Health Alerts, Announcements & Advisories

Outbreak of Ebola Virus Disease in Central Uganda

The California Department of Public Health (CDPH), in collaboration with the U.S. Centers for Disease Control and Prevention (CDC), has been closely monitoring an outbreak of Ebola virus disease (EVD) due to Sudan virus (species Sudan ebolavirus) in Central Uganda. Beginning the week of October 10, 2022, the CDC and Department of Homeland Security began funneling air passengers traveling to the U.S. who have been in Uganda in the three weeks prior to travel to the U.S. through five predesignated airports in the U.S. for EVD screening. Passengers traveling from Uganda who are asymptomatic continue on to their destinations. Local health departments are conducting risk assessments and monitoring returning travelers upon arrival at their destinations. Read More

• Public Health Advisory 11/10/22: Outbreak of Ebola Virus Disease in Central Uganda

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

The Centers for Disease Control and Prevention (CDC) data from October 4, 2021, through April 30, 2022 showed that flu vaccines reduced people’s risk of mild to moderate flu illness by 35% overall. Flu vaccination has been shown in several studies to reduce severity of illness in people who get vaccinated but still get sick, reducing the risk of serious outcomes like hospitalization and death.

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

• Public Health Advisory 9/9/22: Order for Licensed Healthcare Facilities to Implement a Mandatory Influenza Prevention Program for Health Care Workers (HCWs)

UPDATE on COVID-19 Boosters

Following recent approval by the FDA and CDC, the Western States Scientific Safety Review Workgroup recommends either the Pfizer or Moderna bivalent mRNA booster to be given at least 2 months after the primary series or the last booster dose. The Moderna bivalent mRNA vaccine is authorized for use as a single booster dose in individuals 18 years of age and older and the Pfizer bivalent mRNA booster is authorized for use as a single booster dose in individuals 12 years of age and older. The bivalent mRNA vaccines provide superior, up to date, protection against the original strain of SARS-CoV-2 and the current circulating omicron variants BA.4 and BA.5. Read More

• 9/8/2022: Public Health Advisory

BIVALENT COVID-19 BOOSTERS NOW AVAILABLE IN SANTA CRUZ COUNTY

Following recent approval by the FDA and CDC, the Western States Scientific Safety Review Workgroup also recommends either the Pfizer or Moderna bivalent booster to be given 2 months after the primary series or the last booster dose. The Moderna bivalent vaccine is authorized for use as a single booster dose in individuals 18 years of age and older and the Pfizer bivalent booster is authorized for use as a single booster dose in individuals 12 years of age and older. The bivalent vaccines provide superior, up to date, protection against the original strain of SARS-CoV-2 and the current circulating omicron variants BA.4 and BA.5.

“Updating our booster vaccines to combat the circulating variants marks our transition to living with COVID,” said Dr. David Ghilarducci, Deputy Health Officer for the County of Santa Cruz. “The COVID-19 virus continues to change and adapt and so must we. Staying up to date on your COVID vaccinations continues to be the best way to protect yourself and your loved ones.”

Those wanting to receive their bivalent booster vaccine should contact their healthcare provider or book an appointment through MyTurn, Vaccine Finder or local pharmacies. Click here or a list of healthcare providers giving COVID-19 vaccine in Santa Cruz County.

The monovalent mRNA COVID-19 vaccines are no longer authorized as booster doses for individuals 12 years of age and older. Staying up to date on vaccination with the recommended boosters remains the best way to prevent hospitalization and death from COVID-19, including for young children.

Click here for local information about COVID or call (831) 454-4242 between the hours of 8 a.m. and 5 p.m., Monday through Friday

9/7/2022: Public Health Press Release: English Spanish

Information on Prescribing Narcan® (naloxone)

Over the past 15 years, individuals, families, and communities across our Nation have been tragically affected by the opioid epidemic, with a growing number of overdose deaths from prescription and illicit opioids. Locally, accidental deaths due to opioids have more than doubled from 17 in 2017 to 41 in 2020. This steep increase is attributed to the rapid proliferation of illicitly made fentanyl and other highly potent synthetic opioids. These highly potent opioids are being mixed with heroin, sold alone as super-potent heroin, pressed into counterfeit tablets to look like commonly misused prescription opioids or sedatives (e.g., Xanax), and being mixed (often unknowingly) with other illicit drugs like cocaine or methamphetamine. The resulting unpredictability in illegal drug products is dramatically increasing the risk of a fatal overdose. Another contributing factor to the rise in opioid overdose deaths is an increasing number of individuals receiving higher doses of prescription opioids for long-term management of chronic pain. Even when taking their pain medications as prescribed, these patients are at increased risk of accidental overdose as well as drug-alcohol or drug-drug interactions with sedating medications, such as benzodiazepines (anxiety or sleep medications). Read More

• 6/15/2022: Public Health Advisory
• Increase in Fatal Drug Overdoses Across the United States Driven by Synthetic Opioids Before and During the COVID-19 Pandemic

Health Advisory: Recommendation for Meningococcal Vaccine (MenACWY) for Men who have Sex with Men (MSM)—Florida Meningococcal Outbreak

Since April 2022, in response to an ongoing outbreak of serogroup C invasive meningococcal disease (IMD) in Florida, CDC has encouraged gay, bisexual, and other men who have sex with men (MSM) to:

• Receive quadrivalent meningococcal conjugate vaccine (MenACWY) if they live in Florida
• Talk with their healthcare provider about getting MenACWY if traveling to Florida

MSM have previously been at increased risk for serogroup C IMD, whether during 2015-2016 outbreaks in Southern California and other US urban areas, or outside of outbreaks. Over the next months, MSM and transgender persons who have sex with men in California may have increased exposure to meningococcal infection from travel to Florida or attendance at events with MSM from around the country, including but not limited to Pride events in June 2022.

Vaccination Recommendations:

CDPH encourages clinicians to offer MenACWY to MSM and transgender persons who have sex with men.

• MenACWY may be particularly beneficial for MSM and who plan to travel to Florida or to attend gatherings (especially crowded venues) with MSM and transgender persons who have sex with men from around the country.
• Persons with ongoing exposure whose most recent dose of MenACWY was at least 5 years ago should receive a booster dose of MenACWY. Read More

6/6/2022 CDPH Health Advisory

Health Advisory: Monkeypox Virus Infection in the United States

The California Department of Public Health (CDPH) is issuing this advisory to supplement the information contained in the Health Alert issued by the U.S. Centers for Disease Control and Prevention (CDC) to provide additional guidance to California local health jurisdictions (LHJs) and health care providers. Health care providers should notify their LHJ immediately of any potential cases and LHJs should report any suspected monkeypox cases immediately to CDPH.

CDC issued a Health Advisory on May 20, 2022 regarding a confirmed case of monkeypox virus infection in Massachusetts as well as multiple clusters of monkeypox virus infections in other countries. On May 18, the Massachusetts Department of Public Health (MDPH) in coordination with the Centers for Disease Control and Prevention (CDC), confirmed a case of monkeypox virus infection in an adult male with recent travel to Canada. Contact tracing to identify persons who may have been exposed during the patient’s infectious period is ongoing. Read More

5/20/2022 CDPH Health Advisor

Access to Reproductive Health Services

The purpose of this advisory is to reassure the healthcare community that a full range of reproductive services remains accessible in Santa Cruz County. No changes to reproductive healthcare services and access are anticipated in the County. Resources for referral and further information are also provided.

The potential for the United States Supreme Court to overturn Roe v. Wade has raised concerns about the future of reproductive rights and services in Santa Cruz County. This advisory informs the Santa Cruz County healthcare community that a Supreme Court decision will not change access to reproductive health services, including abortion, in Santa Cruz County.

The potential Supreme Court ruling would allow states to set their own policies. California lawmakers have indicated they will not limit abortion services and are considering changing the state constitution to strengthen Californians’ reproductive rights.
We affirm that access to the full range of sexual and reproductive health care is fundamental to our wellbeing as individuals, families, and communities. Read More

5/19/2022 Public Health Healthcare Provider Advisory - en español

UPDATE on COVID-19 Outpatient Antiviral Medications in Santa Cruz County

Following last winter’s highly infectious Omicron surge (BA.1), subsequent known variants (BA.2, BA 2.12.1, BA.4 and BA.5) continue to emerge which are progressively transmissible. Unfortunately, we are starting to see another significant uptick in cases in Santa Cruz County, likely due to these variants.

Fortunately, there are a number of widely available oral and injectable antiviral medications for COVID-19. These therapeutic agents are extremely helpful in minimizing the duration and severity of disease, and most importantly, in preventing hospitalization and death. Supplies of many medications have improved significantly, and current stocks appear to be underutilized in our county. Medications no longer need be limited to the tiers mentioned in previous health advisories. Read More

5/10/2022 Public Health Healthcare Provider Advisory

TWO YEAR ANNIVERSARY OF FIRST CONFIRMED COVID-19 CASE

March 6th marked the two-year anniversary of the first confirmed COVID-19 case in Santa Cruz County. Public Health Officials reflect on the response to the pandemic.

Including the first local COVID-19 case – a passenger from the Grand Princess cruise ship – more than 46,000 cases have been officially recorded, and estimates of actual cases are four times higher, according to the U.S. Centers for Disease Control. So far, 255 County residents have perished at least partly due to COVID-19. “These past two years have been difficult for all of us, especially the families and loved ones of those we have lost,” said Dr. Gail Newel, Santa Cruz County Health Officer. “I want to thank everyone who made sacrifices – everyone who wore a mask to protect themselves and others, employees and employers who kept everyone as safe as possible, parents and students who navigated distance learning – to get us through these last two years. Read More

3/8/2022 Press Release

FDA Revises Evusheld Dosing in EUA

The FDA has revised the emergency use authorization (EUA) for Evusheld (tixagevimab co-packaged with cilgavimab) to increase the initial dose to 300 mg of tixagevimab and 300 mg of cilgavimab.

Healthcare providers should contact patients who have already received the previously authorized dose (150 mg of tixagevimab and 150 mg of cilgavimab) to return to receive an additional dose of 150 mg of tixagevimab and 150 mg of cilgavimab as soon as possible. Evusheld is authorized for use as pre-exposure prophylaxis (PrEP) for prevention of COVID-19 in certain adult and pediatric patients (12 years of age and older weighing at least 40 kg). Read More

3/1/2022 Public Health Healthcare Provider Advisory

Local Shigellosis Cases in Santa Cruz County; Test and Report Symptomatic Patients

Situational Update: Since mid-January 2022, four confirmed Shigella flexneri cases have been identified among residents of our county who are either experiencing homelessness themselves or who may have had contact with others experiencing homelessness. There have been additional reports of associated individuals treated for diarrheal disease within the past month without testing for Shigella. All providers should test and report any individual presenting with symptoms described below. Read More

2/18/2022 Public Health Healthcare Provider Advisory

Updates to the COVID-19 Confidential Morbidity Reporting (CMR) Process

Situational Update: Confidential morbidity reports (CMR) are used for any suspected or confirmed reportable disease that are required by Title 17 to be reported to the local health department including COVID-19. With the Omicron surge, the Communicable Disease Unit has had an influx of COVID-19 CMRs and has begun prioritizing processing based on the following:

• Hospitalizations (for hospitals, please include suspected nosocomial COVID infections)
• Deaths
• Residents/staff of SNF's and all other residential care facilities
• Residents/staff of shelters
• Inmates/staff of jails
• Inmates/staff of Juvenile Hall
• Multisystem inflammatory syndrome in children (MIS-C) or any other rare clinical presentations

Santa Cruz County Health Department requests CMRs for cases where the individual may be linked to the above settings. Read More

2/9/2022 Public Health Healthcare Provider Advisory

Updated Screening Recommendations for Disseminated Gonococcal Infection

Situational Update: On December 23, 2020, the California Department of Public Health (CDPH) issued a Dear Colleague Letter alerting health care providers of increasing reports of Disseminated Gonococcal Infection (DGI) cases in California during the second half of 2020. California now has recorded roughly double the number of DGI cases in 2020 compared to 2019, and DGI cases in 2021 exceeded the total number of cases in 2020 – including four deaths last year that were likely attributable to DGI. Most DGI cases in California have occurred among adults aged 30-50 years old (which is an age group not typically screened for gonorrhea) and disproportionately among Hispanic/Latinx individuals. In addition, approximately a fifth of cases have reported experiencing homelessness, more than a third report using one or more illicit drugs, and a third of total cases report using methamphetamine specifically. Of note, the majority of DGI cases to date did not present with urogenital symptoms. Read More

2/9/2022 Public Health Healthcare Provider Advisory

UPDATE on COVID-19 Outpatient Antiviral Medications in Santa Cruz County

Situational Update:
There are a number of oral and injectable antiviral medications now available for COVID-19. Unfortunately, those effective against Omicron are in short supply and limited allocations have been distributed to Santa Cruz County via the Federal and State allocation process.

Due to the extraordinary number of cases of COVID-19 we are currently experiencing, and the increasing strain on our health care system, it is critical that these limited supplies are allocated in a manner that provides your patients and the community with the greatest benefit. Generally, those patients most at risk of developing severe disease, hospitalization and death should be prioritized as suggested by National Institutes of Health. Read More

1/31/2022 Public Health Advisory

COVID-19 Outpatient Antiviral Medications in Santa Cruz County

Situational Update:
As you are aware, there are a number of oral and injectable antiviral medications becoming available for COVID-19. Unfortunately, those effective against Omicron are in short supply and limited allocations have been distributed to Santa Cruz County via the Federal and State allocation process.

Due to the extraordinary number of cases of COVID-19 we are currently experiencing, and the increasing strain on our health care system, it is critical that these limited supplies are allocated in a manner that provides your patients and the community with the greatest benefit. Generally, those patients most at risk of developing severe disease, hospitalization and death should be prioritized as suggested by NIH.

RECOMMENDATIONS
At this time, Paxlovid and Sotrovimab is limited to Tier 1 patients. As supplies improve, we hope to expand to additional tiers (Table 1). Table 2 shows a summary of the current antiviral and prophylactic medications, listed in order of preference, available in our County. Click on the medication name for an FDA fact sheet. View a helpful CDC webinar on this topic. Read More

1/14/2022 Public Health Advisory

SANTA CRUZ COUNTY HEALTH OFFICER ISSUES ORDER REQUIRING USE OF FACE COVERINGS INDOORS

Santa Cruz County, Calif. – With COVID-19 cases and hospitalizations increasing as we move into the holidays and winter months, the Santa Cruz County Health Officer is issuing a Health Order, effective November 21, 2021 at 11:59 p.m., requiring all individuals to wear a face covering when indoors regardless of vaccination status.

“Unfortunately, a potential winter surge appears to be a significant threat to the health and safety of our community,” said Santa Cruz County Health Officer Dr. Gail Newel. “As we look forward to spending time with those we love during the holidays, it is important to protect vulnerable friends and family members by wearing a mask indoors. Everyone who has not been vaccinated should get their first dose as soon as possible, and anyone who was vaccinated more than six months ago should seek out a booster.”

Masks must be worn in private settings, including your home, when non-household members are present. To help assure compliance, all businesses and governmental entities must require employees to wear masks and post signage that is clearly visible and easy-to-read at all entry points for indoor settings informing the public of the mask requirement. Those working in a closed room or office alone or with members of their household do not have to wear a mask, and masks are not required during indoor activities where they cannot be worn safely such as eating, drinking, swimming, showering in a fitness facility, or obtaining medical or cosmetic services. Read More

11/19/2021 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

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

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

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

• 3/26/2021 Public Health Provider Advisory
• Botulism Poster (English/Spanish)

• 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

• 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 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

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

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

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

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

• 1/26/2021 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

• Public Health Advisory 9/14/20: Order for Licensed Healthcare Facilities to Implement a Mandatory Influenza Prevention Program for Health Care Workers
• 2020-21 Influenza Season Report

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: Local Shigellosis case cluster among persons experiencing homelessness; test & report all symptomatic patients
• Oct. 29, 2019 Public Health Advisory: Local Shigellosis outbreak ongoing in Santa Cruz County; test & report symptomatic patients

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.

• Update: Interim Guidance for Health Care Professionals Evaluating and Caring for Patients with EVALI
• Click here for the most recent update on the California outbreak

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.

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