Mycoplasma Pneumoniae Infections Among Children and Adolescents During Fall and Winter Respiratory Illness Seasonā
CāāDPH/Health Advisory - November 22, 2024ā - āThe California Department of Public Health (CDPH) is issuing a Health Advisory to remind healthcare providers that the U.S. Centers for Disease Control and Prevention (CDC) recently released a bulletin warning of increasing numbers of Mycoplasma pneumoniae (M. pneumoniae) infections, particularly among young children, since late spring. There have been anecdotal reports of incresaed numbers of children hospitalized with M. pneumoniae infection from multiple hospitals in California.
First Case of Clade I Mpox Case Confirmed in California and the United States in a Returning Travelerā
CāāDPH/Health Advisory - November 19, 2024ā - āOn November 15, 2024, testing at the California Department of Public Health (CDPH) confirmed the first case of mpox infection from clade I monkeypox virus (MPXV) in the United States. The patient recently traveled from aāāāān affected country, where clade I MPXV is actively spreading. The patient has relatively mild illness and is recovering after seeking medical care for mpox symptoms. CDPH along with local health departments (LHD) and the U.S. Centers for Disease Control and Prevention (CDC) are investigating potential contacts to the patient; no additional cases have been detected to date. Historically, clade I has caused more severe illness than clade II, however, recent infections from clade I mpox may not be as clinically severe as in previous outbreaks, especially when cases have access to quality medical care. The overall risk of clade I mpox to the general population in California and the United States continues to be low. Health care providers are advised to follow infection prevention and control recommendations for all patients with mpox symptoms and have a heightened index of suspicion for clade I mpox in patients who present with signs and symptoms consistent with mpox and who report either: (1) recent internatiāonal travel, or (2) sexual contact with someone who recently traveled internationally, particularly to Central or East Africa. If clade I mpox is suspected, providers should notify their LHD immediately and collect specimens for clade-specific testing; patients suspected to have mpox should be advised to isolate themselves from others. This California Health Advisory expands upon CDC Health Advisory 519 issued on November 18, 2024 and summarizes California specific guidance for mpox management.
First Case of Clade I Mpox Diagnosed in the United Statesā
CāāDC/Health Advisory - November 18, 2024ā - The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory to provide information about the first case of clade I mpox diagnosed in the United States and recommendations to clinicians about preventing, diagnosing, treating, and reporting mpox cases. On November 15, 2024, the California Department of Public Health (CDPH) confirmed theā first reported case of clade I mpox in the United States. This individual had recently traveled to areas experiencing clade I monkeypox virus (MPXV) transmission and sought medical care for mpox symptoms in the United States. Consistent with other recent clade I mpox cases, the patient has relatively mild illness and is recovering. CDC and the local and state health departments are investigating potential contacts; no additional cases in the United States have been detected as of November 18, 2024. The risk of clade I mpox to the public in the United States remains low.āā Since March 2024, CDC has been working with local, tribal, state, and territorial public health authorities to prepare for potential cases of clade I mpox in the United States by enhancing surveillance, detection, and reporting capacities of existing domestic public health systems and structures. This reported case demonstratāāāes that these systems are working as intended. There is no change to CDC clinical or travel guidance on clade I mpox since HAN Health Update 516. Clinicians should be aware of mpox symptoms, ask patients with comparable signs and symptoms about recent travel history and other risk factors for mpoxā, and consider MPXV testingā. Given the widespread outbreaks in Central and Eastern Africa, additional travel-associated cases may be reported in the future in the United States. Suspected and confirmed cases of clade I mpox should be reported to local, territorial, and state public health authorities as soon as possible. State, local, and territorial public health authorities should report cases to CDC promptly. This includes orthopoxvirus generic (i.e., non-variola orthopoxvirus) positive and clade II negative test results from a patient with travel history to country affected by clade I mpox. CDC recommends vaccination to people who are eligible for mpox vaccine, including those who may have a recent MPXV exposureā.āā
CDPH/Health Advisory - October 14, 2024 ā The California Department of Public Health (CDPH) would like to share new and updated Syphilis Screening Recommendations in response to the rise in syphilis and congenital syphilis rates across California. These recommendations are applicable statewide, and inclusive of all of California, regardless of local case rates. In summary: 1) All sexually active persons 15-44 years old, regardless of gender identity or sexual orientation, should now be screened for syphilis at least once in their lifetime. Following the initial screen, CDPH recommends that syphilis screening be offered annually. 2) Syphilis testing should be included whenever a person of any age is tested for HIV or other sexually transmitted infections, including mpox. 3) All pregnant persons should now be screened for syphilis three times: i) at confirmation of pregnancy or first prenatal encounter, ii) early in the third trimester (at approximately 28 weeks gestation or as soon as possible thereafter), and iii) at delivery. 4) All persons 15-44 years old who enter a correctional facility should ideally be screened for syphilis, preferably at intake. 5) Emergency departments and hospital-affiliated urgent care clinics should screen all pregnant persons for syphilis prior to discharge if syphilis test results are not available for the current pregnancy. CDPH encourages healthcare providers to empirically treat for syphilis while awaiting confirmatory testing, if clinically indicated, among persons who have preliminary positive treponemal or non-treponemal test results āparticularly if the likelihood of successful patient follow-up is uncertain. ā
Disruptions in the Availability of Peritoneal Dialysis and Intravenous Solutions from Baxter International Facility in North Carolina
āCDCā/Health Advisory- October 12āā, 2024 -The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory to inform healthcare providers, pharmacists, healthcare facility administrators, and state, tribal, local, and territorial health departments of a supply disruption of peritoneal dialysis (PD) and intravenous (IV) solutions from the Baxter International's North Cove facility in North Carolina, due to Hurricane Helene. The supply disruption may impact patient care and require adjustments to the clinical management of patients. Healthcare providers, pharmacists, healthcare facility administrators, state, tribal, local, and territorial health departments, regardless of supply chain dusruptions, should immediately assess their supply and develop plans and mitigation strategies to reduce the impact on patient care.
CDPH/Health Advisory- October 10, 2024 -Due to the detection of ciprofloxacin-resistant strains of Neisseria meningitidis, the California Department of Public Health (CDPH) is recommending public health and medical providers in California to discontinue the use of ciprofloxacin for invasive meningococcal diseaāse (IMD) post-exposure prophylaxis (PEP). Rifampin, ceftriaxone or azithromycin are recommended options for IMD PEP in California. No changes to empiric treatment of IMD are recommended at this time.
āFirst cases of human Avian Influenza A (H5N1) in California & Preparation for Respiratory Virus Season (COVID-19, Influenza and RSV)
CDPH/Health Advisory- October 4, 2024ā - The California Department of Public Health (CDPH) urges healthcare providers to prepare for and respond to anticipated increases in illness due to COVID-19, seasonal influenza, and respiratory syncytial virāus (RSV) this fall and winter season. Immunizations for COVID-19, seasonal influenza and RSV are recommended for eligible persons this fall. All recommended respiratory vaccines may be co-administered at the same visit. In general, healthcare providers should follow CDC recommendations, and should encourage patients to receive new or updated doses of respiratory virus immunizations this fall. Providers should encourage early testing and provide antiviral treatment for COVID-19 and seasonal influenza to eligible patients. Prioritize patients who are at higher risk for severe illness, including older adults, immunocompromised patients, those with chronic or underlying conditions, pregnant or recently pregnant individuals, and residents of skilled nursing facilities. Healthcare providers may access CDC and CDPH respiratory virus activity and surveillance data to stay up to date with the latest trends. ā
First Marburg Virus Disease Outbreak in the Republic of Rwandaā
CDC/Health Advisory- October 3ā, 2024ā - The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory to inform clinicians and health departments about the Republic of Rwandaās first confirmed outbreak of Marburg virus disease (MVD) with 36 laboratory confirmed cases and 11 deaths reported as of October 2, 2024, including at least 19 cases in healthcare workers. This report summarizes CDCās recommendations for public health departments and clinicians in the United States on case identification and testing and clinical laboratory biosafety considerations. No confirmed cases of MVD related to this outbreak have been reported in the United States or other countries outside of the Republic of Rwanda to date. Currently, the risk of MVD in the United States is low; however, clinicians should be aware of the potential for imported cases.
Preveāāntion Strategies for Mpox, including Vaccinating People at Risk via Sexual Exposure, for U.S. Travelers Visiting Countries with Clade I Mpox Outbreaks
CDC/Health Update- September 23ā, 2024ā - The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Update to provide additional information about the ongoing outbreak of clade I monkeypox virus (MPXV), the virus that causes mpox, in Central and Eastern Africa. This report is an update to HAN Health Advisory 501 issued in December 2023 and HAN Heath Update 513 in August 2024. MPXV transmission in countries where the virus is endemic is typically via exposure to infected wildlife with subsequent person-to-person spread via close contact (including intimate or sexual contact) with a person with mpox, or direct contact with their respiratory secretions (e.g., snot, mucus) or contaminated objects (e.g., bedding). During the global clade II outbreak, human-to-human transmission of mpox has been predominantly spreading through sexual contact. During 2024, the Democratic Republic of the Congo (DRC) has reported >21,000 suspected clade I mpox cases, its largest annual number on record. Although the proportion of people impacted in DRC (population >99 million) is relatively low, cases are more widespread than in any previously reported DRC outbreak. Clade Ia mpox cases are impacting the western part of DRC (particularly the rural Ćquateur Province). No cases of clade Ia mpox have been reported outside Central African countries where clade Ia MPXV is endemic. Clade Ib mpox cases are impacting the eastern part of DRC and have been spread through regional travel. Early data indicate that a large proportion of clade Ib mpox cases among adults has been associated with sexual contact, including via ongoing transmission believed to be occurring in some countries where the virus is not normally found. Travelers to DRC or other countries with sustained spread of clade I mpox, regardless of sexual orientation or gender identity, should be made aware of activities associated with cases and should be vaccinated with two doses of JYNNEOS if they anticipate certain sexual exposures while traveling. Active monitoring for mpox continues to occur in the United States. Although the United States continues to be affected by an ongoing global outbreak of clade II mpox that began in 2022, no domestic cases of clade I mpox have been identified in the United States at this time. Continue to follow CDCās current vaccine guidance to prevent clade II MPXV infection, which continues to circulate in the United States, and will also help protect against clade I MPXV.ā
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Detection of highly pathogenic avian influenza (HPAI) A(H5N1) in California dairy cattle
CDPH/Health Advisory - September 4, 2024 - The California Department of Public Health (CDPH) is issuing this Health Advisory to notify clinicians and local health departments that avian influenza A(H5N1) has been confirmed in cows at three California dairies located in the Central Valley. Since March 2024, avian influenza A (H5N1) has been detected in multiple U.S. dairy herds. Since April 1, 2024, the Centers for Disease Control and Prevention (CDC) has confirmed four human influenza A(H5N1) infections among commercial dairy workers in other states, all of whom have had mild symptoms including conjunctivitis or respiratory symptoms. Healthcare providers should consider avian influenza A(H5N1) in persons with acute respiratory symptoms and/or conjunctivitis and recent exposure to animals suspected or confirmed to have avian influenza. If avian influenza infection is suspected, providers should notify their local health department immediately. Additional information regarding specimen collection, testing, and provider personal protective equipment (PPE) is provided in this update.
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Increased Oropouche Virus Activity and Associated Risk to Travelers
CDC/Health Advisory- August 16, 2024 - The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory to notify clinicians and public health authorities of an increase in Oropouche virus disease in the Americas region, originating from endemic areas in the Amazon basin and new areas in South America and the Caribbean. Between January 1 and August 1, 2024, more than 8,000 cases of Oropouche virus disease were reported, including two deaths and five cases of vertical transmission associated with fetal death or congenital abnormalities. Countries reporting cases include Brazil, Bolivia, Peru, Colombia, and Cuba. In the United States and Europe in 2024, travel-associated cases have been identified in travelers returning from Cuba and Brazil. As testing and surveillance for Oropouche virus disease increase in the Americas, reports of cases from additional countries are expected. This Health Advisory advises on evaluating and testing travelers who have been in impacted areas with signs and symptoms consistent with Oropouche virus infection. It also raises awareness of the possible risk of vertical transmission (e.g., from gestational parent to fetus during pregnancy) and associated adverse effects on pregnancy and highlights prevention measures to mitigate additional spread of the virus and potential importation into unaffected areas, including the United States.
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Increase in Human Parvovirus B19 Activity in the United States
CDC/Health Advisory- August 13, 2024 ā The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory to notify healthcare providers, public health authorities, and the public about current increases in human parvovirus B19 activity in the United States. Parvovirus B19 is a seasonal respiratory virus that is transmitted through respiratory droplets by people with symptomatic or asymptomatic infection. In the first quarter of 2024, public health authorities in 14 European countries observed unusually high numbers of cases of parvovirus B19. In the United States, there is no routine surveillance for parvovirus B19, and it is not a notifiable condition. Recently, CDC has received reports indicating increased parvovirus B19 activity in the United States. Data include increased test positivity for parvovirus B19 in clinical specimens and pooled plasma from a large commercial laboratory, and reports of clusters of parvovirus B19-associated complications among pregnant people and people with sickle cell disease. The proportion of people with IgM antibodies, an indicator of recent infection, increased among all ages from <3% during 2022ā2024 to 10% in June 2024; the greatest increase was observed among children aged 5ā9 years, from 15% during 2022ā2024 to 40% in June 2024. Among plasma donors, the prevalence of pooled samples with parvovirus B19 DNA >104 IU/mL increased from 1.5% in December 2023 to 19.9% in June 2024.
Update on Clade I Mpox Geographical Spread in Africa: Recommendations for California Health Care Providers
CDPH/Health Update- August 12, 2024 - The California Department of Public Health (CDPH) Sexually Transmitted Diseases Control Branch is issuing this Health Update to notify clinicians and local health departments about the geographical spread of clade I mpox within Africa and recommendations for practice, diagnostic testing, and surveillance for mpox. Clade I mpox is associated with increased transmissibility and fatality rates compared to the currently circulating clade IIb mpox in the US. Healthcare providers are advised to have a heightened index of suspicion for clade I mpox in patients with recent travel to Africa and signs and symptoms consistent with mpox. If clade I mpox infection is suspected, providers should notify their local health department immediately to arrange clade-specific testing.
Rise in Extensively Drug-Resistant Shigella Strains-January to May 2024
CDPH/Health Advisory - August 9, 2024 - The California Department of Public Health (CDPH) is releasing this Health Advisory to alert healthcare providers and clinical laboratories of a rise in extensively drug-resistant (XDR) Shigella strains in California. From January to May 2024, 12% of California Shigella isolates have been identified as XDR based on whole genome sequencing and 75% of adult males with XDR Shigella isolates self-identified as men who have sex with men (MSM). Healthcare providers should tailor any shigellosis antibiotic treatment to available antimicrobial susceptibility testing (AST) data, and counsel patients at increased risk of infection on prevention and risk reduction practices. Clinical laboratories should perform complete antimicrobial susceptibility testing that includes azithromycin, ciprofloxacin, ceftriaxone, trimethoprim-sulfamethoxazole [TMP-SMX], and ampicillin, on available Shigella isolates as resources allow.
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Mpox Caused by Human-to-Human Transmission of Monkeypox Virus in the Democratic Republic of the Congo with Spread to Neighboring Countries
CDC/Health Update - August 7, 2024 - The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Update to provide additional information about the outbreak of monkeypox virus (MPXV) in the Democratic Republic of the Congo (DRC); the first
Health Advisory about this outbreak was released in December 2023. Since January 2023, the DRC has reported the largest number of yearly suspected clade I mpox cases on record. While
clade I MPXV is endemic, or naturally occurring, in DRC, the current outbreak is more widespread than any previous DRC outbreak and has resulted in clade I mpox transmission to some neighboring countries. The Republic of the Congo (ROC), which borders DRC to the west, declared a clade I mpox outbreak in April 2024, and there have been confirmed cases in the Central African Republic (CAR). While clade I mpox is endemic in ROC and CAR, the epidemiologic pattern of recent cases suggests a possible link to DRC.
Disruptions in Availability of Becton Dickinson (BD) BACTECā¢ Blood Culture Bottles
CDC/Health Advisory - July 23, 2024 - the Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory to inform healthcare providers, laboratory professionals, healthcare facility administrators, and state, tribal, local, and territorial health departments of a critical
shortage of Becton Dickinson (BD) BACTECā¢ blood culture media bottles. This shortage has the potential to disrupt patient care by leading to delays in diagnosis, misdiagnosis, or other challenges in the clinical management of patients with certain infectious diseases. Healthcare providers, laboratory professionals, healthcare facility administrators, and state, tribal, local, and territorial health departments affected by this shortage should immediately begin to assess their situations and develop plans and options to mitigate the potential impact of the shortage on patient care.
Increased Risk of Dengue Virus Infections in the United States
CDC/Health Alert - June 25, 2024 - the Centers for Disease Control and Prevention (CDC) issued this Health Advisory to notify healthcare providers, public health authorities and the public of an increased risk of dengue virus (DENV) infections in the United States in 2024. Global incidence of dengue in 2024 has been the highest on record for this calendar year; many countries are reporting higher-than-usual dengue case numbers. In 2024, countries in the Americas have reported a record-breaking number of dengue cases, exceeding the highest number ever recorded in a single year. From January 1 ā June 24, 2024, countries in the Americas reported more than 9.7 million dengue cases, twice as many as in all of 2023 (4.6 million cases). In the United States, Puerto Rico has declared a public health emergency (1,498 cases) and a higher-than-expected number of dengue cases have been identified among U.S. travelers (745 cases) from January 1ā June24, 2024. In the setting of increased global and domestic incidence of dengue, healthcare providers should take additional steps.
Severe Acute Illness and Hospitalizations Linked to Diamond Shruumz ā¢ Chocolate Bars, Cones, and Gummies (microdose products)
CDPH/Health Alert - June 24, 2024 - CDPH, CDC, FDA, and Poison Control are investigating the Diamond ShruumzTM brand chocolate bars, cones, and gummies (all flavors and types). These products, known as microdose products, have been linked to severe acute illnesses and hospitalizations among consumers. As of June 17, 2024, the FDA has reported a total of 26 illnesses from 16 states including California. Twenty-five (25) of the 26 people have reported seeking medical care and 16 have been hospitalized. Health care providers should seek clinical advice from, and report suspected cases to, the California Poison Control System (1-800-222-1222). Providers should also consult the CDC Outbreak Summary for recommendations including diagnostic workup, testing and treatment. Patients/consumers should be advised not to eat, sell, or serve any flavor of Diamond Shruumz-brand Chocolate Bars, Cones, or Gummies. The marketing of these products may appeal to youth and young adults.
Reports of Rare, Severe Dermatophyte Infections Associated with Sexual Contact in the United States
CDPH/Health Advisory-June 19, 2024- The California Department of Public Health (CDPH) would like to inform health care providers that the first known United States (U.S.) case of sexually transmitted Trichophyton mentagrophytes genotype VII (TMVII) was reported in June 2024 in a patient who had recent travel to California. TMVII is a rare dermatophyte (e.g., ringworm or tinea) infection that causes highly inflammatory, painful, and persistent lesions, often affecting the anogenital or perioral areas, and may require weeks of oral antifungal treatment. Prior to this case, sexual transmission of TMVII had been reported in
France, primarily among men who have sex with men (MSM), and among other persons in European countries returning from Southeast Asia who had engaged in sex tourism. Given the novelty of sexually transmitted dermatophyte infections and the potential for local spread in the United States, CDPH would like to inform clinicians of TMVII as a potential emerging public health concern and provide guidance on the clinical recognition, diagnosis, and treatment of patients who are suspected to have this infection.
Disrupted Access to Prescription Stimulant Medications Could Increase Risk of Injury and Overdose
CDC/Health Advisory-June 13, 2024- The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory to inform public health officials, clinicians, and affected patients, their families, and caregivers about potential disrupted access to care among individuals taking prescription stimulant medications and possible increased risks for injury and overdose. On June 13, 2024, the U.S. Department of Justice announced a federal health care fraud indictment against a large subscription-based telehealth company that provides attention-deficit/hyperactivity disorder (ADHD) treatment to patients ages 18 years and older across the United States. Patients who rely on prescription stimulant medications to treat their ADHD and have been using this or other similar subscription-based telehealth platforms could experience a disruption to their treatment and disrupted access to care. A disruption involving this large telehealth company could impact as many as 30,000 to 50,000 patients ages 18 years and older across all 50 U.S. states. Patients whose care or access to prescription stimulant medications is disrupted, and who seek medication outside of the regulated healthcare system, might significantly increase their risk of overdose due to the prevalence of counterfeit pills (PDF) in the illegal drug market that could contain unexpected substances, including fentanyl. Given the national drug overdose crisis and threats associated with the illegal drug market, individuals struggling to access prescription stimulant medications are urged to avoid using medication obtained from anyone other than a licensed clinician and licensed pharmacy. Health officials and healthcare providers may need to assist affected patients seeking treatment for ADHD and should communicate overdose risks associated with the current illegal drug market as well as provide overdose prevention education and mental health support.
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Severe Illness Potentially Associated with Consuming Diamond Shruumz(TM) Brand Chocolate Bars, Cones, and Gummies
CDC/Health Advisory-June 12, 2024 The Centers for Disease Control and Prevention (CDC), Food and Drug Administration (FDA), Americaās Poison Centers, and state and local partners are investigating reports of severe acute illnesses potentially associated with consuming Diamond Shruumz(TM) brand chocolate bars, cones, and gummies marketed as containing a proprietary blend of mushroom. As of June 11, 2024, 12 total illnesses and 10 hospitalizations have been reported in eight U.S. states with ongoing efforts to identify other potential cases. The cause of the reported illnesses is not known at this time. Individuals should not eat, sell, or serve any flavors of Diamond Shruumz(TM) brand chocolate bars, cones, or gummies, and should discard products that have been purchased. CDC and FDA are working to determine whether other products from this company are associated with adverse health effects.
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Influenza A Testing Guidance: Enhanced Surveillance During the Summer Months
CDPH/Health Update-June 12, 2024-In response to the global outbreak of influenza A (H5N1) in birds and recent infections in dairy cattle and humans in the United States, the Centers for Disease Control and Prevention (CDC) and the California Department of Public Health (CPDH) are encouraging enhanced surveillance and continued testing for influenza this summer. Testing for influenza and subtyping all influenza A positives over the summer is key to maintaining visibility of the influenza A subtypes circulating in the community. Providers are also reminded regarding antiviral treatment and prophylaxis recommendations (
local public health departments.
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Meningococcal Disease Cases Linked to Travel to the Kingdom of Saudi Arabia (KSA): Ensure Pilgrims are Current on Meningococcal Vaccination
CDC/Health AdvisoryāMay 20, 2024āThe Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory to alert healthcare providers to cases of meningococcal disease linked to Umrah travel to the Kingdom of Saudi Arabia (KSA). Umrah is an Islamic pilgrimage to Mecca, Kingdom of Saudi Arabia, that can be performed any time in the year; the Hajj is an annual Islamic pilgrimage this year taking place June 14ā19, 2024. Since April 2024, 12 cases of meningococcal disease linked to KSA travel for Umrah have been reported to national public health agencies in the United States (5 cases), France (4 cases), and the United Kingdom (3 cases). Two cases were in children aged 18 and younger, four cases were in adults aged 1ā44 years, four cases were in adults aged 45ā64 years, and two cases were in adults 65 years or older. Ten cases were in patients who traveled to KSA, and two were in patients who had close contact with travelers to KSA. Ten cases were caused by Neisseria meningitidis serogroup W (NmW), one U.S. case was caused by serogroup C (NmC), and the serogroup is unknwon for one U.S. case. Of nine patients with known vaccination status, all were unvaccinated. The isolates from the one U.S. NmC case and two NmW cases (one U.S., one France) were resistant to ciprofloxacin; based on whole-genome sequencing, the remaning eight NmW isolates were all sensitive to penicillin and cirpofloxacin. Healthcare providers shuold also maintain increased suspicion for meningococcal disease in anyone presenting with symptoms of meningococcal disease after recent travel to KSA for Hajj or Umrah pilgrimage. U.S. health departments and healthcare providers should preferentially consider using rifampin, ceftriaxone, or azitrhomycin instead of profloxacin for chemoprophylaxis of close contacts of meningococcal disease cases associated with travel to KSA.
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Adverse Effects Linked to Counterfeit or Mishandled Botulinum Toxin Injections
CDC/Health AdvisoryāApril 23, 2024 ā The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory to alert clinicians about risks of counterfeit or mishandled botulinum toxin injections. CDC, the U.S. Food and Drug Administration (FDA), and state and local partners are investigating clusters of 22 people in 11 U.S. states reporting adverse effects after receiving injections with counterfeit botulinum toxin or injections administered by unlicensed or untrained individuals or in non-healthcare settings, such as homes or spas. Eleven patients were hospitalized and none have died. When botulinum toxin diffuses around the injection site, it can result in adverse effects. Botulism is the disease caused by botulinum toxin circulating in the blood and producing effects remotely from the injection site. There may be symptom overlap between the presentation of localized adverse effects from injection of botulinum toxin, especially in the head and neck, and the early symptoms of botulism. Information about the botulinum toxin injection (e.g., dose) can help distinguish between botulism and localized adverse effects but is challenging to obtain for counterfeit products. Clinicians and health departments should consider the possibility of adverse effects from botulinum toxin injections in patients presenting with localized paralysis. Clinicians should immediately contact their state, tribal, local, or territorial health department if they suspect botulism.
The California Department of Public Health is including this additional guidance specific to California:
The Centers for Disease Control and Prevention (CDC), the U.S. Food and Drug Administration (FDA), and state and local partners are investigating 22 people from 11 states who report adverse effects after receiving injections with counterfeit botulinum toxin or injections administered by unlicensed or untrained individuals or in non-healthcare settings, such as homes or spas. The California Department of Public Health (CDPH) received reports of two California residents who are included in the investigation, one reported purchasing counterfeit āBotoxā on the internet. Both patients received injections in non-health care settings.
Botulism is a medical emergency and requires immediate medical and public health response. Clinicians must immediately report any patients with suspected botulism to their local health department (LHD), and the LHD will notify the CDPH. CDPH staff are available 24/7 to provide technical consultation for botulism testing and to authorize botulism antitoxin (BAT) release in 60 of the 61 California LHDs; Los Angeles County (LAC) Department of Public Health authorizes the release of BAT for LAC residents hospitalized within their jurisdiction.
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Fatality from Lead Poisoning Linked to Use of Hemorrhoid Ointment from Vietnam
CDPH/Health AdvisoryāApril 9, 2024 ā The California Department of Public Health is issuing this Health Advisory to notify health care providers, laboratories and public health departments that a woman in Sacramento developed severe lead poisoning and died in March 2024 after using a hemorrhoid ointment from Vietnam called, Cao BĆ“i TrÄ© CĆ¢y Thįŗ§u Dįŗ§u. The woman purchased the product on Facebook and a relative in Vietnam shipped it to the U.S. Testing of the product found that it contained 4% lead (39,000 ppm), a highly dangerous amount of lead. If healthcare providers have patients that have used this hemorrhoid ointment, urge them to stop using it and order a venous blood lead level (BLL) test immediately. Contact California Poison Control at 1-800-222-1222 for clinical guidance on lead poisoning. See Health-Based Guidelines for BLL in Adults (PDF) for specific recommendations based on the patient's BLL results.
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Highly Pathogenic Avian Influenza A(H5N1) Virus: Identification of Human Infection and Recommendations for Investigations and Response
CDC/Health Advisory ā April 5, 2024 ā The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory to inform clinicians, state health departments, and the public of a recently confirmed human infection with highly pathogenic avian influenza (HPAI) A(H5N1) virus in the United States following exposure to presumably infected dairy cattle. The U.S. Department of Agriculture (USDA) recently reported detections of highly pathogenic avian influenza A(H5N1) virus in U.S. dairy cattle in multiple states. This Health Advisory also includes a summary of interim CDC recommendations for preventing, monitoring, and conducting public health investigations of potential human infections with HPAI A(H5N1) virus.
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Increase in Invasive Serogroup Y Meningococcal Disease in the United States
CDC/Health Advisory ā March 28, 2024 ā The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory to alert healthcare providers to an increase in invasive meningococcal disease, mainly attributable to Neisseria meningitidis serogroup Y (Figure). As of March 25, 2024, 143 cases have been reported to CDC for the current calendar year, an increase of 62 cases over the 81 reported as of this date in 2023. A specific meningococcal strain, sequence type (ST) 1466, is responsible for most (101 of 148, 68%) serogroup Y cases with available sequence type data that were reported across the United States in 2023. Cases caused by this strain are disproportionately occurring in people ages 30ā60 years (65%), Black or African American people (63%), and people with HIV (15%). In addition, most cases of invasive meningococcal disease caused by ST-1466 in 2023 had a clinical presentation other than meningitis: 64% presented with bacteremia, and at least 4% presented with septic arthritis. Of 94 patients with known outcomes, 17 (18%) died; this case-fatality rate is higher than the historical case-fatality rate of 11% reported for serogroup Y cases in 2017ā2021. Healthcare providers should 1) have a heightened suspicion for meningococcal disease, particularly among populations disproportionately affected by the current increase, 2) be aware that patients may present without symptoms typical of meningitis, and 3) ensure that all people recommended for meningococcal vaccination, including people with HIV, are up to date for meningococcal vaccines.
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Increase in Global and Domestic Measles Cases and Outbreaks: Ensure Children in the United States and Those Traveling Internationally 6 Months and Older are Current on MMR Vaccination
CDC/Health Advisory ā March 18, 2024 ā The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory to inform clinicians and public health officials of an increase in global and U.S. measles cases and to provide guidance on measles prevention for all international travelers aged 6 months and older and all children aged 12 months and older who do not plan to travel internationally. Measles (rubeola) is highly contagious; one person infected with measles can infect 9 out of 10 unvaccinated individuals with whom they come in close contact. From January 1 to March 14, 2024, CDC has been notified of 58 confirmed U.S. cases of measles across 17 jurisdictions, including seven outbreaks in seven jurisdictions compared to 58 total cases and four outbreaks reported the entire year in 2023. Among the 58 cases reported in 2024, 54 (93%) were linked to international travel. Healthcare providers should ensure children are current on routine immunizations, including MMR. Given currently high population immunity against measles in most U.S. communities, the risk of widescale spread is low. However, pockets of low coverage leave some communities at higher risk for outbreaks.
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Extension of Long-Acting Benzathine Penicillin G (BicillinĀ® L-A) Shortage
CDPH/Health Advisory ā March 18, 2024 ā The Centers for Disease Control and Prevention (CDC) and the U.S. Food and Drug Administration (FDA) previously announced a long-acting benzathine penicillin G (BicillinĀ® L-A) shortage and estimated recovery of supplies in the second quarter of 2024. Unfortunately, the expected recovery time has now been extended to the fourth quarter of 2024. As such, CDPH is recommending the continued prioritization of BicillinĀ® L-A and ExtencillineĀ® for pregnant people with syphilis and certain infants exposed to syphilis in pregnancy. Furthermore, CDPH reminds providers that oral doxycycline is an appropriate alternative treatment for non-pregnant adults with primary, secondary, early/late latent syphilis and syphilis of unknown duration.
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Immediate Respiratory Isolation Recommended for Persons with Suspected Measles
CDPH/Health Advisory ā March 14, 2024 ā The Centers for Disease Control and Prevention (CDC) is reporting an increase of measles in international travelers, resulting in at least 45 cases reported nationwide so far in 2024. Four cases have been reported in California, all of whom traveled overseas. CDPH recommends that healthcare providers suspect measles in patients with fevers, rash and any of the ā3 Csā (cough, coryza, or conjunctivitis) who have traveled internationally or interacted with international visitors in the last 3 weeks. In healthcare settings, to prevent spread if measles is suspected, isolate the patient immediately, in an airborne infection room (AIIR) if possible, and promptly telephone the local public health department to report suspected cases. Ensure that patients are up to date on measles vaccinations before traveling abroad.
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Substantial Increase in Tuberculosis in California: Recommendations for California Healthcare Providers
CDPH/Health Advisory ā February 26, 2024 ā The California Department of Public Health (CDPH) is releasing this Health Advisory to inform healthcare providers about the recent increase in tuberculosis (TB) cases in California. CDPH encourages providers to consider tuberculosis in their differential diagnoses, to test persons with risk factors for tuberculosis, and to offer treatment to those with latent tuberculosis infection (LTBI) to prevent progression to active TB disease. Healthcare providers in California are required to report TB cases to their local public health department.
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Fever and Rash? Consider Measles. Traveling Abroad? Protect against Measles.
CDPH/Health Advisory ā February 2, 2024 ā The California Department of Public Health (CDPH) reminds health care providers to consider measles in persons presenting with a febrile rash illness and other symptoms consistent with measles. Multiple measles cases have been confirmed in the United States in recent weeks, and have been linked to overseas travel, reflecting a global rise in measles cases. Airborne precautions should be immediately instituted to prevent nosocomial measles exposures, and patients should be up to date with measles vaccinations, especially if planning to travel abroad. Healthcare providers in California should report suspect measles cases to their local health department (LHD) by telephone, even before laboratory confirmation.
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Substantial Rise in Coccidioidomycosis in California: Recommendations for California Healthcare Providers
CDPH/Health Advisory ā January 18, 2024āThe California Department of Health (CDPH) reminds healthcare providers to consider coccidioidomycosis in the differential diagnosis of community acquired pneumonia (CAP) or other respiratory illnesses in endemic or emerging areas. A total of 9280 cases of coccidioidomycosis (PDF) with illness onset dates in 2023 have been reported in California to date, which is higher than any other year on record, and is an increase that is likely to continue this winter due to heavy rainfall last winter after years of drought. Providers should maintain strong suspicion of pulmonary coccidioidomycosis in a patient with CAP who does not respond to an initial course of antibiotics, who has significant exposure to dust or dirt, or whose symptoms last more than 1ā2 weeks. Negative serology in a patient with compatible symptoms may not rule out the diagnosis, and culture and polymerase chain reaction (PCR) test, if available, should be considered in patients with severe disease. Healthcare providers in California should report cases to their local public health department.