Advisory

October 13, 2023

Advisory

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). 

COVID-19:  

• Vaccination: Everyone 6 months and older, including pregnant persons, should get at least one dose of the updated vaccine 2 or more months after their last dose.

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)

Influenza: 

• Vaccination: Everyone 6 months and older (including pregnant persons) should receive a seasonal influenza vaccine.
• Therapeutics: Influenza antiviral treatment is recommended as soon as possible (ideally <48 hours from symptom onset) for any patient at higher risk for influenza complications. 

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. 

• Monoclonal Antibody for Infants and Young Children: 

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

Advisory

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

Advisory

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

Advisory

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 acutecd@acgov.org.

Please see the Health Advisory for detailed information.

August 25, 2023

Advisory

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 acutecd@acgov.org within 1 business day.

Please see the Health Advisory for detailed information, including actions requested of clinicians.

July 10, 2023

Advisory

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

Advisory

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.

May 23, 2023

Advisory

Mpox Updates May 2023

The purpose of this health advisory is to provide updated information to Alameda County health care providers regarding monkeypox cases, testing, and vaccination.

In Alameda County and the United States, cases of mpox (formerly monkeypox) have declined since peaking in August 2022, but the outbreak is not over. Ongoing community transmission in the United States and internationally is occurring. CDC and local partners are investigating a cluster of mpox cases in the Chicago area. As the summer months and celebrations surrounding LGBTQ PRIDE approach, now is the best time to get vaccinated and complete the two-dose mpox vaccine series.

Please see Health Advisory for detailed information, including actions requested of clinicians.

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.