Advisory

December 09, 2024

Advisory

Detection of Highly Pathogenic Avian Influenza (HPAI) A (H5N1) Virus in Alameda County

Alameda County Public Health Department (ACPHD) is issuing this Health Advisory to share information and notify clinicians, public health authorities, and the public about influenza A (H5N1), or bird flu. There are ongoing outbreaks of influenza A (H5N1) in dairy cattle and poultry farms in other counties in California. As of December 9, 2024, there are 58 confirmed human cases in the United States, with 32 cases reported in California. The current public health risk for influenza A (H5N1) infection remains low.

1. Information on the influenza A (H5N1) case in an Alameda County resident.
2. Clinicians are asked to consider influenza A (H5N1) in patients with upper respiratory symptoms and exposure to sick/dead birds, wildlife or domesticated animals or exposure to unpasteurized (raw) milk or milk products.
3. If bird flu is suspected, clinicians should call Alameda County Department of Public Health (510) 267-3250.
4. Evaluation and Testing for Human Avian Influenza A (H5N1) Infection

See H5N1 Health Advisory

November 08, 2024

Advisory

Increase in Pertussis Cases

More than 60 confirmed or probable cases of Pertussis have been reported in Alameda County during the 2024-2025 school year, along with multiple high school outbreaks. This is an increase compared with recent years. No hospitalizations have been reported. Despite high vaccination rates in our community, any person who has Pertussis-like symptoms should avoid taking care of or spending time with pregnant persons or infants, as Pertussis can cause severe illness or, in rare instances, death. A person infected with Pertussis is considered contagious for 21 days after the onset of cough or until 5 days of antibiotics have been completed.  

ACTIONS REQUESTED OF CLINICIANS:

• Suspect Pertussis early in a person with cold-like symptoms and cough if there is a history of exposure to a Pertussis case. Also consider Pertussis if the cough is persistent (≥2 weeks), paroxysmal, or accompanied by post-tussive vomiting. 
• Provide Post-Exposure Prophylaxis (PEP) if high-risk contacts are identified. These include pregnant persons in 3rd trimester, infants, household or occupational contacts of infants, and persons with underlying conditions, such as moderate to severe asthma or immunocompromising conditions, who may experience severe disease.  
• When testing persons with Pertussis symptoms, treat empirically with antibiotics and exclude from exposure to high-risk contacts, school or the workplace pending test results, so as not to expose additional persons.
• If your patient tests positive for Pertussis, advise isolation until 5 days of antibiotics have been completed OR ≥3 weeks have elapsed since cough onset.  
• Provide Tdap booster to pregnant persons in the third trimester of every pregnancy. 
• If you have any questions, please call the Acute Communicable Disease Section at the Alameda County Department of Public Health, Monday through Friday from 8:30 am - 5:00 pm at (510) 267-3250.

See Pertussis Health Advisory

October 09, 2024

Advisory

First Marburg Virus Disease Outbreak in the Republic of Rwanda

The purpose of this advisory is to share a CDC HAN from 10/3/24 about Rwanda’s first confirmed outbreak of Marburg virus disease (MVD). There were 56 cases and 12 deaths reported as of October 8, 2024, including at least 19 cases in healthcare workers. No confirmed cases of MVD related to this outbreak have been reported in the United States or other countries outside of Rwanda to date. Currently, the risk of MVD in the United States is low; however, clinicians should be aware of the potential for imported cases.

Please review the HAN for a full list of recommendations for clinicians, including infection prevention considerations. Contact ACPHD immediately (510-267-3250 M-F 8:30-5PM or 925-422-7595 after hours and on weekends) about any patient who has been to an area with an active MVD outbreak in the past 21 days, AND who has compatible symptoms (e.g., fever, headache, muscle and joint pain, fatigue, loss of appetite, gastrointestinal symptoms, or unexplained bleeding), AND has reported epidemiologically compatible risk factors within the 21 days before symptom onset including direct contact with a symptomatic person with suspected or confirmed MVD, or with any objects contaminated by their body fluids.

Recommendations for Infection Prevention and Control Measures in Hospitals

• Employ a combination of infection prevention and control measures to prevent transmission of MVD in hospitals. These infection prevention and control measures include, but are not limited to:
  • Isolating patients in a private room with a private bathroom or covered bedside toilet if MVD is suspected. Dedicated medical equipment (preferably disposable, when possible) should be used for the provision of patient care.
  • Following separate PPE guidance for managing clinically stable and clinically unstable patients.
  • Ensuring that healthcare workers caring for patients with VHFs have received comprehensive training and demonstrated competency in performing VHF-related infection control practices and procedures.
  • For additional measures, please review the HAN.
• Know that healthcare personnel can be exposed through contact with a patient’s body fluids, contaminated medical supplies and equipment, or contaminated environmental surfaces. Splashes to unprotected mucous membranes (e.g., the eyes, nose, or mouth) are particularly hazardous.
• Minimize procedures that can increase environmental contamination with infectious material, involve handling of potentially contaminated needles or other sharps, or create aerosols.

September 30, 2024

Advisory

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

The fall and winter of 2023-2024 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, including the City of Berkeley, are required to wear high-quality, well-fitting masks in patient care areas from November 1, 2024 through March 31, 2025, regardless of vaccination status (see Order). Alameda County and the City of Berkeley are aligning with many health jurisdictions across the Bay Area in implementing this policy.  

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. 20-16b (requiring Health Care Workers in specified facilities to receive annual flu vaccinations or wear masks), which was suspended last year, has now been rescinded.

September 24, 2024

Advisory

Increased Oropouche Virus Activity and Associated Risk to Travelers

A CDC HAN from 8/16/24 about the increase in Oropouche virus disease originating from endemic areas in the Amazon basin and new areas in South America and the Caribbean was distributed. As of September 17, there were 74 travel-associated cases in the U.S. in 2024, including one in California. Recommendations for healthcare providers include: 

• Consider Oropouche infection in a patient who has been in an area with documented or suspected Oropouche virus circulation within 2 weeks of initial symptom onset (as patients may experience recurrent symptoms). 

• Report any suspected Oropouche infection to the ACPHD immediately at (510) 267-3250, M-F 8:30-5PM. After hours and on weekends, please call (925) 422-7595 and ask to speak with the Public Health Duty Officer on call. 

• Rule out dengue virus infection in travelers with suspect Oropouche virus infection. 

• Inform pregnant people of the possible risks to the fetus when considering travel to areas with reported Oropouche virus transmission. Pregnant people are currently recommended to reconsider non-essential travel to Cuba or other areas with a Level 2 Travel Health Notice.  

• Be aware that people who may be at higher risk for complications or severe disease include pregnant people, older adults, and people with underlying medical conditions. 

• Direct all travelers going to areas with Oropouche virus transmission to use measures to prevent insect bites during travel and for 3 weeks after travel.

September 10, 2024

Advisory

Detection of highly pathogenic avian influenza (HPAI) A(H5N1) in California dairy cattle

A CAHAN from 9/4/24 about the detection of avian influenza A(H5N1) in cows at three California dairies located in the Central Valley is being distributed. Below are some reminders for Alameda County healthcare providers (HCPs): 

• HCPs should consider H5N1 in persons with acute respiratory symptoms and/or conjunctivitis AND recent exposure to animals suspected or confirmed to have avian influenza.
• Providers in Alameda County should immediately report any suspected avian influenza infections to ACPHD at 510-267-3250 (M-F 8:30-5PM). After hours and on weekends, please call 925-422-7595 and ask to speak with the Public Health Duty Officer on call.
• Testing of respiratory and conjunctival specimens for avian influenza is only available at public health laboratories and requires coordination with ACPHD.
• Antiviral treatment is recommended for patients suspected or confirmed to have H5N1 infection.
• Healthcare providers should follow standard, contact, and airborne precautions when caring for patients suspected of having H5N1 infection.   
• Continue to follow the enhanced surveillance guidance shared in a previous CAHAN (6/12/24). 

July 23, 2024

Advisory

Critical shortage of Becton Dickinson (BD) BACTEC™ blood culture media bottles

On July 23, 2024, the Centers for Disease Control and Prevention (CDC) issued a Health Alert Network (HAN) Health Advisory to inform healthcare providers, laboratory professionals, and healthcare facility administrators of a critical shortage of Becton Dickinson (BD) BACTEC™ blood culture media bottles. This shortage has the potential to disrupt patient care by leading to delays in diagnosis, misdiagnosis, or other challenges in the clinical management of patients with certain infectious diseases. Facilities affected by this shortage should immediately begin to assess their situations and develop plans and options to mitigate the potential impact of the shortage on patient care.

For a full list of recommendations, please see the attached Health Advisory.

If you were forwarded this message and would like to receive future communications from ACPHD directly, please register yourself for our AC Alert system here.  

April 29, 2024

Advisory

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

Advisory

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

Advisory

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

Advisory

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 acutecd@acgov.org with questions.

November 14, 2023

Advisory

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.

ACTIONS REQUESTED OF HEALTHCARE PROVIDERS:

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 Hep-immunize@acgov.org.
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 Hep-immunize@acgov.org.
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 Hep-immunize@acgov.org.