County of Marin Health and Human Services

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MCPH OPIC Newsletter #11 February 2024
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OPIC Monthly Newsletter

Issue 11                                                                    February 14, 2024

Greetings from Marin County Public Health (MCPH) Outbreak Prevention and Infection Control (OPIC).
MCPH OPIC team supports healthcare and congregate care facilities mitigate and manage risks and prepare for emergencies. Our monthly newsletters include news, guidance, updates, trainings and educational opportunities for all levels of staff.
Dr. Lael Duncan, Marin County Deputy Public Health Officer, emphasizes the critical role of the RSV vaccine in long-term congregate settings, reducing the risk of infections and outbreaks. The RSV vaccine reduces the risk of serious illness by 80%. Residents are encouraged to request it from their doctor. Protect yourself and others.
Visit MarinHHS.org/Vaccine for more information.

Please share this video with your residents, their families, and your staff.

Guidance Updates from CDPH and CDC


Late Season Prevention of RSV 
Continue year-round to administer private-purchase supplies of RSV vaccines to adults aged 60 years and older. Do not discard unused doses of nirsevimab and RSV vaccines. RSV vaccines and Nirsevimab are expensive and have a lengthy shelf life, so unused doses can be saved for use this Fall. We encourage you to label remaining doses “Keep for Fall 2024.”  CDC updated guidance on nirsevimab use

Resources

CDPH - Public Health Officer, Dr. Aragón:  Letter to Directors and Administrators of Long-Term Care Facilities (LTCFs) (1/19/2024) This letter reviews the importance of vaccination for COVID-19, influenza, pneumococcal and RSV for residents. Article - COVID-19 behind thousands of excess US deaths, analysis shows, 2/7/2024

CDPH COVID-19 Testing and Communications Toolkit for General Public (updated 1/2024)
  

All Facilities Letters (AFLs) from CDPH

AFL 24-06  – Compassionate Access to Medical Cannabis Act  (1/17/2024) permitting medicinal cannabis use by patients over the age of 65 with a chronic disease in all Skilled Nursing Facilities (SNF), Congregate Living Health Facilities (CHLF), Special Hospitals (SH), Hospice Facilities (HOFA), and Home Health Agencies (HHAs).

AFL 24-03 – Health Information Disclosures (1/16/2024): notifies all licensed health care facilities of the chaptering of AB 352 (Chapter 255, Statutes of 2023), amending the Confidential Medical Information Act (CMIA) to prohibit disclosing or sharing of health information relating to sensitive services, including abortion and abortion-related care, with any individual or entity in another state. 
AFL 24-04 – Health Professionals and Facilities Adverse Actions Based on Another State’s Law (1/16/2024): informs facilities about protections for providers of sensitive services.​

AFL 24-02 - Annual Announcement: Online Application Period for Patient Needs Waiver (PNW) and Workforce Shortage Waiver (WSW)  (1/16/2024): the opening January 1, 2024 of the application period for SNFs requesting a Patient Needs Waiver (PNW) and Workforce Shortage Waiver (WSW) for fiscal year 2024-2025.

AFL 23-34 - Coronavirus Disease 2019 (COVID-19) Vaccine Recommendations for Clinically Eligible Individuals (11/13/2023) - reminds facilities of the importance of offering and encouraging COVID-19 vaccinations to clinically eligible individuals, especially those at highest risk of morbidity and mortality, at all interactions across the healthcare continuum.
AFL 23-36 - Recommendations for Prevention and Control of COVID-19, Influenza, and Other Respiratory Viral Infections in California Skilled Nursing Facilities – 2023-24 (12/5/2023)

View AFLs at the All Facilities Letter webpage.  

CDSS Updates

View PINs at the All COVID-19 ASC PINs by Topic webpage. 

To view published Email Blasts, visit the E-Blast webpage

Resources

*FREE*  COVID-19 Test Kits Allocation - LAST ORDERING OPPORTUNITY!

The California Department of Public Health (CDPH) at-home testing program will end, effective February 29, 2024.  Eligible organizations, including LTCFs and SNFs, will be able to order at-home tests only before this date. Orders need to be placed before 2/29/24. Review test kit storage, expiration dates, and important info in the links below:

FREE Virtual Trainings
  • Free, online, Training for staff at LTACHs.
  • Free, online Training for staff at SNFS.
  • Toolkit for Certified Nursing Assistants (CNAs) Training
  • Project Firstline Project Firstline Training Toolkit for EVS Staff
     
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Marin County Public Health's Monthly Updates for LTCFs provide updates regarding guidance, local data and surveillance, and training opportunities. Please contact LTCFReport@marincounty.org to be added to the meeting invitation. 

Next MCPH Monthly meeting is: Tuesday, February 27, 2:00-3:00 PM






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County of Marin · 3240 Kerner Blvd. · San Rafael, CA 94901 · USA

Public Health Newsletter - January 2024
Marin County Public Health Newsletter - January 2024
In this Issue: COVID-19 Isolation | Nirsevimab for Infants I RSV Advisory | Cipro Resistance Advisory | Mental Health for Boys and Men | Cardiovascular Health and Life Expectancy | Message from the Deputy Public Health Officer 
A message to physicians and other health care providers from Marin County's Public Health Officers.

New COVID-19 Isolation Guidance

On January 9, 2024, the California Department of Public Health (CDPH) updated isolation guidance for individuals who test positive for COVID-19. This guidance does not apply to healthcare personnel who work in hospitals or skilled nursing facilities. Individuals can now return to work or school if symptoms are mild and improving, and they have been fever-free for 24 hours without the use of fever-reducing medications. Staying home for at least 5 days is no longer required. Asymptomatic close contacts should test if they are at higher-risk or have higher-risk close contacts.  Cal OSHA COVID-19 prevention regulations and the health officer face mask order in patient areas of specified healthcare settings remain in effect.


Increased Supply of RSV Antibody for Infants

The new RSV infant immunization nirsevimab has been in short supply since itsRSV Virus approval in July, 2023. Following the announcement that the manufacturer is releasing additional doses, the CDC is now advising providers to provide nirsevimab to eligible infants and children as soon as possible. Healthcare providers can order nirsevimab through their usual supplier, or at https://www.vaccineshoppe.com/
For 
Vaccines for Children (VFC) program providers, nirsevimab is available.   For questions on how to become a VFC provider, call Marin County Public Health at 415-473-4163.


RSV Vaccine Advisory

On December 29th, Marin County Public Health issued a Public Health Advisory urging providers to order the RSV vaccine for their patients who live in long term care facilities. To date, there have been two RSV outbreaks in skilled nursing facilities, involving four hospitalizations and one death. RSV is in peak circulation in our community and the vaccine is highly effective at preventing serious disease.


Ciprofloxacin-Resistant Meningococcus Advisory

On January 22nd, Marin County Public Health issued a Public Health Advisory advising providers not to use ciprofloxacin for post-exposure prophylaxis (PEP) for invasive meningococcal disease (IMD) due to an increase in ciprofloxacin-resistant strains of Neisseria meningitidis in our region.  Healthcare providers in Marin County should use rifampin, ceftriaxone or azithromycin for IMD PEP in Marin County.  Suspected cases of meningitis must be reported to Public Health immediately at 415-473-4163.  This highlights critical the importance of antibiotic stewardship in preventing or slowing the development of antimicrobial resistant organisms in our community.


Supporting Men and Boys' Mental Health

Men account for 3 out of 4 suicides and overdoses in Marin County. Men and boys often struggle to recognize personal crises or seek help. Marin County Suicide Prevention Collaborative formed the Men and Boys Action Team to address the disproportionate impact on men in our community. Led by people with firsthand experiences, the team meets regularly to talk through shared challenges, offer mutual support, and inform local efforts to reduce overdose and suicide. The group welcomes anyone over 13 years old who identifies as a male to join their team.  Learn more about their work at Redefining Strength – A Conversation About Marin County Men And Boys’ Mental Health.

Cardiovascular Mortality Drives Local Life Expectancy Gap


Marin County Public Health's epidemiology team recently published an analysis of differences in life expectancy (LE) between groups within Marin. While Marin’s average LE is among the highest in the state, the team found a 15-year gap in longevity between communities. This health inequity is driven mainly by preventable cardiovascular mortality in lower income communities, and especially among Marin’s African American residents. Promoting a health life span for all communities is a priority for Marin County Public Health. Visit MarinHHS.org/Marin-County-Life-Expectancy to learn more about local strategies to reduce this health disparity.

Message from the Deputy Public Health Officer


Four years ago this week, the city of Wuhan was placed on lockdown and the first case of COVID-19 was confirmed in the United States.  Flash forward to today - we have at-home COVID tests, vaccinations, and effective treatment. This month we also reached a historic post-pandemic milestone – shifting from a prescribed isolation period to a symptom-based approach.  COVID is now part of our viral landscape. 

While the acute strain of the pandemic is easing, health care will still be marked by disruption and change.  We have tremendous opportunities to harness lessons learned from the pandemic and galvanize efforts to address the challenges that lay ahead of us. We look forward to collaborating with you in 2024 to improve the health of our community.

With gratitude,

Lisa M. Santora MD, MPH
Deputy Public Health Officer
Lisa.Santora@marincounty.gov

 
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Copyright ©  2023
Marin County Public Health, a division of the Marin County Health & Human Services Department
https://www.marinhhs.org/public-health

Requests for disability accommodations may be made by phoning (415) 473-4381 (Voice), CA Relay 711 or by e-mail at DisabilityAccess@MarinCounty.org. Copies of documents are available in alternative formats, upon request.

County of Marin Logo

Our mailing address is:
3240 Kerner Blvd
San Rafael, CA 94901
MCPH OPIC Newsletter #10 January 2024
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OPIC Monthly Newsletter

Issue 10                                                                    January 18, 2024

Greetings from Marin County Public Health (MCPH) Outbreak Prevention and Infection Control (OPIC).
MCPH OPIC team supports healthcare and congregate care facilities mitigate and manage risks and prepare for emergencies. Our monthly newsletters include news, guidance, updates, trainings and educational opportunities for all levels of staff.

NEW! COVID-19 Guidance Updates from CDPH

New Isolation and Testing Guidelines from CDPH do not apply to certain High Risk Facilities in Marin County. 

High-risk settings include long term care sites and residential congregate facilities for the elderly, facilities where persons at higher risk of severe disease are more likely to be present. Wide spread transmission and large-scale outbreaks are more likely to occur at these sites. Many residents in these locations are persons at high risk of severe COVID-19 disease due to underlying health conditions, advanced age, or both. 

Skilled Nursing facilities should continue to apply isolation guidance as per 2023 documents. Masking for all staff is required in Acute Care Hospitals and SNF settings November 1 to March 31 per Health Order from Marin County Public Health dated September 27, 2023.

CDSS licensed sites are recommended to have residents with COVID-19 infection isolated for 5 days then avoid congregate activities and mask for another 5 days.

During the winter respiratory illness season, masking for all personnel and residents is strongly recommended at all times in common areas, care areas and when near other staff, residents, patients, clients through March 31, 2024. Consult Marin County Public Health or your licensing entity if you have questions.

Return to work and post exposure testing guidance for facility personnel is included in CDC's healthcare infection control guidance and in CDPH AFL 21-08.9. Healthcare personnel and personnel working in high risk congregate  settings (as listed above) that are not covered by AFL 21-08.9 are recommended to follow the guidance outlined in AFL 21-08.9 until further notice by Marin County Public Health.

 

CDC Health Advisory (12/14/23)

Urgent Need to Increase Immunization Coverage for Influenza, COVID-19, and RSV and Use of Authorized/Approved Therapeutics in the Setting of Increased Respiratory Disease Activity During the 2023 – 2024 Winter Season. The alert is for  healthcare providers to increase vaccination due to low vaccination rates against influenza, COVID-19, and RSV (respiratory syncytial virus). “Low vaccination rates, coupled with ongoing increases in national and international respiratory disease activity caused by multiple pathogens, including influenza viruses, SARS-CoV-2 (the virus that causes COVID-19), and RSV, could lead to more severe disease and increased healthcare capacity strain in the coming weeks.”

 

All Facilities Letters (AFLs) from CDPH

AFL: 23-26: Recommendations for Prevention and Control of COVID-19, Influenza, and Other Respiratory Viral Infections in California Skilled Nursing Facilities – 2023-24

This AFL notifies facilities of an updated version of the guidance document which includes streamlined guidance that can be broadly applied for the prevention and control of influenza, COVID-19, RSV, and other common respiratory viruses (e.g., adenovirus, parainfluenza virus, etc.) in California SNFs.

View AFLs at the All Facilities Letter webpage.  

CDSS Updates

Influenza and RSV Vaccination Recommendations 

View PINs at the All COVID-19 ASC PINs by Topic webpage. 

To view published Email Blasts, visit the E-Blast webpage

Resources

*FREE*  COVID-19 Test Kits Allocation - Limited Ordering Opportunities Left

The California Department of Public Health (CDPH) at-home testing program will be coming to an end*, effective February 29, 2024.  Eligible organizations, including LTCFs and SNFs, will be able to order at-home tests. Orders need to be placed before 2/29/24. Review test kit storage, expiration dates, and important info in the links below:


Infectious Disease toolkits

 

Additional Resources:

FREE Virtual Trainings
  • Free, online, Training for staff at LTACHs.
  • Free, online Training for staff at SNFS.
  • Toolkit for Certified Nursing Assistants (CNAs) Training
  • Project Firstline Project Firstline Training Toolkit for EVS Staff
     
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Sign up for our list!
     
Marin County Public Health's Monthly Updates for LTCFs provide updates regarding guidance, local data and surveillance, and training opportunities. Please contact LTCFReport@marincounty.org to be added to the meeting invitation. 

Next MCPH Monthly meeting is: Tuesday, January 23, 2:00-3:00 PM






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County of Marin · 3240 Kerner Blvd. · San Rafael, CA 94901 · USA

Public Health Newsletter - December 2023
Marin County Public Health Newsletter - December 2023
In this Issue: World AIDS Day | Fall Vaccine Progress I Pertussis | Xylazine | Green Space and Longevity | Message from the Public Health Officer 
A message to physicians and other health care providers from Marin County's Public Health Officers.

World AIDS Day

 

December 1st marked the 35th anniversary of World AIDS Day. Marin passed a resolution at the Board of Supervisors to commemorate this day.  HIV is highly preventable and treatable, and all clinicians have a part to play in reaching zero HIV transmission in Marin. Track local  progress with our newly launched HIV dashboard.  A list of local support services can be found here.

 


Fall Vaccine Progress

California reported its first pediatric flu death this month. This is an important reminder to protect eligible residents against common seasonal viruses. Flu, COVID and RSV levels continue to rise in Marin. As of this week, among residents aged 60 and over in Marin, 56% had the flu shot, 49% received the COVID-19 vaccine, and 19% had received the RSV vaccine. While these rates are significantly higher than state averages, a majority of older residents are not fully protected. The Bay Area health officers recently issued a press release encouraging residents to obtain the protection of vaccine


Pertussis

From 2010-2015, Marin County had among the highest rates of pertussis (whooping cough) in  the nation. With increased vaccinations, Marin’s last outbreak was in 2018. Concerningly, six pertussis cases have been reported to Marin Public Health so far this fall. Clinicians should consider pertussis and test any patients with characteristic symptoms. Persons at highest risk include infants who can’t get vaccinated (< 1 year old), pregnant women (especially in the third trimester), and those who may expose infants or pregnant women. Youth get their last vaccine in 7th grade. Public health recommends vaccination for pregnant women and any adult in close contact with infants.


Xylazine

Marin County Public Health monitors wastewater for the presence of xylazine, or Tranq, a powerful veterinary sedative increasingly found in the illegal U.S. drug supply. In May 2023, xylazine was detected locally and has not been detected since then. CDPH recently warned Californians about the dangers of xylazine. in an all Facilities Letter: Xylazine in the Illicit Drug Supply and Patient Best Practices. If and when this substance re-surfaces in Marin wastewater, Public Health will issue a local advisory.


Green Space and Longevity

Marin County is known for long life expectancy and abundant green space. While the health  benefits of being outdoors are well known, a new study provides insights into the cellular  mechanism by which our environment impacts our health.


Message from the Public Health Officer

 

One of the core functions of Public Health is to describe gaps in community health and wellbeing. During the pandemic, timely, locally derived data was critical to our strategic response. Our epidemiologists are committed to providing our clinicians and residents accurate and timely “community vital signs."  New features on our Marin County Public Health website include interactive charts describing local bicycle crashes and injuries, and the latest wastewater levels for nine infectious diseases.

With gratitude,

Matt Willis, MD, MPH
Public Health Officer

 
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Copyright ©  2023
Marin County Public Health, a division of the Marin County Health & Human Services Department
https://www.marinhhs.org/public-health

Requests for disability accommodations may be made by phoning (415) 473-4381 (Voice), CA Relay 711 or by e-mail at DisabilityAccess@MarinCounty.org. Copies of documents are available in alternative formats, upon request.

County of Marin Logo

Our mailing address is:
3240 Kerner Blvd
San Rafael, CA 94901
MCPH OPIC Newsletter #9 December
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OPIC Monthly Newsletter

Issue 9                                                                    December 15, 2023

MCPH OPIC team provides support to healthcare and congregate care facilities as you mitigate and manage risks due to communicable diseases and emergencies. We collaborate with you to achieve high levels of readiness to ensure effective responses to a wide range of events. Our monthly newsletters include news and guidance updates, community status updates, trainings and educational opportunities for all levels of staff.

GUIDANCE AND UPDATES

CDPH COVID-19 and Respiratory Virus Toolkits

The following toolkits include multilingual handouts, videos, wallet cards and graphics that licensees and providers may find helpful:

COVID-19 Test Kits Allocation- limited ordering opportunities left

The California Department of Public Health (CDPH) at-home testing program will be coming to an end*, effective February 29, 2024.  Eligible organizations, including LTCFs and SNFs, will be able to order at-home tests up until this date using the following ordering timeframe:

 

Click here to order: https://labsupport.powerappsportals.us/ordercovidotc/

Complete details, including storage requirements, can be found here: SNF/Elder Care/Long Term Care At-Home Testing Resources 

Respiratory Syncytial Virus (RSV) Isolation Question(s) from MCPH LTCF Meeting on 11/28/2023:

  • Q: How long do we isolate if a resident tests positive for RSV? Is the isolation period just like COVID, at least 10 days of isolation?  
  • A: Persons with RSV are contagious for a minimum of 7 days per CDPH (see table below from AFL 23-26).  After that, isolation may be discontinued when symptoms are substantially resolving and the resident is free of fever for 24 hours. However, some infants, and people with weakened immune systems, can continue to spread the virus even after they stop showing symptoms, for as long as 4 weeks.  If the case is not resolving, or have gotten feedback from the provider, please reach out to MCPH. We will verify with CDPH and follow up with a slide or email.

All Facilities Letters (AFLs) from CDPH AFL: 23-26: Recommendations for Prevention and Control of COVID-19, Influenza, and Other Respiratory Viral Infections in California Skilled Nursing Facilities – 2023-24

This AFL notifies facilities of an updated version of the guidance document which includes streamlined guidance that can be broadly applied for the prevention and control of influenza, COVID-19, RSV, and other common respiratory viruses (e.g., adenovirus, parainfluenza virus, etc.) in California SNFs.

In the new AFL, you'll find the table below which can be very helpful to add to your IP checklists and plans.

View AFLs at the All Facilities Letter webpage.  

View PINs from CDSS at the All COVID-19 PINs by Topic webpage.  
 

NEWS

Holiday and Winter Surge
Marin County Public Health along with CDPH and CDC are expecting to have a moderate surge in COVID-19, RSV and Influenza cases this winter, which combined are expected to have a greater impacts compared to most pre-pandemic surges.  Ensure to have your residents up to date on their respiratory vaccines. 

Winter Norovirus Surge
Norovirus activity is increasing across the United States, with sharp increases of concentrations observed in wastewater throughout California. Wastewater concentrations of Norovirus (GII) are monitored by the WastewaterSCAN program and California Department of Public Health (CDPH). Data show rising concentrations of norovirus since October 2023.
 

COVID-19 Hospitalizations on the Rise
The number of people hospitalized with severe COVID-19 disease has increased 70% in Marin County in the past three weeks. This corresponds to increased virus levels in wastewater, signifying increased local transmission.
 

Marin Public Health Dashboards: Local Data for Local Action Marin County Public Health has ten data dashboards reflecting local public health priorities.

MDRO RESOURCES

Influencing prescriber behavior to reduce unnecessary antibiotic use for respiratory infections.

A new Cochrane Review has identified three clinician-focused strategies that may reduce antibiotic prescribing for acute respiratory infections (ARIs). ARIs—which include conditions such as bronchitis, sinusitis, pharyngitis, and acute otitis media—are considered a significant driver of antibiotic use in primary care settings and consequently a major factor in antibiotic resistance. In the United States, more than 40 million antibiotic prescriptions annually target respiratory conditions. But since many of these illnesses are viral in nature and don't require antibiotics, ARIs are a major target for antibiotic stewardship interventions. Read the Cochrane Review Article by clicking here.

A multifaceted outpatient antibiotic stewardship intervention implemented at Mayo Clinic hospitals was associated with reduced unnecessary antibiotic prescribing for upper respiratory infections. Described here, the specific interventions were standardized provider education, development of a syndrome-based, pre-populated ambulatory panel, peer comparison reporting, and a provider-facing data dashboard to facilitate self-auditing of cases in which antibiotics were flagged as unnecessary. The intervention also included a patient-facing antibiotic commitment poster and handouts for patients promoting symptomatic management. Read the study here at Open Forum Infectious Diseases.

RESOURCES

CDC: RSV Vaccines Approved for Adults  ≥ 60 Years

Arexvy (GSK)

  • One dose, Intramuscular injection.
  • Efficacy: 83% reduction in risk of RSV-associated lower respiratory tract disease* during first RSV season after vaccination.
  • 56% in second RSV season.

Abrysvo (Pfizer)

  • Also approved for pregnant women to prevent severe RSV in infants.
  • One dose, Intramuscular injection.
  • Efficacy: 89% reduction in risk of RSV-associated lower respiratory tract disease* with ≥3 symptoms during first RSV season after vaccination.

*Lower respiratory tract disease signs/symptoms include cough, sputum and difficulty breathing.

CDPH RSV Immunization EZIZ for Long Term Care facilities

CDC: Flu Vaccine Recommendations for Adults ≥ 65 Years
If none of these three vaccines is available at a vaccination opportunity, then any other age-appropriate influenza vaccine should be used.
UPCOMING TRAININGS
  • Free, online, Training for staff at LTACHs.
  • Free, online Training for staff at SNFS.
  • Toolkit for Certified Nursing Assistants (CNAs) Training
  • Project Firstline Project Firstline Training Toolkit for EVS Staff
  • Save the Date: 2/29/24-3/1/24:  Free 2-day Course for IPC training hosted in San Rafael by MCPH and CDPH. 14 hours of CEUs provided. Registration opens in January 2024.
     
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Marin County Public Health's Monthly Updates for LTCFs provide updates regarding guidance, local data and surveillance, and training opportunities. These meetings are held monthly on zoom. Email LTCFReport@marincounty.org to be added to the meeting invitation. 

2024 meeting schedule coming soon. 






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County of Marin · 3240 Kerner Blvd. · San Rafael, CA 94901 · USA

MCPH OPIC Newsletter #8 November
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OPIC Monthly Newsletter

Issue 8                                                                    November 27, 2023

The Outbreak Prevention and Infection Control (OPIC) team's mission is to provide support to healthcare and congregate care facilities as you mitigate and manage risks due to communicable diseases and emergencies. We do this by promoting high levels of readiness, ensuring effective responses, and providing training and educational opportunities. Our monthly newsletters include: news and guidance, community status updates, trainings and educational opportunities.

Guidance and Updates

COVID-19 Level at Medium and the Updated COVID-19 Vaccine

Due to higher concentrations of COVID-19 found in the wastewater, Marin County COVID-19 level is medium. Currently only 36% of Marin residents 65 and older are up to date with their COVID-19 vaccine and only 16% of residents countywide are up to date
 

Regulatory Vaccine Requirements

AB 1797 requires California healthcare providers who administer vaccines to enter information about residents or clients into the California Immunization Registry (CAIR).

Federal regulations 42 CFR 483.80(d)(3) and 42 CFR 483.460(a)(4)(i) require that Long-Term Care (LTC) facilities and Intermediate Care Facilities (ICFs) for Individuals with Intellectual Disabilities (ICFs-IID) must offer COVID-19, Pneumococcal, and Influenza vaccines and education to residents onsite.

CMS certified facilities are required to follow QSO-23-13 ALL 5.01.23

The federal Conditions of Participation, effective 10/07/2005 are here

SNFs are required to report HCP vaccination rates as a Quality Measure into NHSN which would involve record keeping.
 

All Facilities Letters (AFLs) from CDPH

AFL 23-34 Coronavirus Disease 2019 (COVID-19) Vaccine Recommendations for Clinically Eligible Individuals The California Department of Public Health (CDPH) recommends facilities offer COVID-19 vaccinations to clinically eligible individuals. This AFL revision includes information related to updated (2023-2024 Formulation) COVID-19 vaccines.

View AFLs at the All Facilities Letter webpage.  

PINs from CDSS

Influenza and RSV Vaccination Recommendations 

Recommendations made by the Centers for Disease Control and Prevention (CDC) on the updated COVID-19 vaccination recommendations for the fall and winter virus season, as well as providing information on testing and treatment for COVID-19.

To view published Email Blasts (E-Blasts), please visit the E-Blast webpage

November is C. Diff Awareness Month

Clostridioides difficile AKA C. diff, is a bacteria that causes life-threatening diarrhea. It is usually a side-effect of taking antibiotics. CDI is the most commonly reported healthcare-associated infection in hospitals. All California acute care hospitals are required to report healthcare facility-onset CDI to the California Department of Public Health (CDPH) via the National Healthcare Safety Network. 

Most vulnerable population: 

  • People 65 and older who take antibiotics and receive medical care.
  • People staying in hospitals and nursing homes for a long period of time. 
  • People with weakened immune systems or previous infection with C. diff. 
CDPH C.Diff Quick Sheet for healthcare facilities
CDPH HAI Program:  C. Diff infection (CDI) resource page
CDC - CDI Resource


Multi-Drug Resistant Organisms (MDROs)  Resources: Stay up to date with the latest information on Antimicrobial Resistance and Antibiotic Stewardship:

Resources

Infectious Disease toolkits

 

State Epidemiologist Dr. Erica Pan Shares Tips for Reducing Respiratory Viruses
New videos featuring Dr. Erica Pan are now available. The videos provide tips for reducing respiratory virus illness this fall and winter and can be shared on social media. Californians can help reduce the spread of viruses by staying up to date on vaccines, staying home and testing if sick, seeking prescription treatments if they test positive for flu or COVID-19, consider masking indoors, washing hands and covering coughs.

Additional Resources:

Upcoming Trainings
  • Free, online, Training for staff at LTACHs.
  • Free, online Training for staff at SNFS.
  • Toolkit for Certified Nursing Assistants (CNAs) Training
  • Project Firstline Project Firstline Training Toolkit for EVS Staff
     
Was this email forwarded to you? 
Sign up for our list!
     
Marin County Public Health's Monthly Updates for LTCFs provide updates regarding guidance, local data and surveillance, and training opportunities. Please contact LTCFReport@marincounty.org to be added to the meeting invitation. 

Next MCPH Monthly meeting is: Tuesday, November 28, 2:00-3:00 PM






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County of Marin · 3240 Kerner Blvd. · San Rafael, CA 94901 · USA

Public Health Newsletter - November 2023
Marin County Public Health Newsletter - November 2023
In this Issue: Beyfortus Shortage | COVID-19 Vaccine I Marin County Toolkit for Fall Vaccines | Mpox Advisory | Gun Violence Restraining Orders | APEC | Message from the Deputy Public Health Officer 
A message to physicians and other health care providers from Marin County's Public Health Officers.

Beyfortus Shortage

This year two new forms of protection against RSV were released—a conventional vaccine for adults, and an antibody formulation for infants (Beyfortus™). The supply of nirsevimab (Beyfortus™) has fallen far below demand, resulting in a local shortage.  Last month, Centers for Disease Control and Prevention (CDC) recommended prioritizing available 100 mg doses for young infants aged <6 months with underlying conditions who are at increased risk for severe disease, and stopping use in children aged 8–19 months during the 2023–2024 season. In light of this shortage, MCPH strongly recommends that providers vaccinate pregnant patients between 32 - 36 weeks with the RSV vaccine to provide their infants with antibody protection during the first 6 months of life.


COVID-19 Level at Medium and the Updated COVID-19 Vaccine

Due to higher concentrations of COVID-19 found in the wastewater, Marin County has increased to Marin COVID level to medium levels this week. Currently only 36% of Marin residents 65 and older are up to date with their COVID-19 vaccine and only 16% of residents countywide are up to date. This month on Wednesdays and Thursdays, Safeway is offering COVID-19, flu, and RSV vaccines to non-Kaiser patients ages 19 and older at the Marin Health and Wellness Campus (3240 Kerner Blvd in San Rafael).  Walk-ins and appointments are welcome.  Please refer your patients to our only weekend vaccine clinic on Saturday, November 18th from 9 am to 3 pm.


Tracking Local COVID-19 Severe Illness Burden

MCPH has created a comprehensive  and accessible Marin County "Respiratory Virus Season" communications toolkit for your use. This toolkit includes open-source graphics, printable flyers, video reels, pre-written captions, and alt-text in English and Spanish. The toolkit is available to download online.  Please share and post widely.


Mpox Advisory

Last week Marin County Public Health (MCPH) issued a Public Health Advisory with updated clinical guidance on mpox. Mpox cases are rising statewide, and for the first time in nearly a year, a case of mpox was reported in Marin that coincided with viral detection in local wastewater. Clinicians should take a sexual history, consider mpox when evaluating rashes, and recommend the JYNNEOS vaccine for patients at risk. Contact MCPH at (415) 473-4163 for clinical support or visit https://www.marinhhs.org/mpox for more information.


Gun Violence Restraining Order

Gun Violence Restraining Order BannerFirearms are responsible for the majority of suicides and homicides in the United States.  A Temporary Gun Violence Restraining Order is a tool to protect persons in crisis by temporarily preventing access to guns and ammunition. The person's immediate family member, including a spouse, parent, child, grandparent, or any other person who regularly lives with them now or lived with them in the last 6 months, can file a restraining order online or at Marin County Superior Court. Clinicians who are concerned about a patient’s access to guns can contact local law enforcement to assess for a temporary restraining order.  Learn more at Prevent and Prepare | California Governor's Office of Emergency Services.

APEC

This week San Francisco is hosting the 2023 Asian Pacific Economic Cooperation (APEC) conference. Certain sections of San Francisco are closed to traffic as dignitaries and their entourages travel through the Bay Area. The MCPH Healthcare Preparedness Program (HPP) worked with local hospitals and emergency response agencies to prepare for this global gathering. Sign up for AlertMarin to stay connected and receive updates.
 

Message from the Deputy Public Health Officer

 

Globally we have watched millions of people forcibly displaced from conflicts, crises, and disasters. Nationally we are observing increases in mass shootings, overdoses, and suicides.  Locally we see our neighbors struggle with substance use and mental health disorders and homelessness. While these realities, especially when amplified by social media, can lure us into a feeling of despair, we are surrounded by opportunities to build resilience, connections, and hope.  Marin’s Community Action Teams are fostering engagement in mental health and well-being, suicide prevention and substance use awareness activities.  Marin Medical Reserve Corps is partnering with OD Free Marin to train residents in Lifesaving Skills.  In October, Marin’s Housing First program provided permanent supportive housing to 31 persons experiencing chronic homelessness, including 5 veterans.  TAY Radio Marin is literally amplifying Marin’s youth voices.  Everyday we are surrounded by acts of kindness that are changing the world - for the better.  As we move into the holiday season, I encourage everyone to practice not only the art of medicine, but the art of kindness

With gratitude,

Lisa M. Santora, MD, MPH
Deputy Public Health Officer

 
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Copyright ©  2023
Marin County Public Health, a division of the Marin County Health & Human Services Department
https://www.marinhhs.org/public-health

Requests for disability accommodations may be made by phoning (415) 473-4381 (Voice), CA Relay 711 or by e-mail at DisabilityAccess@MarinCounty.org. Copies of documents are available in alternative formats, upon request.

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Public Health Newsletter - October 2023
Marin County Public Health Newsletter - October 2023
In this Issue: Drop-in Clinics | Fentanyl Advisory I COVID-19 | Health Worker - Mental Health | PrEP | Masking | Childhood Lead Week | Message from the Public Health Officer 
A message to physicians and other health care providers from Marin County's Public Health Officers.

Drop-in Vaccination Clinics Return to Marin

In November, Marin Public Health, Safeway, and Marin Community Clinics are offering COVID-19, flu, and RSV vaccines to those aged 19 and above at the Marin Health and Wellness Campus on Wednesdays and Thursdays from 10:00 am to 4:00 pm. Both walk-ins and appointments are accepted.


Fentanyl Advisory

On October 3, 2023, the Marin County Public Health (MCPH) department issued a public health advisory describing a spike in fentanyl use and overdoses. Since that time, levels have normalized, but this serves as a reminder of the unpredictability and variability of fentanyl supply and use.


Tracking Local COVID-19 Severe Illness Burden

Marin Publlic Health is adding a new feature to the COVID 19 hospitalization dashboard. Starting this week, the number of new COVID-19 admissions per day into Marin hospitals will be shown in an interactive display. Tracking daily admissions helps describe trends in rates of severe illness in Marin. The current trend is stable and will be monitored closely for the onset of a seasonal surge. 


Health Worker - Mental Health


The CDC released  a recent study showing that health workers are under unprecedented stress, reporting more poor mental health days and higher levels of burnout and harassment than in pre-pandemic times and compared to other industries. There are physician wellness resources available from San Francisco Marin Medical Society to address this critical issue. By providing a supportive workplace, employers can promote health worker well-being.

 


Masking Order

Marin County, alongside other Bay Area counties, instituted a health order that requires patients, staff and visitors to wear a mask in hospitals and skilled nursing facilities for the fall and winter virus season, November 1, 2023 through March 31, 2024. It applies to all individuals within the facility while they are in patient care areas. Children under age 6 and those with a valid medical reason are exempt.


PrEP Recommendations


The US Preventive Services Task Force has given a grade A endorsement of Pre Exposure Prophylaxis drugs to prevent HIV, including Descovy and Truvada (daily pills), as well as cabotegravir (long acting injectable). This designation validates this as standard of care and requires private insurers to cover the cost with no copay or deductible under the Affordable Care Act.

Lead Poisoning Prevention Week

The week of October 22nd marks National Lead Poisoning Prevention Week, and the theme is “Together, we can prevent lead exposure!” Routine screening of children is the best prevention.  Lead-based paint is of a particular concern in Marin County, where more than 74% of the housing was built before 1978.  MCPH offers resources and more information for providers.

 

Message from the Public Health Officer


The CDC report on healthcare worker mental health above resonates with many of us in our local healthcare community. The report shows that the feelings of stress we may be experiencing are common and shared. Despite this, isolation, or a feeling of “aloneness” in our experience, is a common feature of burnout. As stewards of health, we are often better at focusing on our patients than ourselves. Across Marin, grassroots “meet up” groups are forming to foster community among clinicians, and institutions are establishing wellness initiatives. Clinician well-being is a public health priority, and we are grateful for the care you extend to one another. 

Yours in health,

Matt Willis, MD, MPH
Public Health Officer
mwillis@marincounty.org

 


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Marin County Public Health, a division of the Marin County Health & Human Services Department
https://www.marinhhs.org/public-health

Requests for disability accommodations may be made by phoning (415) 473-4381 (Voice), CA Relay 711 or by e-mail at DisabilityAccess@MarinCounty.org. Copies of documents are available in alternative formats, upon request.

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MCPH OPIC Newsletter #7 October
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OPIC Monthly Newsletter

Issue 7                                                                    October 12, 2023

The Outbreak Prevention and Infection Control (OPIC) team's mission is to provide support to healthcare and congregate care facilities as you mitigate and manage risks due to communicable diseases and emergencies. We do this by promoting high levels of readiness, ensuring effective responses, and providing training and educational opportunities. Our monthly newsletters include: news and guidance updates, community status updates, available trainings and other educational opportunities.

Guidance Updates

Marin County Public Health Order
Marin County, alongside other Bay Area counties, instituted a health order that requires patients, staff and visitors to wear a mask in hospitals and skilled nursing facilities for the fall and winter virus season, November 1, 2023 through March 31, 2024.

The intent of the order is to protect individuals in these high-risk healthcare settings and limit the spread of seasonal respiratory viruses including RSV, influenza, and COVID-19. It will apply to all individuals within the facility while they are in patient care areas. Children under age 6 and those with a valid medical reason are exempt.

Marin County Public Health Advisory
Local Spike in Fentanyl Use and Overdoses
During the week preceding September 17, 2023, the concentration of norfentanyl, a marker of fentanyl use, doubled in Marin wastewater compared to the previous week. The following week, Emergency Medical Services responded to eight suspected opioid overdoses, double the usual weekly rate. This pattern could signify increased availability and intentional use of fentanyl or increased levels of fentanyl contamination in other substances.

AVISO DE SALUD PÚBLICA
 

All Facilities Letters (AFLs) from CDPH

COVID-19 Treatment Resources for Skilled Nursing Facilites

AFL 23-29 Coronavirus Disease 2019 (COVID-19) Treatment Resources for Skilled Nursing Facilities (SNFs)  provides guidance recommending that all SNF residents with symptomatic COVID-19 be evaluated by a prescribing clinician to be considered for COVID-19 therapeutics. This AFL also provides information regarding available guidance and resources and recommends SNFs provide information on appropriate therapeutics to their healthcare personnel (HCP) who have symptomatic COVID-19. 

Legal Requirement to submit immunization data

AFL 23-26 New Legal Requirement to Submit Immunization Data is now available. This AFL notifies SNFs and ICFs of the chaptering of AB 1797 (Chapter 582, Statutes of 2022) requiring all California healthcare providers to report vaccine administration information to a California Immunization Registry (CAIR or Healthy Futures/RIDE).SNFs and ICFs must ensure that they enter every vaccine administered, along with patient’s race and ethnicity, into the immunization registry to support access to immunization data needed for the Centers of Medicare and Medicaid Services (CMS) reporting.

If you have any questions about this AFL, please contact the CAIR Help Desk via email at CAIRHelpdesk@cdph.ca.gov or phone at 800-578-7889. or your Local CAIR Representative

View AFLs at the All Facilities Letter webpage.  

 

PINs from CDSS

Influenza and RSV Vaccination Recommendations 

The best way to prevent flu and its potentially serious complications is by getting a yearly flu vaccine.  CDC recommends flu vaccination for everyone 6 months and older.  Flu vaccination is especially important for people 65 years and older because they are at higher risk of developing serious flu complications. 

New CDC RSV Vaccination Recommendations

RSV infections can cause severe illness in older adults, including pneumonia, as well as worsening of underlying medical conditions like asthma, other chronic lung disease or congestive heart failure.  Adults at highest risk for severe RSV infection include:

  • Older adults
  • Adults living in long-term care facilities

The CDC recommends use of new RSV vaccines from GSK and Pfizer for people 60 years and older based on discussions with their healthcare provider about whether RSV vaccination is right for them.  These new vaccines are available now.
Expired COVID-19 Test Kit Guidance

Marin Public Health recommends that you suspend use of test kits that are beyond their extension date.  

Please dispose of all test kits that are beyond the FDA Extension date. 
At this time, County Public Health has limited supply of test kits.  While we work with CDPH to secure additional, non-expired test kits, please work with your vendors to purchase additional test kits, as needed for your facility/agency, to ensure CalOSHA / CDPH / CDSS compliance.

Marin Updates 

Marin County Public Health dashboards share local data and public health priorities to engage and educate the community we serve. Explore information on Reportable Communicable Diseases, COVID-19, InfluenzaLife Expectancy by Community, Non fatal and Fatal Overdoses, Hepatitis C, and the COVID-19 Community Assessment.

Multi-Drug Resistant Organisms (MDROs) News, Resources, and Trainings
Marin County Public Health is maintaining our focus on the threat of Multi-Drug Resistant Organisms. 
If your facility would like to receive an onsite training on MDROs and Enhanced Standard Precautions, please email your request to LTCFReport@marincounty.org

MDRO NEWS

Stay tuned for upcoming educational opportunities and news.

Upcoming Trainings

CDPH HAI IP Training for SNFs
The California Department of Public Health (CDPH) Healthcare Associated Infections (HAI) Program's Infection Prevention (IP) Training for Skilled Nursing Facilities (SNF) Online Course is back.  

The course provides practical guidance for implementing an infection prevention program in a skilled nursing facility (SNF) using evidence-based guidelines for preventing serious healthcare-associated infections (HAIs) including central line associated bloodstream infections (CLABSI), Clostridioides difficile infection (CDI), and catheter-associated urinary tract infections (CAUTI). 

 

California Department of Public Health/HAI Program approved by the California Board of Registered Nursing, Provider # 17280, for 18 contact hours. Register via the link below:

Infection Prevention (IP) Training for Skilled Nursing Facilities (SNF) Online Course Landing webpage:  



Virtual Long-Term Care IP Essentials Training
October 18–20, 2023
Managing infection prevention and control (IPC) in long-term care settings presents a unique set of challenges and issues. This training provides the foundation of the role of the infection preventionist (IP) and the practice of being an effective IP in a long-term care setting, including creating and managing successful IPC programs and mitigating risk at your facility. This training also covers CMS required topics. Learn more and register today!

Virtual LTC-CIP Certification Preparation Course
November 13–15, 2023
The LTC-CIP Certification provides a standardized measure of the basic knowledge, skills, and abilities expected of professionals working in the field. Successful long-term care infection prevention certification indicates competence in the practice of infection prevention and control within a long-term care setting. This comprehensive workshop includes guidance and support from a certified instructor(s) and access to the APIC Learning System for LTC-CIP. Space is limited, enroll today!


California Association of Long Term Medicine (CALTCM)
Infection Preventionist Orientation Program on demand training

This “on-demand” program is specifically targeted to infection preventionist nurses, however all who have a leadership role in infection prevention in a long term care setting will benefit. Infection Preventionists, Directors of Nursing, Assistant Directors of Nursing, Directors of Staff Development and more will have the opportunity to learn directly from an important leader in the field of infection prevention in long term care setting, Dolly Greene, RN, BSN, CIC. The CALTCM Infection Preventionist Orientation Program provides all the foundational information an Infection Preventionist needs to get started in their role through four (4) training modules.

  • Module 1 – Infection Preventionist Duties and Outcome Surveillance (1:08 min)
  • Module 2 – Process Surveillance and Antibiotic Stewardship (45 min)
  • Module 3 – Occupational Health & Immunization Program (43 min)
  • Module 4 – Infection Preventionist Resources and Tools (25 min)

Resources

Infectious Disease toolkits

     
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Next MCPH Monthly meeting is: Tuesday, October 24, 2:00-3:00 PM






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County of Marin · 3240 Kerner Blvd. · San Rafael, CA 94901 · USA

Public Health Newsletter - September 2023
Marin County Public Health Newsletter - September 2023
In this Issue: Wildfire Smoke | COVID-19 Vaccine I Buprenophine Training | RSV On the Rise | National Preparedness Month | Rabies Guidance | Message from the Deputy Public Health Officer 
A message to physicians and other health care providers from Marin County's Public Health Officers.

Wildfire Smoke in Marin

Active wildfires to the north recently threatened local air quality.  Last week, Marin County Public Health issued a health advisory when the Air Quality Index increased above 150 for much of Marin. Prolonged smoke exposure increases risk for respiratory and cardiovascular events. The CDC has guidance for clinicians to address air quality concerns with vulnerable populations. Clinicians should ensure asthma plans are up to date, and counsel at-risk patients to remain indoors as much as possible and use N-95 type masks outdoors when AQI is greater than 150.


COVID-19 Fall Vaccine Update

This fall, COVID-19 vaccine has arrived. Marin County Public Health joins the CDC in recommending the 2023 monovalent COVID-19 vaccine for everyone 6 months and older. Your highest risk patients should be offered the vaccine as soon as it’s available, following CDC clinical guidance. Dr. Willis explained the fall vaccine for the public in a recent video

Bivalent mRNA COVID-19 vaccines should be removed from inventory. Access to and payment for COVID-19 vaccines has transitioned from government-run to the commercial market. For more information, see the CDPH Commercialization Provider Transition Guide. The COVID-19 Bridge Access Program (BAP) will support vaccines for underinsured and uninsured adults. Providers selected to participate in this program received enrollment instructions this month.


Buprenophine for Beginners Training

California Medical Society Virtual Grand Rounds on October 10, for 12-1 PM  fulfills 1 of the 8 hours of opioid specific training required for DEA license renewal. Buprenorphine is effective for outpatient treatment for Opioid Use Disorder. Learn more about local overdose prevention at OD Free Marin.


Respiratory Syncytial Virus (RSV)

RSV season has begun in some parts of the country. The CDC issued a Health Advisory about RSV activity across some parts of the Southeast. The CDC recommends vaccine for older adults and the newly approved Beyfortus™ for infants to prevent severe RSV disease.


National Preparedness Month

September is National Preparedness Month. The current wildfires provide a reminder of the importance of preparation for disasters and emergencies. Healthcare providers should all sign up to receive emergency notifications at the Public Emergency Portal, for situational awareness when an event occurs. ReadyMarin is a one-stop resource for preparedness in Marin County.

World Rabies Day

1 in 10 bats tested in Marin County carry the rabies virus. Rabies disease is generally fatal, and highly preventable with vaccine and post exposure prophylaxis (PEP). Questions on indications and method for rabies vaccine and PEP frequently arise.  Marin County Public Health created a poster to help remind clinicians about how to administer PEP. To download this poster click here.


Message from the Deputy Public Health Officer

Winter respiratory season is here and visits for respiratory infections are increasing.  It is a great time to remind patients of the basics - staying home when sick, handwashing, and “strategic masking.”  People can make their own choices about wearing masks to protect against COVID-19 and other respiratory diseases.  Patients should consider wearing a mask if they or a loved one is at high risk for infection.  Staff who work in  health care settings with frequent exposures to respiratory viruses should consider wearing a mask.  Individuals who spend prolonged times in crowded indoor settings should consider wearing a mask, especially when circulating respiratory viruses are very high.  

Another layer of protection is awareness of local viral activity.  The annual winter virus surge typically begins between October and December in Marin. Local wastewater surveillance offers the earliest signal of winter virus circulation. Providers should visit  Marin County Public Health’s wastewater surveillance sites regularly for Flu and RSV, and for COVID-19 to stay informed about local viral activity.  

Stay well,

Lisa Santora, MD, MPH
Deputy Public Health Officer
lsantora@marincounty.org

 


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Copyright ©  2023
Marin County Public Health, a division of the Marin County Health & Human Services Department
https://www.marinhhs.org/public-health

Requests for disability accommodations may be made by phoning (415) 473-4381 (Voice), CA Relay 711 or by e-mail at DisabilityAccess@MarinCounty.org. Copies of documents are available in alternative formats, upon request.

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Our mailing address is:
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Public Health Newsletter - August 2023
Marin County Public Health Newsletter - August 2023
In this Issue: West Nile Virus | Tough Mudder Rashes I Catch-up Vaccine Schedule | RSV IZ for Infants | DEA Training Requirement | Suicide Prevention | Message from the Public Health Officer 
A message to physicians and other health care providers from Marin County's Public Health Officers.

West Nile Virus Detected Locally

Early this month the Marin/Sonoma Mosquito and Vector Control District reported the first dead bird infected with West Nile virus (WNV) for 2023 in our region. WNV is the most common and serious vector-borne disease in California. Clinicians should be aware that WNV season, typically later summer and fall, has begun in Marin. 

West Nile Virus disease should be considered in any person with a febrile or acute neurologic illness who has had recent exposure to mosquitoes, blood transfusion, or organ transplantation. WNV cases should be reported to Marin Public Health at MarinCD@marincounty.org with a CMR report and by phone to 415-473-4163 within one working day. For details on how to report click here. For more information on clinical evaluation, diagnostic testing, and treatment please refer to the CDC.


Aeromonas Causing Rash Illness in Tough Mudder Race Participants

Sonoma County Public Health has received reports of participants who developed a rash with fever, muscle pain and nausea after the Tough Mudder race at Sonoma Raceway on Aug. 19 and 20. Racers are drawn from across the region. Aeromonas has been identified as a cause, which responds to ciprofloxacin. For more information click here.


National Immunization Awareness Month

August is Immunization Awareness Month. Marin County has made remarkable progress in childhood vaccinations. In order to maintain high levels of protection during this season of back-to-school vaccines, Marin Public Health is reminding clinicians to refer to the CDC’s Catch-up Immunization Schedule. CDC also offers guidance in  how to recommend vaccinations to hesitant patients of all age groups.


A New RSV Immunization for Infants


A new immunization against respiratory syncytial virus (RSV) will be available for infants this fall. Nirsevimab (Beyfortus™) is a long-acting monoclonal antibody that has demonstrated an 80% reduction in the risk of hospitalizations and healthcare visits for RSV in infants. CDC recommends immunization for infants under 8 months and some older babies at increased risk of severe RSV illness. The immunization is available through the Vaccine for Children (VFC) program and through most insurers. For more information visit: RSV in Infants and Young Children | CDC.

Treating Opioid Use Disorder: DEA Training Requirement for All Licensees

Treatment of opioid use disorder (OUD) reduces risk of overdose and the harm of long term addiction. The Medical Board of California is requiring licensees who are registering or renewing a DEA license to complete an eight hour training requirement.

Board licensees who completed their one-time 12-hour CME course on pain management and the treatment of terminally ill and dying patients may have already satisfied this requirement.

 

 

This requirement can be met with multiple options, as long as it totals eight hours.
Please see the DEA notice for additional information or guidance on this matter.

Suicide Prevention Resources


September is Suicide Prevention and Recovery Month. Suicide a leading cause of preventable death In Marin County. For people considering suicide, real time connection with another person can be a life-line. 988 Suicide & Crisis Lifeline is a direct connection to compassionate, accessible care and support for anyone experiencing suicidal thoughts or any mental health or substance use related distress. 

Healthcare providers should ensure their patients are aware of and can access 988 for times in need. Clinicians can also play a role in preventing suicide by joining the Marin County Suicide Prevention Collaborative for in person and virtual meetings throughout the year.  The collaborative’s schedule of events is HERE.

 

Message from the Public Health Officer

Deputy Public Health Officer, Dr. Lisa Santora

For Marin Public Health, one of our take-homes of the pandemic was the need to provide frequent and reliable communication to the public. We now offer a weekly public health status update to the community covering a range of locally relevant topics. As an example, last week I outlined fall vaccine options in this video. We can combat misinformation together by providing consistent, clear and shared messages from healthcare and public health. Sign up to receive our weekly Public Health Status Updates here.

Matt Willis, MD, MPH
 


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Copyright ©  2023
Marin County Public Health, a division of the Marin County Health & Human Services Department
https://www.marinhhs.org/public-health

Requests for disability accommodations may be made by phoning (415) 473-4381 (Voice), CA Relay 711 or by e-mail at DisabilityAccess@MarinCounty.org. Copies of documents are available in alternative formats, upon request.

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Our mailing address is:
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MCPH OPIC Newsletter #6 August
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OPIC Monthly Newsletter

Issue 6                                                                    August 9, 2023

The Outbreak Prevention and Infection Control (OPIC) team's mission is to provide support to healthcare and congregate care facilities as you mitigate and manage risks due to communicable diseases and emergencies. We do this by promoting high levels of readiness, ensuring effective responses, and providing training and educational opportunities. Our monthly newsletters include: news and guidance updates, community status updates, available trainings and other educational opportunities.

Guidance Updates

Responding to COVID-19 in the Workplace - for Employers

 Audience: All California employers 

  • Purpose: to help employers understand the steps they can take to prevent the spread of COVID-19 and to respond quickly and appropriately to cases and outbreaks in the workplace.

  • Brief: updates to the existing guidance include the addition of new resources related to Cal/OSHA COVID-19 Prevention Non-Emergency Regulations, the update of references to outbreak and reporting guidance, and the update of recommendations and links on masking.
  • Primary Authoring Department: Occupational Health Branch (OHB) 

Updated Infection Control Plan Forms (from CDSS)

All Facilities Letters (AFLs) from CDPH

Extreme Heat Guidance All Facilities Letter (AFL)

  • Healthcare facilities should implement recommended precautionary measures to keep individuals safe and comfortable during extremely hot weather. Facilities must have contingency plans in place to deal with the loss of air conditioning, or in the case when no air conditioning is available, take measures to ensure patients and residents are free of adverse conditions that may cause heat-related health complications. Facilities must report extreme heat conditions that compromise patient health and safety and/or require an evacuation, transfer, or discharge of patients. Review the linked AFL for full guidance and resources.  

View AFLs at the All Facilities Letter webpage.  

 

PINs from CDSS

Preparation For Extreme Heat, Public Safety Power Shutoffs, And Wildfire Emergencies

  • PIN 23-13-CCLD reminds providers about the need to prepare for extreme heat, public safety power shutoffs (PSPS), and wildfire emergencies. It also provides information on the Everbridge Mass Notification System and how it will be used to notify providers of disasters, such as fires and PSPS.

Multi-Drug Resistant Organisms (MDROs) News, Resources, and Trainings
Marin County Public Health is maintaining our focus on the threat of Multi-Drug Resistant Organisms. Actions and ongoing projects related to this topic include:

  • Monitoring and reporting Carbapenemase Producing Organisms as new CDC guidance.
  • Active surveillance and mitigation for Candida auris in specific high risk settings. 
  • Promotion, education and support for Antibiotic Stewardship Programs. 
  • Participation the North Bay Multi-County MDRO workgroup. 
    • The North Bay MDRO workgroup collaborates and shares educational opportunities, information about ongoing case investigations and outbreaks, best practices for specimen handling and lab use, issues of policy and strategy. We work closely with CDPH HAI, CDPH Epidemiology, the Microbiological Diseases Laboratory, CDC and others as needed. Learnings from this setting inform our local health department practices and recommendations to partners like you. 

MDRO NEWS

Stay tuned for upcoming educational opportunities and news.

Marin Updates 

Marin County Public Health has seven data dashboards reflecting local public health priorities and displaying local public health data.

Climate Change and Infectious Diseases  

This week the CDC reported cases of malaria that were acquired in the United States. The presence of malaria-carrying mosquitoes in Florida signals the northern migration of tropical disease vectors due to climate change. No locally acquired malaria cases have been reported in California. A wet spring has increased local mosquito activity. The Marin/Sonoma Mosquito & Vector Control District samples local mosquito populations for emerging diseases and offers guidance for personal protection.  


Upcoming Trainings
CALTCM Infection Preventionist Orientation Program 

This “on-demand” program is specifically targeted to infection preventionist nurses, however all who have a leadership role in infection prevention in a long term care setting will benefit. Infection Preventionists, Directors of Nursing, Assistant Directors of Nursing, Directors of Staff Development and more will have the opportunity to learn directly from an important leader in the field of infection prevention in long term care setting, Dolly Greene, RN, BSN, CIC. The CALTCM Infection Preventionist Orientation Program provides all the foundational information an Infection Preventionist needs to get started in their role through four (4) training modules:

  • Module 1 – Infection Preventionist Duties and Outcome Surveillance 

  • Module 2 – Process Surveillance and Antibiotic Stewardship 

  • Module 3 – Occupational Health & Immunization Program 

  • Module 4 – Infection Preventionist Resources and Tools 

Resources

Resources to assist providers in being prepared for extreme heat, public safety power shutoffs, and wildfire emergencies:

 

Infectious Disease toolkits

     
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Email:  DSteckline@marincounty.org 
 

Next Ombudsman meeting is: Tuesday, August 29, 2:00-3:00 PM






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County of Marin · 3240 Kerner Blvd. · San Rafael, CA 94901 · USA

Public Health Newsletter - July 2023
Marin County Public Health Newsletter - July 2023
In this Issue: Climate Change & Infectious Diseases | Vaccines & the "Tripledemic" Viruses | Reportable Disease Requirements I Wildfire Information | Preventing Skin Cancer in Marin | Supporting Pediatric Provider Workforce | Message from the Deputy Public Health Officer 
A message to physicians and other health care providers from Marin County's Public Health Officers.

Climate Change and Infectious Diseases

This month, the CDC reported cases of malaria that were acquired in the United States. The presence of malaria-carrying mosquitoes in Florida signals the northern migration of tropical disease vectors due to climate change. No locally acquired malaria cases have been reported in California. A wet spring has increased local mosquito activity. The Marin/Sonoma Mosquito & Vector Control District samples local mosquito populations for emerging diseases and offers guidance for personal protection.


Vaccines and the "Tripledemic" Viruses

Last month, the FDA and CDC agreed on recommendations for a monovalent fall COVID-19 vaccine targeting the XBB lineage. The CDC also announced recommendations for a newly developed RSV vaccine for adults 60 years and older. The annual flu shot will also soon become available. The availability of all three vaccines can mitigate the “tripledemic” experienced last year. So far, FDA and CDC have not issued any guidance regarding potentially spacing out vaccines for patients who receive all three. The CDC ACIP has posted their recommendations from the most recent meeting. Clinicians should stay aware of recommendations as fall grows nearer. For additional resources visit: The California Department of Public Health, Immunization Branch website.


Reportable Disease Requirements and Timeliness

Under CA Code of Regulations Title 17, some diseases are required to be reported by health care providers and labs to the local health department. This includes immediate reporting of suspected cases of some rare, severe and easily transmitted illnesses, such meningococcus. Review the Title 17 list of Reportable Diseases and Conditions for the diseases that are required to be reported to Marin County’s Communicable Disease Prevention and Control Unit. Health care providers should report via phone if urgent, or use the web-based Confidential Morbidity Report (CMR). For suspect and active tuberculosis cases, complete our confidential online report for TB.





Person experiencing poor air quality in NYC.

 

Wildfire Information


With climate change impacting the severity and the likelihood of fires, it’s important to stay aware and prepared during the wildfire season. Marin County provides resources for the community to prepare and stay informed when wildfires threaten our health. The CDC recommends healthcare providers  inform patients at high risk (e.g. people with asthma, COPD, heart disease, young children, and those who are pregnant) about the hazards of breathing wildfire smoke. See the list of resources by the CDC for healthcare professionals to remain informed about wildfires.

Preventing Skin Cancer in Marin


Skin cancer is the most common form of cancer among Marin County residents. July marks UV Safety Awareness Month. The CDC advises health care providers to remind patients about the importance of sun safety and recommends the use of sunscreen, sun protective clothing, and to find shade when appropriate. Skin checks remain an important screening step in preventive care. Staying aware of the local UV index can help prevent overexposure to harmful solar radiation. 


 

Supporting our Pediatric Provider Workforce


The U.S. Department of Health & Human Services has launched a new Pediatric Specialty Loan Repayment Program to recruit and retain clinicians who provide health care to children and adolescents. Clinicians who agree to provide three years of full-time pediatric care, or child and adolescent behavioral health care can receive loan repayment assistance up to $100,000.
 

Message from the Deputy Health Officer

Deputy Public Health Officer, Dr. Lisa Santora

 

Marin Public Health is now actively preparing for the wildfire season, which includes extreme heat and extended power outages.  Healthcare providers can share disease-specific emergency readiness materials with patients to help them prepare for disasters and emergencies.  Another important strategy to increase community preparedness is Lifesaving Skills Training.  The Marin Medical Reserve Corps (MMRC) offers these trainings countywide throughout the year. On August 19, Marin EMS is partnering with the MMRC, county fire departments, and local hospitals to host its annual sidewalk CPR event.  On this day, free lifesaving skills training, including hands-only CPR, AED use, Narcan, and Stop the Bleed, will be offered at multiple locations countywide (#marinsidewalkcpr).  We look forward to seeing you, your staff and your patients on the 19th.

Stay well,

Lisa M. Santora, MD, MPH
lsantora@marincounty.org


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