Advisory

April 28, 2023

Advisory

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

Advisory

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

Advisory

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

Advisory

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

Advisory

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.

February 23, 2023

Advisory

Emergence of Candida auris

Emergence of Candida auris in Healthcare Facilities in Northern California and Increase in Incidence of Carbapenemase-Producing Organisms

Alameda County Public Health Department (ACPHD) is notifying healthcare providers of the identification of a patient with Candida auris (C. auris) colonization in our jurisdiction in January 2023 transferred from an Acute Care Hospital in Contra Costa County. The patient was identified upon admission screening and had no known risk factors or exposures in healthcare facilities outside of Northern California. Due to the presence of C. auris locally, ACPHD encourages healthcare facilities to screen patients on admission from any long-term acute care hospital (LTACH), subacute/ventilator-equipped skilled nursing facility (vSNF) and any healthcare facility in Nevada state.

Please see full health advisory for detailed information.

February 07, 2023

Advisory

Information to Healthcare Providers on Doxy-PEP

There is a new opportunity for prevention of sexual transmitted infections (STIs) for Alameda County residents called doxycycline post-exposure prophylaxis, or doxy-PEP.   This letter provides provisional guidance to healthcare providers on this strategy. As new information becomes available this guidance may be modified. Doxy-PEP is doxycycline 200 mg taken within 72 hours of sex (preferably within 24 hours of sex).

• Healthcare providers should counsel gay men and other men who have sex with men, and transgender people regarding doxy-PEP as a part of comprehensive sexual health counseling.
• Gay men and other men who have sex with men and transgender people who have had a recent STI and who are not taking HIV PrEP should be counseled about HIV PrEP and new long-acting formulations (cabotegravir).
• Adult gay men and other men who have sex with men, and transgender women who are interested in doxy-PEP and who have had a recent STI (chlamydia, gonorrhea or syphilis in the last year), or who are taking HIV PrEP, or who have had more than 1 oral or anal condomless sex partner in the last year, or who are people living with HIV, should be offered doxy-PEP.
• Doxycycline can be taken as often as every day, depending on frequency of sexual activity, but individuals should not take more than 200 mg within a 24-hour period.

For any questions, please reach to Alameda County Public Health, SexualHealth@acgov.org or 510-267-3220

January 27, 2023

Advisory

Evusheld No Longer Authorized + Therapeutics Warmline

The purpose of this Health Advisory is to share current COVID-19 therapeutics information with clinicians in Alameda County.

1. On January 26, 2023, the FDA announced that Evusheld is not currently authorized for emergency use in the U.S. It is recommended that facilities and providers with Evusheld retain all product in the event that SARS-CoV-2 variants which are neutralized by Evusheld become more prevalent in the U.S. in the future.  
2. ASPR has released information sheets for providers on ritonavir-boosted nirmatrelvir/Paxlovid and molnupiravir/Lagevrio.
3. COVID-19 therapeutics warmline now available! California healthcare providers can now call 1-866-268-4322 (866-COVID-CA) to receive free and confidential consultation on COVID-19 testing and treatment, Monday through Friday, 6 am – 5 pm.  Health care providers of any experience level can call to speak with a clinician or pharmacist about drug-drug interactions or any other clinical challenges. The warmline is managed by the UCSF National Clinician Consultation Center. Voicemail messages left after hours will be returned on the next business day. 

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

January 17, 2023

Advisory

Uganda Ebola Outbreak Declared Over and Traveler Monitoring Discontinued

On January 11, 2023, the World Health Organization declared the Uganda outbreak of Ebola virus disease (EVD) due to Sudan virus is over. Federal, state and local public health monitored travelers returning from Uganda from October 7, 2022, through January 10, 2023.

• CDC no longer recommends post-arrival risk assessment and management of travelers returning from Uganda.
• All monitoring activities have been discontinued.

Please see health advisory.

January 04, 2023

Advisory

Take Me Home Self-Collection Kits

The purpose of this Health Advisory is to inform healthcare providers about the Take Me Home self-testing program for STIs, HIV, and HCV. Actions requested of healthcare providers include:

• Participate in the Take Me Home by sharing the link with patients. Providers can request promotional materials/fliers.
• Counsel HIV-negative patients diagnosed with a bacterial STI in the past six months about PrEP. Patients who request PrEP should be prescribed it even if a provider perceives the patient as low risk of acquiring HIV.
• Follow the HIV and STI prevention and treatment guidelines as outlined by the CDC in their Sexually Transmitted Infections Treatment Guidelines, 2021.

Please review the advisory for further details.

December 09, 2022

Advisory

Updated Mpox Guidance for Healthcare Providers

The purpose of the attached Health Advisory is to share updated guidance regarding JYNNEOS with healthcare providers. Actions requested of healthcare providers include:

1. Offer JYNNEOS vaccine to ANY person who may be at risk or believes they may be at risk and give vaccine to ANY person who requests it.
2. Routinely offer either subcutaneous (SC) or intradermal (ID) JYNNEOS administration to all persons who are eligible to receive either.
3. Ensure that ALL persons who get the JYNNEOS vaccine complete the vaccine series.

Please review the Health Advisory for further details.

November 21, 2022

Advisory

Respiratory and Influenza-Like Illnesses Guide

ACPHD is informing local healthcare providers about the early rise of respiratory diseases seen in all age groups, especially influenza and Respiratory Syncytial Virus (RSV) in addition to COVID-19 infection. Influenza and RSV have increased in incidence this fall, earlier by several weeks compared to recent years in the US and California which is significantly impacting healthcare; hospital censuses are increased by ~10% across California and pediatric healthcare delivery systems in California are stressed. Please review the attached advisory for detailed updates and requested actions of providers.