Advisory: Masking and Vaccination in Health Care and Long-term Care Facilities

As respiratory viruses surge this winter, Marin County Public Health issued an advisory strongly recommending that healthcare and long-term care facilities implement masking policies from November 1, 2024, to March 31, 2025. All staff and visitors should wear high-quality masks during close contact with patients and residents. Facilities are urged to review Cal/OSHA standards, promote vaccinations, enforce hand hygiene, enhance cleaning protocols, and monitor respiratory virus activity. These measures aim to reduce transmission risks and protect vulnerable populations during the winter season.

National Respiratory Syncytial Virus (RSV) Month

October is National Respiratory Syncytial Virus (RSV) Month. RSV is the leading cause of hospitalization for infants in the United States. Pregnant people can help protect their babies before birth by getting the RSV vaccine at 32 through 36 weeks of pregnancy, from September 1 – January 31.  Pregnant people also need updated 2024-25 COVID-19 and flu vaccines as well as the Tdap vaccine at 27-36 weeks gestation.  Centers for Disease Control and Prevention (CDC) has updated its Guidelines for Vaccinating Pregnant Persons.

Updated Syphilis Screening Recommendations

• Once in a lifetime screening of all sexually active persons 15-44 years old.
• Annual screening whenever a person is tested for HIV or other sexually transmitted infections, including mpox.
• All pregnant persons at confirmation of pregnancy or first prenatal encounter, early in the third trimester and at delivery.
• All persons 15-44 years old who enter a correctional facility at the time of intake.

Virtual Grand Rounds - From Avian Flu to COVID-19 - How the "One Health" Approach Improves Human, Animal and Environmental Health

Marburg Virus Disease in Rwanda

Rwanda is experiencing its first outbreak of Marburg virus disease (MVD), with 65 reported cases and 15 deaths as of October 28, 2024. Most infections are among healthcare workers. The CDC is assisting the Rwandan Ministry of Health, deploying scientists to support case tracking, laboratory testing, and infection control. Currently, there are no Marburg cases in the U.S., and the risk remains low. Most ill travelers returning from an area with an active MVD outbreak are usually ill with a more common infection, such as malaria. Healthcare providers are urged to stay informed about the outbreak. Marin County Public Health is working with local hospitals to ensure their readiness to receive and isolate a person of interest and care for the patient.  Health care providers should contact Marin County Public Health immediately if a confirmed traveler from a filovirus affected area or a close contact presents with viral symptoms.  Call (415) 473-4163 during business hours; after hours call (415) 479-5305.

Message from the Public Health Officer

Please join me in welcoming Dr. Melanie Thompson as our new Deputy Health Officer. With over a decade of experience in healthcare, including her role as Chief Medical Officer at Marin Community Clinics, Dr. Thompson’s expertise in health equity and strategic health initiatives will greatly benefit our Public Health team and our community.  Feel free to contact us at our new email address, HealthOfficer@marincounty.gov, which is checked daily during business hours.

The end of daylight-saving time is a reminder that seasons are changing. Take time to ensure you, your facility, and your patients are prepared for seasonal emergencies, including flooding and extended power outages.  Stay informed, know your local flood zones, have a plan for evacuation, and keep your vehicle’s gas tank full (or fully charged).

With gratitude,

Lisa M. Santora, MD, MPH
Health Officer
 

---

RSV Vaccine

Last year, a new respiratory syncytial virus (RSV) vaccine was approved for older adults, providing additional protection against respiratory syncytial virus. RSV and flu are associated with substantial mortality among older adults > 65 years old. The Centers for Disease Control and Prevention (CDC) recommends everyone ages 75 and older and adults ages 60–74 who are at increased risk of severe RSV disease get an RSV vaccine once.  Marin Public Health epidemiologists estimate that 35% of our population is 75 and older and 30% of Marin residents are 65 and older and have received this vaccine.  At this time, annual (seasonal) RSV vaccination is not recommended.

Fall Vaccine Opportunities

Immunizations are a core prevention strategy to lower risk from respiratory viruses.  Residents can obtain vaccines from their healthcare providers, in pharmacies, or in dedicated vaccine clinics. Marin Public Health and Safeway Pharmacy are offering COVID, flu (regular and high dose), and RSV vaccinations at the Marin Health and Wellness Campus, located at 3240 Kerner Blvd, San Rafael. Clinics are scheduled on October 12 and 26, from 10:00 AM to 4:00 PM (closed for lunch from 12:45 PM to 1:30 PM). For more information and to schedule an appointment, visit the Safeway Vaccination Clinic.

Mpox

Got Milk? H5N1 Update

Teeth, Fangs, and Vaccine

We frequently receive after-hours inquiries about post-exposure rabies prophylaxis. Rabies is endemic in Marin's bat population. With about 10% testing positive, bats are the main source of rabies exposure in our area. Marin Public Health, in partnership with Marin Humane, addresses animal bites and ensures timely post-exposure prophylaxis (PEP). Complex cases often involve pediatric patients bitten by unidentified dogs. We urge health care providers to review our Rabies Information website and encourage pet owners to keep their cats and dogs up to date on rabies vaccinations.

Weathering the Storms: National Preparedness Month

Suicide Prevention

With suicide rates in Marin County higher than state averages, identifying at-risk individuals, providing support and interventions, and facilitating access to mental health resources is critical. As part of National Suicide Prevention Month,  the Marin Suicide Prevention Collaborative launched the Ask, Listen, Connect campaign and introduced the 988 Hope and Help toolkit. This month, Marin Public Health epidemiologists also published a suicide prevention data dashboard, which provides interactive data to monitor suicide trends and support prevention efforts in the community. Please take time to care for yourself, review and share these resources.

Message from the Public Health Officer

Last week in his Farewell Message, Dr. Willis looked back on his 12 years as Marin County's Health Officer and highlighted our community's “superpower” - recognizing our shared interdependence and taking collective action.  In his next chapter, Dr. Willis will focus on climate health and enhancing public health communication.  You can find his “next post” at Your Local Epidemiologist, which is a newsletter that translates public health science for the community.  Our Public Health team is deeply grateful for Dr. Willis’ leadership on both blue sky and gray sky days.   Safe travels, Dr. Willis! Embrace the adventure ahead and enjoy the journey.

In Gratitude,

Lisa M. Santora, MD, MPH
Public Health Officer
 

---

Mpox

Slapped Cheek Disease

Human parvovirus B19 is a respiratory virus that causes "fifth disease," a common childhood illness with symptoms like a "slapped cheek" rash, fever, and joint pain. While usually mild, it can cause serious illness in pregnant and immunocompromised persons.  This month, the Centers for Disease Control and Prevention (CDC) issued an alert advising providers and the public of a significant increase in human parvovirus B19 activity in the United States.  Providers should have increased suspicion for parvovirus B19 in patients presenting with fever and rash.  This is also an opportunity to promote CDC recommendations for core prevention strategies to prevent respiratory illness, including practicing good hand hygiene and masking to reduce spread of parvovirus B19 and other respiratory viruses.

Shigella

This month, the CDPH alerted healthcare providers of a rise in extensively drug-resistant (XDR) Shigella strains in California. The majority of drug-resistant cases have been among self-identified men who have sex with men (MSM). Healthcare providers should tailor any shigellosis antibiotic treatment to available antimicrobial susceptibility testing (AST) data, and counsel patients at increased risk of infection on prevention and risk reduction practices.

COVID-19 Vaccine is Here

Marin continues to experience a surge in Covid activity.  Fortunately, COVID-19 vaccines are arriving to Marin next month.  The CDC recommends that everyone ages 6 months and older receive an updated 2024-2025 COVID-19 vaccine. Patients are eligible for a vaccine if it has been more than 2 months since their last Covid infection, but from an immunological perspective, it is optimal to receive an updated vaccine 4 – 6 months after infection.  It is important to remember that you can co-administer the COVID-19 and other vaccines, including flu. Our vaccine finder page has links to Marin locations offering the updated COVID-19 vaccine.

Tobacco Cessation

Ember Stomp

Join Marin Public Health on September 7^th at Fire Safe Marin’s Ember Stomp, a free wildfire prevention festival at the Marin County Fairgrounds. The event will feature Marin County Fire's simulation of the historic September 1923 fire, which burned large swaths of Marin County.  While fire prevention efforts are reducing the risk of wildfire, we have already experienced multiple fires this season.  Health care providers should review wildfire readiness, including preparedness for extended power outages, with medically frail patients, including those with chronic respiratory diseases.

Message from the Deputy Public Health Officer

As school gets underway, it's time to refocus on fundamental aspects of our well-being, starting with social connectedness. Building and maintaining connections is crucial for our community's resilience. Next month, as we observe Suicide Prevention and Recovery Month, the theme will be "Ask, Listen, Connect." You can explore more about fostering connections by visiting the Marin Behavioral Health and Recovery Services (BHRS) website.
Our commitment to checking in on one another is vital not only for supporting mental health but also for preparing for and responding to emergencies. September is National Preparedness Month, a perfect opportunity to ensure we’re all ready for unexpected situations. I encourage you to take a moment this month to reach out to an older neighbor who lives alone. Your effort can make a significant difference.

In Gratitude,

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

---

Back to School Vaccines

Last year, Marin County childhood vaccination rates were among the highest in the state. This reflects the successful partnership between local public health and healthcare providers, to reverse a history of preventable outbreaks and lower than state-average vaccination rates. California law requires students receive certain immunizations before attending school or childcare. Providers should continue support families to stay up to date on vaccines ahead of the new school year. Resources are available on the ShotsforSchool webpage.  In addition to required vaccines, protection against other vaccine-preventable diseases is recommended. This includes human papillomavirus (HPV)  a leading cause of preventable cancer.

Wildfire Smoke

Sidewalk CPR

Marin County Public Health, Emergency Medical Services, and the Marin Medical Reserve Corps  are partnering in the annual sidewalk CPR event on Saturday August 17^th from 10 am to 2 pm. The event is held at multiple locations throughout Marin simultaneously and offers the public free training on Hands-Only CPR, Stop the Bleed, how to use an AED, and Narcan administration. In last year’s event, over 1000 people were trained across 13 sites. Clinicians can post this flyer to invite patients, friends and family to this fun, free, potentially lifesaving training.

Summer COVID-19 Surge & Masking

On July 30, Marin County Public Health issued a Public Health Advisory signaling ongoing high rates of COVID-19 transmission and severe illness in our community. July has seen the highest number of COVID-19 hospitalizations and deaths of any month in 2024. Marin Public Health recommends masking in high-risk settings, including hospitals and nursing homes, vaccinating residents aged 65 or older who have not received a vaccine in over six months, and treating older residents diagnosed with COVID-19.

Gun Violence and Public Health

UV Protection Especially Important in Marin

Marin County has among the highest rates of melanoma in California. This is consistent with other communities with active outdoor recreation, higher than average days of sunlight, and a high proportion of white residents of older age.  Summer is in full swing and clinicians can support skin health by reminding patients of protective measures, as recommended by the U.S. Preventive Services Task Force.

Message from the Public Health Officer

We recognize that as clinicians your offices are flooded with guidance and recommendations for supporting patient health. Our goal is to provide you with the local angle on any given topic, to help you sift among competing priorities in your medical practice. For each topic, we try to provide Marin specific data for practical and actionable local guidance. Please do not hesitate to offer suggestions for topics for future newsletters.
 
Yours in Health,

Matt Willis, MD, MPH
Public Health Officer


 

---

Extreme Heat

Extreme heat is here and of growing concern.  Parts of California and the nation have already experienced major excessive heat events this summer.  Today, the National Weather Service (NWS) is forecasting a possible HeatRisk for the Bay Area starting this weekend.  Extreme heat can lead to serious medical emergencies, especially for vulnerable populations, including young children, older adults, people with chronic diseases and disabilities, outdoor workers and those who are pregnant.  New resources are available from the Governor’s Office at HeatReadyCA.

COVID-19 Surge and Outlook for this Fall

Since June 1, the amount of SARS-CoV-2 in Marin County wastewater has more than doubled to a four-month high. COVID-19 hospitalizations have followed a similar pattern and continue to rise.  The FDA advisory panel unanimously recommended that the Fall 2024 COVID vaccine be updated to target the JN.1 variant or one of its descendants. In Marin County, JN.1 was the dominant strain from December 2023 to April 2024. The KP.2 variant, which gained local dominance in May, is closely related to JN.1. Vaccine production is currently on track for availability in August.

Wildfire Smoke

Suicide Prevention Dashboard Launched

Message from the Public Health Officer

This week, I had a chance to meet Dr. Tony Fauci after a lecture at Dominican University. His account of the federal pandemic response brought vivid memories of our local experience. I was reminded of the strong and immediate partnership with our clinical community during those uncertain times. The slack channel exchanges between Bay Area health officers in early 2020, made public through the Freedom of Information Act, help capture the degree to which the early response fell to us at the local level. As the nation reflects on the pandemic response, Marin Public Health remains grateful for the bond with our healthcare community.
 
In gratitude,

Matt Willis, MD, MPH
Public Health Officer


 

---

Influenza Circulating in Marin is Not H5N1

Marin County Public Health is closely monitoring the national H5N1 bird flu outbreak. In early May, a late season rise in influenza A levels in wastewater raised concerns about the possibility of local H5N1 transmission. Starting May 20th, Marin County began testing wastewater for the presence of H5N1, and none has yet been detected. This suggests ongoing presence of routine seasonal flu H1N1, highlighting the importance of the seasonal flu vaccine. The risk to the public for H5N1 remains low. For more information, including guidance for clinicians, visit the CDC’s H5N1 Bird Flu: Current Situation Summary.

Rabies Risk Low but Present in Marin

Rabies infection is nearly 100 percent fatal in humans. While no human cases have ever been reported in Marin, about one in ten local bats tested carry the rabies virus. Marin clinicians should be aware that Post-Exposure Prophylaxis (PEP) may be recommended for individuals who had contact with a bat, or who experience bites or scratches with other animals, when rabies cannot be ruled out. All Marin County emergency departments offer rabies PEP. Rabies control happens daily with investigations performed by Marin Public Health, animal control by Marin Humane and testing at our regional public health laboratory. Clinicians with questions about rabies PEP should visit Marin Public Health rabies webpage or contact us at 415-473-4163.

Public Health Leadership Hand-Off

COVID-19: FLiRT Variant Driving Transmission

Social Isolation

Clinicians and Public Leaders Join Forces for E-Bike Safety

Message from the Deputy Public Health Officer

As we conclude May Mental Health Month, I encourage all of you who focus every day on caring for others to prioritize your own well-being.  Self-care is vital to preventing burn-out.  Take a moment to focus on your needs, find time to connect with family and friends, and practice gratitude.  The Self Care for Healthcare Workers Modules developed by SAMHSA offer videos, checklists, and toolkits to recognize stress levels and build resilience. Remember, taking care of yourself allows you to better care for others!
 
In gratitude,

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


 

---

Mental Health Month

May is Mental Health Month.  At least one in four people in our Marin community faces a mental health or substance use challenge. Marin County Behavioral Health and Recovery Services and partners invite you to join events throughout May to prioritize mental health and combat stigma. Highlights include:

• May 2: Marin Maternal Mental Health Community Forum with California Surgeon General, Dr. Diana Ramos. RSVP to Michelle@First5Marin.org
• May 9: Drew Robinson, former SF Giant and Mental Health Advocate:  A survivor’s story about mental health, hope and recovery. Register
• May 18: "One Stride at a Time: 5K for Hope, Help, and Recovery." Register 
• May 21: "Honoring Stories, Transforming Minds" with Living Arts Playback Theater. Register to share and heal through theater.

More events can be found here.

Highly Pathogenic Avian Influenza

The spread of H5N1 Avian Influenza  into mammals, including humans, has gained significant media attention recently. Clinicians may be called upon to explain risk for their patients. Dr. Willis offered a video update on this emerging threat for the Marin public on April 26. No cases among humans or livestock have been reported in California or Marin. Avoiding contact with dead birds and not consuming raw milk are two simple steps to protect against infection. Marin Public Health will continue to provide any relevant updates.

National Volunteer Week and the Medical Reserve Corps

Last week was National Volunteer Week. The Marin Medical Reserve Corps (MMRC) is a volunteer based organization dedicated to protecting the health of residents, especially during large scale emergencies. The MMRC has played a pivotal role in several recent responses, including the pandemic, wildfires, and the opioid crisis. Learn more and sign up to join the MMRC here.

Winter Respiratory Virus Season Ends

Emergency Medical Services Leaders Honored

Message from the Public Health Officer

Public Health is back in the headlines lately with concerns about the spread of Avian flu H5N1 to humans.  It remains important to place this threat in context, while not minimizing risk. There is no immediate danger to our community. At the same time, this emerging virus demonstrates the importance of maintaining infrastructure for responding to pandemic threats, and of maintaining strong ongoing communication between healthcare and public health.

Thank you for providing excellent care for our community.

Matt

Matthew Willis, MD, MPH
Public Heath Officer


 

---

Pertussis

Last week, MCPH issued a health advisory due to an outbreak of pertussis (whooping cough) at Tamalpais High School. People who have been vaccinated for pertussis often present with mild symptoms. MCPH recommends providers have a high index of suspicion and a low threshold for testing and evaluating individuals for pertussis.  Protect infants from pertussis by advising pregnant women and family members to get a DTaP vaccine.

Fentanyl Update

There were five overdose deaths in Marin due to fentanyl in the last two weeks of February, which corresponded with an increase in wastewater and 911 calls for non-fatal overdose events.  Earlier this month, MCPH issued a health advisory to clinicians and substance use treatment providers.    Overdose prevention is a top priority locally in Marin, and OD Free Marin is holding a community forum to address this critical issue on April 10^th from 6:30-8pm.  To join the conversation and be part of the solution Register here.

New Tools for Addressing Alzheimer's

CDPH estimates that in 2019, over 7,000 Marin residents were living with Alzheimer’s disease, and that number is projected to double by 2040.  Out of growing concern statewide about the impact of Alzheimer’s and related dementias, CDPH has released a tool to help families; the tool addresses prevention, early identification, and advance planning.  Learn more at TakeOnAlz.com.

California Surgeon General in Marin for Maternal Mental Health

California’s Surgeon General, Dr. Diana Ramos will be coming to Marin on Thursday, May 2, to give a keynote address at First 5’s Marin Communications Forum.  The talk will be focused on all aspects of Maternal Mental Health from Adverse Childhood Experiences to pregnancy to post-partum. More information can be found on the Facebook event page.

Community Health Assessment
 

Every three years, Marin Public Health gathers with stakeholders across our community to re-assess local health needs and set shared priorities. The Community Health Assessment (CHA) is required for achieving Public Health Accreditation and describes health indicators, disease prevalence, social determinants of health, access to healthcare services and other factors. Focus is placed on understanding health disparities, identifying areas for improvement, and informing interventions to promote health for all members of the community. The next CHA process will occur in 2025. Please click here to view the last Marin County Community Needs Assessment: A Summary of Key Findings.

Long-Term Care Settings Outbreak Free 

Message from the Deputy Public Health Officer

This week, Public Health was in the news.  The Marin IJ feature our Marin County Life Expectancy Dashboard and the work of our Community Response Teams, which have been renamed Community Resilience Teams to reflect a broader scope of work post-pandemic.  It also highlighted how the pandemic fortified our public health system and the importance of harnessing lessons learned to improve the health and safety of our community.  We have deep gratitude for our ongoing partnership with Marin’s health care providers.  Thank you for all you do each day to keep our community, especially our most vulnerable residents, healthy and safe.
 
In gratitude,

Lisa M. Santora, MD, MPH
Deputy Heath Officer


 

---

Measles Update

Measles, once nearly eliminated in the U.S., is on the rise again globally and nationally. The California Department of Public Health issued a health advisory, reminding health care providers to consider measles in persons presenting with a febrile rash illness. Clinicians should ensure patients are up to date with measles vaccine and report any suspected cases to Marin Public Health at 415-473-4163. Travelers should check CDC’s Travel Health Notices to monitor measles risk abroad. For more information visit CDPH EZIZ Measles Resources.

Think TB

Tuberculosis infections are on the rise in California, partly due to reductions in screening rates during the pandemic.  Active TB disease is effectively prevented with testing and treatment of latent TB (LTBI). Marin County clinicians are reminded to “Think TB” and test at-risk residents for LTBI. Providers should not repeat testing unless new risk factors emerge, and only treat LTBI after active TB is ruled out.  For guidance, visit TB Risk Assessment (ca.gov). Report any suspect or active TB cases to Marin Public Health using the online confidential reporting form.

Emergency Alert System Test

On March 23 at 10AM, the County of Marin Office of Emergency Management (OEM) will conduct a first ever countywide test of AlertMarin.  AlertMarin is designed to reach residents countywide during an emergency incident, to communicate instructions to evacuate, shelter in place, or take other protective actions. Clinicians should encourage staff, patients and families who live or work in Marin to sign-up to receive emergency alerts ahead of the test.

Safety Concerns After a Flood

Climate change is accelerating natural disasters, including flooding. Healthcare providers should be equipped to manage emerging threats to health. The California Department of Public Health has developed materials for healthcare providers and patients regarding flooding, including a preparation checklist and clinical guidance for infectious, dermatologic, and injury concerns. This guidance is posted on a new Marin Public Health landing page. dedicated to flood safety.

Social Media and Teen Mental Health
 

The U.S. Surgeon General has cited an increasing body of evidence showing social media can harm the mental and social well-being of young people. The Marin County Office of Education (MCOE) has developed a resource guide for parents that clinicians can share with families. MCOE has also joined a lawsuit against social media companies to accelerate change and offset costs associated with supporting youth who have been negatively impacted.

Unpacking Marin's Top Health Ranking 

Message from the Public Health Officer

For many of us in healthcare, our roles have shifted rapidly from direct pandemic response to managing the consequences of four years of disrupted health services. Resurgences in measles and TB are partly attributable to reduced screening and vaccinations. Teen mental health has suffered from a combination of social isolation and accelerated social media. Together, these point to the value of the everyday work of preventive care, and the irreplaceable value of personal relationships with our patients. For me, it’s reassuring to recognize that pandemic recovery happens in the routine elements we all bring to the vocation of healthcare. Thank you for your stamina and compassion as we continue to care for our community.

Sincerely,

Matt Willis MD, MPH
Public Health Officer
Matt.Willis@marincounty.gov

---