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

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

January 07, 2015

Advisory

Measles Cases in Alameda County and California

As of January 8, 2015, Alameda County Public Health Department (ACPHD) has confirmed one case of measles in 2015, and is investigating two additional suspect cases. These cases were likely exposed during a visit to Disneyland or Disney California Adventure Park 12/17-12/18/14. As of 1/6/15, an additional six cases have been confirmed in California with similar exposure, and three others are under investigation in CA and Utah. All patients reported visiting Disneyland or Disney California Adventure Park in Orange County, California between December 15th and December 20th, 2014. Confirmed CA cases range in age from 8 months to 21 years. Of the seven confirmed CA cases, six cases were unvaccinated for measles (two were too young to be vaccinated, and one had received appropriate two doses of MMR vaccine). Several large contact investigations are ongoing. It is likely that a person infectious with measles was at Disneyland or Disney California Adventure Park on these dates. However since persons can be infectious with measles for 9 days we cannot rule out the possibility of additional exposure dates or venues.

Think of measles in patients with a fever and rash, especially with a history of travel or exposure to returning travelers or measles patients. Although most measles cases occur in unvaccinated patients, cases have occurred in patients who reported a history of MMR vaccination.

October 29, 2014

Advisory

Ebola Virus Disease

West Africa continues to experience the largest known outbreak of Ebola Virus Disease, with high case fatality rates, in three countries: Liberia, Guinea and Sierra Leone. Spread of Ebola was contained in Nigeria, and it has been declared Ebola-free by the World Health Organization. A small number of Ebola cases continue to be diagnosed in travelers returning from West Africa to the United States, and two cases of Ebola were diagnosed in health care workers who cared for a patient with Ebola while he was critically ill in Texas. To date, other persons with a known exposure to confirmed cases in the US have not developed Ebola. As of 10/11/14, CDC is screening all travelers coming into the US from the three impacted countries, and notifying local health departments in their final destination of their arrival. Alameda County Public Health Department (ACPHD) is actively monitoring travelers arriving from these 3 countries with widespread Ebola transmission, including health care workers, for 21 days after date of departure from West Africa. All healthcare providers, including those in primary care and other outpatient settings, should be prepared to identify and temporarily isolate a patient presenting with fever and recent travel from one of the Ebola-affected areas. Early recognition and appropriate infection control precautions continue to be critical for disease control.

October 14, 2014

Advisory

Enterovirus D68 (EV-D68) Respiratory Illness & Acute Flaccid Paralysis Surveillance

As of September 30, 2014, 472 cases of EV-D68 have been confirmed in 41 states, including seven cases in California: six in southern California residents, and one case has been identified in northern California. In addition, the Centers for Disease Control & Prevention (CDC) are investigating a cluster of pediatric patients hospitalized with acute flaccid paralysis and spinal cord lesions in Colorado; the possible linkage of these to the respiratory illness outbreak is still under investigation. Some of the Colorado cases with neurologic illness had respiratory specimens test positive for EV-D68.

October 08, 2014

Advisory

Ebola Virus Disease

The first case of Ebola Virus Disease (Ebola) diagnosed in the United States (US) was confirmed by the Centers for Disease Control and Prevention (CDC) on 9/30/14 and occurred in a traveler from Liberia to Dallas, Texas. The patient fell ill on 9/24/2014, sought medical care at a Dallas hospital on 9/26/14 and was released despite a reported history of recent travel to Liberia. On 9/28/14, he returned to the same hospital and was admitted for treatment. The CDC issued a Health Advisory on 10/2/14 to advise clinicians to identify, isolate, and immediately report suspected Ebola cases to their local health department. Early recognition and appropriate infection control precautions are critical for disease control.

May 22, 2014

Advisory

Middle Eastern Respiratory Syndrome Coronavirus (MERS CoV)

As of May 2, 2014, the CDC confirmed that the first case of Middle Eastern Respiratory Syndrome Coronavirus (MERS CoV) has been reported in a US citizen in Indiana. On May 11 a second case was confirmed in Florida. The cases are unrelated. Both were healthcare workers who had returned from the Middle East. On May 16, 2014 the first domestic secondary case was reported in Indiana. This case was exposed to the first case and remains asymptomatic, but lab testing indicates exposure and immune response to MERS-CoV. The CDPH and CDC have provided guidelines for healthcare providers.

March 28, 2014

Advisory

Measles Cases in Alameda County and California

As of February 18, 2014, 14 confirmed cases of measles have been reported to the California Department of Public Health (CDPH) with onsets since January 1, 2014. This is a higher number of cases than expected early in the year; from 2008-2013, 8 to 31 confirmed measles cases were reported annually. Most cases have involved contact with international visitors or unimmunized Californians who got measles after travelling in the Philippines, Europe, Asia, Africa, or India. It is more important than ever for children and adults to make sure that they are either immune or have been vaccinated. Alameda County Public Health Department has been actively involved in case and contact investigation and disease control activities.

January 17, 2014

Advisory

Influenza Activity in Alameda County

Statewide flu activity has been upgraded to "widespread." Across the country and within California and Alameda County, influenza A (pH1N1), which is in all formulations of the 2013-14 flu vaccine, has been the predominant strain this season. Since its emergence in 2009 pH1N1 has been observed to cause more illness in children and young adults, compared to older adults, although severe illness was seen in all age groups. As of 1/16/14, we have confirmed three deaths in persons <65 years of age due to pH1N1. Vaccination and good hygiene and infection control practices remain the best prevention strategies. Future updates/information will be posted here:

January 06, 2014

Advisory

FDA expects temporary shortage of liquid oseltamivir

Increased demand and manufacturing delays are expected to cause a temporary shortage of the liquid form of the influenza drug oseltamivir (Tamiflu) in coming days, the Food and Drug Administration (FDA) announced on its Web site. The oral suspension formulation is intended for small children and others who can't swallow capsules.

"Genentech is experiencing temporary delays in manufacturing of Oral Suspension. A brief shortage of Oral Suspension is expected in early to mid-January," the FDA said on its "Current Drug Shortages" page. The agency also listed increased demand as a reason for the shortage. The company expects to have more of the product in mid-January, officials said.

Oseltamivir remains available in capsules at all three doses (30, 45, and 75 milligrams), the FDA reported. It said children over 1 year old can be dosed correctly with 30- or 45-mg capsules. For those who can't swallow capsules, a capsule can be opened and mixed with chocolate syrup or some other liquid as directed by a health professional. Also, professionals can use 75-mg capsules to make a liquid form of the drug.

Scattered shortages of the liquid drug were reported in several recent years, including 2013, 2011, and the 2009 pandemic, prompting pharmacies to compound it from capsules.

August 27, 2013

Advisory

Tuberculin Skin Test Solution Shortages

Ongoing shortages of Tubersol and limited availability of Aplisol, the purified protein derivative (PPD) solutions used for tuberculin skin testing (TST) may impact provider ability to assess patients for latent tuberculosis infection (LTBI). In April 2013, the Centers for Disease Control and Prevention (CDC) issued information regarding nationwide shortages of Tubersol and Aplisol solutions. The current projection for restoration of normal production of Tubersol is this fall. The shortage of Tubersol has created increased demand for Aplisol and shortages of both PPD solutions. See Advisory for information on prioritization and substitutions for TST tests.

June 07, 2013

Advisory

Hepatitis A: Multistate Outbreak Linked to Frozen Berry Product and Alameda County Pharmacy Exposure

As of June 7, 2013, the CDC reports 79 people from 8 states with hepatitis A virus (HAV) infections that may be linked to consumption of Townsend Farms Organic Antioxidant Blend frozen berry and pomegranate mix widely distributed in Costco stores. As of June 7, the California Department of Public Health reports 33 California residents from 15 local health jurisdictions (including 1 Alameda County case) are part of this outbreak. Costco has removed the product from their stores and is notifying customers who bought the product. The manufacturer has recalled the product.

In Alameda County, a case of HAV infection was identified in an employee of Target store pharmacies in San Leandro and in Hayward on Whipple Road.

February 04, 2013

Advisory

Doxycycline and Tetracycline Shortage

On February 4, 2013 the State of California Department of Public Health released a notification about recent shortages of Doxycycline and Tetracycline, which may impact your ability to treat or provide prophylaxis for patients.

The Food and Drug Administration (FDA) reported a shortage of doxycycline on January 18, 2013. Doxycycline is a recommended therapy for some sexually transmitted infections and syndromes including Chlamydia, nongonococcal urethritis, epidiymitis and pelvic inflammatory disease. It is also an alternative therapy for syphilis in patients with a penicillin allergy. Reports were also received of a shortage of tetracycline, which is an alternative to doxycycline for treating certain conditions.

For additional information about the availability of doxycycline or tetracycline including expected dates of resolution for different manufacturers and current distribution allotments please visit the FDC Drug Shortage website and for CDC-recommended and additional STD alternative regimens please consult the 2010 STD Treatment Guidelines or visit this CDC site for updates.

January 25, 2013

Advisory

Nationwide Shortage of Isonizaid (INH)

There is currently a nationwide shortage of INH, one of the most important drugs to treat tuberculosis (TB) disease and latent TB infection (LTBI). The low inventory is attributed to a shortage of the active ingredient for making INH and shipping delays.

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