Health Officer Monthly Newsletter for Orange County Clinicians
December 2024
December 17, 2024
Regina Chinsio-Kwong, DO County Health Officer
The holidays can be a stressful time for everyone, especially caregivers, health care workers, and clinicians! It is an important time for all of us to take steps for our personal wellness - this includes socially connecting by checking with one another, taking breaks, getting adequate rest, engaging in physical activity, practicing mindfulness, spending time with loved ones and much more. For anyone struggling, resources are available locally and across our state. Find out more at https://OCNavigator.org or www.mentalhealth.ca.gov.
Additionally, there are many resources to help providers care for families and children who need mental health care access. The California Child and Adolescent Mental Health Access Portal (Cal-MAP) offers timely access to no-consult consultation, education and resource navigation with psychiatrists, psychologists, and social workers for families and youth throughout California. Learn more at https://cal-map.org. As a provider, you can request new consults on the website or by calling (800) 253-2103. Additional resources, training and Continuing Medical Education is available on the website.
Families, teens and young adults can also access free resources and linkage to care through CalHOPE programs - BrightLife Kids and Soluna. Additionally, the California Department of Public Health (CDPH) Never a Bother website provides mental health resources for young adults.
Respiratory Virus Updates (RSV)
As of December 13, 2024, according to the Centers for Disease Control and Prevention (CDC), Flu, RSV and COVID cases are picking up across the nation. COVID-19 activity is beginning to increase, RSV activity is moderate and continues to increase in most areas of the United States.
In Orange County, COVID-19 percent positivity remains low while RSV and influenza test positivity continue to increase.
Link to California Department of Public Health (CDPH) Weekly Respiratory Virus Report
COVID Vaccine - research supporting updated vaccine efficacy: A recent research study published in JAMA revealed BNT162b2 (Pfizer-BioNTech) XBB vaccine effectiveness against COVID-19 associated hospitalization, Emergency Department or urgent care visits among children age 5-17, ranged from 63-73% during the 2023-24 season
Respiratory Virus Prevention
Encourage everyone to reduce risk of catching respiratory viruses like COVID-19, flu and RSV (and Measles) by:
- Stay up to date on vaccines
- Wear a mask in crowded spaces, like airports and planes
- Wash hands frequently
- Avoid travel and stay away from others when sick and seek medical care for guidance
- Monitor for symptoms after potential exposure
Communicable Disease Control Division Updates
Measles
Measles was confirmed in an infant who returned from travel outside of the country.
Press Release/Health Alerts issued December 5, 2024:
- Los Angeles: Public Health Confirms Measles Case in Los Angeles County
- Orange County: Measles Case in OC | Orange County California - Health Care Agency
- CD HEALTH ALERT: Measles in a Traveler in Orange County | Orange County CaliforniaHealth Care Agency
Whenever cases are confirmed locally, once our Communicable Disease Control Division (CDCD) is made aware, efforts are made to contact those potentially exposed. The HCA follows CDPH and CDC measles investigation and response which is summarized on the CDPH’s Measles Investigation Quicksheet
While we do our best to contact potentially exposed individuals, there are times where we may not be able to connect with the individual (voice mail, no returned call, etc.), or there may be others exposed we may not know about. This is why press releases may be shared to the broader community for awareness of public areas where exposure may have occurred. It is important to pay attention to dates/times and locations listed on a press release about potential exposure areas. If an at-risk individual was at those sites, it is important to talk about the options for Post Exposure Prophylaxis and the importance of following Public Health recommendations. On occasion, depending on the exposure risk, a person may be called by our team and advised to quarantine for the full 21 days from time of exposure.
What can you do to prepare your staff/clinic?
- Review CDPH resources
- Review the CDPH’s Measles Healthcare Exposure Investigation Quicksheet and Measles Investigation Quicksheet
- Inform families of travel risks and available vaccines to prevent illness
- *While Measles, Mumps, and Rubella (MMR) vaccines are recommended age 12-15 months and again at 4-6 years of age, infants age 6 months to 11 months who are travelling internationally are advised to receive an MMR vaccine
- Advise anyone planning to travel to also consider monitoring for symptoms upon their return
Resources:
Handouts/Factsheets: The CDC has created a helpful travel Fact Sheet (available in many different languages) about preventing measles before and after travel that can be shared with the community: Preventing Measles Before and After Travel Fact Sheet | Measles (Rubeola) | CDC.
Video: Consider playing CDC’s Get Vaccinated & Prevent Measles video in the waiting room.
Flyers: Consider posting informational flyers in the waiting area
-Preventing Measles Before and After Travel Fact Sheet | Measles (Rubeola) | CDC
-International Travel and MMR Vaccine Flyer for Providers | Measles (Rubeola) | CDC
-International Travel and Measles Infographic | Measles (Rubeola) | CDC
-CDPH resources
H5N1 Avian Influenza Updates
Bird Flu continues to be widespread across wild birds and continues to cause outbreaks in poultry and US dairy cows with increasing human cases in US dairy and poultry workers, and others with exposure to infected animals, including sick or dead birds (Canadian case, suspected Louisiana case). Additional cases have recently been identified in zoo animals. The CDC is watching this situation carefully and continues to conclude that the overall risk to the public remains low and maintains that there is no evidence of person to person spread at this time.
• On November 22, 2024, H5N1 was confirmed in a child in Alameda County, California who had no known contact with an infected animal. The CDC released a technical analysis of the genomic sequence data for this case demonstrating that this case was very similar to viruses detected in dairy cattle and poultry and that the virus in this case is not related to the virus that caused the severe illness in the Canadian teenager.
• H5N1 has been detected in raw milk produced by several raw milk distributors in California (CDPH Raw Farm Recall and CDFA Recall for raw milk)
1. The initial detection led the US Department of Agriculture’s (USDA) Animal and Plant Health Inspection Service (APHIS) issuing a New Federal order and the National Milk Testing Strategy (NMTS). The new federal order requires the following:
the sharing of raw milk samples, upon request, from any entity responsible for a dairy farm, bulk milk transporter, bulk milk transfer station, or dairy processing facility that sends or holds milk intended for pasteurization,
herd owners with positive cattle must provide epidemiological information that enables activities such as contact tracing and disease surveillance, and
private laboratories and state veterinarians must report positive results to the USDA that come from tests done on raw milk samples drawn as part of the NMTS.
2. Earlier this month, Marin County reported a suspected case of bird flu in a child who developed mild symptoms after consuming raw milk.
3. Los Angeles County Public Health Department is currently investigating 2 suspected avian flu illnesses in indoor pet cats that drank recalled raw milk.
• The CDPH released a Health Update to providers on December 6, 2024 advising to consider H5N1 in persons with acute respiratory symptoms and/or conjunctivitis and recent exposure to animals suspected or confirmed to have H5N1 OR recent consumption of raw dairy products.
• Influenza A activity is being monitored via wastewater across the nation. H5 wastewater detections in California continue to increase and have been detected in all California public health regions. The likely primary source for the high H5 levels in California is likely from dumped milk dairy products according to the CDPH.
The HCA’s CDCD continues to request that hospital and clinical laboratories in Orange County submit the first fifteen (15) 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 Orange County click here
Providers are advised to contact the HCA with any persons who have influenza-like illness and known history of exposure to H5N1-infected human cases, animal populations, or consumption of unpasteurized dairy 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
Webinars:
December 11, 2024 - American Medical Association: USDA milk testing, raw milk recall, plus new flu treatment study and the current COVID variant | AMA Update Video | AMA
News/media/articles:
Avian flu suspected in cats that drank raw milk as virus kills animals at Arizona zoo | CIDRAP Positive avian flu bulk-tank tests prompt another raw-milk recall in California | CIDRAP
Legionella Updates
Locally, we have seen an increase in Legionella cases in the past year, similar to national trends. Updates for community-level outbreaks can be found at https://www.ochealthinfo.com/legionella. A provider health alert was released to inform providers of an increase in cases in northwest Westminster. To date, no new cases have been identified in either of the communities that had outbreaks.
Simple measures everyone can follow to control the growth of Legionella in their home/community include:
- Monitor/maintain adequate disinfectant levels for pools and hot tubs even when not in use
- Maintain and frequently clean decorative fountains (automate disinfectant, clean, and disinfect if algae, biofilm, cloudy water, foul odor, or visible debris is present)
- Flush faucets and showerheads that have not been used for > 1 week before use
- Clean and maintain devices that use water (includes portable humidifiers, neti pots, etc.)
- Use only genuine windshield wiper when filling windshield wiper fluid tank for your vehicle
Helpful resources to help patients and communities learn more about Legionella and how to control the growth of Legionella in their homes and communities:
• General information: Legionnaires’ Disease Fact Sheet
• Legionnaires’ Disease Prevention Providing a Home for Guests, not Legionella
• Preventing Waterborne Germs at Home | Drinking Water | CDC
• Controlling Legionella in Hot Tubs | Control Legionella | CDC
• About Legionella Control | Controlling Legionella | CDC
• For Businesses: Preventing Legionella | Orange County California - Health Care Agency
Trichophyton Mentagrophytes Genotype VII identified in Orange County
On November 26, a CD Health Alert was issued to alert providers that a case of trichophyton mentagrophytes genotype VII (TMVII) was confirmed in Orange County. This fungus was first detected in the United States back in June 2024. Providers should have a high suspicion in patients presenting for inflammatory, painful, or persistent skin lesions affecting the genitals, buttocks, or face. The case that was confirmed in Orange County presented similar to what was reported in the CDC Morbidity and Mortality Weekly Report (MMWR) Notes from the Field article.
Empiric treatment should be initiated in TMVII suspected cases based on clinical presentation, such as in cases of topical treatment failure, highly inflammatory appearance, and anogenital lesions.
Diagnosis with KOH prep and fungal culture of skin scrapings should be attempted in all suspected cases. Fungal isolates should be submitted to select labs for genetic testing and species identification.
The CDC published an article in October to alert providers of this. Providers should consider this when evaluated dermatophyte infections noted in the truncal area. If suspected, appropriate testing/treatment should be given and further Sexually Transmitted Infections testing should be offered.
- CDPH Heath Advisory - Reports of Rare, Severe Dermatophyte Infections Associated with Sexual Contact in the United States 6/19/2024
- CDC MMWR - Notes from the Field: Trichophyton mentagrophytes Genotype VII — New York City, April–July 2024 MMWR Weekly / October 31, 2024 / 73(43);985–988
- American Academy of Dermatology - Trichophyton mentagrophytes genotype VII and other emerging dermatophytes of concern
For questions or concerns, providers can contact the HCA Communicable Disease Control Division at (714) 834-8180.
Mpox Clade I Updates
On November 15, the CDPH confirmed the first known case of clade I mpox (formerly known as monkeypox) in the United States in San Mateo County in northern California. This individual had recently traveled to a region in Africa where clade I mpox transmission has been occurring. There is no evidence currently that clade I mpox is spreading among persons in California or the United States. Clade II mpox, which was the cause of the mpox global outbreak in 2022, continues to cause local transmission at low levels throughout the United States, including Orange County. For more information see the CDC’s mpox page
Other Public Health News and Highlights
Rabies Infection Results in Death of a Fresno County Resident
CDPH Press Release: November 27, 2024: CDPH Reminds Public of Rabies Precautions Following Death of Fresno County Resident
As mentioned with previous newsletters, rabies disease continues to carry an approximate 99% mortality rate. It can be prevented by avoiding contact with animals that could harbor rabies, particularly bats, and to seek immediate care following recent potential contact/exposure. Many times, bat bites may go unnoticed, as bats leave little evidence of a puncture or wound! This is why it is important to seek immediate care if there is possible exposure (bite or penetration, contamination of wounds, abrasions including scratches) or other situations where saliva or infectious material comes into contact with mucous membranes or an open wound and to get guidance from the experts!
Report any bite or scratch caused by teeth from a domestic or wild animal to OC Animal Care at (714) 796-6421.
Report dead, sick or nesting bats immediately to OC Animal Care at (714) 935-6848 or go to OC Animal Care’s website to complete a bite reporting form at Report an Animal Bite | OC Animal Care
The HCA created a Bat Flyer available here: OC_Rabies_Bats_Flyer_2024_FINAL.pdf
CDPH RabiesBrochure.pdf Preventing Rabies from Bats | Rabies | CDC ACIP Recommendations: Rabies Vaccine | ACIP Recommendations | CDC
ALERTS/RECALLS
Lead Alerts
1. Cookware Products and Lead
The Food and Drug Administration (FDA) issued a letter to retailers and distributors of certain cookware products on December 12, 2024, to inform them that alloys used to make the cooking products could cause lead to leach into foods, creating the potential for elevated levels of lead in the blood. Several products have been identified with some distributed by Amazon, Etsy, Lowes and Walmart. You can see the FDA’s list of cookware here
2. Food Products and Lead - Cinnamon
On November 18, 2024, IHA Beverage of Commerce, California, recalled Super Cinnamon Powder because of elevated levels of lead The recalled product is packaged in a 4 oz plastic bag and labeled as Super Dried Cinnamon Powder 4 oz with UPC# 610232012476. Specifically, products showing Vitamin A and C on the nutrition facts label are affected. These packets of dried cinnamon were sold at retail stores in California, including in Orange County and a few stores across the US. More information about this recall is available on the FDA website. Images of the product are above.
The CDPH recommends the following:
• Raise awareness about these products.
• Advise patients/families to:
1. Avoid utilizing potentially contaminated products to prepare or store food.
2. Avoid eating, selling, or serving potentially contaminated food products.
3. Check their homes and discard these products if present.
4. Test children for lead exposure if children consumed foods contaminated with lead, or foods prepared or stored in contaminated products
Please help share this information with your families and clients and contact Orange County Childhood Lead Poisoning Prevention Program (CLPPP) at (714) 567-6220 if you have any questions or concerns.
For additional information and resources, please refer to the OC CLPPP website at: https://ochealthinfo.com/lead and CDPH website at: https://www.cdph.ca.gov/Programs/CCDPHP/DEODC/CLPPB/Pages/CLPPBhome.aspx.
Foodborne Illness - Multistate Outbreaks (https://www.cdc.gov/outbreaks/index.html)
1. Listeria Outbreak - Ready-to-Eat Meat Yu Shang Food, Inc.
Early November, the USDA recalled Yu Shang products due to a multistate listeria outbreak. As of December 5, 2024, the CDC identified 10 cases from California linked with the outbreak. The CDPH issued a Press Release December 11, 2024 urging consumers to not eat Yu Shang Food, Inc ready-to-eat meat and poultry products.
According to the CDC, as of December 5, 2024:
• 19 cases, 17 hospitalizations, 2 deaths - across 8 states (includes California which has had 10 reported cases to date) have been confirmed, Involving Yu Shang Food ready-to-eat meat and poultry products
• Recalled products include with “Yu Shang” (establishment number “P46684” or “EST.M46684”) on the label and all products produced prior to October 28, 2024
2. Cucumbers - Salmonella Outbreak
• 68 cases, 18 hospitalizations, 0 deaths, across 19 states (includes California)
• November 27 - SunFed Produce LLC - recalled all sizes of whole fresh American cucumbers grown by Agrotato, SA de CV in Sonora, Mexico that were sold between October 12, 2024 to November 26, 2024
3. Organic Carrots - E. coli Outbreak
• 39 cases, 15 hospitalizations, 1 death across 18 states (includes California)
• Grimmway Farms - recalled multiple sizes and brands of bagged organic baby and whole carrots with the latest best if used by date of 11/12/2024.
Orange County Community Health Improvement Plan
The Orange County Community Health Improvement Plan Workgroups are now meeting! Do you know of someone who is interested or who would benefit our community through engagement in these workgroups? Encourage them to get involved by contacting us at occhip@ochca.com
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, care navigation, and economic disparities. 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.
Training and Webinar Opportunities:
National Foundation for Infectious Diseases COVID-19 Updates and Best Practices - January 7, 2025
California Medical Association (CMA) Virtual Grand Grounds: Infectious Disease on the Rise: Updates on Winter Respiratory Viruses, Avian Flu, Mpox and More - January 14, 2025 at 12 noon
Previously recorded webinars
CDPH - Immunizing for Two+: Enhancing Maternal Protection and Vaccine Uptake (Recorded December 10, 2024) Recording Slides
CDC
Legionella Training available at: Legionella Training | Control Legionella | CDC
Clinical Overview of Measles: Diagnosis, Laboratory Testing, & Outbreak Response, June 2024
COCA 2023: We Must Maintain Measles Elimination in the United States: Measles Clinical Presentation, Diagnosis, and Prevention
COCA MPOX Update: Clinical Management and Outbreaks June 2024
Center for Infectious disease Research and Policy (CIDRAP) Osterholm Update Episode 172: A tunnel of Uncertainty December 5, 2024
National Emerging Special Pathogens Training and Education (NETEC) Dengue: A Rising Concern in Global Health Podcast December 4, 2024 Top 10 Takeaways from H5N1 Wastewater Monitoring Podcast November 22, 2024
The International Society for Neglected Tropical Diseases- Breaking Rabies Boundaries: World Rabies Day 2024 (global perspective of what is happening to treat/control rabies)
American Public Health Association Webinars
CMA Recorded Webinars Virtual Grand Rounds (cmadocs.org)
National Foundation for Infectious Disease Webinars https://www.nfid.org/educationevents/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.