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.

July 21, 2022

Advisory

Make Evusheld Available to Eligible Patients

The purpose of this health advisory is to remind clinicians about thebavailability of Evusheld as pre-exposure prophylaxis (PrEP) for COVID-19 in certain adult and pediatric patients (12 years of age and older weighing at least 40 kg). Providers are encouraged to reach out to all patients eligible for Evusheld to discuss risks and benefits and ensure access to this medication. Please visit ACPHD’s Treatment webpage for more information.

For questions regarding the distribution of COVID-19 outpatient therapeutic products within ALCO, please contact Cynthia Frankel, RN, Alameda County Therapeutics Distribution Lead at cynthia.frankel@acgov.org

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

May 25, 2022

Advisory

CDC-HAN: COVID-19 Rebound After Paxlovid Treatment

The CDC has issued a Health Advisory to provide an update on the potential for recurrence of COVID-19 or “COVID-19 rebound” after Paxlovid treatment. COVID-19 rebound has been reported to occur between 2 and 8 days after initial recovery and is characterized by a recurrence of COVID-19 symptoms OR a new positive viral test after having tested negative. A brief return of symptoms may be part of the natural history of SARS-CoV-2 infection in some persons, independent of treatment with Paxlovid and regardless of vaccination status. Available information suggests that persons treated with Paxlovid who experience COVID-19 rebound have had mild illness; there are no reports of severe disease. Please see the health advisory for recommendations for healthcare providers.

For questions regarding the distribution of COVID-19 outpatient therapeutic products within ALCO, please contact Cynthia Frankel, RN, Alameda County Therapeutics Distribution Lead at cynthia.frankel@acgov.org

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

May 24, 2022

Advisory

Cases of Monkeypox Identified in Non-Endemic Countries Including the US

The Alameda County Public Health Department has issued a health advisory for clinicians regarding monkeypox in light of reports of global transmission of monkeypox including the United States. As of May 24, 2022, monkeypox virus infections have been confirmed in Australia, Europe and North America including 1 confirmed in a Massachusetts resident – all countries where the virus is non-endemic. In addition, patients with symptoms compatible with monkeypox infection are under investigation in the United States (7) who are all confirmed with Orthopox viral DNA. Cases of monkeypox have been identified since early May 2022; many of the cases have involved men who identify as gay, bisexual or have sex with men (MSM) without a history of travel to an endemic country. Clinical details on these cases, including any hospitalizations or deaths, are currently unknown.

Please review the full health advisory for additional background and action requested of clinicians.

May 19, 2022

Advisory

Homemade Infant Formula to Infants

On May 13th, the California Department of Public Health issued a Health Advisory on the current infant formula shortage which includes helpful recommendations for families. The California Department of Public Health/Women, Infants and Children Division (CDPH/WIC) is monitoring reports of widespread low-stock situations, outages, and rationing of powdered infant formula in California.

Actions requested of clinicians:

  • Please remind families that they should not excessively dilute formulas or attempt to make their own infant formulas at home.
  • WIC staff are encouraging families to consult with their pediatrician before making any substitutions, especially for infants requiring a specialized or therapeutic formula. Healthcare providers who provide care for children in critical need of a particular specialty formula should contact Abbott directly to request the product by calling 1-800-881-0876 or visiting their formula information and product request form.

April 29, 2022

Advisory

Bebtelovimab + Evusheld appointments available at Total Infusion!

We are pleased to announce that Total Infusion remains open to administer both Bebtelovimab (provider and patient referrals) and Evusheld (provider referrals only). The appointment page can be found here: https://totalinfusion.com/book-an-appointment/ or you can call (510) 878-9528 with questions.

For general questions about treatment,please contact Arnie Spanjers, MD, Alameda County Public Health Department at arnie.spanjers@acgov.org

April 26, 2022

Advisory

Recommendations for Adenovirus Testing and Reporting of Children with Acute Hepatitis of Unknown Etiology

The CDC and the California Department of Public Health (CDPH) have issued a health advisory regarding a cluster of pediatric cases of hepatitis associated with Adenovirus type 41. Clinicians are requested to report cases of children that meet the following criteria to the local health department within one business day.

Reporting criteria:

Children <10 years of age with elevated aspartate aminotransferase (AST) or alanine aminotransferase (ALT) (>500 U/L) AND who have an unknown etiology for their hepatitis (with or without any adenovirus testing results, independent of the results) since October 1, 2021

To report cases to Alameda County Public Health Department, contact the Acute Communicable Disease (ACD) Section

By phone: at 510-267-3250 option 2, Monday –Friday 8:30am through 5PM.

By secure email: acutecd@acgov.org

April 25, 2022

Advisory

Availability and Use of Treatments for Outpatients with Mild to Moderate COVID-19

The Centers for Disease Control and Prevention (CDC) issued a Health Alert Network (HAN) Health Advisory to provide an update about the availability and use of recommended therapies for COVID-19 and to advise against using unproven treatments that have known or potential harms for outpatients with mild to moderate COVID-19.  

For patients with mild to moderate COVID-19 who are not hospitalized and who are at increased risk for severe COVID-19 outcomes, several treatment options, including antiviral medications and monoclonal antibodies, are now widely available and accessible. Please see the Health Advisory for full details and note the following: 

For general questions about treatment, please contact Arnie Spanjers, MD, Alameda County Public Health Department at arnie.spanjers@acgov.org  

April 01, 2022

Advisory

CAHAN: Use of Outpatient COVID-19 Therapeutics in California

On March 30th, the California Department of Public Health (CDPH) issued this alert on the use of outpatient COVID-19 therapeutics in California. As supply of therapeutics has increased and overall COVID-19 cases have decreased across California, there is no longer a limited supply of COVID-19 therapeutic treatments in most locations. As of this writing, all outpatients with mild to moderate COVID-19 who are at risk for disease progression should be offered treatment if eligible based on the product Emergency Use Authorizations (EUAs). Treatment should be offered regardless of vaccination status and because of the predominance of the Omicron sub-variant BA.2, sotrovimab is no longer authorized for use in California. This Health Alert also includes information on the new Test to Treat Locator

Please see the updated Alameda County Health Advisory. You are also encouraged to view yesterday’s webinar, COVID-19 Outpatient Therapeutics + Pre-Exposure Prophylaxis, with Dr. Nicholas Moss, Alameda County Health Officer, and Dr. John Openshaw. Dr. Openshaw is an infectious disease physician and researcher who leads the COVID-19 Clinical Team at the California Department of Public Health. He is on the faculty at Stanford University School of Medicine and regularly sees adult infectious disease patients in San Mateo and Santa Clara Counties. To learn more about COVID-19 drug-drug interactions, please check out the Liverpool COVID-19 Drug Interaction Tool

For questions regarding the distribution of COVID-19 outpatient therapeutic products within ALCO, please contact Cynthia Frankel, RN, Alameda County Therapeutics Distribution Lead at cynthia.frankel@acgov.org. For clinical questions about COVID-19 therapeutics, please contact Arnie Spanjers, MD, Alameda County Public Health Department at arnie.spanjers@acgov.org  

March 31, 2022

Advisory

Outpatient Therapies for the Treatment and Prevention of COVID-19 in High-Risk Patients

The purpose of this Health Advisory is to inform clinicians in Alameda County about the availability of outpatient therapies for high-risk patients with 1) mild to moderate COVID-19 illness who are not yet hospitalized; or 2) ongoing risk of exposure to COVID-19. When resources are limited, therapy should be prioritized for patients who are at the highest risk of progressing to severe COVID-19, as described in the NIH Panel’s interim statement. As availability increases, it may be possible to offer available therapies to all eligible patients. 

Recent updates to the Health Advisory include:

  • New NIH treatment guidelines released
  • Change in Sotrovimab window of therapy from within 10 days to within 7 days of symptom onset
  • Change in dose of Evusheld; additional dose recommended for those who got smaller first dose
  • Addition of Bebtelovimab as a recommended mAB therapy
  • Remdesivir available for outpatient treatment of children and adults
  • Therapeutic locator websites available
  • Federal Test to Treat initiative launched 

Please also visit our COVID-19 website. For questions regarding the distribution of COVID-19 outpatient therapeutic products within ALCO, please contact Cynthia Frankel, RN, Alameda County Therapeutics Distribution Lead at cynthia.frankel@acgov.org. For clinical questions about COVID-19 therapeutics, please contact Arnie Spanjers, MD, Alameda County Public Health Department at arnie.spanjers@acgov.org  

February 28, 2022

Advisory

FDA Revises Evusheld Dosing in EUA

The FDA has revised the EUA for Evusheld (tixagevimab co-packaged with cilgavimab) to increase the initial dose to 300 mg of tixagevimab and 300 mg of cilgavimab. Patients who have already received the previously authorized dose (150 mg of tixagevimab and 150 mg of cilgavimab) should receive an additional dose of 150 mg of tixagevimab and 150 mg of cilgavimab as soon as possible. Evusheld is authorized for use as pre-exposure prophylaxis (PrEP) for prevention of COVID-19 in certain adult and pediatric patients (12 years of age and older weighing at least 40 kg).

Based on the most recent available data, a higher dose may be more likely to prevent infection by Omicron subvariants BA.1 and BA.1.1 than the originally authorized Evusheld dose. Please also review our recent Health Advisory, Outpatient Therapies for the Treatment and Prevention of COVID-19 in High-Risk Patients, regarding the availability of therapeutics for patients with 1) mild to moderate COVID-19 illness who are not yet hospitalized; or 2) ongoing risk of exposure to COVID-19. Information is also available on our COVID-19 website.

For questions regarding the distribution of COVID-19 outpatient therapeutic products within ALCO, please contact Cynthia Frankel, RN, Alameda County Therapeutics Distribution Lead at cynthia.frankel@acgov.org. For clinical questions about COVID-19 therapeutics, please contact Arnie Spanjers, MD, Alameda County Public Health Department at arnie.spanjers@acgov.org.

February 24, 2022

Advisory

UPDATE: COVID-19 CMR Reporting

COVID-19 CMR Reporting Updates

Actions: Health Care Providers in Alameda County should submit COVID-19 Confidential Morbidity Reports (CMRs) within 24 hours on patients with SARS-CoV-2 infection that have been hospitalized or have died. Providers should continue to report on patients with Multi-System Inflammatory Syndromes in Children (MIS-C).  Healthcare facilities should continue to report weekly COVID-19 cases to CDPH as per AFL 21-25. Laboratories must continue to report positive and negative results via Electronic Laboratory Reporting (ELR) or by fax within 24 hours.

ACTIONS REQUESTED OF CLINICIANS:

  1. Health Care Providers in Alameda County should submit CMRs within 24 hours on patients with SARS-CoV-2 infection that have been hospitalized or have died.
  2. Continue to submit CMRs on patients with MIS-C and all non-COVID-19 Title 17 reportable conditions.

Additional Resources:

Order of the State Public Health Officer: Revision of Mandatory Reporting of Covid-19 Results by Health Care Providers

Alameda County Public Health Department CMR-D (COVID) reporting:

Email: COVIDreport@acgov.org
Fax: (510) 273-3944
For non-urgent concerns, email nCoV@acgov.org

 

February 22, 2022

Advisory

Update on Distribution and Patient Prioritization for Evusheld

The purpose of the CAHAN is to inform clinicians that: 

  1. Evusheld is now being directly allocated to local health jurisdictions similar to the other federally allocated COVID-19 therapeutics. Evusheld received an emergency use authorization (EUA) for pre-exposure prophylaxis (PrEP) against COVID-19 on December 8, 2021. Healthcare facilities that would like to acquire product should contact Cynthia Frankel (see below).
  2. Overall weekly supplies of Evusheld distributed from HHS have remained relatively consistent. However, product scarcity is still possible, especially as the number of sites administering this treatment increases. In cases where supply is limited by supply or logistical constraints, providers should follow NIH treatment guidelines.  

Please also review our recent Health Advisory, Outpatient Therapies for the Treatment and Prevention of COVID-19 in High-Risk Patients, regarding the availability of therapeutics for patients with 1) mild to moderate COVID-19 illness who are not yet hospitalized; or 2) ongoing risk of exposure to COVID-19. Information is also available on our website at https://covid-19.acgov.org/antibody-treatment 

For questions regarding the distribution of COVID-19 outpatient therapeutic products within ALCO, please contact Cynthia Frankel, RN, Alameda County Therapeutics Distribution Lead at cynthia.frankel@acgov.org 

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

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