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Measles in California
In 2019, two outbreaks linked to patients with international travel  have been reported in California, and over 700 cases have been reported nationally. This week, Marin County parents received this letter, outlining the public health measure of excluding unvaccinated children from school if there is a case on campus. The California Department of Public Health has issued updated measles clinical guidance. For more information on measles in Marin County, click here. |
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An Aspirin (Apple) a Day ...
Last month, the American College of Cardiology / American Heart Association released a national guideline on aspirin use in the primary prevention of Atherosclerotic Cardiovascular Disease (ASCVD). Based upon cardiovascular risk, adults as young as 40 ye ars old may benefit from daily aspirin. On the other hand, it is no longer recommended to start or continue aspirin for primary prevention. Aspirin is still recommended at any age for clinical ASCVD. As guidelines change, healthy eating and active living remain the mainstay for cardiovascular and diabetes prevention.
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STI Treatment Is Prevention 
During the past six years, Marin County has seen a significant rise in sexually transmitted infections (STIs) in all groups, and particularly among men who have sex with men (MSM). As part of April's STD Awareness campaign, the California Department of Public Health is encouraging providers to test for chlamydia and gonorrhea in MSM. The most common symptom of an STI is no symptoms at all. Therefore, risk-based STD screening is critical to reduce STI prevalence in our community. The Centers for Disease Control and Prevention offers free self-study modules and CME credit.
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Local Opioid Crisis Response
 Marin's response to the opioid epidemic was highlighted at the RxDrug Abuse and Heroin Summit in Atlanta last week. The presentation, entitled "Think Local, Act Local," featured RxSafe Marin and Safe Med LA as examples of community-wide action through local opioid safety coalitions. The President and First Lady attended the conference, signifying federal interest in a response that's informed by successful models. The RxSafe Marin dashboard tracks our progress against established goals county-wide.
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Public Health Program Spotlight: Women, Infants, & Children (WIC)
WIC offers healthy foods and support for nutrition, health and breastfeeding for families at critical periods of growth and development. WIC provides:
- Nutrition experts who specialize in nutrition for mothers and their children.
- Support and information about breastfeeding, including access to breastfeeding experts.
- Help in accessing health care and other social and economic supports.
- Special checks to buy healthy foods, such as fruits, vegetables, whole grains, milk, eggs, bread, cereal and more.
We count on health care providers to refer  to the WIC Program. For more information, please call 415-473-4029 or email: marincountywic@marincounty.org
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Message from the Public Health Officer
 It's hard to believe that measles is back after being nearly eliminated in 2000. To date this year, there are more than 700 cases nationally, including some in several Bay Area counties. Marin County has been spared so far in the latest outbreak, but we are vulnerable. Although childhood vaccination rates are 94 percent overall, in some schools less than half of students are fully vaccinated. Marin hosts visitors from all over the world, our residents are frequent travelers, and measles is more common abroad. Your vigilance in promoting vaccination and identifying and reporting potential cases is vital to protecting our community. Warm Regards,
Matt Willis
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endix to the County's 
This month's newsletter covers two climate-related threats to health - power shut-offs due to fire risk and extreme weather shelters. These offer a glimpse into the societal disruption and health impacts of climate change. They also offer lessons in how we can become more resilient. As stewards of health for Marin, we can use our voice to highlight the everyday impact of changes to our environment on community well-being. I'm grateful for your support as we recognize climate change as a public health crisis. 
Flu Update
that describe the clinical features of measles, including diagnosis, treatment and infection control measures. This year, there have been 5 measles outbreaks in California, 4 of which were linked to international travel. Providers should make sure patients have measles protection before international travel.
a poster to help remind clinicians about how to administer PEP. The poster can be downloaded 
Marin Recognizes Overdose Awareness Day
Message from the Deputy Public Health Officer
Due to an expected shortage of APLISOL, the Centers for Disease Control and Prevention (CDC) is 
orld Health Organization (WHO) declared the current Ebola outbreak in the Democratic Republic of the Congo a 
The Rabies Control Program is one of Marin County's mandated communicable disease prevention and control programs. Annually, 10-12% of captured bats in Marin County test positive for rabies. Most human rabies cases in the United States have been caused by bat bites that were unrecognized or undetected due to bats' extremely fine teeth. Human rabies can be prevented by providing rabies pre-exposure prophylaxis (if indicated), prompt local treatment of bite wounds, and/or appropriate rabies post-exposure prophylaxis. Marin County Public Health works closely with 
Last month, we informed readers about the risk of extended power outages (3 - 5 days) due to the launch of PG&E's 
Public Safety Power Outages
is an exception. Thanks to 
California State Board of Pharmacy, Marin County Health and Human Services, and RxSafe Marin are hosting a free Continuing Education forum for pharmacists on July 20th, 
Public Health Program Spotlight: Community Epidemiology
Marin County Whole Person Care pilot program
Opioid overdose remains a leading cause of accidental death in Marin. The 
Second Wave in Seasonal Flu
updated. Direct any questions to Marin County HHS Communicable Disease Prevention and Control unit at 415-474-4163.
t Marin city to take action against the harms of vaping and flavored tobacco, joining Corte Madera, Larkspur and Sausalito. This follows the lead of the County Board of Supervisors' 2018 vote to prohibit the sale of all flavored vaping and tobacco products in unincorporated areas of Marin. This response is being mirrored in Sacramento, where
Many low-income Marin residents are food insecure and experience higher rates of preventable cardiovascular disease. The Marin City Health and Wellness Center food pharmacy program offers low-income patients the fresh taste and nutritional benefits of produce direct from local farms. Clinic patients who screen positive for food insecurity are given a prescription for free produce at the weekly Rollin' Root mobile market, provided by the Agriculture Institute of Marin and supported by Marin HHS. Other sites that offer affordable local produce through Rollin' Root are available 
o measles. While recent measles outbreaks in other states have sparked concern, Californians are not at significant risk for measles unless they travel to Clark County. While providers should consider measles in patients with fever and a descending rash, measles is unlikely in the absence of contact with a confirmed case of measles or a history of travel or exposure to travelers. The California Department of Public Health (CDPH) has issued 
Association (WFA) for celebrating the diverse cultures of our county. The Global Stage showcased community performers' artistic interpretations and expressions of the "All for One & Fun for All!" theme. The fair also hosted an International Festival of Short Film and Video, culinary contests, including a Recetas Latinas Contest for Latino foods, and an Out at the Fair day for Marin County's LGBTQ+ community.
ergency shelter beds. After a decade, the Rotating Emergency Shelter Team (REST), which provided 60 additional winter emergency shelter beds, ended in April 2018. This season, HHS developed a Severe Weather Emergency Shelter (SWES) plan to open emergency shelter beds when cold-weather conditions increase the risk of hypothermia-related morbidity and mortality for residents who are unsheltered. This winter season, we have activated the SWES plan four times and provided seven nights of shelter at the Health & Wellness Campus. 
018, there has been an outbreak of pertussis (aka whooping cough) in Marin County. Outbreaks commonly occur every 3 to 5 years. Compared to 44 cases of pertussis in 2017, Marin County had 249 reported cases in 2018. As of January 2019, there were 18 confirmed cases of pertussis in Marin County. Visit Marin HHS' 
essments and services to low-income children and youth in California. In 2016, the CHDP adopted the American Academy of Pediatrics' (AAP) 
Training our "First" First Responders
Limiting Local Antimicrobial Resistance 
reporting
Public Charge
Congenital Syphilis
Marin Passes Flavored Tobacco Ban 
Wildfire Smoke Response 
October, there has been a growing number of cases of acute flaccid myelitis (AFM) across the United States. No cases have yet been reported for Marin County. AFM is a rare neurological condition that primarily occurs in children, characterized by sudden onset of weakness in one or more limbs and abnormalities of the spinal cord gray matter on magnetic resonance imaging (MRI). Some cases are testing positive for enteroviruses A71 and D68. Clinicians should contact Marin County Communicable Disease Prevention and Control (CDPC) if they suspect AFM at 415-473-4163. CDPC will coordinate specimen collection (CSF, serum, stool, and NP/OP) and laboratory testing.
environmental disease in young children. Marin County Public Health recommends that all children be assessed for potential lead exposure, especially recent immigrants. In addition, the 
Every fall, Marin County experiences a surge in gastrointestinal illness, primarily focused in schools and congregate living settings. Norovirus, the most common form of seasonal gastroenteritis, is highly contagious and is transmitted by direct contact with an infected person; consuming contaminated food or water; and hand-to-mouth contact. Symptoms often only last for one day, but cases are infectious for 48 hours after symptoms resolve. To learn more about norovirus, and for instructions on reporting outbreaks, visit the Marin County Communicable Disease Prevention and Control (CDPC) 
In order to promote better-informed prescribing practices, starting October 2, physicians must consult CURES (Controlled Substance Utilization Review and Evaluation System) prior to prescribing DEA Schedule II, III, or IV medications, with some exceptions. The California Board of Medicine is responsible for regulation and enforcement of the new law for physicians and has developed 
he first rabies vaccine. Rabies is nearly always fatal and is endemic in Marin wildlife. Approximately ten percent of bats tested in Marin carry rabies. Animal bites are reportable events to Marin Public Health. Visit the Marin 
defense for health care providers and patients alike. On November 1st, the 
nity-wide supports. Marin County Office of Education, Health and Human Services, and others partnered to develop 
are increasing in frequency and severity, resulting in a higher rate of all-cause and cardiovascular mortality. The most common diagnoses in heat-related hospital admissions include the following preventable conditions: heat stroke and sunstroke, fluid and electrolyte disorders, and acute kidney failure. The risk of hospitalization is greatest in adults older than 85 (primarily due to volume depletion and heat exhaustion). Households need to 
(EMS) system are identified and connected to care. We are partnering with Bright Heart Health, who provides professional outreach and referrals to treatment and recovery services, such as a naloxone or buprenorphine prescription and a warm hand-off to a treatment program. This effort is a multisectoral collaboration, including Public Health, Behavioral Health and Recovery Services and community providers.
On my first day at work in Marin County, I "participated" in a full-scale exercise at the Emergency Operations Center (EOC). Basically, I watched -- I had never been in an EOC environment. I mistakenly thought that I wouldn't be responding to an emergency anytime in the near future. A couple of days later, I deployed to Lake County with the Marin Medical Reserve Corps (MMRC). In 2017, I deployed to the EOC to coordinate shelter operations at the Marin Center during the North Bay fires. As I write today, the MMRC stands ready again to deploy to Lake County to provide medical services. Our ability to serve our communities depends on our own preparedness. I encourage you to visit 
Zika infections in California. With summer here, many Marin County residents are travelling to Zika-endemic areas. The most frequented countries of Zika exposure include Mexico, Nicaragua, and Guatemala. Encourage your patients to stay informed and protected by visiting the 
and 21 deaths since November 2016. Incidence has been high among homeless people. To protect those at highest risk, Marin HHS has partnered with St. Vincent de Paul homeless services in five hepatitis A vaccination clinics over the past year. Incidence in Marin County has not increased. Clinicians are reminded to 
ation in adolescence is known to be associated with poor social and educational outcomes, and evidence is accumulating of an association with early onset psychosis and suicidality. Health care providers play an important role in screening adolescents and counseling families regarding substance use.
e, along with screening, treatment and prophylaxis for high risk contacts. To protect new mothers and their young babies, pregnant women should 
and gay and bisexual men specifically, continue to face the highest levels of syphilis. In recent years, syphilis has also risen among women. One of the most disturbing trends is increasing rates of congenital syphilis. Since 2013, the number of babies in California born with congenital syphilis has more than quadrupled --- to 278 last year. The Centers for Disease Control and Prevention (CDC) developed the 
Take-Back Day
Latent Tuberculosis in Marin 
ty residents. The data are used for planning and evaluating programs and prioritizing resources. We have compiled a dashboard of continuously updated data stories or collections of data. You can explore these "Live Stories" 
experiencing homelessness and/or using illicit drugs in settings of limited sanitation. The best way to prevent hepatitis A infection is to get vaccinated. Data show that hepatitis vaccination coverage is low in Marin County. The hepatitis A vaccine it recommended for anyone wishing to obtain immunity.
Healthy Pain Management
ns regularly field questions and concerns regarding 
cians to call for major reforms in gun control policies, including removing barriers to studying gun violence. The voice of these Marin physicians echoes that of major physician organizations, including the American Medical Association and the California Medical Association. Clinicians who want to join the movement against gun violence can connect to colleagues in the 
Marin County's Aging Action Initiative's Spring Convening is scheduled for Tuesday, April 3, from 9am to 4pm. Topics will include reframing aging, falls, and aging equity. This is a free event, for public sector agencies, non-profit organizations and health sector providers. You can register for this event 
Vaccinate Your Cat!
