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 12, 2018

Advisory

Joint Advisory on Cyclosporiasis in San Francisco Area

Alameda County Public Health and Berkeley Public Health Joint Advisory on Cyclosporiasis in San Francisco Area

In recent months, local health departments (LHDs) in the San Francisco Bay Area have received an unusually high number of reports of cyclosporiasis (infection with Cyclospora cayetanensis) in patients who have not traveled outside the United States (U.S.). As of July 9, 2018, 50 cases not associated with international travel were reported to the California Department of Public Health (CDPH). Only one case has been reported to the Alameda County Department of Public Health (ACPHD) and no cases have been reported to the City of Berkeley Public Health Division in 2018; however, this may be due to under-detection of this infection, which requires special testing methods. LHDs are investigating cases with CDPH to identify a common source. Cyclosporiasis is endemic in tropical and subtropical regions. Prior cyclosporiasis outbreaks in the U.S. have been associated with imported fresh produce items.

June 01, 2018

Advisory

Increased Pertussis Cases in School-Aged Children

Since January 2018, Alameda County Public Health Department (ACPHD) has noted a marked increase in reported pertussis cases in school-aged children across the county, and clusters of pertussis cases in some schools. Most cases have occurred in high school-aged children. Like the rest of California, Alameda County has experienced a cyclical increase in pertussis cases every 3 to 5 years; the most recent peaks were in 2010, 2014, and now, 2018.

Full Health Advisory

April 05, 2018

Advisory

Measles in San Francisco Bay Area

Between 3/5/18 and 4/3/18, measles has been confirmed in six (6) unvaccinated patients who are residents of Santa Clara County (5) and Alameda County (1). One (1) additional linked case has been confirmed in Nevada. All cases are linked to an unvaccinated traveler who was exposed in Europe and developed measles after returning to the San Francisco Bay Area. Local health departments in the Bay Area are conducting contact investigations. Measles is very infectious, and airborne transmission can occur in settings with large numbers of people like healthcare facilities, schools, childcares, shopping centers, public transportation, airports, and amusement parks. Clinicians should be vigilant in identifying and appropriately managing suspected measles cases to avoid ongoing transmission and ensuring that their patients and staff are up-to-date with immunizations.

Full Health Advisory

March 22, 2018

Advisory

School Water Lead Testing and Blood Lead Level Testings

Increased levels of lead have been found in water drawn from schools in Alameda County. Schools and school districts are notifying parents about the potential lead exposures at the school and blood lead level testing. As a result, we expect parents and school staff will be requesting a blood lead test and would like you to order a blood lead test for a suspected exposure to lead.

In 2012, the Centers for Disease Control and Prevention (CDC) established a new "reference value”"of 5 micrograms per deciliter for blood lead levels, thereby lowering the level at which evaluation and intervention are recommended. Depending on your patient’s age and blood lead level, they may be referred for Lead Poisoning Prevention Services, i.e. a combination of health, environmental and residential hazard reduction services, provided by the Alameda County Healthy Homes Department’s Lead Poisoning Prevention Program.

Full Health Advisory

January 04, 2018

Advisory

Influenza Testing, Treatment and Vaccination

The California Department of Public Health has issued a clinical advisory to direct clinicians about national influenza testing and treatment recommendations. All patients with suspected or confirmed influenza who are hospitalized, severely ill, or at higher risk for complications should be treated as soon as possible with a neuraminidase inhibitor antiviral agent such as zanamivir or oseltamivir and tested using a real-time reverse polymerase chain reaction (rRT-PCR) assay. The full clinical advisory is linked below.

Other Resources:

October 30, 2017

Advisory

Hepatitis A Vaccine Supply Prioritization: Guidance for Healthcare Facilities and Clinician

A hepatitis A outbreak in San Diego, Santa Cruz and Los Angeles counties means that medical providers in Alameda County and Berkeley need to take particular precautions to:

  • raise their awareness of Hepatitis A symptoms
  • conduct additional screening questions about risk factors
  • be aware of refined priorities for Hepatitis A vaccination given that the national supply of vaccine is constrained and being prioritized and distributed based on jurisdiction, risk factors and priority groups
  • report all suspected and confirmed HAV cases immediately

Full ACPHD & BPH Joint Hepatitis A Vaccine Supply Prioritization Advisory
Alameda County Hepatitis A webpage

September 29, 2017

Advisory

Joint Hepatitis A Outbreak Prevention Advisory

Alameda County Public Health and Berkeley Public Health
Joint Hepatitis A Outbreak Prevention Advisory

Outbreaks of hepatitis A are currently ongoing in San Diego, Santa Cruz and Los Angeles counties in persons who are homeless and/or using illicit drugs. The outbreak in San Diego is the largest person-to-person hepatitis A outbreak in the US since hepatitis A vaccine became available in1996, and has a mortality rate of ~3.6%.  To prevent and control hepatitis A outbreaks, the California Department of Public Health (CDPH), the Alameda County Public Health Department (ACPHD) and Berkeley Public Health Department (BPH) recommend offering Hepatitis A vaccine to persons who are homeless or who might be using illicit injection or non-injection drugs.  Although there have been no reported cases of hepatitis A in Alameda County or the City of Berkeley associated with these outbreaks or among known homeless or illicit drug users, both ACPHD & BPH encourage hepatitis A virus (HAV) vaccination to prevent an outbreak from occurring locally.

Actions Requested of Clinicans:

  1. PROVIDE HAV vaccine to persons who are homeless and/or who use illicit drugs and to persons who have frequent close contact with the homeless or drug-using populations. This includes those who provide personal care, food service, janitorial, maintenance, or sanitation services to these populations. Serologic testing for HAV immunity is not recommended prior to vaccination. Vaccinate with either single antigen HAV vaccine or the combined HAV/HBV (Twinrix) vaccine.
  2. CONTINUE routine HAV vaccination for:
  3. REPORT immediately all suspect and confirmed HAV cases in homeless or illicit drug users to ACPHD Acute Communicable Disease section by calling 510-267-3250, M-F 8:30a-5p, or after hours call: 925-422-7595. For Berkeley residents only, contact the Berkeley Communicable Disease program by calling 510-981-5292.

July 31, 2017

Advisory

Immunize to Prevent and Control Hepatitis A Outbreaks in Homeless and Illicit Drug Users

Hepatitis A Outbreak Situation Update

Outbreaks of hepatitis A are occurring among persons who are homeless and/or using illicit drugs in San Diego County and Santa Cruz County. To prevent and control hepatitis A outbreaks, the California Department of Public Health (CDPH) and the Alameda County Public Health Department (ACPHD) recommend offering Hepatitis A vaccine to persons who are homeless or who might be using illicit injection or non-injection drugs.  Although there has been no increase in reported hepatitis A cases in Alameda County, ACPHD encourages hepatitis A vaccination to prevent an outbreak from occurring locally.  Please see the CDPH advisory for more details about the outbreaks and immunization recommendations.

Hepatitis A Prevention by Immunization

Hepatitis A Vaccine
While two doses of Hepatitis A vaccine separated by 6 months are recommended for full disease protection, high levels of protection are reached from just one dose.  Any person needing vaccine should be referred first to their regular source of primary care. If the client’s regular source of primary care does not have the vaccine in stock (which would, hopefully, be unusual), they should be able to refer to a local pharmacy.

Medi-Cal (both fee for service and Medi-Cal managed care) covers hepatitis A vaccine without need for any prior authorization.  If a client has Medi-Cal and their regular source of primary care does not carry the vaccine, they can be referred to an in-network pharmacy.  To determine an in-network pharmacy, the client can call the member services phone number on the back of their Medi-Cal card.

Uninsured clients can find hepatitis vaccine a few different ways.  Uninsured clients who are registered patients at the clinics participating in the Vaccines for Adults (VFA) program can be vaccinated there.  Other uninsured clients who are not registered with a participating VFA program clinic can receive free vaccines at the Family Justice Center immunization clinic held on Thursday afternoons from 1-4pm in Oakland, or other clinics listed here.  We request that if clients will be referred to get vaccinated at Family Justice Center, that the referring provider call in advance to 510-267-3230 to ensure the clinic is prepared to receive adults during back-to-school clinics in August.  
The Alameda County Public Health Department is also working on securing additional Hepatitis A vaccine doses to be able to respond quickly should there be any increased disease activity in our community.

June 13, 2017

Advisory

Alameda County Health Officer Order for Reporting Carbapenem-Resistant Enterobacteriaceae

Carbapenem-Resistant Enterobacteriaceae (CRE) are untreatable or difficult to treat bacteria that are resistant to carbapenem antibiotics and nearly all available antibiotics. They can cause serious illness and death; bloodstream infections are fatal in 40% -50% of cases. CRE was designated by the CDC in 2013 as one of the three most urgent drug resistant threats in the United States. CRE are easily spread between infected or colonized patients by health care workers and equipment, unless rigorous infection prevention precautions are taken. Cases and outbreaks of CRE have been increasingly recognized in recent years in Northern California, including Alameda County. On June 13, 2017, the Alameda County Public Health Department (ACPHD) issued a Health Officer Order for reporting CRE and submitting CRE isolates to the Alameda County Public Health Laboratory, effective June 15, 2017.

May 26, 2017

Advisory

Increased Norovirus Activity in School Settings

Alameda County and California are experiencing an unusually large proportion of reported gastrointestinal illness outbreaks among students and staff in school settings. This has been attributed to a new strain of
Norovirus that has been circulating in Europe and Asia since last year and is now in the US and CA. Infection spreads quickly in settings where people are in close contact with each other, such as cruise ships, health care facilities, daycare centers, schools and summer camps. The most important steps to prevent the spread of Norovirus in schools are to ensure that:

  1. Ill persons stay home while sick and for another 48 hours after symptoms go away.
  2. Everyone regularly washes hands especially after using the bathroom and before eating.
  3. Contaminated and frequently-touched objects and surfaces are thoroughly and frequently cleaned with an approved disinfectant, as Norovirus can survive for many days on surfaces.

May 17, 2017

Advisory

Foodborne Botulism Outbreak

From mid-April through May 16, 2017, 10 cases of foodborne botulism have been reported to Sacramento, San Joaquin, Colusa and Solano county public health departments. Cases consumed nacho cheese sauce from the Valley Oak Food and Fuel gas station in Walnut Grove (Sacramento County). No cases of botulism from this outbreak have been reported in Alameda County residents, but Alameda County residents who consumed prepared food at the Valley Oak Food and Fuel gas station in Walnut Grove until May 6 may still develop symptoms. Providers are asked to consider botulism in patients with compatible neurological symptoms and to report suspected cases immediately to the Alameda County Health Department.

November 02, 2016

Advisory

Recall of Frozen Strawberries from Egypt Potentially Contaminated with Hepatitis A

CA Department of Public Health has issued a Health Advisory on 11/2/16 providing Post-Exposure Prophylaxis Recommendations for persons who may have consumed recalled Frozen Strawberries potentially contaminated with Hepatitis A.

A large recall of frozen Egyptian strawberries that have been distributed widely in the United States, including California, has been issued due to the possibility of hepatitis A virus (HAV) contamination. The U.S. Centers for Disease Control and Prevention (CDC), the U.S. Food and Drug Administration (FDA), and state and local officials have been investigating an outbreak of HAV linked to frozen strawberries imported from Egypt. Alameda County Environmental Health & Public Health are conducting follow-up notifications of all Alameda County Facilities known to receive this product, and will work with facilities to ensure any remaining product has been destroyed and identify any persons with potential exposures that occurred within the last 14 days that are recommended to receive Post-exposure Prophylaxis (PEP).

Additional detailed guidance regarding Hepatitis A PEP are in attached advisory.

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