Shigella if cultures are positive. In addition, providers are reminded to submit Shigella isolates to the Alameda County Public Health Laboratory (ACPHL) for further testing.

Please refer to the Health Advisory for more information.

January 09, 2024


Discontinuation of ciprofloxacin for invasive meningococcal disease (IMD) post-exposure prophylaxis (PEP)

The purpose of this Health Advisory is to update clinicians on the current recommended regimen for post exposure prophylaxis for invasive meningococcal disease in Alameda County.

Due to the detection of ciprofloxacin-resistant strains of Neisseria meningitidis, local health jurisdictions (LHJs) in the Bay Area and Sacramento regions are recommended to discontinue the use of ciprofloxacin for invasive meningococcal disease (IMD) post-exposure prophylaxis (PEP).

December 11, 2023


Severe and Fatal Confirmed Rocky Mountain Spotted Fever among People with Recent Travel to Tecate, Mexico

The Centers for Disease Control and Prevention (CDC) has issued the attached Health Alert Network (HAN) Health Advisory to notify healthcare providers and the public about an outbreak of Rocky Mountain spotted fever (RMSF) among people in the United States with recent travel to or residence in the city of Tecate, state of Baja California, Mexico.

RMSF is a severe, rapidly progressive, and often deadly disease transmitted by the bite of infected ticks, although many patients do not recall being bitten by a tick. Doxycycline is the treatment of choice for patients of all ages. As of December 8, 2023, five patients have been diagnosed with confirmed RMSF since late July 2023; all had travel to or residence in Tecate within 2 weeks of illness onset. RMSF is endemic in multiple border states in northern Mexico, including but not exclusive to Baja California, Sonora, Chihuahua, Coahuila, and Nuevo León. Healthcare providers should consider RMSF in their differential diagnosis of patients who have reported recent travel to Tecate, Mexico, or other areas of northern Mexico and subsequently develop signs or symptoms of an unexplained severe febrile illness. Consider initiating doxycycline based on presumptive clinical and epidemiologic findings, and do not delay treatment pending the result of a confirmatory laboratory test.Early treatment with doxycycline saves lives. 

Healthcare providers can contact ACPHD's Acute Communicable Disease Section at with questions.

November 14, 2023


Perinatal Hepatitis B Reporting

The purpose of this Health Advisory is to remind Healthcare Providers to submit reports of Hepatitis B Virus (HBV) in a pregnant person OR an infant born to a person with HBV to the ACPHD Perinatal HBV Prevention Program.

California state law (California Code of Regulations Title 17, Section 2500) mandates reporting of perinatal HBV in a pregnant person to local public health departments within one week. ACPHD investigates these reports and provides case management to HBsAg positive pregnant persons and their infants.


  1. Screen all pregnant persons with an HBsAg.
  2. Evaluate all HBsAg-positive pregnant persons for treatment eligibility with antiviral therapy.
  3. Report any pregnant person with a positive HBsAg to the ACPHD Perinatal Prevention Program by completing a Confidential Morbidity Report. Please send the Confidential Morbidity Report, and ensure the question regarding pregnancy status is completed, via fax to (510-268-2111) or e-mail to
  4. Report any infant born to a pregnant person with a positive HBsAg to the ACPHD Perinatal Prevention Program by completing a Hospital Report Form. Please send the Hospital Report via fax to (510-268-2111) or e-mail to
  5. Direct any clinical questions or consultation regarding management of a pregnant person with a positive HBsAg or an infant born to a person with a positive HBsAg to the ACPHD Perinatal Prevention Program by phone at 510-268-2347 or e-mail at

October 13, 2023


CAHAN: Preparation for Respiratory Virus Season

The California Department of Public Health has issued a Health Advisory Preparation for Respiratory Virus Season (COVID-19, Influenza and RSV) (10/10/23)


o   Vaccinating pregnant persons protects infants <6 months old, who had a similar COVID-19 hospitalization rate to adults aged 65–74 in 2022. 

  • Therapeutics: Treatment as soon as possible (ideally <48 hours from symptom onset) decreases risk of serious illness, hospitalization, and death. 

o   Updated NIH Treatment Guidelines (10/10/23)

o   AFL-23-29 Coronavirus Disease 2019 (COVID-19) Treatment Resources for Skilled Nursing Facilities (SNFs) (9/26/23)


Respiratory Syncytial Virus (RSV): 

  • Vaccination:

o   Adults 60 and older may receive an RSV vaccine, using shared clinical decision-making

o   Persons who are 32-36 weeks during September to January should receive RSV vaccine to protect their babies against severe RSV disease. 

o   Infants younger than 8 months who are born during – or entering – their first RSV season should receive one dose of nirsevimab. Some older infants/toddlers should receive a dose before their second RSV season. 

COVID-19, influenza & RSV vaccines can be co-administered.  

See also: Updated laboratory reporting requirements for SARS-CoV-2, influenza virus, and respiratory syncytial virus (RSV) .

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 (SUSPENDED 9/20/2023) (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.

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