Health Alerts

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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ALERT	conveys the highest level of importance; warrants immediate action or attention.
ADVISORY	provides important information for a specific incident or situation; may not require immediate action.
UPDATE	provides updated information regarding an incident or situation; unlikely to require immediate action.

February 22, 2021	Advisory	Increased Interseasonal Respiratory Syncytial Virus (RSV) Activity in Parts of the Southern United States On June 10th, the Centers for Disease Control and Prevention (CDC) issued a health advisory to notify clinicians and caregivers about increased interseasonal respiratory syncytial virus (RSV) activity across parts of the Southern United States. Due to this increased activity, CDC encourages broader testing for RSV among patients presenting with acute respiratory illness who test negative for SARS-CoV-2. ACPHD Health Advisory
February 22, 2021	Advisory	ACPHD Health Advisory on Interim Quarantine Guidance for Vaccinated Health Care Personnel CDC has recently released additional quarantine guidance for persons fully vaccinated against COVID-19. The Alameda County Public Health Department (ACPHD) has updated Health Officer Order 20-06 (Blanket Isolation/Quarantine Order) to align with CDC recommendations, and developed the attached interim guidance for quarantine among vaccinated health care personnel. ACPHD Health Advisory
December 2, 2020	Advisory	ACPHD Health Advisory on Influenza and Respiratory Illness 2020-2021 The Health Advisory is designed to help Alameda County clinicians prepare for the influenza season, which generally occurs from November through April. This Health Advisory outlines several actions requested of Alameda County clinicians, emergency departments, pathologists and healthcare facilities. ACPHD Health Advisory
November 20, 2020	Alert	Updates November 2, 2020 Health Alert Health Officers for Alameda County and the City of Berkeley are updating their joint Health Officer order mandating that all licensed health care facilities in Alameda County and the City of Berkeley require their health care workers (HCW) to receive an annual influenza vaccination. This Order mandates that health care facilities implement a process for requiring HCW to receive vaccination unless a HCW can produce sufficient documentation to obtain a medical exemption. Unlike in previous years, mask wearing is not an adequate substitution for vaccination under this Order. Health Officers for Alameda County and the City of Berkeley are clarifying their previous joint order (No. 20-16) mandating that all licensed health care facilities in Alameda County and the City of Berkeley require their health care workers (HCW) to receive an annual influenza vaccination. In accordance with previous years, this updated Order includes an exemption for HCW who opt to not receive influenza vaccination due to religious beliefs. Joint Health Officer Order No. 20-16b: Mandatory Flu Shots for Health Care Workers Order
August 17, 2020	Update	Updated COVID-19 Healthcare Provider Reporting Requirements for Alameda County - Replaces June 17, 2020 Health Advisory This updated guidance for COVID-19 laboratory testing is intended to inform Alameda County Public Health Department (ACPHD) efforts to control the epidemic and aid decision-making by clinicians and other testing providers. The guidance identifies groups that should be prioritized for testing, but it is not a requirement to test in these groups. Testing decisions and policies must be flexible to account for ongoing limitations in testing resources and protective equipment. Clinical judgment should be used to guide testing of symptomatic1 persons. ACPHD typically issues additional testing guidance for certain settings and situations, including outbreaks. ACPHD COVID-19 Health Update
August 17, 2020	Update	COVID-19 Testing Guidance for Alameda County – Replaces May 12, 2020 Health Advisory Positive real-time polymerase chain reaction (RT-PCR) tests and antigen tests for current SARS-CoV-2 infection— not antibody— must be reported to the Alameda County Public Health Department (ACPHD). ACPHD COVID-19 Health Update
August 7, 2020	Update	Interim Guidance on Testing for SARS-CoV-2 before Non-Urgent Surgical, Dental, and Diagnostic Procedures During the COVID-19 epidemic in Alameda County, urgent medical and dental procedures have continued in both outpatient and inpatient settings. On May 13, 2020, the Alameda County Public Health Department (ACPHD) released a Health Advisory encouraging medical and dental providers gradually to resume non-urgent clinical services, with several important caveats. While there is active transmission of SARS-CoV-2 in Alameda County, ACPHD recommends that facilities, medical, and dental providers implement policies and strategies that include screening of all patients for symptoms of COVID-19 and selective preprocedural testing of patients undergoing non-emergent surgical, dental, or diagnostic procedures that may involve intubation or the generation of biological aerosols. ACPHD COVID-19 Health Update
July 29, 2020	Update	Discontinuation of Transmission-Based Precautions and Release from Home Isolation Guidance Following a COVID-19 Infection This document describes updated guidance for releasing a person from home isolation or removing a patient or resident of a healthcare facility from Transmission-based Precautions for COVID-19. The test-based strategy, previously described as an option for ending isolation, should no longer be considered except in very specific circumstances and after consultation with an infectious disease expert. ACPHD COVID-19 Health Update
July 7, 2020	Advisory	FDA Issues Warning About Hand Sanitizer Containing Methanol On July 5, 2020, the Center for Disease Control (CDC) issued a Health Advisory indicating that serious adverse events have been observed in persons using methanol-based hand sanitizers. The CDC advises consumers not to use any hand sanitizer that has been recalled by the FDA due to the potential presence of methanol, a “toxic alcohol”, as an active ingredient. Methanol can cause blindness and/or death when absorbed through the skin or when swallowed. Currently, most of the recalled products are manufactured in Mexico. ACPHD COVID-19 Health Advisory
June 17, 2020	Advisory	Updated COVID-19 Healthcare Provider Reporting Requirements for Alameda County Positive real-time polymerase chain reaction (RT-PCR) tests for current SARS-CoV-2 infection — not antibody or antigen tests — must be reported to the Alameda County Public Health Department (ACPHD). This Advisory updates reporting requirements for Alameda County Providers and Laboratories. COVID-19 ACPHD Health Advisory ACPHD COVID-19 Reporting Webpage
June 17, 2020	Advisory	Updated Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with Coronavirus Disease 2019 (COVID-19) Healthcare Provider Reporting Requirements for Alameda County In accordance with a recent CDC health advisory and as first discussed in the 5/20/20 ACPHD Health Advisory, Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 is reportable to Alameda County Public Health Department (ACPHD). This Advisory updates reporting requirements for Alameda County Clinicians, Emergency Departments, Pathologists, and Healthcare Facilities. COVID-19 ACPHD Health Advisory ACPHD COVID-19 Reporting Webpage
May 21, 2020	Advisory	Discontinuation of COVID-19 Transmission-Based Precautions Guidance for Alameda County Patients and residents at Acute Care Hospitals and Long Term Care Facilities in Alameda County with suspected or confirmed COVID-19 infection must be isolated or in an appropriate cohort using Transmission-Based Precautions for the duration of their infectious period. Federal guidance for removal of Transmission-Based Precautions offers several different strategies to determine the end of the infectious period. This Advisory describes the criteria that must be met to discontinue Transmission-Based Precautions for patients and residents with suspected or confirmed infection with COVID-19, including individuals who have been diagnosed with asymptomatic infection. COVID-19 ACPHD Health Advisory
May 20, 2020	Advisory	Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with Coronavirus Disease 2019 (COVID-19) now reportable to Alameda County Public Health Department (ACPHD) Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 is now reportable to Alameda County Public Health Department (ACPHD). Report cases meeting CDC’s case definition for Multisystem Inflammatory Syndrome in Children (MIS-C) within 24 hours to the Alameda County Public Health Department (ACPHD) at (510) 267-3250, Mon-Fri 8:30 am to 5 pm. After hours and on weekends, call Alameda County Fire Dispatch at (925) 422- 7595 and ask to speak to the Public Health Duty Officer on call. Laboratory results must be reported by Electronic Laboratory Reporting (ELR), fax or secure email within 24 hours. Please make sure to report as completely as possible, including race and ethnicity information. COVID-19 ACPHD Health Advisory
May 13, 2020	Advisory	Resumption of Non-Urgent Health Care Services in Alameda County As Alameda County continues to respond to the COVID-19 pandemic, providers and facilities are encouraged to gradually resume full scope of services when possible and safe to do so, based on California Department of Public Health (CDPH) and Alameda County Public Health Department (ACPHD) guidance. COVID-19 ACPHD Health Advisory
May 12, 2020	Advisory	Updated COVID-19 Testing Guidance for Alameda County The following updated guidance for COVID-19 laboratory testing is intended to inform Alameda County Public Health Department (ACPHD) efforts to control the epidemic and aid decision-making by clinicians and other testing providers. The guidance sets out groups that should be prioritized for testing but it is not a requirement to test in these groups. Testing decisions and policies must be flexible to account for ongoing limitations in testing resources and protective equipment. Clinical judgment should be used to guide testing of symptomatic persons. ACPHD typically issues additional testing guidance for certain settings and situations, including outbreaks. COVID-19 ACPHD Health Advisory
April 8, 2020	Advisory	New COVID-19 Healthcare Provider Reporting Requirements for Alameda County As of April 7, 2020, a total of 602 COVID-19 cases and 15 deaths have been reported among Alameda County residents, excluding the City of Berkeley. Although the Alameda County Public Health Department (ACPHD) continues to conduct individual COVID-19 case and contact investigations, we are prioritizing public health resources towards investigations in settings (e.g., long-term care facilities) or among persons (e.g., healthcare providers or first responders) where there is concern for ongoing transmission. To ensure that ACPHD prioritizes resources for public health investigations, effective April 8, 2020 we have modified our County’s COVID-19 reporting requirements for healthcare providers as summarized in tjhis Health Advisory. For more information on testing specifics, please see the full ACPHD Health Advisory: COVID-19 ACPHD Health Advisory
April 3, 2020	Advisory	Health Care Providers to Disseminate ACPHD Isolation and Quarantine Orders to Patients with Suspected COVID-19 The Alameda County Health Officer issued blanket isolation orders that will apply to all persons diagnosed with suspected or confirmed COVID-19 and blanket quarantine orders that will apply to close contacts of cases. Effective 4/3/20, Alameda County Public Health Department directs Alameda County health care partners to disseminate blanket orders to all patients being tested for COVID-19 or who are presumptively diagnosed with COVID-19 without testing BEFORE they leave the health care facility. Alameda County healthcare providers should use the procedure described in the Update to request COVID-19 testing by our Public Health Lab (ACPHL). Please limit testing requests by phone to the hours 9am-5pm, 7 days per week. For more information on testing specifics, please see the full ACPHD Health Advisory: COVID-19 ACPHD Health Advisory
March 6, 2020	Update	COVID-19 Testing Changes Alameda County healthcare providers should direct COVID-19 testing to commercial laboratories and other non-public health laboratories now offering COVID-19 testing. Providers may determine which patients are suspect COVID-19 cases using clinical judgement but should alert Alameda County Public Health Department (ACPHD) regarding the priority cases listed below. ACPHD approval is no longer needed for testing. Alameda County healthcare providers should use the procedure described in the Update to request COVID-19 testing by our Public Health Lab (ACPHL). Please limit testing requests by phone to the hours 9am-5pm, 7 days per week. For more information on testing specifics, please see the full ACPHD Health Update: COVID-19 ACPHD Health Update
March 6, 2020	Advisory	COVID-19 Testing Recommended for Symptomatic Persons Who Were Aboard the Grand Princess Cruise Cases of COVID-19 have been detected among persons on the Grand Princess Cruise that departed San Francisco February 11 and returned on February 21. The Alameda County Public Health Department (ACPHD) is advising County residents who were aboard the Grand Princess Cruise who have been symptomatic with fever, new cough or difficulty breathing since the cruise to be tested for COVID-19 by their healthcare provider. Testing is recommended even if symptoms resolved. Commercial testing is now available for COVID-19 without ACPHD approval. General updated COVID-19 testing guidance will be posted shortly. For more information, including Actions Requested of Clinicians, please see the full ACPHD Health Advisory: COVID-19 ACPHD Health Advisory
March 3, 2020	Update	COVID-19 Update and Interim Guidance A presumptive case of COVID-19 was detected in an Alameda County resident who had contact to a case in another jurisdiction. The Alameda County Public Health Department (ACPHD) is taking appropriate action. Cases of COVID-19 without travel history or links to known cases have been reported in our region and across the United States. These cases of COVID-19 in the Bay Area indicate local community transmission, and warrant public health and healthcare providers in Alameda County to continue preparing for increasing numbers of identified cases and a surge of patients. On February 27, the Centers for Disease Control and Prevention (CDC) released updated guidance for evaluating persons under investigation (PUI) for COVID-19. For more information, please see the full ACPHD Health Update: COVID-19 ACPHD Health Update
February 19, 2020	Update	Novel Coronavirus Disease (COVID-19) The disease caused by the 2019 Novel Coronavirus (2019-nCoV) has now been officially named COVID-19 by the World Health Organization. No COVID-19 cases have been identified in Alameda County. On February 12, the Centers for Disease Control and Prevention (CDC) released updated guidance for evaluating possible persons under investigation (PUI) for 2019-nCoV in the following categories: • Severely ill patients for whom a known source of exposure has not been identified • Persons with fever and lower respiratory tract symptoms and travel to China within 14 days that are being regularly monitored by local health departments or referred for evaluation from border screening For more information, please see the full ACPHD Health Update: Novel Coronavirus Disease (COVID-19) ACPHD Health Update
February 5, 2020	Update	Novel Coronavirus (2019-nCoV) The emerging 2019 Novel Coronavirus (2019-nCoV) is now circulating in mainland China and cases have been reported in the United States and other countries. On January 31st, the Centers for Disease Control and Prevention (CDC) released updated criteria for persons under investigation (PUI) for 2019-nCoV and the U.S. government declared a Public Health Emergency. The declaration included restrictions for travelers entering the country from China, effective February 3. For more information, please see the full ACPHD Health Update: Novel Coronavirus (2019-nCoV) ACPHD Health Update CDC Update and Interim Guidance on Outbreak of 2019-nCoV (2/1/2020) CDC 2019-nCoV Flowchart (2/1/2020)
January 22, 2020	Alert	Novel Corona Virus 2019 – Wuhan Pneumonia Outbreak The Centers for Disease Control and Prevention (CDC) issued a health update on January 17, 2020 about the 2019 Novel Coronavirus (2019-nCov). This CDC HAN Update provides a situational update and guidance that supersedes the January 8, 2020 HAN. It adds guidance for evaluation of patients under investigation (PUI) for 2019-nCoV, prevention and infection control guidance, including the addition of a recommendation for eye protection, and additional information on specimen collection and testing. The first confirmed case of 2019-nCoV in the United States is a healthy male in his 30s in Washington State, who arrived at Seattle-Tacoma Airport on January 15, 2020 after traveling to Wuhan. Local suspect cases should be reported immediately by phone to Public Health. Resources for providers, including travel alert posters and a checklist for clinicians managing patients who may have 2019-nCoV, are available online from the CDC. Reporting Alameda County Acute Communicable Disease Control: Weekdays 8:30am–5pm Phone: (510) 267-3250 After hours Phone: (925) 422-7595 and ask for the public health duty officer on call. Berkeley Public Health Division: Weekdays 8am-5pm Phone: (510) 981-5292 After hours: Phone: (510) 981-5911 and ask for the Health Officer on call. For more information, please see the full CDC Heatlh Update and Alameda County Guidance Checklist: Full CDC Health Update (1/17/20) Alameda County Guidance Checklist (1/22/20) CDPH All Facilities Update and Interim Guidance (1/23/20)
January 3, 2020	Advisory	Fentanyl Overdose The increased availability of illicitly-produced fentanyl, fentanyl-compounds, and fake pills is an emerging and ongoing threat to public health and safety. In 2019, 51 opioid-related deaths were reported in Alameda County from January 1, 2019 to December 16, 2019. Many fentanyl overdoses occur among persons who may be aware that they are using fentanyl or a related substance. However, there have been recent anecdotal reports in Alameda County of an increasing number of suspected fentanyl overdoses among persons without a history of opioid use, such as cocaine and methamphetamine users. Many persons who choose to use stimulants are unaware of the emergence of fentanyl laced compound drugs in the overall Bay Area drug supply, and the powerful potency of fentanyl. In addition, many opioid pills, which are made to look like real prescription medications, are now made by counterfeiting organizations and may contain fentanyl. Death from fentanyl toxicity can be more rapid than from other opioids, and overdoses may require more naloxone for reversal than other opioids – prompt peer response is essential. In addition, there are concerns regarding the increase in synthetic opioid and fentanyl derivatives that may be longer-acting, and may not be detected in routine urine toxicology screens. This alert provides awareness and actions for all health care providers in Alameda County to take when presented with a suspected or confirmed opioid overdose case at their facility. Please see the full Health Advisory for more information, including actions requested of clinicians. Full Health Advisory
December 3, 2019	Update	Congenital Syphilis (CS) Screening Guidelines for Pregnant Women Syphilis rates are rising in Alameda County, across California, and throughout the country. Nationally, the rate of congenital syphilis has risen 40% in the last year alone, to a rate of 33 per 100,000 live births in 2018. California has the fifth-highest rate of congenital syphilis in the country, with 68 cases per 100,000 live births in 2018. In Alameda County in 2017, the rate of congenital syphilis was 26 per 100,000 live births. Healthcare providers treating pregnant women can prevent congenital syphilis by following CDC recommended screening and treatment guidelines for pregnant women living in communities with high syphilis prevalence. Please see the full Health Update for more information, including actions requested of clinicians. Full Health Update
October 2, 2019	Joint Advisory	Reminder regarding Mandatory Flu Vaccination or Masking of Health Care Workers During Every Influenza Season Health Officers for Alameda County and the City of Berkeley are reminding health care providers and their employers regarding their joint Health Officer order (originally dated Aug. 28, 2013) mandating that all licensed health care facilities in Alameda County and the City of Berkeley require their health care workers (HCWs) to receive an annual influenza vaccination or, if they decline, wear a mask during every influenza season while working in patient care areas. Influenza season dates are defined as November 1 to April 30 of the following year. This order is ongoing and applies to each influenza season, unless rescinded or modified. Please see the full Joint Advisory for more information. Full Joint Advisory Influenza FAQ (CDC, 2019) Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the ACIP – United States, 2019–20 Influenza Season (MMWR, 2019)
October 1, 2019	Update	Updates to Reportable Disease Requirements The California Department of Public Health (CDPH) has updated the California Code of Regulations, Title 17, Sections 2500 and 2505, which govern reporting requirements for healthcare providers and laboratories. Changes to Section 2500 provider reporting requirements are summarized in this Health Update. More information about disease reporting in Alameda County, including Section 2505 laboratory reporting requirements, can be found on our Reportable Diseases & Conditions website. Changes to both sections 2500 and 2505 go into effect October 1, 2019. The Alameda County Public Health Department (ACPHD) has additional reporting requirements beyond those of the state’s, and as such, clinicians and healthcare facilities must follow Alameda County-specific disease reporting requirements. Please see the full Health Update for more information and updated recommendation for providers. Full Health Update ACPHD Reportable Diseases Grid - October, 2019
September 4, 2019	Joint Advisory	Vaping Associated Pulmonary Injury This is an update to our 8/22nd Vaping Associated Pulmonary Injury (VAPI) Joint Health Advisory. The California Department of Public Health (CDPH) continues to work with local health departments to investigate cases of severe lung disease associated with vaping cannabis and working to analyze vaping products recovered from patients. This advisory includes a revised case definition and requested actions of clinicians. Please see the full Joint Advisory for more information and updated recommendation for providers. Full Joint Health Advisory from Alameda County and the City of Berkeley
September 3, 2019	Update	Tuberculosis Health Update: Screening for Healthcare Personnel & Nationwide Tuberculin Skin Test Shortage Several updates regarding tuberculosis (TB) have been sent to healthcare facilities in the past few months by the California Department of Public Health (CDPH) and Centers for Disease Control and Prevention (CDC). The Alameda County Public Health Department (ACPHD) is releasing this health update to provide a brief summary of two of these notifications: 1) CDPH All Facilities Letter 19–28 regarding TB Screening for Healthcare Personnel; and 2) CDC Nationwide Shortage of TB Skin Test Antigens. Please see the full Tuberculosis Health Update for more information. Full Tuberculosis Health Update
August 22, 2019	Joint Advisory	Severe Acute Pulmonary Disease Associated with Cannabis or Cannabidiol Oil Vaping California Department of Public Health (CDPH) is working with local health departments to investigate cases of severe lung disease associated with vaping cannabis and working to analyze vaping products recovered from patients. Nearly all patients reported vaping cannabis products in the weeks prior to hospital admission. Since June 2019, at least 20 cases of severe acute pulmonary disease in previously healthy adults were reported in California. Cases were first identified as a cluster of patients seen in Kings County. Cases are among residents of multiple counties in Northern and Southern California. See Full Advisory for more information and recommendations for providers. Full Joint Health Advisory from Alameda County and the City of Berkeley
August 1, 2019	Joint Advisory	Travel Associated Diseases: Ebola, Dengue, Malaria, and Measles Alameda County Public Health Department (ACPHD) and the City of Berkeley Public Health Division (COBPHD) regularly receive reports of malaria, dengue, and measles in persons with a history of international travel. Ebola Virus Disease (EVD) has also re-emerged in an outbreak in the Democratic Republic of the Congo. As the early symptoms of these diseases are non-specific, travel history is essential for timely diagnosis. Patients may not be aware of pre-travel recommendations for measles immunization or malaria chemoprophylaxis; proactive questioning about planned or recent travel assists with prevention, appropriate infection control, and diagnosis. Please see the Full Travel Associated Diseases Health Advisory for more information and an outline of actions requested of Healthcare Professionals. Full Travel Associated Diseases Health Advisory
May 20, 2019	Alert	Measles Current Situation: The City of Berkeley has 1 confirmed case of measles in a Berkeley adult resident. This individual is no longer contagious. This resident spent time at a few public venues during the infectious period (05/05/19 – 5/13/19), and it is not possible to identify every individual who may have been exposed. One location where there was prolonged exposure was the Berkeley Bowl located on Oregon Street. The resident visited the establishment on May 7th between 3 and 5 pm. Please see the Full Measles Health Alert for more information and an outline of actions requested of Healthcare Professionals. Full Measles Health Alert
April 8, 2019	Advisory	Measles in Alameda County Situation Update for Alameda County: An individual infectious for measles visited an Alameda county restaurant 3/23/2019. See the March 28, 2019 Media Release Restaurant Exposure for more information. New cases can develop in the 7-21 days after exposure to this and other recent cases. Clinicians are requested to consider/suspect measles in patients with a rash and fever ≥101°F (38.3°C) regardless of travel history. Ask about measles vaccination and exposure to known measles cases, international travel, or international visitors in the three weeks prior to illness. Please see complete Clinician Guidance in the full Health Advisory. Full Measles Health Advisory
March 29, 2019	Update	Chronic Hepatitis B Infection: Call for Testing, Vaccinating and Providing Treatment Hepatitis B virus (HBV) is highly infectious and transmitted via blood or sexual contact. Persons with chronic HBV infection (presence of hepatitis B surface antigen (HBsAg), HBV DNA, or Hepatitis B e antigen (HBeAg) for at least 6 months) require medical care as they are at increased risk for liver cirrhosis, liver cancer, and death. It is estimated that there are over 23,000 cases of chronic hepatitis B infection in Alameda County, yet there are only about 8,000 cases documented in the California Reportable Disease Information Exchange (CalREDIE). Approximately 1 in 12 people born in countries where hepatitis B is endemic and living in Alameda County is potentially chronically infected. The Alameda County Public Health Department (ACPHD) asks clinicians to: Test Patients for hepatitis B infection Vaccinate those who are susceptible Provide guideline-driven evaluation, monitoring and treatment for persons with chronic HBV Hep B ACPHD Health Update - March 2019
February 28, 2019	Advisory	CDPH Measles Clinical Guidance Measles continues to circulate in much of the world, including Europe, Asia and Africa. International travel, domestic travel through international airports, and contact with international visitors can pose a risk for exposure to measles. Recent measles outbreaks in other states have sparked concern about the risk to Californians. However, to date, all measles cases in the current Clark County, Washington measles outbreak were exposed locally, with little risk to Californians unless they travel to Clark County. While providers should consider measles in patients with fever and a descending rash, measles is unlikely in the absence of confirmed measles cases in your community or a history of travel or exposure to travelers. This guidance discusses which patients should be prioritized for measles testing Full Measles Clinical Guidance from California Department of Public Health
January 31, 2019	Joint Advisory	Advisory Discharge Guidelines for Patients Experiencing Homelessness Effective January 1, 2019, California Health & Safety Code Section 1262.5 requires general acute care hospitals, acute psychiatric hospitals and special hospitals to offer the following to patients experiencing homelessness prior to discharge:Screening or referrals “for infectious disease common to the region, as determined by the local health department” Immunizations appropriate to their “presenting medical condition” The full advisory provides joint guidance to hospitals within the local health jurisdictions of Alameda County and the City of Berkeley to comply with Section 1262.5. Full ACPHD-Berkeley Joint Advisory
January 23, 2019	CDC Health Advisory	Third Case of Rifampin/Penicillin-Resistant Strain of RB51 Brucella from Consuming Raw Milk On January 23, 2019, the Centers for Disease Control and Prevention (CDC) issued a health advisory regarding Brucella RB51 exposures from consuming raw milk. The CDC reports on three confirmed cases of brucellosis from Brucella RB51 as well as exposures in 19 states, including California. The full health advisory can be found at the link below. Per Title 17 section 2500,2505, suspected and confirmed cases of Brucellosis are immediately reportable to the local public health department. To report cases to Alameda County Public Health Department, contact: Acute Communicable Diseases Section: 510-267-3250 M-F 8:30am-5pm. Weekends and afterhours: 925-422-7595 Full CDC Health Advisory
November 21, 2018	Update	Improving Air Quality The Bay Area Air Quality Management District (BAAQMD) has extended its Spare the Air alert through Wednesday, 11/21st, due to some pockets of “unhealthy” air quality remaining in the East Bay, but improvements to moderate air quality are anticipated throughout the region on Thursday, 11/22nd. Full Health Update
November 14, 2018	Advisory	Unhealthy Air Quality (Updated Nov. 16) The Bay Area Air Quality Management District (BAAQMD) has an ongoing Spare the Air alert - updated on Wednesday, November 14th through Tuesday, November 20th. The Bay Area is continuing to experience heavy smoke from the Camp Fire in Butte County. Air quality continues to be unhealthy through much of the region. Full Health Advisory ACPHD Wildfire Smoke Resources
November 14, 2018	Advisory	Wildfire Smoke: Ongoing Spare the Air Alert The Bay Area Air Quality Management District has an ongoing Spare the Air alert updated on Wednesday 11/14^ththrough Friday 11/16^th. The Bay Area is continuing to experience heavy smoke from the Camp Fire in Butte County. Air quality continues to be unhealthy through much of the region. While air quality is in the “unhealthy” range, the best option for everyone, especially children, the elderly, and persons with chronic lung or heart disease, is to stay indoors with windows and doors closed, and avoid prolonged outdoor activities. Masks, if properly fitted, may be helpful for those who must be outdoors. Masks are not suitable for men with beards or young children. Persons with chronic lung or heart disease or other medical conditions, should check with their healthcare provider before using an N95 mask, as they can make breathing more difficult. To monitor local air quality conditions and indicators to stay indoors, visit www.airnow.gov. For additional guidance, see the attached Alameda County Public Health Wildfires & Air Quality flyer and visit our Wildfire Resources page at Air Quality, which has links to the flyer in additional languages.
September 21, 2018	Joint Advisory	Mandatory Influenza Vaccination or Masking of Health Care Workers During Every Influenza Season Health Officers for Alameda County and the City of Berkeley are re-issuing their joint Health Officer order (originally dated Aug. 28, 2013) mandating that all licensed health care facilities in Alameda County and the City of Berkeley require their health care workers (HCWs) to receive an annual influenza vaccination or, if they decline, to wear a mask during every influenza season while working in patient care areas. Influenza season dates are defined as November 1 to April 30 of the following year. This order is ongoing and applies to each influenza season, unless rescinded or modified. Full Alameda County & Berkeley Public Health Advisory
July 12, 2018	Joint Advisory	Alameda County Public Health and Berkeley Public Health 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. Full Alameda County & Berkeley Public Health Advisory CDPH Cyclosporiasis Health Advisory
June 1, 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
May 11, 2018	Community Update	High Levels of Pertussis in Alameda County Pertussis, also known as whooping cough, is a contagious disease affecting the lungs. It is caused by a bacteria that can spread when an infected person coughs, sneezes or talks near to other people. Pertussis can affect people of all ages but infants younger than 6 months are at greatest risk for severe disease leading to hospitalization and death. The highest rates of pertussis are seen in infants who are too young to have received all their pertussis vaccines, and in teenagers 14 to 17 years old whose pertussis vaccine protection has "worn off". Full Update
April 5, 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
March 21, 2018	Joint Update	Alameda County Public Health and Berkeley Public Health Hepatitis A Guidance for Healthcare Facilities and Clinicians A high demand of single antigen hepatitis A vaccine resulted in a national vaccine shortage toward the end of 2017. Currently, issues with single antigen vaccine supply and ordering appear to be resolved. Medical providers should now be vaccinating based on their own inventory instead of trying to ration or prioritize hepatitis A vaccine. Administer hepatitis A vaccine to any person exposed to a case of hepatitis A (household/sexual contact) and continue to vaccinate all persons in the following risk groups: Persons currently experiencing homelessness Persons using illicit drugs Men who have sex with men Persons with chronic liver disease Persons traveling to or working in countries where hepatitis A is common If inventory permits, also consider vaccinating persons with close contact to individuals in high risk groups listed above as well as anyone seeking protection from hepatitis A disease. Full ACPHD & BPH Joint Hepatitis A Guidance Update
January 4, 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. CDPH Influenza Clinical Advisory CDC: Influenza Advisory 12/27/17 Other Resources: CDPH Influenza Page CDC Influenza Page
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
October 11, 2017	Alert	Unhealthy Air Quality Due to Wildfires Information is evolving rapidly; please check website resources listed for most current information. Very unhealthy air quality from the North Bay wildfires continues to cause unprecedented levels of air pollution throughout the Bay Area. Due to changing wind patterns, air quality could be impacted for many days. Local air quality will be variable and unpredictable; it may improve at times, or get worse very quickly. Today's air quality for the majority of Alameda County is within the 100-150 range, which is Unhealthy for Sensitive Groups. Air quality tomorrow, Friday, Saturday and Sunday are expected to worsen and be designated Unhealthy. Active children and adults, and people with respiratory disease, such as asthma, should limit prolonged outdoor exertion. Residents should protect themselves from the impacts of heavy smoke. If you see or smell smoke in the immediate area, avoid outdoor activity, including exercise. Prevention Bay Area residents impacted by wildfire smoke are advised to: Stay aware of health warnings related to smoke. Close windows and doors. Set air conditioning units and car vent systems on re-circulate to avoid drawing in outside air./li> Limit outdoor activities to avoid unnecessary exposure to smoke. Parents and school/day care administrators should check air quality readings before allowing children to engage in outdoor sports and recreational activities while air quality is unhealthy. Website Resources: Bay Area Air Quality District: Air Monitoring Data CDC for smoke-related sickness: https://www.cdc.gov/disasters/wildfires/smoke.html Bay Area Air Quality District for air advisories, Spare the Air Alerts: http://www.baaqmd.gov/ Cal Fire statewide fire summary, updates on evacuations, red flag warnings: http://www.fire.ca.gov/ National Weather Service 5-day forecast: http://www.weather.gov/forecastmaps Full Unhealthy Air Quality Health Advisory
September 29, 2017	Update	Mandatory Influenza Vaccination or Masking of Health Care Workers During Every Influenza Season As Health Officers for Alameda County and the City of Berkeley, we are updating our joint Health Officer orders (originally dated Aug. 28, 2013) mandating that all licensed health care facilities in Alameda County and the City of Berkeley require their health care workers (HCWs) to receive an annual influenza vaccination or, if they decline, to wear a mask during every influenza season while working in patient care areas. This order applies to all facilities regardless of documented HCW influenza vaccination rate. The 2017update defines Influenza Season as November 1 to April 30 of the following year. This order is ongoing and applies to each influenza season, unless rescinded or modified. 2017 Alameda County & City of Berkeley Joint Advisory Original 2013 Joint Influenza Vaccination or Masking Advisory
September 29, 2017	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: 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. CONTINUE routine HAV vaccination for: Persons with chronic liver disease, including those with hepatitis B or C virus infection Users of injection and non-injection illicit drugs Men who have sex with men Persons traveling to or working in countries that have high or intermediate levels of HAV transmission Any person wishing to obtain immunity to HAV 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. Full ACPHD & BPH Joint Hepatitis A Outbreak Prevention Advisory Alameda County Hepatitis A webpage
August 9, 2017	Update	Updated Guidance for Health Care Providers Caring for Pregnant Women with Possible Zika Virus Exposure On August 2, 2017 the California Department of Public Health released Updated Guidance for Health Care Providers Caring for Pregnant Women with Possible Zika Virus Exposure. This guidance differs from CDC’s 7/28/17 guidance update, which extends discretion to states where regional epidemiology and travel patterns may deviate from patterns seen in other parts of the country. The Alameda County Public Health Department is adopting the new CDPH guidance. As of 8/4/2017,) there have been 37 cases of Zika virus infection in Alameda County (and an additional 3 in Berkeley), many of whom were pregnant women. Providers should continue to screen pregnant women for possible Zika virus exposure and continue advising women who are pregnant or who want to conceive in the near future to avoid unnecessary travel to areas where Zika is circulating and to follow the appropriate recommendations for preventing sexual transmission. When indicated, testing should be ordered through commercial labs for patients with Zika virus exposure related to travel or sexual contact and either uncomplicated clinical illness (regardless of pregnancy status) or who are asymptomatic pregnant women. California Department of Public Health Zika Testing Guidance Update
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. California Department of Public Health Hepatitis A Outbreak Advisory
June 13, 2017	Advisory	*Alameda County Health Officer Order for Reporting Carbapenem-Resistant Enterobacteriaceae* (CRE)** 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. Health Officer Order for Reporting Carbapenem-Resistant Enterobacteriaceae (CRE) ACPHD CRE page
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: Ill persons stay home while sick and for another 48 hours after symptoms go away. Everyone regularly washes hands especially after using the bathroom and before eating. 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. Full Norovirus Health Advisory CDC Norovirus Page
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. Full Foodborne Botulism Outbreak Health Advisory California Department of Public Health Communication CDC Botulism Page
March 2, 2017	Update	ACPHD and BPH Joint Zika Virus Update Alameda County Public Health Department (ACPHD) and Berkeley Public Health (BPH) are now encouraging providers to route Zika virus testing through commercial labs for uncomplicated situations. Routing directly to authorized commercial labs does not compromise quality and improves turnaround time by up to five weeks. Clinicians should continue to obtain testing through Public Health (ACPHD or BPH) in complex or questionable situations, such as: A fetus or infant with microcephaly or signs of congenital Zika virus syndrome whose mother was potentially exposed to Zika virus; A person with Guillain-Barré syndrome and potential exposure to Zika virus; or When sexual, local mosquito-borne, laboratory, or blood transfusion/organ transplant exposure is suspected. If there are clinical circumstances where it is unclear whether a specimen should be routed through ACPHD or a commercial lab, clinicians should consult with the ACPHD Acute Communicable Disease section during normal business hours M-F 9am – 5pm by calling 510-267-3250. For Berkeley residents only, contact the Berkeley Communicable Disease program by calling 510-981-5292. Full Joint Alameda County and Berkeley Public Health Joint Zika Update ACPHD Zika Page CDPH Zika Page CDC Zika Page
November 2, 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. CDPH Hepatitis A Outbreak linked to Frozen Strawberries: Post-exposure Prophylaxis Advisory FDA Recall and Investigation California product distribution
October 24, 2016	Advisory	Zika Virus Disease Updated Advisory As of 9/16/16, the CDC has described the characteristics of 2,382 confirmed or probable cases of Zika virus disease with symptom onset during January 1–July 31, 2016. Most (99%) cases were travel-associated, with 98% reporting travel to an area with Zika transmission, and 1% reporting sexual contact with a returning traveler. United States acquired cases included 26 mosquito-borne cases, one laboratory-acquired infection, and one patient with unknown transmission mode. Sixty-five (3%) patients were hospitalized, and one died. For details, please see http://dx.doi.org/10.15585/mmwr.mm6536e5. Alameda County has reported 20 cases of Zika virus infections & California has reported 348 (including 43 pregnant women, and 2 infants with birth defects, and 3 due to sexual transmission) as of 10/21/16. All California cases are travel-associated, with no locally acquired mosquito borne transmission. Local Case Counts For updated information on Zika cases in Alameda County and California, please refer to ACPHD Zika website. Case counts will be updated weekly on Fridays. Areas with Active Mosquito-Borne Zika Transmission For information on areas of the world, including parts of the United States, with active Zika virus transmission, please refer to http://www.cdc.gov/zika/geo/index.html This Zika health advisory summarizes key updates since the last Zika health advisory on 8/6/16. The key updates include new information and guidance for prevention of sexual and travel- associated Zika transmission, Zika testing criteria and availability, and specialty society clinical practice guidelines for managing pregnant women, fetal evaluation, and evaluating and managing infants with possible congenital Zika virus infection. We will be issuing further health advisory updates as relevant information becomes available. Full Alameda County Public Health Zika Advisory ACPHD Zika Page CDPH Zika Page CDC Zika Page
August 10, 2016	Advisory	Zika Virus Disease Updated Advisory As of 8/3/2016, CDC reports 1818 travel-associated Zika infections in the continental U.S., including 479 infections in pregnant women, 16 sexually transmitted infections, and 5 patientswith Guillain-Barré syndrome. One laboratory-acquired infection has been reported. Florida has reported 6 non-travel associated Zika cases due to local mosquito transmission. As of 7/28/16, 15 liveborn infants with birth defects and 6 pregnancy losses associated with Zika have been reported in the continental U.S. As of 8/5/16 California reports 134 cases including 1 due to sexual transmission, 23 pregnant women, and 2 infants with birth defects. All CA cases have been travel associated; 10 of the 134 cases are in Alameda County. See https://www.cdph.ca.gov/HealthInfo/discond/Pages/Zika.aspx for weekly updated case counts. See http://www.cdc.gov/zika/geo/index.htm for current list of Zika-affected areas. New information on Zika infection continues to emerge and guidelines for Zika virus testing have been updated by the CDC on 7/25/16. This health advisory summarizes key updates since the last Zika health advisory on 4/1/16 and includes new information and guidance for Zika virus testing in pregnant women in Alameda County as well as updates in interim guidance for prevention of sexual transmission of Zika virus for couples in which one partner has traveled to or resides in an area with active Zika transmission. Full Alameda County Public Health Zika Advisory ACPHD Zika Page CDPH Zika Page CDC Zika Page For health care providers: Update: Interim Guidance for Health Care Providers Caring for Pregnant Women with Possible Zika Virus Exposure - United States, July 2016 Update: Interim Guidance for Prevention of Sexual Transmission of Zika Virus — United States, July 2016
June 27, 2016	Advisory	Meningococcal Outbreak in Southern California Since May 2016, nine confirmed cases of Meningococcal disease, including one death, have been reported in men living in Southern California, most of who were men who have sex with men (MSM). Six of the cases are known to be caused by serogroup C and one additional case is awaiting serogroup identification. This represents a substantial increase above the typical number of reported cases. Persons with HIV infection are known to be at risk of Meningococcal disease and vaccines are urged for adult gay and bisexual men at risk, and for all people with HIV. This advisory provides background information and Meningococcal vaccine recommendations to help clinicians safely address the current Meningococcal disease outbreak. Full California Department of Public Health (CDPH) Advisory
June 13, 2016	Advisory	Bicillin L-A (Benzathine Penicillin G) Shortage On April 29th, 2016, a Bicillin L-A (Benzathine Penicillin G) drug shortage was announced by the Food and Drug Administration (FDA). Benzathine penicillin G 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 estimates the Bicillin L-A shortage will last until at least July, 2016. This advisory provides recommended actions and resources to help clinicians safely address the current Bicillin L-A drug shortage. Full Alameda County Public Health Department Advisory
April 19, 2016	Alert	Drug Overdose Health Alert: Fentanyl-Contaminated Street Norco ® Clarification on Reporting to County Public Health Overdoses due to illicitly obtained drugs that strongly resemble the prescription drug Norco® have been reported in California, including in Sacramento and Contra Costa County. Instead of acetaminophen and hydrocodone, these counterfeit drugs actually contained an undetermined amount of fentanyl, a powerful synthetic opiate analgesic. The California Department of Public Health (CDPH) issued a Drug Overdose Health Alert on April 8, 2016 entitled "Fentanyl-Contaminated Street Norco®". This alert describes the recent report of 48 overdoses and at least 10 deaths over a 10-day period in Sacramento County that appear to be associated with the consumption of these counterfeit Norco® pills. CDPH is requesting that all health care facilities report suspected and confirmed fentanyl overdoses to local health departments to assess the magnitude and outcomes of this situation in California. This alert provides awareness and actions for all health care providers in Alameda County to take when presented with a suspected or confirmed opioid overdose case at their facility. Full Alameda County Public Health Department Advisory CDPH Drug Overdose Health Alert: Fentanyl-Contaminated Street Norco - April 8, 2016
April 1, 2016	Advisory	Zika Virus Disease Updated Advisory Zika virus transmission continues in Latin America, the Caribbean, Oceania/Pacific Islands and Cape Verde in Africa. As of 3/29/2016, two Alameda County residents have been confirmed by laboratory testing to have had travel-associated Zika virus infection. On 3/25/2016, The California Department of Public Health (CDPH) announced the first confirmed Zika virus case in California acquired through sexual contact with a partner with travel-associated Zika-infection. As of 3/25/16, CDPH began diagnostic Plaque Reduction Neutralization Testing (PRNT) for Zika virus on serology specimens, which no longer require confirmatory testing at CDC. New information on Zika infection continues to emerge and guidelines for Zika virus testing have been updated. This health advisory summarizes key updates since the last Zika health advisory on 3/11/16 and includes new information and guidance for Zika virus testing in Alameda County. Clinical illness is now defined as having one or more of the following signs or symptoms: acute onset of fever, maculopapular rash, arthralgia or conjunctivitis. (Previously, two or more signs/symptoms were required.) The CDC updated its interim guidance for prevention of sexual transmission and preconception counseling recommendations for Zika virus. Full Alameda County Public Health Department Advisory ACPHD Zika Page CDPH Zika Page CDC Zika Page For travelers: Centers for Disease Control and Prevention (CDC) list of Zika-affected areas For health care providers: New: Preventing Transmission of Zika Virus in Labor and Delivery Settings Through Implementation of Standard Precautions - United States, 2016 (CDC) - 3/25/16 Updated: Questions and Answers for Healthcare Providers caring for Pregnant Women and Women of Reproductive Age with Possible Zika Virus Exposure (CDC) - 3/26/16
March 11, 2016	Advisory	Zika Virus Disease Updated Advisory Zika virus transmission continues in Latin America, the Caribbean, Oceania/Pacific Islands and Cape Verde in Africa. New information on Zika infection continues to emerge and guidelines for Zika virus testing have been revised, including the addition of more testing capabilities of the California Department of Public Health (CDPH) Viral and Rickettsial Disease Laboratory (VRDL). This health advisory summarizes key updates since the last Zika health advisory on 2/11/16 and includes new information and guidance for Zika virus testing in Alameda County. As of 3/11/16, one Alameda County resident has been confirmed by laboratory testing to have had travel-associated Zika virus infection. Health care providers should consider testing for Zika virus infection in the following persons with a potential Zika virus exposure: Zika Virus symptoms within two weeks of exposure Asymptomatic pregnant women Infants born to a mother with a potential Zika virus exposure Patients with Guillain-Barre Syndrome Potential Zika virus exposure is defined as (a) travel to areas with active Zika Virus transmission in the 2 weeks before symptoms onset; or (b) condomless sexual contact with a male partner who traveled to an area of active Zika virus transmission and had symptoms of Zika disease during travel or within 2 weeks of return. Full Alameda County Public Health Department Advisory ACPHD Zika Website CDPH Zika Website CDC Zika Website For travelers: Centers for Disease Control and Prevention (CDC) list of Zika-affected areas For health care providers: New: CDPH FAQ for Health Care Providers New: Transmission of Zika Virus Through Sexual Contact with Travelers to Areas of Ongoing Transmission- Continental United States, 2016 – 2/27/16 New: Zika Virus Infection Among U.S Pregnant Travelers – August 2015 – February 2016 – 2/26/16
March 1, 2016	Advisory	Preventing Prescription Drug Misuse and Abuse - Opioids Please distribute to all providers in your practice. Prescription drug misuse and overdose is a national epidemic, according to the Centers for Disease Control and Prevention (CDC). Nationally, each year, prescription narcotics result in more fatal overdoses than heroin and cocaine combined and, in 2015, surpassed auto accidents as the number one cause of accidental deaths. In California, deaths involving opioid prescription drugs have increased 16.5 percent since 2006. In 2012, there were more than 1,800 deaths from all types of opioids – 72 percent involved prescription opioids. In Alameda County, deaths from opioid misuse tripled between 2005 and 2014 and hospitalizations for opioid-related, non-fatal overdoses increased by over 74 percent. This advisory provides actions and resources to help clinicians safely prescribe opioid prescriptions. Full Alameda County Public Health Department Advisory CURES 2.0 (California’s Controlled Substance Utilization Review and Evaluation System)
February 11, 2016	Advisory	Zika Virus Disease Updated Advisory Zika virus transmission continues in Latin America, the Caribbean, Oceania/Pacific Islands and Cape Verde in Africa. New information on Zika infection continues to emerge and guidelines for Zika virus testing have been revised, including specific revisions for testing in pregnant woman. This health advisory summarizes key updates since the last Zika health advisory on 1/29/16 and includes new information and guidance for Zika virus testing in Alameda County. In California, six travel-associated Zika cases were reported between 2013 and 2015. On 2/9/16, ACPHD confirmed an Alameda County resident has preliminarily tested positive for the Zika virus. The person was infected with Zika virus while traveling in a Zika-affected country. Health care providers should consider testing for Zika virus infection in persons with a compatible clinical illness and pregnant women with recent travel to affected areas. Full Alameda County Public Health Department Advisory ACPHD Zika Website CDPH Zika Website CDC Zika Website For travelers: Centers for Disease Control and Prevention (CDC) list of Zika-affected areas For health care providers: New: CDPH Health Advisory - Zika Information for California Healthcare Providers - February 8, 2016 Updated: Interim Guidelines for Health Care Providers Caring for Pregnant Women and Women of Reproductive Age with Possible Zika Virus Exposure- United States, 2016 – 2/5/16 (CDC)
January 29, 2016	Advisory	Zika Virus Disease and Current Travel-Associated Viral Diseases of Concern Outbreaks of Zika virus disease have been reported in 24 countries and territories in Latin America, the Caribbean, and Oceania/Pacific Islands. Zika virus causes a mild illness in 20% of those infected, with symptoms of fever, rash, joint pain, and red eyes beginning within 14 days of travel to a country with Zika virus transmission. Additionally, in Brazil and other countries with Zika virus transmission, an unusual increase in the number of infants born with microcephaly has been reported. The virus is transmitted by the Aedes mosquito, which is not native to California but has been detected in 12 California counties. Thus far, the few Zika virus disease cases reported in Californians have occurred in returning travelers; no local transmission has been identified. Health care providers should obtain travel histories from patients with a febrile illness, and consider testing for dengue fever, chikungunya, or Zika virus disease in persons with a compatible clinical presentation and a history of travel to Latin America, the Caribbean, and Oceania/Pacific Islands. Providers should counsel patients who are pregnant or who are attempting to become pregnant about special travel precautions and preventing mosquito bites. Full Alameda County Public Health Department Advisory ACPHD Zika Website CDPH Zika Website CDC Zika Website For travelers: Centers for Disease Control and Prevention (CDC) list of Zika-affected areas CDC Zika Virus general information CDPH Health Advisory, Zika Virus in Latin America For health care providers: CDC Interim Guidelines for Pregnant Women During a Zika Virus Outbreak – United States, 2016 CDC Interim Guidelines for the Evaluation and Testing of Infants with Possible Congenital Zika Virus Infection – United States, 2016 Alameda County Public Health Department Zika Testing Request Form Instructions for completing the CDC Arbovirus Diagnostic Laboratory submission form
December 9, 2015	Advisory	Chikungunya and Dengue in Mexico and Latin America The California Department of Public Health (CDPH) urges Californians to protect themselves against mosquito bites if traveling to Mexico or Latin America, where there have been increasing reports of chikungunya and dengue infections. Chikungunya infection causes fever and joint pain; as of November 2015, over 10,000 cases were reported in Mexico this year, and over 34,000 cases were reported in the Caribbean and Central and South America. Dengue causes fever, headache, joint pain and muscle pain; over 23,000 cases have been reported in Mexico this year as of November 2015, and widespread outbreaks have occurred throughout the Caribbean and Central and South America in recent years. For travelers: California Department of Public Health (CDPH) Travel Advisory, December 2015 – Chikungunya and Dengue in Mexico and Latin America CDPH news release, December 9, 2015 Centers for Disease Control and Prevention (CDC) – Mosquito Bite Prevention for Travelers For health care providers: CDPH guidance to clinicians for diagnosis and reporting of chikungunya and dengue infections CDC clinical comparison of chikungunya and dengue infections and testing guidance
September 2, 2015	Advisory	Measles in a UC Berkeley Student One laboratory-confirmed case of measles has been identified in a UC Berkeley student. As of September 1, 2015, no Alameda County residents outside of the City of Berkeley have been identified as contacts to this case. However, the case spent time at many public venues while infectious, so not all contacts could be identified. For Healthcare Providers: Consider measles in patients with fever, followed by a descending rash that starts on the face or head, regardless of age, immunization status, or travel history. Call Alameda County Public Health Department (ACPHD) at 510-267-3250 to report suspected measles cases who live in Alameda County outside of Berkeley, and to arrange for expedited PCR testing at the Public Health Laboratory; do not send specimens to a commercial lab. Implement airborne precautions immediately for patients with a febrile rash illness with suspected measles. City of Berkeley Public Health Alert
September 9-11, 2015	Advisory	Heat Advisory The National Weather Service has issued a heat advisory for the San Francisco Bay Area that remains in effect until Friday, 9/11. More info from Alameda County Public Health More Info from The National Weather Service
September 2, 2015	Advisory	Measles in a UC Berkeley Student One laboratory-confirmed case of measles has been identified in a UC Berkeley student. As of September 1, 2015, no Alameda County residents outside of the City of Berkeley have been identified as contacts to this case. However, the case spent time at many public venues while infectious, so not all contacts could be identified. For Healthcare Providers: Consider measles in patients with fever, followed by a descending rash that starts on the face or head, regardless of age, immunization status, or travel history. Call Alameda County Public Health Department (ACPHD) at 510-267-3250 to report suspected measles cases who live in Alameda County outside of Berkeley, and to arrange for expedited PCR testing at the Public Health Laboratory; do not send specimens to a commercial lab. Implement airborne precautions immediately for patients with a febrile rash illness with suspected measles. City of Berkeley Public Health Alert
September 2, 2015	Advisory	Legionellosis at San Quentin State Prison As of September 1, 2015, six confirmed cases of legionellosis have been reported in inmates of San Quentin State Prison. No confirmed cases have occurred among prison guards, staff, family members living on prison grounds, or visitors. For Healthcare Providers: Consider testing for legionellosis in patients with pneumonia who visited or worked at San Quentin State Prison in August 2015. Please order a Legionella urine antigen test and culture of lower respiratory tract secretions (e.g., sputum, lung tissue, broncheoalveolar lavage), specifying suspected legionellosis to ensure that specimens are cultured on appropriate media. Report confirmed and suspected legionellosis cases to ACPHD by phone (510-267-3250) or fax (510-268-2111) in Alameda County residents not living in the City of Berkeley. Marin County Public Health Alert
July 29-30, 2015	Advisory	Heat Advisory The National Weather Service has issued a heat advisory for the San Francisco Bay Area that remains in effect until Thursday, July 30. More info from Alameda County Public Health More Info from The National Weather Service
June 25, 2015	Update	Ebola Virus Disease The ongoing Ebola epidemic in West Africa that started last year is the largest in history, and continues to affect the countries of Guinea and Sierra Leone. Liberia was declared free from Ebola virus transmission by the World Health Organization on May 9, 2015. In the US, the Centers for Disease Control and Prevention (CDC) has not declared Liberia Ebola free, but classifies Liberia as a country with former widespread transmission and current, established control measures. Effective June 17, 2015, the CDC changed its monitoring procedure for Liberian travelers from public health active monitoring to traveler self monitoring. Travelers from Liberia will continue to be screened in the 5 east coast airports they must pass through to enter the US. CDC will continue to notify California Department of Public Health (CDPH) and local health departments of travelers arriving in our jurisdictions for informational purposes. Alameda County is no longer actively monitoring travelers from Liberia. CDC, CDPH, and Alameda County Public Health Department recommends that healthcare providers: Should conduct thorough histories that include: health status, travel, and exposures. Should assess travel history for any possible infectious disease exposures (e.g., MERS-CoV, malaria) and not focused only on Ebola-affected countries. Should use clinical judgment to evaluate patients based on those histories and their symptoms. Should implement infection control measures as appropriate to travel history and clinical presentation. Follow standard protocols for patient care (e.g., medical equipment and procedures, infection control, laboratory testing) If the patient reports travel from Liberia and no travel into Guinea and Sierra Leone – no Ebola-specific precautions are required. Should continue to report suspect cases of any potential high risk infectious disease to Alameda County Public Health Department Acute Communicable Disease at 510-267-3250. ACPHD Ebloa Page CDPH Ebola Page CDC Ebola Page
June 11, 2015	Update	Middle Eastern Respiratory Syndrome Coronavirus (MERS CoV) In light of the recent largest outbreak of MERS-CoV outside of the Arabian Peninsula in Korea, the CDC has issued Health Advisory including an update of the criteria for a Patient Under Investigation for MERS-CoV to add – “A history of being in a healthcare facility (as a patient, worker, or visitor) in the Republic of Korea within 14 days before symptom onset.” Only two patients in the U.S. have ever tested positive for MERS-CoV infection, both in May 2014, while more than 500 have tested negative. The CDC has also issued updated Interim Infection Prevention and Control Recommendations for Hospitalized Patients with Middle East Respiratory Syndrome Coronavirus (MERS-CoV). This updated guidance continues to recommend standard, contact, and airborne precautions. In addition, the updated infection control guidance emphasizes additional elements of infection prevention and control programs that should be in place to prevent the transmission of any infectious agents including respiratory pathogens such as MERS-CoV in healthcare settings. CDC continues to closely monitor the MERS situation globally and work with partners to better understand the risks of this virus, including the source, how it spreads, and how infections might be prevented. CDC recognizes the potential for MERS-CoV to spread further and cause more cases globally and in the U.S. We have provided information for travelers and are working with health departments, hospitals, and other partners to prepare for this. CDC MERS-CoV Health Advisory Centers for Disease Control MERS-CoV page
May 22, 2015	Health Advisory	Carbapenem-Resistant Enterobacteriaceae (CRE) Carbapenem-Resistant Enterobacteriaceae (CRE) are untreatable or difficult to treat multidrug-resistant organisms that have developed high levels of resistance to carbapenems, a class of antibiotics that includes doripenem, ertapenem, imipenem and meropenem. Risk factors for CRE colonization or infection include open wounds, presence of indwelling devices including endotracheal tubes, multiple co-morbidities, and high antimicrobial use. Long-term acute care (LTAC) hospitals have the greatest prevalence of patients with CRE-colonization or infection as a result of receiving and caring for patients who have many CRE risk factors and a history of lengthy hospitalizations. Multiple clusters and outbreaks of CRE have been increasingly recognized in recent years in Northern California acute and long-term care facilities, including facilities in Alameda County. CRE are highly transmissible in healthcare settings and both infected and colonized patients can serve as reservoirs for transmission. Early recognition and prompt implementation of infection control precautions are critical to control the spread of CRE in our region. Full ACPHD Health Advisory ACPHD CRE page California Department of Public Health CRE Page Centers for Disease Control CRE Page
February 20, 2015	Health Advisory	Measles Cases in Alameda County and California As of February 20, Alameda County Public Health Department (ACPHD) has confirmed 6 cases of measles in 2015 and is investigating other suspect cases, and California has confirmed 123 cases. Measles is very infectious, and airborne transmission can occur in crowded settings. 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. All Alameda County residents should ensure they are immune or have been vaccinated against measles. 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. ACPHD Health Advisory – Feb. 20, 2015 CDPH Health Advisory - Feb. 20, 2015 ACPHD Measles Page CDPH Measles
January 16, 2015	Health Advisory	Measles Cases in Alameda County and California As of January 16, Alameda County Public Health Department (ACPHD) has confirmed 4 cases of measles in 2015 and is investigating other suspect cases. The State of California has confirmed 33 recent cases. An outbreak of measles from exposures associated with visits to Disney theme parks in December 17-20th, 2014 has resulted in 28 cases throughout California, including in Alameda County. Five additional cases have no identified common exposures with the outbreak. Cases involve both children and adults, ages 7 months to 59 years old, including 15 unimmunized individuals. A small number of cases were previously immunized. Measles is very infectious, and airborne transmission can occur in crowded settings. Outbreaks in California typically involve infected international visitors or unimmunized persons traveling overseas in areas where large measles outbreaks are occurring, followed by local spread. All Alameda County residents should ensure they are immune or have been vaccinated against measles 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. ACPHD Health Advisory – January 16, 2015 ACPHD Measles Page CDPH Measles
January 7, 2015	Health 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. CDPH Health Advisory – January 7, 2015 CDPH Measles Press Release- January 7, 2015 Alameda County Public Health Department - Measles
October 29, 2014	Health 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. ACPHD Health Advisory ACPHD Ebola Page CDPH Ebola Page CDC Ebola Page
October 8, 2014	Health 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. ACPHD Health Advisory CDPH Ebola Page CDC Ebola Page
October 1, 2014	Health 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. ACPHD Health Advisory CDC Enterovirus D68 Page
August 19, 2014	Update	Ebola Virus and West Nile Virus Update There is currently a large outbreak of Ebola Virus Disease (EVD) in the West African countries of Guinea, Sierra Leone, Liberia, and most recently, Nigeria. As of August 19, the World Health Organization has reported a cumulative total of 2240 suspect and confirmed cases and 1229 deaths. CDC has advised travelers to avoid all non-essential travel to Guinea, Sierra Leone, and Liberia, and has issued a lower level alert for Nigeria. As of August 19, 2014, there are no EVD cases acquired in the United States. While the risk of importation of Ebola into the United States is considered to be very low, Alameda County Public Health Department (ACPHD) is working with the California Department of Public Health (CDPH) to prepare in the event that a returning traveler from these countries develops illness that may be concerning for EVD. Early identification of such cases and prompt infection control implementation will be key components to containment and prevention of spread. As of August 13, 2014, Alameda County reported 51 dead birds and 10 mosquito pools positive for West Nile Virus (WNV); this is an unusually high number and already higher than all prior years. Mosquito Abatement has undertaken precautions to treat mosquitoes in areas where activity is highest in Livermore. There are currently no reported symptomatic cases of human WNV in Alameda County this year, and there are 57 reported human cases in CA from 36 jurisdictions. Ebola Virus and WNV Update CDPH Ebola Page CDC Ebola Page
June 10, 2014	Update	Middle Eastern Respiratory Syndrome Coronavirus (MERS CoV) The CDC had previously reported on May 17, 2014 that an individual from Illinois who had extended face-to-face contact with the Indiana case had become infected with MERS CoV but had no symptoms. After further laboratory testing on May 28, the CDC announced that they have now concluded that the Illinois resident was not infected with MERS CoV ACPHD Health Update MERS-CoV Patient Alert Poster
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. ACPHD Health Advisory CDPH MERS CoV page CDC MERS Cov page
March 28, 2014	Advisory	Measles Cases in Alameda County and California As of March 28, 49 confirmed cases of measles have been reported to the California Department of Public Health (CDPH) with onsets since January 1, 2014; an additional case is reported today by Alameda County. 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. ACPHD Health Advisory & Actions for Clinicians CDPH Health Advisory Update CDPH Measles News Release - March 28, 2014
February 19, 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. ACPHD Health Advisory & Actions for Clinicians CDPH Health Advisory- February 19, 2014 Alameda County Public Health Department - Measles
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: Health Advisory & Actions for Clinicians For additional information on flu refer to: http://www.acphd.org/flu
January 6, 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. FDA Drug Shortages:Oseltamivir
September 4, 2013	Update	Recurrent Nationwide Shortage of Tuberculin Skin Test Antigen Solutions In April 2013, CDC reported that TUBERSOL®, a product of Sanofi Pasteur Limited, was in shortage nationwide. Although supplies were restored in early June 2013, TUBERSOL® is in shortage again until at least the middle of October 2013. At the current time, the 5 tuberculin units/0.1 mL, 5 mL (50 tests), multiple dose vials are unavailable. The 5 tuberculin units/0.1 mL, 1 mL (10 tests), multiple dose vials are in limited supply. This CDC notice advises public health officials, clinicians, and workers in occupational health and infection control about how to adapt testing protocols to the recurrent shortage. CDC Update
August 28, 2013	Advisory	Mandatory Influenza Vaccination or Masking or Health Care Workers During Every Influenza Season Alameda County Health Officer has updated the joint order with the Berkeley Health Officer mandating that all licensed health care facilities in Alameda County and the City of Berkeley require their health care workers (HCWs) to receive an annual influenza vaccination or, if they decline, to wear a mask during the influenza season while working in patient care areas. Alameda County & City of Berkeley Joint Advisory Frequently Asked Questions Preliminary Findings Health Care Worker Flu Vaccine Coverage
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. Alameda County Public Health Department Advisory
June 7, 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. Actions Requested of Clinicians ACPHD Hepatitis A Information CDPH Hepatitis A Updates CDC Hepatitis Outbreak Updates
June 3, 2013	Update	Multistate Outbreak of Hepatitis A As of May 31, 2013, the Centers for Disease Control and Prevention have reported 30 people ill with acute hepatitis A from five states, including California. Illnesses may be linked to consumption of contaminated “Townsend Farms brand Organic Antioxidant Blend”, a frozen berry and pomegranate seed mix, sold from late February 2013 until late May 2013 at Costco stores. Health care providers evaluating patients with acute hepatitis should ask about exposure to this product and report suspected cases to Alameda County Public Health Department at 510-267-3250. Health care providers should provide hepatitis A postexposure prophylaxis to patients who are susceptible to hepatitis A infection within two weeks of their last exposure to this berry product. CDC hepatitis A outbreak information California Department of Public Health Hepatitis A Postexposure Prophylaxis Guidance
May 1, 2013	Update	Human Infections with Novel Influenza A (H7N9) As of April 29, 2013, Chinese public health officials have reported to the World Health Organization (WHO) a total of 126 human cases of laboratory-confirmed avian influenza A (H7N9) in China, including 24 deaths. Dates of illness onset range from February 19 to April 27, 2013. Very limited person-to-person transmission or epidemiologic link between a few of the cases has been identified. Actions Requested of Clinicians
April 9, 2013	Update	Human Infections with Novel Influenza A (H7N9) As of April 7, 2013, Chinese public health official have reported to the World Health Organization (WHO) a total of 21 human cases of laboratory-confirmed avian influenza A (H7N9) in China, including 6 deaths, 12 cases with severe respiratory illness, and three mild cases. These are the first known human infections with this influenza strain. No cases of human infection with novel influenza A (H7N9) have been detected in the U.S. Actions Requested of Clinicians
February 4, 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. Alameda County Public Health Department Advisory
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. Alameda County Public Health Department INH Advisory
December 14, 2012	Advisory	Meningococcal Vaccine Recommendations for Men Who Have Sex with Men Meningococcal Disease is a severe infection caused by the bateria Neisseria meningitidis. It can cause either meningococcal meningitis or meningococcemia (septic infection). If it is untreated, it leads to death in 50% of people who catch it. Even with early diagnosis it causes death in 5-15% of the people who become ill. Neisseria meningitidis is spread through contact with the saliva, phlegm, or other fluids from the nose or mouth of an infected person. Close contact includes: kissing, sneezing or coughing on someone, living in a crowded space together (e.g. in a dormitory), sharing food, drinking from the same cup, eating with the same utensils, sharing a cigarette or pipe. Currently there is an outbreak of meningococcal disease happening in NY among men who have sex with men. These cases are all the same serogroup -C. There was 1 case in August 2010, 4 cases in 2011, and 11 cases in 2012. 9 have been HIV+. These men have contacted each other online, using phone apps, and at parties and bars. This type of meningococcal disease is vaccine preventable. At this time, persons who wish to reduce their risk of meningococcal disease, including MSM, may choose to receive meningococcal vaccine, which can be safely administered to HIV-infected persons. New York City Advisory CA Dept. of Public Health Clinician Advisory CDC Meningococcal Disease Information
October 4, 2012	Advisory	Meningitis and Stroke Associated with Potentially Contaminated Product The Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) are coordinating a multi-state investigation of fungal meningitis among patients who received an epidural steroid injection. Several of these patients also suffered strokes that are believed to have resulted from their infection. CDC Advisory CDC Updates on Meningitis Outbreak FDA Statement on Meningitis Outbreak
October 1, 2012	Advisory	Mandatory Influenza Vaccination or Masking of Health Care Workers During Influenza Season Alameda County Health Officer is issuing a joint order with Berkeley Health Officer mandating that all licensed health care facilities in Alameda County and the City of Berkeley require their health care workers (HCWs) to receive an annual influenza vaccination or, if they decline, to wear a mask during the influenza season while working in patient care areas. Facilities with a documented 90 percent or greater HCW influenza vaccination rate are exempt from the masking requirement. Alameda County & City of Berkeley Advisory Frequently Asked Questions
September 5, 2012	Alert	Hantavirus Guidance for Physicians with Patients Presenting with Concerns or Symptoms of Hantavirus Pulmonary Syndrome After Visit to Yosemite National Park The California Department of Public Health is collaborating with the Centers for Disease Control (CDC) and the National Park Service to investigate the outbreak of hantavirus in recent visitors to Yosemite National Park. CDPH issued this more detailed health alert and guidance for physicians that supports and builds on the previous ACPHD health alert. CDPH alert/guidance
August 31, 2012	Update	Hantavirus Cardiopulmonary Syndrome in California The California Department of Public Health has reported six confirmed cases of Hantavirus Cardiopulmonary Syndrome (HCPS) in visitors who stayed in Yosemite National Park from early June to mid-July 2012. Clinicians are asked to educate patients that HCPS is a rare disease that is prevented by avoiding contact with rodents and excreta. Clinicians may consider testing for HCPS in patients with fever, severe pulmonary disease and a history of contact with rodents in rural areas. Suspected HCPS cases should be reported to Alameda County Public Health Department at 510-267-3250. Hantavirus Health Update from Alameda County Public Health
May 6, 2012	Advisory	Hot Summer Weather Advisory The summer season with its potential for fluctuating high temperatures is approaching. Health care facilities are reminded that the elderly and other health compromised individuals are more susceptible to extremes in temperature and dehydration. Weather advisory from California Department of Public Health
January 25, 2012	Advisory	NOVEL H3N2 INFLUENZA VIRUS: INCREASED SURVEILLANCE California Department of Public Health (CDPH) is requesting increased surveillance and testing for influenza in children less than 18 years of age. Since July 2011, a novel swine-origin triple reassortant H3N2 influenza virus (S-OtrH3N2) has been reported in 5 states with a total of 12 cases. California has no cases but heightened surveillance is being requested. Novel Flu H3N2 Advisory Laboratory specimen submission Form for Influenza, including novel strains
October 5, 2011	Alert	Healthcare Providers: Mumps Health Alert Alameda County has 4 confirmed and 3 probable cases of Mumps that are epidemiologically linked. Individuals are at increased risk for mumps if they are unvaccinated. Mumps should be considered in the differential diagnosis even in fully immunized individuals. Health Alert from Alameda County Public Health
August 18, 2011	Advisory	Pediatric Health Providers: Fatal Vaccine-Preventable Pneumococcal Disease Immunize all children younger than 5 years of age who have not yet received 13-valent pneumococcal conjugate vaccine. Health Advisory from California Department of Public Health
May 20, 2011	Advisory	FDA Warns Not to Feed SimplyThick to Premature Infants Do not feed the thickening product called SimplyThick to infants born before 37 weeks because it may cause a life-threatening condition. U.S. Food and Drug Administration Press Release
May 3, 2011	Advisory	Measles Since January 2011, 11 cases of measles have been reported in California. A nationwide increase in the numbers of reported measles cases has also been noted this year. As in recent years, nearly all of the cases are known to have involved recent travel to Europe or Asia, or contact with international travelers (including via transit through U.S. international airports). Some of the cases have been intentionally unvaccinated children. Health Advisory - May 2011 Think Measles Flyer CDPH Investigation Quicksheet for Clinicians
May 19, 2010	Alert	Mercury Poisoning Linked to Face Cream The California Department of Public Health (CDPH) issued a Health Alert May 19, 2010 notifying persons who may be using unlabeled, nonprescription face creams from Mexico for the purpose of skin lightening, fading freckles and age spots, and preventing acne that these products contain very high levels of mercury, are harmful to your health, and should not be used. CDPH Health Alert Warning: Mercury in homemade face products
February 23, 2010	Alert	Measles Health Alert Four cases of measles have been diagnosed in the San Francisco Bay Area in the past two weeks. Two cases occurred in two unvaccinated toddlers who traveled to Europe and Asia; one case in an older adult who traveled to Europe; and the fourth case was an unvaccinated adult with no travel history. Measles Investigation Quick Sheet for Healthcare Providers Measles FAQs
July 23, 2009	Alert	Novel H1N1 Flu Updated Antiviral Recommendations from the California Department of Public Health
July 20, 2009	Alert	Novel H1N1 Flu Guidance on Novel H1N1 Infections with Executive Summary
September 20, 2008	Update	Rabies Vaccine Supply Shortage Rabies Vaccine Supply Situation (CDC) Rabies Vaccine Request Form
August 29, 2008	Update	Rabies Vaccine Supply Shortage Health Alert Update #1 for Health Care Providers
August 26, 2008	Alert	Rabies Vaccine Supply Shortage The Centers for Disease Control & Prevention has strongly recommended that health care providers, state and local health authorities, and animal control officials take immediate steps to ensure the appropriate use of human rabies vaccine due to a national rabies vaccine shortage. Health Alert Guidance for health care providers Info for the public from the Centers for Disease Control and Prevention
July 10-11, 2008	Advisory	Heat Advisory The National Weather Service has issued a heat advisory for the San Francisco Bay Area that remains in effect until 8 p.m. Friday, July 11. More info from Alameda County Public Health More Info from The National Weather Service
July 8-10, 2008	Advisory	Health Advisory, Red Flag Warning, Spare the Air The National Weather Service has issued a heat advisory for the San Francisco Bay Area and a red flag warning for the North and East Bay hills that remain in effect noon today, July 8, until 5 p.m. Thursday, July 10. The Bay Area Air Quality Management District has a spare the air notice for the same period. More Info from The National Weather Service More info from Bay Area Air Quality Management District
June 25-27, 2008	Advisory	Air Quality Health Advisory Bay Area Air Quality Management District Issues Health Advisory Info from Bay Area Air Quality Management District
May, June 2008	Update	Salmonella Outbreak Update New cases of Salmonella linked to certain types of tomatoes have been reported to CDPH. More info from U.S. Food & Drug Administration More info from Centers for Disease Control
May 16, 2008	Advisory	Heat Advisory The National Weather Service's heat advisory for the San Francisco Bay Area remains in effect noon to 8 p.m. today, May 16. More info from Alameda County Public Health

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