Health Officer Monthly Newsletter for Orange County Clinicians
November 2024
November 20, 2024
Regina Chinsio-Kwong, DO County Health Officer
A Month of Gratitude
As we near the end of November, I want to extend my gratitude for your dedication to our community’s health and well-being. According to the 2022 census, Orange County (OC) is the third most populous county in California, behind Los Angeles and San Diego, OC is the sixth most populous county in the United States and is more populous than 19 American states and Washington D.C. We have 34 hospitals, 24 that are Emergency Receiving Centers, 4 trauma centers, and hundreds of clinics serving nearly 3.15 million residents. This month, as we navigate challenges and opportunities ahead, our focus remains on strengthening collaboration and enhancing quality of care for all. In this edition, you’ll find updates on recent public health initiatives, best practices for patient engagement, and resources to support you in addressing seasonal health needs. Thank you for your continued commitment and partnership as we work together to create a healthier future for our shared communities.
Respiratory Virus Updates (RSV)
RSV activity is starting to increase in California, while COVID-19 and influenza activity are currently low (see graph for OC).
According to the Centers for Disease Control & Prevention (CDC), other respiratory infections are on the rise - including pertussis and mycoplasma pneumonia. According to the CDC, mycoplasma pneumonia increased from 1.0% to 7.2% among children age 2-4 years and from 3.6% to 7.4% among children age 5-17 from March 31 to October 5, 2024.
For additional RSV information in California: Weekly Respiratory Virus Report.
Vaccine Updates:
• CDC updated vaccine recommendations following the American Committee on Immunization Practices (ACIP) meeting in October:
Pneumococcal Vaccines
A pneumococcal conjugate vaccine (PCV) is recommended for all PCV-naïve adults aged ≥50 years
COVID-19 Vaccines
In addition to previously recommended 2024-2025 vaccination:
• A second dose* of 2024-2025 COVID-19 is recommended for adults age 65 years and older
• A second dose** of 2024-2025 COVID-19 vaccine is recommended for people age 6 months-64 years who are moderately or severely immunocompromised
• Additional doses (i.e., 3 or more doses) of 2024-2025 COVID-19 vaccine is recommended for people age 6 months and older who are moderately or severely immunocompromised under shared clinical decision-making
*If previously unvaccinated and receiving Novavax, two doses are recommended as initial vaccination series followed by a third dose of any age-appropriate 2024-2025 COVID-19 vaccine 6 months (minimum interval 2 months) after second dose
**If previously unvaccinated or receiving initial vaccination series, at least two doses of 20242025 vaccine are recommended, and depending on vaccination history more may be needed. This additional 2024-2025 vaccine dose is recommended 6 months (minimum interval 2 months) after completion of initial vaccination series.
Meningococcal Vaccines
• MenB-4C (Bexsero®) is recommended as a two-dose series at 0 and 6 months when given to healthy adolescents and young adults age 16–23 years based on shared clinical decision-making for the prevention of serogroup B meningococcal disease
• MenB-4C (Bexsero®) is recommended as a three-dose series at 0, 1–2, and 6 months when given to persons age ≥10 years at increased risk for serogroup B meningococcal disease (i.e., persons with anatomic or functional asplenia, complement component deficiencies, or complement inhibitor use; microbiologists routinely exposed to N. meningitidis isolates; and persons at increased risk during an outbreak)
Recent publications related to vaccines:
Nationally, vaccination coverage among US kindergarteners declined for all reported vaccines during the 2023-2024 school year (Vaccination Coverage and Exemptions among Kindergartners | SchoolVaxView | CDC)
- Rates ranging from 92.3% for DTaP (Diphtheria, Tetanus, Pertussis) to 92.7% for MMR (Measles, Mumps and Rubella)
- Coverage for MMR, DTaP, polio and varicella vaccines dropped in over 30 states compared to the previous year
- The number of kindergartners attending school without documentation completing the MMR vaccine series was about 280,000 during the 2023-2024 school year
- Vaccine exemptions increased nationally from 3% in 2022-23 to 3.3% in 2023-24, with exemptions exceeding 5% in 14 states
- While California exemptions reduced from the previous year
Influenza and Underutilization of Antiviral Treatment for Influenza:
A new CDC-led study, Underutilization of Influenza Antiviral Treatment Among Children and Adolescents at Higher Risk for Influenza-Associated Complications — United States, 2023–2024 | MMWR, published in CDC MMWR (Morbidity and Mortality Weekly Report)
November 14, 2024 found that fewer children and teens hospitalized with flu were prescribed antiviral treatment in 2023-24 compared to 2017-2018. With respiratory virus season underway, all hospitalized children and adolescents and those at higher risk for influenza complications who are seen in outpatient settings with suspected influenza should receive antivirals as soon as possible to reduce the risk for influenza complications.
Respiratory Syncytial Virus (RSV) - Nirsevimab Efficacy in Alaska Native Infants
A recent study published in the CDC’s MMWR November 14, 2024 estimates that Nirsevimab (Beyfortus) was 89% effective against infant hospitalization in Alaska for RSV. The findings support current CDC recommendations
Helpful links/infographics:
CDPH, CDC, California Immunization Coalition 2024-2024 Fall-Winter Immunization Guide English, Spanish Vaccines & Immunizations | Vaccines & Immunizations | CDC
https://www.cdph.ca.gov/Programs/OPA/Pages/Communications-Toolkits/Respiratory-VirusPrevention.aspx
https://www.cdc.gov/respiratory-viruses/guidance/index.html Plan for Travel | Measles (Rubeola) | CDC, travel-infographic.jpg (580×580), Travel infographic 2
Communicable Disease Control Division (CDCD) Updates
H5N1 Avian Influenza Updates
• California recently identified a possible bird flu case in a child in Alameda County who presented with mild upper respiratory symptoms and who had no known contact with an infected animal. The child has been treated and is recovering at home. The California Department of Public Health (CDPH) issued this press release on the case.
• New outbreaks of H5N1 continue to occur in California dairy cow farms. Prior to the most recent case, over 25 human cases reported in the state were amongst persons in persons with close contact with infected dairy cows at dairy farms.
• No human cases have been identified in Orange County.
• CDCD requests that hospital and clinical laboratories in Orange County submit the first fifteen influenza-positive nasopharyngeal specimens each month to the Orange County Public Health Laboratory for subtyping and possible strain typing None have tested positive for H5N1 thus far. For information on submitting influenza specimens in OC click here
• Providers are recommended to contact public health with any persons who have influenza-like illness and known history of exposure to H5N1-infected human cases or animal populations. The HCA can work with the provider to facilitate testing of the patient. You can email epi@ochca.com or call (714) 834-8180. Additional information on the California situation can be found here.
On November 7, 2024, the CDC released a new MMWR, featuring the following:
• Personal Protective Equipment Use by Dairy Farmworkers Exposed to Cows Infected with Highly Pathogenic Avian Influenza A(H5N1) Viruses — Colorado, 2024
• Serologic Evidence of Recent Infection with Highly Pathogenic Avian Influenza A(H5) Virus Among Dairy Workers — Michigan and Colorado, June–August 2024
The CDC also updated its guidelines for employers and workers:
• CDC Expands Guidance to Better Protect Farm Workers and Livestock Owners to Lower the Risk of Becoming infected with Bird Flu
• Information for Employers Providing Personal Protective Equipment to Reduce Exposure to Novel Influenza A
• Interim Guidance for Employers to Reduce Exposure to Novel Influenza A (Such as H5N1 Bird Flu) for People Working with or Exposed to Animals
• Information for Workers Exposed to H5N1 Bird Flu
• Highly Pathogenic Avian Influenza A(H5N1) Virus: Interim Recommendations for Prevention, Monitoring, and Public Health Investigations
Mycoplasma
Mycoplasma pneumoniae is a common case of pneumonia in children. Similar to the rest of the country, Orange County has seen an increase in M. pneumoniae infections in recent
months. The CDC reports that young children have particularly been affected. National surveillance has found antibiotic-resistant M. pneumoniae to be rare, and macrolides such as azithromycin remain the treatment of choice. Providers should consider using a secondline antibiotic regimen, such as fluoroquinolones or tetracyclines, to treat patients with suspected or confirmed M. pneumoniae infection who aren't improving on macrolides.
Legionella
Locally, more legionella cases have been confirmed in the past year. The HCA issued a press release you can read here. Updates for community-level outbreaks can be found at https://www.ochealthinfo.com/legionella. A provider alert was released to inform providers of an increase in cases (7 confirmed cases in last 4 weeks) in northwestern Westminster. Sign up to receive our Provider Advisories by clicking here
Providers should:
• Consider testing for Legionnaires’ disease in any patient who develops pneumonia and lives in, works in, or has spent significant time in the mapped area within 14 days of symptom onset.
• What to test:
• Urine Antigen Testing AND
• Sputum PCR when the test is available (as this can help identify community sources linked to the incident).
• The urine antigen testing only identifies L. pneumophila serogroup 1, not other serogroups - hence whole genome sequencing performed on positive specimens can be utilized to identify sources.
• Report any suspect or confirmed case of Legionnaires’ disease immediately to Orange County Public Health at (714) 834-8180 (after hours call (714) 628-7008 to speak to the On-Call provider)
Testing for legionellosis should be considered particularly in patients who have failed outpatient antibiotic therapy for community-acquired pneumonia and patients with severe pneumonia, such as those requiring intensive care.
During a disease outbreak investigation:
HCA Environmental Health (EH) and Communicable Disease Control Divisions (CDCD) conduct a joint investigation to identify potential community sources. Potential sources of Legionella such as cooling towers or swimming pools are assessed for their water management plans, with environmental testing performed as appropriate. The HCA follows up with each facility with findings from their investigation.
Common Sources of Legionella include:
- Cooling towers, hot tubs, household showers, and decorative fountains
Learn more:
General Fact Sheet | Legionella | CDC
Clinical Guidance for Legionella Infections | Legionella | CDC
CDC Discoveries Legionnaires' Disease
CDC Controlling Legionella
Preventing Waterborne Germs at Home | Drinking Water | CDC
Dengue
As we move through November, and mosquito counts lower in the community, local transmission of dengue becomes less likely. However, international travel will continue, and levels of dengue in Mexico and other countries remains extremely high. Providers should continue to consider dengue in patients who present with appropriate symptoms, particularly with a history of international travel. Additional information can be found here.
Mpox Clade I
On November 16, California confirmed the first Clade I Mpox Case in the United States (CDPH, CDC). The case was diagnosed in a person who resides in Northern California and developed symptoms after returning from travel to Eastern Africa. The individual is recovering in isolation at home. Results for additional viral characterization is pending. Travel associated cases of subclade Ib have been reported in other countries outside of Africa. The CDC anticipates that the overall risk of clade I mpox to the general population in the US from the outbreak experienced in Central and Eastern Africa remains low.
On November 19, a California Health Alert Network notification was sent out to summarize California specific guidance on mpox management.
The CDC maintains that 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 international 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.
Other Public Health News and highlights
Black Infant Health Program Launches in Orange County
In the US and OC, Black mothers have higher rates of severe maternal morbidity and Black infants have higher rates of preterm birth and low birthweight than their non-Hispanic White counterparts. These disparities often persist despite socioeconomic class and education. A recent report by the CDPH (Centering Black Mothers in California) provides insights as to how maternal and infant health are affected by structural racism, chronic stress, and lack of access to high quality, respectful health care.
The HCA has been collaborating with other county and community partners to address these disparities and is excited to announce that Orange County is launching a Black Infant Health (BIH) program BIH aims to improve health among Black mothers and babies by empowering pregnant and mothering Black women to make healthy choices for a brighter future. The BIH group model is a promising strategy for improving Black birth outcomes. Services are provided within a safe, culturally affirming group environment or a nurturing one-on-one setting. BIH participants report enhanced life skills and reduced stress; greater feelings of personal empowerment, leading to healthy behavior changes; and strong social support, including positive connections to their heritage and the Black women in their community.
The OC BIH program is enrolling now. Black women (16 years or older), who are pregnant or parenting (up to six months postpartum), regardless of income, are invited to enroll. Services are provided at no charge. The OC BIH program is a collaboration between the HCA, First 5, and Breastfeed LA.
For more information, or to enroll a client, call HCA Public Health Nursing (714) 834-7747 or email PublicHealthNursing@ochca.com and specify the referral is for BIH.
Alerts/Recalls
CDC warns of new E. coli outbreak linked to organic carrots | CDC Newsroom November 17, 2024
• CDC posted a Food Safety Alert regarding a multi-state outbreak linked to organic carrots sold by Grimmway Farms with best if used by dates ranging from 9/11/2024 to 11/12/2024.
• Brands include 365, Bunny Luv, Cal-Organic, Compliments, Full Circle, Good & Gather, GreenWise, Marketside, Nature's Promise, OOrganic, President's Choice, Simple Truth, Trader Joe's, Wegmans, Wholesome Pantry.
• As of November 17, the outbreak has resulted in 39 illnesses across 18 states, with 15 hospitalized and 1 death.
• People who are experiencing E. coli symptoms including diarrhea and fever, vomiting, or dehydration are advised to seek medical attention.
• Items purchased should be thrown away or returned to the store of purchase. Additionally, households/businesses should wash and sanitize items and surfaces that may have touched the recalled organic carrots.
Orange County Community Health Improvement Plan
The HCA has published the Orange County Community Health Improvement Plan (OC CHIP) Plan update for 2024-26. The community identified six priority areas to focus efforts in: mental health, substance use, diabetes/obesity, housing/homelessness, economic disparities, and care navigation. Workgroups in each area are currently forming. If you would like to join us or learn more, please email us at occhip@ochca.com. To access the OC CHIP plan please visit OC Health Improvement Plan | Orange County California - Health Care Agency
Awareness Month/ Observances
November
The Great Smoke Out - November 21
The Great American Smokeout (GASO) was started by the American Cancer Society in the 1970’s to encourage individuals to quit smoking (Great American Smokeout). According to research, “Even when doctors provide brief simple advice about quitting smoking, this increases the likelihood that someone who smokes will successfully quit” (Physician advice). Health care providers can help their patients quit this November 21 by using the “Ask, Advise, Refer” model:
1) Ask about tobacco use
2) Advise to quit
3) and Refer to cessation (AAR)
The US Surgeon General released a new report “Eliminating Tobacco-Related Disease and Death, Addressing Health Disparities” noting that while cigarette smoking has declined by more than 50% among US adults since 1965, disparities exist because of a variety of factors including poverty, discrimination, social determinants of health, financial obstacles in accessing treatment and gaps in tobacco prevention and control protections.
In Orange County, health care providers can refer to 1-866-NEW-LUNG, funded by the HCA.
NEW LUNG offers free help over the phone, virtually, and in person. Adults 18 and older can receive nicotine patches. Adult cessation services are in English, Spanish, Vietnamese, Korean, and Farsi. For more information, visit https://www.1866newlung.com/.
Lung Cancer Awareness Month
Cancer is the second leading cause of death in the US, exceeded only by heart disease, with one of every five deaths in the US being due to cancer. In 2022, in the US, 131,888 people died of lung cancer which is the leading cause of cancer death in the US. Smoking is the leading cause of lung cancer and while smoking rates have declined, it remains a significant risk factor especially with the rise in vaping, or use of e-cigarettes; more than 2.5 million youth reported E-cigarette use in 2022 (Reference). To combat this, California enacted the “flavor ban” which prohibits retailers from selling flavored tobacco products; the law was strengthened in January 2024 with increased efforts on enforcement (learn more about the law here). HCA Public Health Services offers free tobacco cessation counseling and services, such as nicotine replacement therapy, through 1-866-NEW-LUNG and the Anaheim Regional Medical Center.
Recordings for CME/CE Credit: UCSF Smoking Cessation Leadership Center
· Free Cessation Services:
o Kick-It California: Provider Referral for Quit Services
o 1-866-NEW-LUNG: Orange County services
Even though rates of lung cancer in the US have declined overall, rates among Asian American women have increased by 2% each year. Nonsmoking Asian American women are twice as likely to be diagnosed with lung cancer compared to their White nonsmoking counterparts. While only about 20% of people with lung cancer in the US never smoked, the percentage of nonsmokers is 57% among Asian American women with lung cancer and 80% to 90% for Chinese and Indian American women with lung cancer. There are currently no screening guidelines for nonsmokers, but studies are underway looking at additional risk factors to help clinicians determine who should be screened.
US Antibiotic Awareness Week (USAAW) - November 18-24
The CDC’s theme this year is “Fighting Antimicrobial Resistance Takes All of Us” and utilizing a One Health approach is proving to be an important model in addressing challenges that impact all of us. This year, many different events (Wildfires, Dengue, Bird Flu, etc.) have pointed to highlighting the connection of human health, animals, and plants and our shared environment. A toolkit has been created to help easily share the message and to educate the community
American Diabetes Month
November is American Diabetes Month, a time to raise awareness about the growing prevalence of diabetes and the crucial role health providers play in managing and curbing this disease. Diabetes can lead to serious complications, therefore regular screening, especially for at-risk populations is essential in identifying patients who are prediabetic, where lifestyle interventions can be most effective. In 2021, approximately 8.4% of adults have diabetes in Orange County and 58.1% of residents are considered overweight or obese; concerningly, this number is also high among 5th grade students with approximately 36.6% who are overweight or obese (Reference). To address the epidemic in Orange County, diabetes and obesity have been selected as priority issues in the Community Health Improvement Plan (CHIP) 20242026. Click HERE to learn more about this effort.
American Diabetes Association Standards of Care in Diabetes 2024
· Improving health outcomes of people with diabetes: target setting for the WHO Global Diabetes Compact
· Patient Education Poster: How to Prevent Type 2 Diabetes CDPH Diabetes Prevention and Awareness Resources
Prematurity Awareness Month
Preterm birth (<37 weeks of gestation) is associated with short and long term health, neurologic, cognitive, and behavioral consequences. Although the percentage of births that are premature in Orange County is lower than that in California and the United States, and lower than the Healthy People 2030 goal (9.4%), it has steadily been increasing since 2017 and there are marked racial and ethnic disparities. In 2022, 8.8% of the births overall in Orange County were premature, while 11.8% of Black infants and 9.7% of Hispanic infants were born premature. The percent of preterm births decreased in Asians and Whites between 2021 and 2022 but increased in Blacks and Hispanics. Mothers older than age 40 years had the highest percentage of preterm births (13.2%) while 15-19 year olds and 30-34 year olds had the lowest (8.1%). Using the March of Dimes grading criteria for preterm birth rate, Orange County overall would have had an A in 2022. However, marked geographic disparities can be noted by the Orange County cities with large numbers of live births in 2022
that were included on the report [Irvine (7.1% preterm; A), Santa Ana (10.0%); C), and Anaheim (10.5%; D+)].
Clinicians caring for pregnant persons and women of childbearing age can help reduce the risk of preterm birth by treating chronic health conditions and mental health disorders, screening for and treating sexually transmitted infections, ensuring patients keep their prenatal care appointments, encouraging cessation of smoking, alcohol and substance use during pregnancy, and providing referrals for community supports to reduce socioeconomic and psychosocial stressors. November is a time to raise awareness about preventable causes of preterm birth and improve outcomes for all moms and babies in Orange County.
• 2023 March of Dimes Report Card
National Family Caregivers Month
National Family Caregivers Month recognizes the rising number of older adults and residents requiring care beyond health care professionals in the community. Families are commonly relied upon as a primary source to support those with disabilities. This month is a great time to celebrate, raise awareness and educate communities to increase support for caregivers. OCNavigator.org provides a range of resources that can be accessed by the community and caregivers.
Training and Webinar Opportunities:
CDPH Vaccines for Children Afternoon TEAch WebinarWhat’s New with Winter Respiratory Viruses
December 5, 2024 at 12 p.m. PT
CDPH Vaccines for Adults WebinarLooking Ahead: 2025 Recertification Essentials, Program Updates and ACIP Updates
December 11, 2024 at 12 p.m. PT
White Faces, Black and Brown Lives: Racial Disparities in the Overdose CrisisWhite Faces, Black and Brown Lives: Racial Disparities in the OD Crisis Tickets, Tue, Nov 19, 2024 at 4:30 PM | Eventbrite
November 19, 2024 at 1:30 p.m. PT
Previously recorded webinars -
CDC- Legionella Training available at: Legionella Training | Control Legionella | CDC
CMA Resources: Virtual Grand Rounds (cmadocs.org) - Recorded Webinar Videos California Health Alert Network
2024 Webinar Series - Indicators of Climate Change: Bridging Science and Action Indicators of Climate Change: Bridging Science and Action | OEHHA
National Foundation for Infectious Disease Webinars: https://www.nfid.org/education-events/webinars/
Infectious Disease Society of America Public Health Page: Public Health (idsociety.org)
World Health Organization Webinars: https://www.who.int/teams/epi-win/epi-win-webinars
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Clinicians are encouraged to subscribe to the OC Health Care Agency’s Provider Advisory list to receive immediate notification of communicable disease related alerts. Providers can be added to our email list by signing up at this link: Provider Advisory Email Advisory.