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.

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.

Increase in Human Parvovirus B19 Activity in the United States

CDC/Health Advisory- August 13, 2024 – 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 2022–2024 to 10% in June 2024; the greatest increase was observed among children aged 5–9 years, from 15% during 2022–2024 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.

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) BACTEC™ 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) BACTEC™ 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 – 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 1– 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 ™ 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.

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), America’s 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.

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.

Meningococcal Disease Cases Linked to Travel to the Kingdom of Saudi Arabia (KSA): Ensure Pilgrims are Current on Meningococcal Vaccination

CDC/Health Advisory–May 20, 2024–The 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 14–19, 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 1–44 years, four cases were in adults aged 45–64 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.

Adverse Effects Linked to Counterfeit or Mishandled Botulinum Toxin Injections

CDC/Health Advisory–April 23, 2024 – 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 “Botox” 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.

Fatality from Lead Poisoning Linked to Use of Hemorrhoid Ointment from Vietnam

CDPH/Health Advisory–April 9, 2024 – 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 Bôi Trĩ Cây Thầu Dầu. 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.

Highly Pathogenic Avian Influenza A(H5N1) Virus: Identification of Human Infection and Recommendations for Investigations and Response

CDC/Health Advisory – April 5, 2024 – 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.

Increase in Invasive Serogroup Y Meningococcal Disease in the United States

CDC/Health Advisory – March 28, 2024 – 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 30–60 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 2017–2021. 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.

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 – March 18, 2024 – 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.

Extension of Long-Acting Benzathine Penicillin G (Bicillin® L-A) Shortage

CDPH/Health Advisory – March 18, 2024 – 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 (Bicillin® 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 Bicillin® L-A and Extencilline® 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. 

Immediate Respiratory Isolation Recommended for Persons with Suspected Measles

CDPH/Health Advisory – March 14, 2024 – 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 “3 Cs” (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.

Substantial Increase in Tuberculosis in California: Recommendations for California Healthcare Providers

CDPH/Health Advisory – February 26, 2024 – 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.

Fever and Rash? Consider Measles. Traveling Abroad? Protect against Measles.

CDPH/Health Advisory – February 2, 2024 – 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.

Substantial Rise in Coccidioidomycosis in California: Recommendations for California Healthcare Providers 

CDPH/Health Advisory – January 18, 2024–The 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 1–2 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.