From Barnyards to Beaches: H5N1 in California Seals

UC Davis has confirmed California’s first cases of highly pathogenic avian influenza (H5N1) in northern elephant seals, marking the virus’s first detection in this species in the state. Marin County benefits from the expertise of the Marine Mammal Center, whose marine wildlife health surveillance strengthens regional One Health awareness and coordination. As H5N1 continues to circulate in wildlife, including dairy cows and poultry, healthcare providers play a critical role in early recognition. When evaluating patients with influenza-like illness, please ask about recent exposure to wildlife, marine mammals, backyard flocks, commercial poultry, or dairy cattle, and follow current public health guidance for testing and reporting suspected cases.

Rising Measles Cases in California

When Seconds Count: Clinical Actions that Change Stroke Outcomes

Stroke remains a leading cause of death and disability in Marin County. Clinicians can improve outcomes by prioritizing routine blood pressure screening and aggressive management of hypertension, which is the most significant modifiable stroke risk factor. Patient education is equally critical. Ensure patients and caregivers recognize stroke warning signs using FAST (face drooping, arm weakness, speech difficulty) and understand the need to call 911 immediately. Promote community preparedness by recommending the PulsePoint app to help locate nearby AEDs and mobilize trained responders.

Every Visit Counts: Strengthening Cancer Prevention in Marin County

Cancer prevention and early detection are critical to improving health outcomes in Marin County, where cancer is the leading cause of premature death. Clinicians can help reduce cancer burden by routinely assessing risk, reviewing screening status, and following evidence-based screening guidelines. Vaccination is a key prevention strategy. Strongly recommend the HPV and Hepatitis B vaccines when indicated, using clear, evidence-based counseling to address hesitancy. National Cancer Prevention Month is an opportunity for Marin County clinicians to strengthen prevention conversations, close screening and vaccination gaps, and connect patients to timely preventive care.

Fluoride, Drinking Water, and Children's Oral Health

This month, the Marin County Board of Supervisors recognized National Children’s Dental Health Month, reaffirming the County’s commitment to prevention and evidence-based oral health. In Marin County, some patients receive fluoridated water through public systems, while others, especially those on private wells or small systems do not. Fluoride has a long, strong safety record and is effective in preventing cavities, especially children with limited access to dental care. Health care providers can support oral health by asking about water sources, reinforcing twice-daily brushing with fluoride toothpaste, encouraging regular dental visits, and connecting families to local dental resources.

Caring for Children Under 5 Exposed to Infectious Tuberculosis

Young children exposed to infectious tuberculosis face unique and urgent risks. Compared to adults, TB in children under five can progress rapidly, present with subtle or atypical findings, and lead to severe disease if not recognized early. To support clinicians navigating these challenges, the Mayo Clinic Center for Tuberculosis (MCCT) has released the Children Under 5 Exposed to Infectious TB Guide. This evidence-based resource outlines key steps for timely evaluation, diagnosis, and management.

Message from the Health Officer

A School Outbreak, A Clinical Reminder: Think TB

Recent TB activity in the Bay Area, including an outbreak at Archbishop Riordan High School in San Francisco, underscores the need for vigilance across the TB spectrum. Providers should maintain clinical suspicion for active TB in patients with persistent cough, fever, night sweats, or weight loss, particularly with congregate setting exposures, and promptly initiate airborne precautions and report to Marin County Public Health. Health care providers must complete this confidential online report for all suspect and active tuberculosis cases among Marin County residents. Please do not wait for laboratory confirmation before reporting.

Fourth Case of Measles in the Bay Area

Vaccine Guidance Update: California Aligns with AAP - Not CDC

This week the the California Department of Public Health (CDPH), in coordination with its partners in the West Coast Health Alliance (WCHA), endorsed the 2026 American Academy of Pediatrics (AAP) Recommended Child and Adolescent Immunization Schedule. This schedule differs from recent national changes issued by the CDC.  Providers are encouraged to refer to AAP guidance and clinical resources for the recommended vaccine schedule and counseling tools to ensure immunization practices align with California-endorsed standards and best support pediatric patients and families.

DEA Extends Telehealth Flexibilities for MAT

In partnership with HHS, the DEA issued a fourth temporary extension of COVID-19 telehealth flexibilities, ensuring medication-assisted treatment (MAT) for opioid use disorder can continue via telemedicine through December 31, 2026. DEA-registered practitioners may prescribe Schedule II–V controlled medications, including Schedule III–V OUD medications, via audio-video visits without a prior in-person exam. New final rules effective December 31, 2025 further clarify telehealth options for OUD and veterans’ care.

Staying connected matters. Strong professional community helps us share knowledge, support one another, and respond when it matters most. One way to stay engaged locally is through the San Francisco Marin Medical Society, which offers opportunities to connect with colleagues and stay informed. We also encourage providers to consider joining the Marin Medical Reserve Corps—an important way to serve the community and be ready during public health emergencies.

Message from the Health Officer

Contra Costa Measles Case Highlights Local Risk and Early MMR Guidance

A measles case confirmed in Contra Costa County this week was not travel related, suggesting possible local measles activity in the Bay Area. This follows a large U.S. measles resurgence (over 2,000 cases nationwide) and recent airport exposures during the holiday travel period, increasing the risk of regional spread. Measles is highly contagious, can spread before symptoms appear, and can remain airborne or on surfaces for hours. Marin County Public Health urges providers to counsel families on early MMR vaccination for children with upcoming travel. Infants 6–11 months should receive one early MMR dose before travel; children 12 months and older should follow the routine 2-dose schedule (minimum 28 days apart). Review travel plans, confirm immunity, and vaccinate at least two weeks before departure when possible. Suspect measles in patients with fever and a generalized maculopapular rash, especially when accompanied by cough, coryza, or conjunctivitis. Contact Marin County Public Health immediately to report and coordinate testing: 415-473-4163 (business hours) or 415-479-5305 (after hours).

New Vaccine Resources for Marin Parents

Winter Respiratory Season Has Arrived; Encourage Patients to Get Vaccinated

Winter respiratory viruses are increasing in Marin, raising the risk of serious illness especially for young children, older adults, and individuals with chronic conditions. Vaccination remains the most effective way to prevent severe disease and hospitalization. Clinicians should strongly recommend routine and seasonal vaccines and provide clear, evidence-based answers to patient questions. Kaiser members can find convenient, no-cost vaccine locations at https://mydoctor.kaiserpermanente.org/ncal/flu-and-covid-19-vaccine-locations/. If you don’t offer vaccines at your clinic, please direct patients to Marin County Public Health’s Vaccine Finder, which provides up-to-date information on available vaccines and sites across the county: https://coronavirus.marinhhs.org/vaccinefinder.

Clinical Guidance: Hepatitis B

Hepatitis B is a serious, vaccine-preventable liver infection that can lead to chronic disease, cirrhosis, or cancer. Routine vaccination beginning at birth and continuing through all age groups remains the most effective prevention strategy. Most people develop protective immunity, but an estimated 5–15% may not respond and need evaluation and counseling about repeat vaccination or post-exposure prophylaxis. Providers should screen for Hepatitis B, vaccinate eligible patients and address non-response appropriately.

Preventing TB Disease Starts in Primary Care

Latent tuberculosis infection (LTBI) should be managed like other chronic conditions identified in primary care. Without treatment, LTBI can progress to active TB, leading to preventable hospitalizations and complications. Treating LTBI markedly reduces reactivation risk, especially in higher-risk populations such as Asian American, Black, and Latino patients. California law now requires TB risk-based screening in adult primary care, reinforcing the role of PCPs in identifying, treating, and preventing TB disease.

Message from the Health Officer

Vaccine Disinformation at the Federal Level

The Centers for Disease Control and Prevention (CDC) recently revised language on its vaccine safety webpage, to suggest that the statement “vaccines do not cause autism” is not evidence-based. This wording conflicts with decades of rigorous, peer-reviewed research showing no causal relationship between vaccines and autism. Although neurologic vaccine adverse events are extremely rare and significant for the families affected, the benefits of vaccination overwhelmingly outweigh these risks. Vaccines are safe, effective, and essential for protecting children and communities. Regardless of evolving federal communications, Marin County Public Health (MCPH) remains committed to providing clear, evidence-based information and to supporting healthcare providers in promoting vaccination as a cornerstone of preventive care. We encourage providers to consult Immunize.org and the Vaccine Safety Resource Center (vaccinesafety.edu) for clear, evidence-based guidance on vaccine science and safety.

COVID-19 Vaccines for Children 6 Months to < 3 Years

CDPH Recommendation: Male Partner Treatment for Recurrent BV

The CDPH Office of STIs and HCV has issued a new Dear Colleague Letter advising clinicians to consider concurrent treatment of male partners of women with confirmed recurrent bacterial vaginosis in ongoing monogamous relationships. This approach aims to reduce recurrence and improve treatment outcomes.

Clinical Guidance: Infant Botulism Linked to ByHeart Infant Formula

Following the ongoing infant botulism outbreak associated with ByHeart infant formula, MCPH issued an advisory earlier this month. We ask healthcare providers to maintain a high index of suspicion for infant botulism in formula-fed infants. Key symptoms include constipation, poor feeding, weak cry, diminished suck/gag, and respiratory difficulty. If infant botulism is suspected, immediately consult the Infant Botulism Treatment and Prevention Program (IBTPP) for guidance.  Please report suspected cases immediately by calling 415-473-4163.

Marin Rallies in Response to Food Insecurity

Earlier this month, the County of Marin activated its Emergency Operations Center (EOC) when SNAP/CalFresh benefits were delayed. Working with community partners, the county rapidly distributed food to affected individuals and families. The Marin Community Foundation also launched the Food on Every Table Fund, which provided direct assistance to those in need and will support the development of a countywide nutrition security plan. Healthcare providers play a key role in promoting nutrition security by routinely screening for food insecurity and referring to programs including CalFresh, WIC, and community-based resources. We encourage all providers to integrate food insecurity screening and referral into everyday practice to support patients and strengthen community health.

World AIDS Day Event - December 5

You’re invited to a World AIDS Day gathering to honor lives lost, celebrate survivors, and reflect on major advances in HIV prevention and treatment.  The event will be held at Vivalon (999 3rd St., San Rafael) on December 5, 2025, 5:30–7:30 PM.  Speakers include Jane Spahr and Karyn Kleinman (Marin LGBTQ+ Center), Marcelino Alcorta (AIDS Healthcare Foundation), and Dr. Melanie Thompson (Marin County Public Health). More than 40 years into the epidemic, effective antiretroviral therapy, U=U (Undetectable = Untransmittable), and Pre-Exposure Prophylaxis (PrEP) have transformed HIV care and prevention. We encourage all providers to routinely screen for HIV and actively offer PrEP to patients who may benefit.

Message from the Health Officer

CalFresh Benefits: What it Means for Marin

CalFresh aka as SNAP at the federal level is considered one of the most effective anti-poverty programs in California and nation-wide.  Due to the current government shutdown, effective November 1,  nearly 15,000 Marin residents will not be able to access this critical benefit, which allows people access to food and preserves limited income for other basic needs.  The Office of Emergency Management and HHS activated the Emergency Operations Center to develop and implement a plan with key community partners, including the SF Marin Food Bank and the County Office of Education, to get resources to residents who are food insecure.

2025 Community Health Needs Assessment

BHSA Integrated Plan FY26/27-FY28/29 Open for Public Comment

The Behavioral Health Services Act (BHSA) Integrated Plan for FY 2026–2029 is now available for a 30-day public comment period from October 3 to November 4, 2025. Read the Plan. Submit your comments. The plan outlines initiatives to strengthen behavioral health care across Marin County, including housing interventions, full-service partnership programs, behavioral health services and supports, and early Intervention programs. Public Hearing: Tuesday, November 4, 2025 | 6:00 PM Point Reyes Conference Room 20 North San Pedro Rd., San Rafael, CA.  Or join via Zoom (Meeting ID: 892 8195 5591 | Passcode: 81389).

Tobacco Minimum Floor Price Law

On Tuesday, the Marin County Board of Supervisors adopted a Tobacco Minimum Floor Price Law (MFPL), a measure designed to reduce tobacco use, protect youth from nicotine addiction, and advance the County’s equity goals. The ordinance sets a $12 minimum price for tobacco and nicotine products which will increase by $1 on an annual basis. It also bans the sale of vapes and heated tobacco products. The ordinance takes effect on September 1, 2026, with compliance enforced in partnership with the Marin County Sheriff’s Office. Marin would join more than 50 California jurisdictions—including San Francisco, Alameda, Contra Costa, San Mateo, and Sonoma Counties—that have adopted similar protections. For more information about Marin County’s tobacco prevention efforts, visit: https://www.marinhhs.org/tobacco-prevention-services.

Infection Prevention Quarterly Workshop

Marin County Public Health invites you to attend an in-person workshop designed to strengthen your Infection Prevention (IP) Program. Join fellow Infection Preventionists and facility partners for a hands-on, collaborative learning experience focused on real-world challenges, practical tools, and peer networking. Topics: Catheter-Associated Urinary Tract Infection, Vaccinations, Overview of our Regional Public Health Lab and Ombudsman Program. Thursday, December 4, 2025 8:00 AM – 12:30 PM (8:00 – 8:30 AM registration, we will promptly start at 8:30 AM) 3240 Kerner Blvd, San Rafael, CA 94901 Room 109–110 Registration required: https://forms.office.com/g/C8cAHwz5VB. This workshop will be in person only – no virtual option available.

Newborn Screening - Termination and New Coalition

Advances in genomic sequencing may soon allow us to screen for hundreds of conditions with a single test, and the Advisory Committee on Heritable Disorders in Newborns and Children (ACHDNC) remains disbanded following its abrupt termination by the U.S. Department of Health and Human Services (HHS) in April 2025. This decision, made without public explanation, has sparked widespread concern among medical professionals, patient advocacy groups, and policymakers due to the committee’s central role in guiding the Recommended Uniform Screening Panel (RUSP)—the list of conditions recommended for newborn screening across U.S. states. In response to the ACHDNC’s dissolution, the American College of Medical Genetics and Genomics (ACMG) announced the formation of a Newborn Screening Coalition in October 2025. While this coalition represents a crucial stopgap measure to prevent immediate harm, experts stress it cannot fully replace federal coordination. The coalition is expected to launch in early 2026 and include 15 voting members from diverse professional backgrounds.

mpox (Monkeypox)

Last week, the California Department of Public Health issued an advisory that there had been community spread of Clade I mpox in Southern California. Providers are reminded to remain vigilant for mpox cases. If you encounter patients with characteristic rash or other concerning symptoms, visit our  local mpox webpage for the latest guidance on testing.

Message from the Deputy Health Officer

Respiratory Virus Season 2025-2026: Protecting Our Community

As the respiratory virus season begins, vaccination remains the most effective way to prevent severe illness from COVID-19, influenza, and RSV.  Marin County Public Health (MCPH) and leading medical organizations recommend the updated COVID-19 vaccine and the annual influenza vaccine for everyone 6 months and older. In addition, RSV vaccination is recommended for all adults 75 and older, adults aged 60 –74 with risk factors, and pregnant patients to protect their newborns. Updated vaccines are widely available this fall, including free walk-in access for Kaiser Permanente members ages 6 months and older. California’s new AB 144 secures vaccine access by establishing a statewide schedule and extending liability protection for providers through 2030. Make every patient visit a prevention opportunity by co-administering vaccines when appropriate and proactively scheduling high-risk patients.

Preserving Vaccine Choice to Protect Marin's Children

Back-to-School Resilience

As students return to school, Marin data reveal urgent concerns: local 11th graders report social-emotional distress at rates above the state average—the highest of any grade in California—and teens continue to present with elevated rates of emergency visits for self-harm, suicide attempts, and alcohol-related disorders. The Ask. Listen. Connect initiative calls on clinicians to embrace their critical role in suicide prevention by asking directly about suicidality, listening with empathy, and connecting patients to hope and help. To support providers in this work, resources such as the AAP Bright Futures Toolkit (validated screening tools), the  AAP SBIRT clinical report (substance use guidance) and additional resources on suicide risk screening provide practical evidence-based tools to strengthen early identification and intervention in youth mental health.

ACOG Affirms Safety of Acetaminophen in Pregnancy

The American College of Obstetricians and Gynecologists (ACOG) has reaffirmed that acetaminophen remains the safest first-line analgesic and antipyretic during pregnancy. A comprehensive review of decades of evidence shows no clear causal link between in-utero acetaminophen exposure and adverse neurodevelopmental or reproductive outcomes. Untreated maternal fever and pain carry well-established risks, making effective management essential. ACOG advises clinicians to recommend acetaminophen as indicated, at the lowest effective dose for the shortest duration necessary. This guidance underscores the importance of reassuring pregnant patients that acetaminophen use is safe and beneficial when clinically appropriate. Unsubstantiated claims about the safety risk of acetaminophen undermines clinical guidance and may lead to delays or avoidance of appropriate treatment, increasing potential harms for both maternal and fetal health.

Protecting Reproductive Health Access

Reproductive health care is under mounting pressure nationwide. A federal court ruling has suspended Medicaid reimbursements to Planned Parenthood for one year, and mifepristone faces ongoing legal challenges. Locally, the need is clear: between 2021 and 2023, chlamydia rates among Marin teens nearly tripled, and nearly 100 teen births were recorded. These trends highlight the importance of sustaining trusted providers and ensuring timely, evidence-based care. To support clinicians, UCSF has launched the Reproductive Health Hotline (ReproHH)—a free, nationwide, confidential resource offering real-time guidance from UCSF specialists in sexual and reproductive health. Call 1-844-ReproHH (1-844-737-7644), Monday–Friday, 8 a.m.–4 p.m. PT, or learn more at reprohh.ucsf.edu.

Ebola Advisory: What Marin Providers Need to Know

The CDC has issued a health advisory following a new Ebola outbreak in the Kasai Province of the Democratic Republic of the Congo, the second most populous (and the 2^nd largest) country in Africa. With 37 confirmed cases and 19 deaths, including health care workers, clinicians in Marin should remain alert. While the risk to the U.S. is low, providers should remain vigilant for infectious symptoms in patients who have recently traveled to the affected area. If Ebola is suspected, immediately isolate the patient, use appropriate PPE, and call Marin County Public Health immediately (415-473-4163); after hours call (415 479 5305).  Marin County Public Health’s Healthcare Preparedness Program (HPP) supports clinics, hospitals, and healthcare facilities in staying prepared for these rare but high-risk threats. Learn more: https://www.marinhhs.org/healthcare-preparedness-program.

Message from the Health Officer

Maintaining Vaccine Confidence: The Role of Local Healthcare Providers

This month is National Immunization Awareness Month. The national spotlight has returned to vaccine safety with the relaunch of the federal Task Force on Safer Childhood Vaccines, led by NIH Director Jay Bhattacharya. It’s the first time in 25 years such a panel has been convened, and it comes at a time of wavering confidence in public institutions and in science itself. The CDC’s authority is being reduced, reflecting a broader shift in federal priorities regarding data, scientific standards, and evidence-based practices. At the same time, social media is amplifying vaccine-related misinformation, contributing to public confusion and a decline in trust in health guidance. Your impact starts here. Patients rely on you for clarity. By addressing concerns directly and connecting families to trusted resources such as Let's Get Real about Vaccines and Johns Hopkins Institute for Vaccine Safety, you build trust and strengthen vaccine confidence. Vaccination embodies the values we uphold as healthcare providers—family, community, and personal responsibility—protecting not only each patient but also our children, older parents, and immunocompromised neighbors.

mRNA Vaccine Safety and Research Funding

Hepatitis B Birth Dose: A Critical Step in Preventing Chronic Infection

Healthcare providers play a crucial role in preventing lifelong hepatitis B virus (HBV) infection by providing timely vaccinations and educating families. HBV is 100 times more infectious than HIV, and perinatal infection carries up to a 90% risk of chronic disease, often progressing silently to cirrhosis or liver cancer. Before universal infant vaccination began in the early 1990s, over 18,000 U.S. children under age 10 were infected annually; routine immunization—beginning with a birth dose—has since reduced pediatric HBV cases by 95%.

Administering the first dose of the HBV vaccine within 24 hours of birth is essential, even if maternal screening is negative. It initiates early immunologic priming and immune memory, offering long-term protection. With its strong safety record, the hepatitis B vaccine is a trusted, life-saving intervention providers can confidently recommend.

Valley Fever: Don't Miss the Diagnosis

Although Valley fever is uncommon in Marin County, it may be under-recognized and under-tested. Consider this diagnosis in patients with respiratory or systemic symptoms lasting more than 7–10 days (e.g., cough, fever, night sweats, dyspnea, chest pain, fatigue). Take a detailed exposure history, including:

• Recent residence, work, school, or travel in endemic regions (Central/Southern California, the Southwest).
• Activities with soil or dust exposure (digging, construction, off-road recreation, agriculture).
• Outdoor occupations, especially construction, agriculture, and wildland firefighting—risk increases during fire season when soil disruption is common.

Early recognition and testing support timely management and patient education.  Learn more from the California Department of Public Health (CDPH): Valley Fever (Coccidioidomycosis).

Clinical Perspective: Understanding Mifepristone's Safety and the Importance of Informed Access

Mifepristone has been an FDA-approved component of early abortion care and miscarriage management for over two decades. Its safety and efficacy are well established, with serious adverse events remaining rare when used as directed. Major medical organizations, including ACOG and the AMA, continue to support its use based on a robust body of clinical evidence. Ideological groups seeking to restrict abortion access have promoted inflated complication rates based on unverified, non-peer-reviewed data. These claims lack clinical context and aim to undermine trust in safe, evidence-based reproductive care. As providers, it’s critical to assess such claims through the lens of evidence-based practice and uphold standards of scientific rigor. Ensuring continued access to mifepristone protects patient autonomy and reproductive health.

Message from the Health Officer

Protecting Kids: Back to School Vaccines

As the new school year approaches, the Association of Bay Area Health Officials (ABAHO) is calling on health care providers to make immunizations a top priority. Vaccines are a safe, effective, and essential part of preventive care—protecting children and communities from serious diseases like measles, pertussis, and polio.  Health care provider’s play a central role in building and maintaining community immunity. Encourage families to check vaccination records and schedule well-child visits early. Together, we can support vaccine confidence and help all children start the school year protected and ready to learn. Visit https://www.vaccinesafety.edu/ to access evidence-based resources for health professionals. 

Health Alert:  Bicillin Out of Stock

FDA's Juul Authorization Threatens Youth Health: What Providers Can Do

The FDA’s decision to authorize the sale of Juul e-cigarettes, including menthol flavors, is a step backward in protecting youth from nicotine addiction. Juul played a central role in the youth vaping epidemic due to its sleek design and flavored products that were especially appealing to teenagers. Despite national progress, youth use remains high, and local data indicate cause for concern. In Marin County, nearly 1 in 4 11th graders report vaping nicotine or marijuana in their lifetime. More concerningly, 14% are currently vaping nicotine and 12% are currently vaping marijuana — underscoring the urgent need for prevention and intervention. Providers should screen adolescents for nicotine and marijuana vaping, educate families about the risks of e-cigarettes, refer youth to evidence-based cessation resources, and advocate for local policies that reduce commercial tobacco and nicotine use. Learn more at https://kickitca.org.

Helping Families Navigate Healthy Social Media Use

Healthcare providers can help families address youth anxiety, depression, and social isolation linked to excessive social media use—especially doom scrolling. Instead of focusing on screen time alone, guide families to reflect on how media is used and how it makes their teens feel. Recommend screen-free routines (e.g., before bed), advise families to co-create a Family Media Plan and to have open conversations about online content. Encourage positive alternatives like outdoor activities and in-person social time. Remind parents that teens may need support their teens replacing harmful habits with healthy coping strategies. For quick guidance, review the AAP’s The 5 Cs of Media Use, which is a simple framework to help families foster intentional, balanced digital habits that support mental health and connection.

Message from the Health Officer

Vaccines and Informed Consent: Your Role in the Wake of ACIP Misinformation

At the June 2025 ACIP meeting, Lyn Redwood revived long-debunked claims about thimerosal and vaccine safety, misleadingly linking vaccines to autism and misrepresenting mercury science. While routine pediatric vaccines have been thimerosal-free since 2001, and extensive research confirms no connection between vaccines and autism, such misinformation continues to influence patient perceptions. Despite the lack of scientific basis, the panel voted 5-1 to recommend thimerosal-free single-dose influenza vaccines for children, pregnant women, and all adults. As a health care provider, informed consent means more than listing risks and benefits—it requires anticipating fears, dispelling myths with empathy, and grounding your guidance in clear, current evidence. Be proactive: tell patients what’s in their vaccines, what isn’t, and why vaccines remain among the safest, most effective tools in medicine. Learn more at https://www.vaccinesafety.edu/.  

Bird Flu isn't on Summer Break

Feline Flu

Marin County Public Health (MCPH) reminds doctors and veterinarians that any case of influenza A in cats must be reported immediately, as required by Title 17 CCR Section 2500. Influenza A, including H5 strains, is considered a novel virus infection with pandemic potential and poses a public health risk. Feline influenza A infection may signal a new source of human exposure. Prompt reporting allows health officials to monitor contacts and investigate sources, such as raw meat or milk. If you suspect feline flu, contact MCPH to coordinate testing (415-473-4163). For more information, visit What Veterinarians Need to Know about Bird Flu.

Firearm Injury Prevention: A Vital Role for Healthcare Providers

Each year, Marin County loses community members to firearm-related deaths—many of which are preventable. As healthcare providers, we are in a unique position to help reduce this risk and save lives.
If a patient—or someone they care about—is in emotional distress, encourage them to call or text 988, the Suicide & Crisis Lifeline. This free, confidential service is available 24/7. However, the future of this critical lifeline is at risk, as the federal government is considering cuts to its funding. Now more than ever, it’s important to raise awareness and ensure our patients know help is still available.
One of the most effective suicide prevention strategies is to increase time and distance between a person in crisis and a firearm. This means promoting safe storage practices: keeping firearms locked, unloaded, and stored separately from ammunition.
You can help by incorporating safe firearm storage counseling into clinical conversations. You should ASK (Asking Saves Kids), "is there an unlocked gun in your house?” and reinforce the importance of storing firearms unloaded and locked up. The resources below offer practical guidance:

• Marin Gun Safety Collaborative
• AAP: Gun Safety for Pediatricians
• UCSF BulletPoints Project – Provider tools for firearm injury prevention counseling

Fast Bikes, Young Riders, Big Risks: What Providers Need to Know

In response to a sharp rise in youth e-bike injuries, three more Marin jurisdictions—Larkspur, Corte Madera, and Fairfax—have joined the county in banning riders under 16 from operating class 2 e-bikes. These bikes, as manufactured, are capable of reaching 20 mph with a throttle, pose heightened safety risks, particularly for youth aged 10–15, who experience five times the accident rate of other age groups. Concerningly, it's not uncommon for e-bikes to be illegally modified to reach speeds of up to 40 mph, further increasing injury risk. The ordinance also mandates helmet use. Health care providers can support this effort by counseling families on e-bike safety, injury risks, and the importance of helmet use during routine visits.  Learn more in this article co-authored by Marin Health’s Drs. Maa and Alfrey:  Electric Bikes Are Emerging as Public Health Hazard.

Prepare Vaccine Storage for Emergencies and Power Outages

In preparation for wildfire season, all vaccine providers are recommended to register with their utility company to receive local emergency alerts.  Review and update your organization's plan for managing and relocating vaccines during emergencies, and confirm your organization has the necessary supplies, equipment, and trained staff to transport refrigerated vaccines and frozen vaccines if needed.  Identify a backup storage site that maintains proper vaccine temperatures, and if storing Vaccines for Children (VFC) Program vaccine, ensure the location complies with all VFC program requirements.  In areas prone to outages, consider installing backup power sources.  After any emergency event or power outage, document any temperature excursions, consult vaccine manufacturers if vaccines were exposed to out-of-range temperatures, and report any issues involving VFC vaccines in myCAvax. 

Message from the Health Officer

Navigating COVID-19 Vaccine Updates: Guidance for Patients and Providers

Recent changes in federal COVID-19 vaccination recommendations have raised questions among patients and health care providers alike. It is important to understand that longstanding vaccine guidance has been developed over decades through a transparent, science-based process led by the Advisory Committee on Immunization Practices (ACIP). This committee carefully reviews data and expert input to ensure vaccine recommendations prioritize safety and effectiveness. The extensive body of scientific evidence demonstrates that COVID-19 vaccines are safe and effective for people aged 6 months and older, including pregnant individuals and young children. Vaccination remains a key tool in preventing severe illness, hospitalization, and complications associated with COVID-19, including risks during pregnancy and early infancy. Health care providers should proactively address concerns by discussing the known risks and benefits of vaccination. Encouraging patients to receive the 2024–2025 COVID-19 vaccine supports individual and public health and helps maintain broad protection against the evolving virus.

Protecting Newborns: Preventing Hepatitis B and Congenital Syphilis

What Medi-Cal Cuts Could Mean in Marin

Governor Newsom’s May Revise budget proposes significant Medi-Cal cuts that will directly impact access to care in Marin County. These include freezing enrollment for adults with unsatisfactory immigration status, adding $100/month premiums, and eliminating dental, in-home support, and long-term care benefits for certain populations. The plan also reinstates the $2,000 asset limit for seniors and limits access to one class of prescription drugs. These changes will delay care, crowd emergency rooms, and increase uncompensated costs, straining our already burdened community health centers and hospitals. Immigrants and low-income residents are essential to Marin’s agriculture, construction, hospitality, caregiving, and domestic work sectors. Limiting their access to care risks disrupting vital services and frays the connections that make Marin thrive. Learn more about #Health4All at https://health-access.org/.

Mental Health Month Reminder: Keep It Top of Mind, Every Day

As May Mental Health Month wraps up, Marin Health and Human Services (HHS) thanks all healthcare providers who joined us in raising awareness, reducing stigma, and promoting healing. Your role in supporting mental wellness—both for patients and yourselves—is essential. Despite Marin’s strong health rankings, we continue to see elevated rates of suicide, substance use, and mental health needs. Mental health must remain a priority in our everyday patient interactions, not just once a year.  Share these resources with your patients and their families:

• 988 Suicide & Crisis Lifeline (call or text)
• Marin BHRS Access Line: 1-888-818-1115
• Marin Behavioral Health and Recovery Services: https://www.marinbhrs.org/

Alert: Emerging Drug Threats — Medetomidine and Carfentanil

Two dangerous substances—medetomidine and carfentanil—are increasingly appearing in the illicit drug supply, posing serious risks for overdose and death. Medetomidine is a veterinary sedative not approved for human use. Since 2022, it has been detected in street opioids across North America. Carfentanil is an extremely potent synthetic opioid—100 times stronger than fentanyl—used to sedate large animals. It has re-emerged in parts of the illicit drug supply and may not respond to standard naloxone doses, significantly increasing the risk of fatal overdose.  Last month Santa Clara Department of Public Health confirmed the first carfentanil-related overdose death. These trends point to an increasingly toxic and unpredictable drug supply. Advise patients to avoid non-prescription pills, use fentanyl test strips, and carry naloxone (Narcan), an opioid-reversal drug. While naloxone can be effective in reversing overdoses, multiple high-dose administrations may be required in cases involving carfentanil. For overdose prevention tools, local data, and community resources, visit OD Free Marin.

Message from the Health Officer

TB on the Rise in Marin

Last week we Marin County Public Health (MCPH) issued an Advisory on an increase in TB cases countywide. In 2024, we treated 13 active TB cases — a 44% increase from 2023 and a 225% increase from 2022. While many cases result from reactivation of latent TB infection (LTBI) in older adults and high-risk groups, we are seeing more U.S.-born residents in local transmission patterns. MCPH and the California Department of Public Health (CDPH) are investigating a large TB outbreak. Three healthcare workers, including first responders, were diagnosed with new TB infections in the past year. California law requires primary care providers to assess adult patients for TB risk. Please review TB risk factors with your patients at their next visit.

Support Mental Health Awareness

Protecting Young Lives: Teen Driver Safety

We are deeply saddened by the recent loss of four young lives in our community. This tragedy underscores the critical reality that motor vehicle crashes remain the leading cause of death among U.S. teens. As prom and graduation season approaches—a time of both celebration and increased risk—it is vital that we work together to promote teen driver safety. Healthcare providers can play a key role by counseling families about the dangers of distracted and impaired driving, encouraging clear driving rules, and promoting safe decision-making. Impact Teen Drivers – California offers free, evidence-based resources for parents, teens, and educators to help prevent accidents.

Protecting Patient Care Amid Rising Deportations

The new administration’s immigration policies focus on ramping up border restrictions and interior enforcement, including rescinding protections at sensitive locations including health care facilities. These actions heighten fear among immigrant families, including U.S.-born children, impacting health, well-being, and access to care.  Detentions and deportations create fear and trauma in families, leading to mental health struggles and causing many to avoid seeking needed health care. Health care providers can support immigrant families by creating safe, welcoming environments, reinforcing patient confidentiality, developing protocols for potential encounters with immigration enforcement, and ensuring access to essential care.

Message from the Health Officer

When I heard about the Woodacre accident, my heart — like the hearts of so many in Marin — broke. My children are 12 and 14 years old; it easily could have been them. As our family prayed for the grieving families and friends, we also took time to talk about the importance of safe driving. In our daily gratitude practice, we reflected on how much we take for granted in this fragile, precious, and fleeting life. Even as we continued with the routines of daily life, the weight of the community’s grief stayed with us — a reminder of how deeply we are all connected in times of sorrow. Let’s look out for each other and drive with extra care — every choice we make can mean everything to someone else.

Lisa Santora, MD MPH
Public Health Officer
 

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Measles Exposure Among International Travelers

Marin County Public Health recently investigated two cases involving travelers exposed to measles during a long-haul international flight. A key challenge in our response was the inability to access vaccination records quickly. Exposed individuals may be subject to quarantine, school or work exclusion, and public health monitoring without documented proof of immunity.
This serves as an important reminder:

• Encourage patients to review and carry copies of their vaccine records.
• Ensure travelers are up to date on MMR vaccination, particularly for international travel.
• Discuss the risks of exposure without immunity, including potential quarantine and post-exposure protocols.

Please support your patients in preparing for safe travel and help us strengthen community protection against measles and other vaccine-preventable diseases.

Time to Prepare for a Spring COVID Wave

Ask. Screen. Connect.: Supporting Mental Health

As the COVID-19 pandemic recedes, its impact on the mental health of teens and young adults continues to emerge. Social isolation during critical developmental periods has left many young people experiencing anxiety, depression, and loneliness. Healthcare professionals can help heal these invisible wounds and support the long-term well-being of youth and families. Create space for open conversations by asking nonjudgmental, open-ended questions about patients’ social lives and emotional well-being. Screen for anxiety and depression using validated tools and normalize discussions about mental health as part of routine care. Connect patients and families with trusted resources, such as CalHOPE. This platform offers free, confidential digital support through two mobile apps:

• BrightLife Kids – Behavioral health coaching for parents, caregivers, and children ages 0–12
• Soluna – Mental health support and tools for youth and young adults ages 13–25

Visit Marin BHRS at  https://www.marinbhrs.org/ to learn about local behavioral health resources, supports, and services, including the 988 Suicide & Crisis Lifeline.

Bird Flu Update

As flocks of wild birds return to the north, we are preparing for another surge in bird flu activity statewide.  Migratory birds play a key role in the global spread of avian flu by shedding the virus along seasonal flyways and infecting poultry flocks and dairy herds. We are also seeing more cases among cats from direct contact with infected birds or consumption of raw meat or milk from infected animals. Healthcare providers should consider avian flu in patients with conjunctivitis or respiratory symptoms and animal exposure. Suspected cases must be reported immediately to Marin County Public Health by calling 415-473-4163. Collect respiratory and eye swabs for testing; initiate antiviral treatment and offer prophylaxis to close contacts. Providers should stay updated with guidance to ensure early detection and response. Marin County Public Health provides local updates on our Bird Flu (H5N1) webpage.

Message from the Health Officer: Public Health is Essential

I still wear a t-shirt from the pandemic that says, “Apparently, I’m essential. #PublicHealth.” It was a quiet badge of honor from a time when thousands of Marin residents stood up to protect our community. History tells us public health is easy to forget—until the next crisis hits. Marin County Public Health along with health departments nationwide are now grappling with the CDC’s abrupt and short-sighted withdrawal of $11.4 billion in COVID-era funding. This critical investment in a chronically underfunded public health system enhanced disease surveillance, prevented outbreaks in nursing homes, and supported rapid responses to rising threats like avian flu, measles, and resurgent tuberculosis. Public health is our first line of defense. Vaccination, education, and infection control don’t just prevent illness—they save lives and reduce hospitalizations, long-term complications, and health care costs. For example, a single measles vaccine costs under $30; one outbreak can cost hundreds of thousands.
Now is the time to champion sustained public health funding. An ounce of prevention is worth many times more than a pound of cure.

Thank you for your continued support of public health and partnership.

Lisa Santora, MD MPH
Public Health Officer
 

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Fentanyl Deaths in Sonoma County

Last weekend, two teens died in Santa Rosa due to suspected fentanyl poisoning; two other teens were hospitalized. It was reported that the youth believed they were using cocaine; however, their drug supply contained fentanyl.  Overdose is the leading cause of death in Marin County for residents aged 55 and younger. Fentanyl, a high potency synthetic opioid, is the most common substance involved in local overdose deaths.  Visit Data Dashboard — OD Free Marin to learn more about overdose in Marin County.  See the Public Health Update published this week.
 Providers are asked to share the following messages with people who use drugs:

• Carry Naloxone. You may need to use multiple doses. Get free Naloxone: odfreemarin.org/nalaxone/
• Test your drugs before using. Fentanyl test strips are available through Ritter Center.
• Start low and go slow.
• Do not use drugs alone. If no one will be close by while you are using, call Never Use Alone at 1-800-484-3731

For treatment options, call the Behavioral Health & Recovery Services Access Line (24/7) at 1-888-818-1115 or visit here.

Flu Update

Bird Flu Update

The H5N1 bird flu continues to spread, affecting wild birds, poultry, and dairy cows. While the risk to the general public remains low, there have been over 70 confirmed human infections, mostly from direct contact with sick animals. The virus hasn't yet mutated to spread between humans. The U.S. has ramped up its response, including financial aid for poultry producers and research into vaccines. Primary care providers should advise at-risk individuals, such as farmers and families with backyard poultry, on precautions to prevent infection:  avoid direct contact with birds and other animals that could be infected with bird flu; get the seasonal flu vaccine; only consume pasteurized dairy products; and cook poultry and eggs to an internal temperature of 165°F.  Marin County Public Health will provide local updates on our Bird Flu (H5N1) webpage.

Eating Disorders

In recognition of Eating Disorder Awareness Week, Kelly Harvard, Senior Program Coordinator in our Maternal, Child, and Adolescent Health program, published an Op-Ed in the Marin IJ discussing the critical role of negative body images in adolescent eating disorders.. As healthcare providers, it is essential to understand the profound impact body dissatisfaction has on both mental and physical health, particularly among adolescents and marginalized populations, such as LGBTQ+ youth. Negative body image is a significant contributing factor to eating disorders, depression, anxiety, and self-harm, with the onset typically occurring between the ages of 12 and 25. Providers are in a unique position to offer early recognition, intervention, and ongoing support for individuals affected by body image issues.

Immigration and Primary Care

Possible Medi-Cal Cuts Ahead

Message from the Deputy Health Officer

In an ever-changing world, the partnership between communities and healthcare providers is crucial. Communities are the bedrock of public health, offering the social, cultural, and environmental context for our lives. Effective public health strategies are rooted in community engagement, including health education, disease prevention, and promoting healthy lifestyles.
 
Healthcare providers extend beyond their role in clinical care by collaborating with community organizations, contributing to public health research, and sharing data. These partnerships lead to improved health outcomes, reduced healthcare costs, and increased health equity. By working together, communities and healthcare providers can eliminate disparities and ensure that everyone has access to quality care. Together, we can build a healthier and more just future for all.


In partnership,

Melanie Thompson, DO
Deputy Public Health Officer
 

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Updated Return to Work Guidelines for Healthcare Personnel with Contagious Illness

This month, the California Department of Public Health (CDPH) issued updated guidance on work exclusions for healthcare personnel (HCP) with contagious illness.  This guidance applies to HCPs with COVID-19, influenza, and other acute respiratory viral infections, regardless of diagnostic testing results.  Healthcare personnel are not to return to work until at least 3 days have passed since symptom onset and at least 24 hours have passed with no fever (without using fever-reducing medicines), symptoms are improving, and they feel well enough to return. Returning healthcare personnel should wear masks when they return to work.

Winter Respiratory Virus Season

Bird Flu Update

H5 bird flu is still widespread in wild birds and continues to infect California poultry and dairy cows. There are now 67 confirmed human cases nationwide, primarily among dairy and poultry workers, and one death. It is suspected that H5N1 may be underdiagnosed, especially in California, where 536 dairy herds are experiencing outbreaks and remain under quarantine.  Centers for Disease Control and Prevention (CDC) has advised hospitals, laboratories, and clinicians to test and subtype for non-seasonal flu to enhance disease surveillance. While the H5N1 avian influenza remains a low risk to the public, enhanced surveillance is needed to monitor for potential human-to-human transmission. If you see symptoms consistent with bird flu, including fever and conjunctivitis, after contact with animals (e.g., backyard flocks) or consumption of raw milk products, contact Marin County Public Health to coordinate testing (415-473-4163).

Suicide Prevention

Never a Bother is California’s youth suicide prevention campaign designed with, for, and by youth and their caregivers. Register on Zoom to join the CDPH Office of Suicide Prevention on February 5, 2025, from 12:00 – 1:30 pm, for a webinar sharing key learnings about the campaign. Marin’s healthcare providers can also join the Marin County Suicide Prevention Collaborative. Register here to participate in the next Collaborative meeting, "Finding Hope in Marin County: A Data Presentation," on Wednesday, March 5th, from 2:00 - 3:00 pm. For facts, how to support and receive support, visit: https://prevention.marinbhrs.org/suicide-prevention. 

Proposition 1 Update:  Behavioral Health Services Act (BHSA)

Southern California Wildfire Update

Message from the Health Officer

This week, the rise in Immigration and Customs Enforcement (ICE) removal operations hits close to home for me. As a descendant of both documented and undocumented immigrants—who worked both “legally and illegally” to support their families—and the wife of a refugee, I deeply understand the sacrifices that allow my family the privilege to live, work, and attend school in Marin. Most immigrants in our country have faced unimaginable challenges to create a better life for their loved ones.  They and their children, who are citizens, make valuable contributions to our communities. Our local economy depends on an undocumented workforce in essential industries like agriculture, caregiving, construction, and hospitality. While we await a fair immigration system that balances security, offers a pathway to citizenship, and meets the needs of immigrants and the labor market, I hope our community will support a compassionate approach that ensures undocumented residents have access to essential services, legal aid, and economic opportunities. I am thankful for partners like Canal Alliance for helping immigrants and their families “achieve their dreams.”

Stay strong and kind,

Lisa M. Santora, MD, MPH
Health Officer
 

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Bird Flu

Last week Marin County issued a public health advisory in response to increasing H5N1 activity statewide, and after investigating what was considered by CDPH a suspect case in a toddler who became ill after raw milk consumption.  Additionally, the Governor proclaimed an emergency to coordinate a multi-agency response to H5N1.  CDC has confirmed the first severe case of bird flu in a person in Louisiana, who was hospitalized with severe symptoms after interacting with an infected backyard bird flock. CDC maintains that there is no evidence of human-to-human transmission, and that the virus is not considered endemic to the U.S. in either animals or humans. While the risk to the public remains low, clinicians should inquire about potential occupational and/or raw milk exposures particularly for patients presenting with red eyes as part of their clinical complaint.  Public health’s H5N1 webpage is up to date.

Opioid Settlement Survey

Marin receives funding through California’s Opioid Settlements with the pharmaceutical industry, and Marin Public Health is seeking input from community constituents on how these funds are used for specific opioid remediation strategies. We would like your feedback on proposed strategies and any other strategies to prevent and respond to the opioid crisis in Marin. Please fill out this survey. For more information visit the ODFree Marin website.

Winter Storm Surge

988 Suicide Crisis Line

Holidays can trigger depression and anxiety.  Marin County Behavioral Health and Recovery Services (BHRS) reminds residents that help, and hope are just a call or text away. Any resident experiencing a mental health or substance use crisis can contact the 988 Suicide Crisis Lifeline by dialing 988, text “MARIN” to the Crisis Text Line at 741741 or go to 988lifeline.org. Marin residents seeking behavioral health services can call the 24-hour, confidential Access Line at 1-888-818-1115.

Flu Vaccine

Updated Syphilis Screening Recommendations

Message from the Deputy Public Health Officer

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
 

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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
 

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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
 

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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


 

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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


 

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