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Health Alerts, Announcements & Advisories

Archived Health Alerts & Advisories - Current Water Quality Information

Post Date  Information
September 14, 2021
Public Health
Provider Advisory

Order for Licensed Healthcare Facilities to Implement a Mandatory Influenza Prevention Program for Health Care Workers

The Health Officer of Santa Cruz County has ordered that all licensed healthcare facilities and Emergency Medical Services (EMS) providers in Santa Cruz County implement a mandatory influenza vaccination program for the 2021-2022 influenza season. All the facility's Health Care Workers (HCWs) must receive an annual influenza vaccine or, if they decline, wear a mask while providing direct patient care or working in patient care areas during the influenza season.

Duration of Order:
For the purposes of this order, the influenza season is defined as October 31, 2021 to March 31, 2022. If influenza surveillance data suggest widespread influenza activity late in the spring, this order may be extended. Please note that this order will be reissued for the 2022-2023 influenza season.

9/14/2021 Public Health Provider Advisory

August 16, 2021
Public Health
Provider Advisory

FDA Approves Third Dose of Moderna and Pfizer COVID-19 Vaccine for Moderate to Severely Immunocompromised Individuals

Situational Update: On August 12, 2021, the U.S. Food and Drug Administration (FDA) amended the emergency use authorizations (EUAs) for both the Pfizer-BioNTech COVID-19 Vaccine and the Moderna COVID-19 Vaccine to allow for the use of an additional dose in certain immunocompromised individuals, specifically, solid organ transplant recipients or those who are diagnosed with conditions that are considered to have an equivalent level of immunocompromise. This action was taken because studies indicate that some immunocompromised people do not build the same level of immunity after vaccination. Additional small studies demonstrated that fully vaccinated immunocompromised individuals have accounted for a large proportion of hospitalized post-vaccination cases and that immunocompromised people are more likely to transmit the virus to household contacts.

The County of Santa Cruz Public Health Division recommends medical providers utilize the ACIP’s guidance for determining which of their patients may benefit from a third dose of Moderna or Pfizer vaccine. ACIP defined moderate to severe immunosuppression as:

  • Active treatment for solid tumor and hematologic malignancies
  • Receipt of solid-organ transplant and taking immunosuppressive therapy
  • Receipt of CAR-T-cell or hematopoietic stem cell transplant (within 2 years of transplantation or taking immunosuppression therapy)
  • Moderate or severe primary immunodeficiency (e.g., DiGeorge, Wiskott-Aldrich syndromes)
  • Advanced or untreated HIV infection
  • Active treatment with high-dose corticosteroids (i.e., ≥20mg prednisone or equivalent per day), alkylating agents, antimetabolites, transplant-related immunosuppressive drugs, cancer chemotherapeutic agents classified as severely immunosuppressive, TNF blockers, and other biologic agents that are immunosuppressive or immunomodulatory
  • Read More

8/16/2021 Public Health Provider Advisory

July 22, 2021
Public Health
Provider Advisory

Increase in Fatal Drug Overdoses from Fentanyl

Fentanyl is a powerful synthetic opioid that is 50 to 100 times more potent than morphine. Because of fentanyl’s high potency, it poses a greater risk for overdose. Non-prescribed fentanyl is being sold in counterfeit pressed pills, marketed as NorcoⓇ, PercocetⓇ, XanaxⓇ, and OxycontinⓇ. Fentanyl is also being sold as heroin in a powder form and has been found in methamphetamines, cocaine, and even illicit cannabis. California is one of 16 states with a greater than 50% increase in fatal overdoses involving synthetic opioids in a 12-month comparison (Health Alert Network Advisory).

Locally, fatal overdoses from fentanyl nearly quadrupled from 5 in 2019 to 19 in 2020 (May 2021 Santa Cruz Coroner Data). Local Coroner’s data indicates that fentanyl is co-occurring with many different substances as noted above.

ACTIONS REQUESTED OF HEALTHCARE PROVIDERS

Fentanyl Fact Sheet

April 26, 2021
Public Health
Provider Advisory

Multidrug-resistant Organisms found in Santa Cruz County Healthcare Facilities

Santa Cruz County Public Health is alerting healthcare providers of several cases of carbapenemase-producing carbapenem-resistant organisms (CP-CRO), which include carbapenemase-producing carbapenem-resistant Enterobacterales (CP-CRE). Carbapenemases are enzymes that inactivate carbapenems and other β-lactam antibiotics. About 30% of CRE carry a carbapenemase, with Klebsiella pneumoniae carbapenemase (KPC) being most common in the U.S. Another less common carbapenemase is New Delhi Metallo-beta-lactamase (NDM). Both NDM/KPC-producing Enterobacter cloacae and KPC-producing Citrobacter freundii, have been detected in local acute care facilities in our county in recent months. These are rare, drug-resistant organisms that have the potential to spread easily to other patients in healthcare settings. The California Department of Public Health (CDPH) recommends a coordinated approach among healthcare facilities and public health to contain CP-CRO in California. Read More

4/26/2021 Public Health Provider Advisory

March 26, 2021
Public Health
Provider Advisory

Wound Botulism (with history of injection drug use)
Recently, a wound botulism patient presented to a local emergency department with a history of injection drug use and symptoms suggestive of botulism (difficulty swallowing, blurred vision, and general weakness). Wound botulism was not considered in the differential diagnosis until 6 days after the initial assessment and the patient required prolonged intensive care treatment. The source of the botulism remains unknown and additional cases may occur. This is the second wound botulism case locally in recent months. Public Health asks that local health care providers be aware of the overall increase in reported wound botulism cases associated with injection drug use, including these local cases and several other clusters in California. Read More

 

March 11, 2021
Public Health
Provider Advisory
NEW CDC TREATMENT RECOMMENDATIONS FOR GONOCOCCAL INFECTIONS
Regimen for uncomplicated gonococcal infections of the cervix, urethra, rectum, and pharynx:
  • Ceftriaxone 500 mg IM as a single dose for persons weighing <150 kg (330 lb)11
  • If chlamydial infection has not been excluded, providers should treat for chlamydia with doxycycline 100 mg orally twice daily for 7 days.2
Alternative regimens for uncomplicated gonococcal infections of the cervix, urethra, or rectum if ceftriaxone is not available:
  • Gentamicin 240 mg IM as a single dose plus azithromycin 2 g orally as a single dose
    OR
  • Cefixime 800 mg orally as a single dose. If treating with cefixime, and chlamydial infection has not been excluded, providers should treat for chlamydia with doxycycline 100 mg orally twice daily for 7 days.2 No reliable alternative treatments are available for pharyngeal gonorrhea.
For persons with pharyngeal infection who have a history of a beta-lactam allergy, a thorough assessment of the reaction is recommended.
  • For persons with an anaphylactic or other severe reaction (e.g., Stevens Johnson syndrome) to ceftriaxone, consult an infectious disease specialist for a recommendation.
  • Read More

3/11/2021 Public Health Provider Advisory

March 8, 2021
Public Health Advisory

COVID-19 Screening and Testing for New Admissions
Santa Cruz County continues to experience outbreaks in most of our Skilled Nursing Facilities (SNF), assisted living/memory care, congregate living facilities and hospitals.

  • Residents being admitted to a congregate setting from acute care, transitional care, or another congregate setting are at particularly high risk for contracting COVID.
  • Despite most residents of congregate settings having been vaccinated with one or two doses, there is still the need for vigilant monitoring upon admission.
  • If the patient has not been vaccinated, vaccination should be offered upon admission.
  • New admits should be admitted to a welcome unit and monitored for 14 days with at least daily screening/temperature checks (every shift recommended).
  • Full PPE should be worn by staff when providing direct patient care to a new admit.
  • New admits should, when possible, have a private room.
  • Read More

3/8/2021 Public Health Advisory

Feb 23, 2021
Press Release

Covid 19 Vaccination of Seniors and Patients Being Discharged to Long Term Care Facilities
People age 65 and older and residents of long term care facilities are at the highest risk for severe morbidity and mortality from Covid-19 infection. Fortunately, the majority of our residents in these categories have been vaccinated with at least one dose of a Covid-19 vaccine and our hospitalization and death rates from Covid-19 are declining rapidly. It is imperative that we vaccinate the remaining unvaccinated individuals age 65 and older and those being discharged to long term care facilities to extend vaccine protection to these high-risk individuals to reduce the spread of Covid-19 to patients, other long term care facility residents and facility staff.

We are asking all acute care hospitals in Alameda, Contra Costa, Marin, Napa, San Francisco, San Mateo, Santa Clara, and Santa Cruz Counties to immediately institute protocols to offer Covid-19 vaccine to all unvaccinated patients age 65 and older before discharge to home as well as to all patients before discharge to a skilled nursing facility or other long term care facility. Read More

Feb 16, 2021
Press Release

MEDICAL RESERVE CORPS TURNS 16

On February 11th, the Santa Cruz County Medical Reserve Corps (MRC) celebrated 16 years since its founding in 2005. MRC units were established after the tragic terrorist events of 9/11, and the Anthrax attacks that followed. Medical and health professionals came together to organize, train and equip local volunteers to assist Public Health and the community in emergency preparedness and response to all-hazards incidents.

Santa Cruz County MRC volunteers have responded to numerous incidents including disease outbreaks catastrophic wildfires, floods, power outages and today’s COVID-19 pandemic. Throughout the past year, MRC volunteers have supported Public Health with COVID-19 contact tracing, case investigations, infection prevention, sheltering of persons experiencing homelessness, and the CZU Complex wildfire evacuation and shelters. As vaccine has become available, MRC volunteers have been on the frontlines vaccinating disabled home-bound elders and supporting mass vaccination clinics.  Read More

Jan 26, 2021
Public Health Advisory

Local Guidance Regarding Communal Activities from Health Officer
The California Department of Social Services (CDSS) and the California Department of Public Health (CDPH) have released guidance allowing communal dining and some group activities under very specific conditions. Dr. Newel does not recommend these due to current widespread community disease transmission.

COVID-19 is a new virus that is still being studied and is not yet well understood. New variants are circulating which make this virus more easily transmissible. We know it can survive both on surfaces, as well as in the air, therefore any activities that increase virus in the air or on surfaces by bringing groups of people together will increase the risk of transmission.

In addition, the Health Officer's Order regarding visitation at skilled nursing and residential healthcare facilities is still in effect.

Currently the County is in the Widespread/Purple Tier of the State’s Blueprint for a Safer Economy. The Health Officer's recommendations will remain in place until we reach the Red Tier at which point facilities may consider using the CDSS and CDPH guidance. Read More

Ongoing
Public Health Updates
Coronavirus (2019-nCoV) Information, Updates & Clinical Guidance
Sept. 14, 2020
Public Health
Advisory

Order for Licensed Healthcare Facilities to Implement a Mandatory Influenza Prevention Program for Health Care Workers

The Centers for Disease Control estimates that in the US as many as 62,000 people died of influenza during the 2019/2020 flu season and up to 740,000 were hospitalized. Health Care Workers (HCWs) are both at risk for influenza and can transmit the virus to their vulnerable
patients. Influenza vaccination of HCWs protects medically fragile patients and reduces employee absenteeism during influenza season.

State law requires that acute care hospitals and certain employers offer influenza vaccinations to employees or have the employee sign a declination statement if they choose not to be vaccinated. While compliance to these existing laws is high, actual HCW vaccination rates are not and may be below that which will blunt the spread of infection in a health care setting. Mandatory vaccination with masking policies have been shown to increase HCW vaccination rates to above 90%. Read More

Jan 6, 2020
Public Health Advisory Update

Ongoing: Local Shigellosis case cluster among persons experiencing homelessness; test & report all symptomatic patients

Current Situation:
Between December 31st, 2019, and January 2, 2020, a cluster of 3 confirmed Shigella sonnei cases have been identified at local Emergency Departments among persons experiencing homelessness. All providers should test and report any individual presenting with symptoms described below.

Between June 1st, 2019 – January 2, 2020, 34 confirmed Shigella sonnei and Shigella unspecified cases were identified in an outbreak in Santa Cruz County (more than twice the average rate). Most diagnosed Santa Cruz County cases (68%) sought medical care at an emergency department, and 41% of all cases required hospitalization.
Fifty percent of the recent cases reported experiencing homelessness. Men who have sex with men are at an elevated risk for Shigellosis. Local Shigella sonnei cases continue to exist in the general population, as well.

Shigellosis is a diarrheal illness caused by the highly infectious Shigella bacteria, and infected persons can shed up to four weeks after illness. Infections can be subclinical or self-limiting. Typical symptoms last 5-7 days and include watery or bloody diarrhea, abdominal pain, fever, and malaise. Read More

Jan 6, 2020
Public Health Advisory Update

UPDATE: E-cigarette, or Vaping, Product Use-Associated Lung Injury (EVALI)

The outbreak of E-cigarette, or Vaping, Product Use-Associated Lung Injury (EVALI) has continued in California and nationwide. CDPH urges local health departments to continue reporting new or suspected cases through the identified channels currently in place.

In light of new findings that at least 25% of hospital readmissions and deaths from EVALI occur within two days of hospital discharge, CDC now recommends more stringent follow-up plans than in prior clinical guidance documents:

  • Within 48 hours of hospital discharge, all patients diagnosed with EVALI should see a primary care provider or pulmonologist in an outpatient follow-up appointment.
  • During hospitalization and follow-up, EVALI patients should be offered support for cessation of e-cigarette, or vaping use.
  • Prior to hospital discharge, EVALI patients should be clinically stable for 24-48 hours.
Ongoing Ticks and Tick-Borne Diseases

Spring is a time of high tick activity in our coastal hills and residents should be aware when spending time outdoors. Santa Cruz County Mosquito and Vector Control (SCCMVC) staff and the California Department of Public Health (CDPH) collaborate to collect and test ticks in the County. At least 2% of Western black-legged ticks (Ixodes pacificus) tested in recent years contain the bacteria that can cause Lyme disease. In 2013, there were 5 reported cases of Lyme disease in Santa Cruz County, about the annual average (1.66 cases per 100,000 people).

The western black legged tick (Ixodes pacificus) and other human biting ticks found in Santa Cruz County such as the Pacific Coast tick (Dermacentor occidentalis) may carry other tick-borne diseases. Thus, SCCMVC plans to conduct surveys for these tick species and will submit them to the CDPH for testing. Because of tick-borne disease risk, residents are advised to take precautions to protect themselves from tick bites.

The tick starts out as an egg then matures into a larva, nymph and adult stage over several years. The nymph life stage is active in spring and summer, and is found on tree trunks, fallen logs, wooden benches and in leaf litter and feed on smaller animals, but they will also attach to people and pets. Adult ticks are active in fall when they climb to the tips of vegetation, often alongside trails or paths, and attach themselves to hosts, such as deer, pets or humans that brush against them.

Ticks feed by sticking their mouthparts into the skin of their host and sucking blood. Infections such as Lyme disease may be transmitted when the feeding tick is attached for at least a day. Immature ticks are about the size of a pinhead, and may be missed without careful examination.

The risk of being bitten by ticks may be reduced with the following precautions:

  • Wear long pants and long-sleeved shirts. Tuck pant legs into boots or socks and tuck shirts into pants.
  • Wear light-colored clothing so ticks can be easily seen.
  • Use a repellent registered for use against ticks; always follow label directions.
  • Stay in the middle of a trail and avoid logs, tree trunks, trail margins, brush and grassy areas.
  • Inspect yourself frequently while in tick habitat. Once out of tick habitat, thoroughly check your entire body and pets. Parents should examine their children, especially on the scalp and hairline.
  • Shower and launder clothes soon after activity in tick habitat.

To reduce the possibility of infection, remove attached ticks as soon as possible. Gently and firmly grasp the tick close to the head and pull it straight out, preferably with a tick tool or with fine-pointed tweezers. Save the tick for identification. Ticks should be kept alive by placing the tick into a sealable bag or container with a moist cotton ball in a refrigerator or cooler. The person removing the tick should wash their hands before and after removal and apply antiseptic to the bite area. Insecticides, Vaseline, lighted matches or gasoline should not be used to remove ticks because these techniques are ineffective or unsafe. Anyone who develops symptoms after being bitten by a tick should consult his or her physician.

Painful redness that occurs less than 24 hours after a tick bite and does not expand is likely a local allergic reaction to the tick bite. Early Lyme disease also has a rash but the Lyme disease rash appears three to 30 days after the tick bite, is often painless, and spreads to greater than 5 cm in diameter. The spreading rash can be accompanied by flu like symptoms, such as fever and body aches. Lyme disease is treated with antibiotics and most patients recover without complications, particularly when the disease is diagnosed early. If left untreated, Lyme disease can progress to arthritis and in some cases serious nervous system problems.

Individuals should consult their physician immediately if symptoms similar to those described for Lyme disease develop within one to several weeks after being bitten by a tick.

Click here to view the media release

Prevent Tick Bite - Pamphlet provided by CDPH

Additional information on Lyme disease and other tick-borne diseases

Archived Health Alerts & Advisories