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Emergency Departments (ED) in Marin County and across the state are continuing to experience surges related to respiratory illness. As of January 27th, 470 out of 2,217 tests performed in all three Marin hospitals were positive for influenza, with one reported death under age 65. Clinicians can help protect ED resources for patients who require emergency response by managing lower risk illness on an outpatient basis. The vast majority of patients evaluated for flu-like illness in EDs are sent home. Refer to these 
Opioid Overdose Reversals in the Community
Marin Medical Reserve Corps (MMRC) Answers the Call
Let's Talk Cannabis 
2017 was a remarkable year in public health in Marin County. The response of the Marin County medical community to the North Bay wild fires was inspiring and reassuring. Our health care providers accommodated surges of patients displaced by the fires into our hospitals and clinics, and staffed shelters for evacuees. This event also highlighted the value of preparedness and planning for future events, which is work for 2018. In 2017, we also moved closer to an integrated care system for Marin's most vulnerable residents, with HHS transferring safety net clinical services to Marin Community Clinics. This newsletter is resuming its monthly schedule and your suggestions for topics is always welcome. 
Influenza activity has increased significantly in California and in Marin County over the last few weeks, and influenza A (H3N2) is currently predominating this season. In general, H3N2 is associated with more deaths and hospitalizations in persons 65 years and older and in children under 2 years old. Marin County Emergency Departments (EDs) are managing a high volume of influenza patients. Most patients evaluated for influenza-like illness (ILI)1 in EDs are sent home. Clinicians can help protect ED resources for patients who require emergency response by managing lower risk ILI on an outpatient basis. While vaccine effectiveness this season is lower than most years, the recommendations for immunization with seasonal influenza vaccine remain the same. Even when vaccine effectiveness is limited, immunization prevents illnesses and hospitalizations, decreases severity of disease, and offers protection against other strains of influenza that are circulating.
Additional Resources Marin County Public Health – www.marinflu.org
CDPH – www.cdph.ca.gov/Programs/CID/DCDC/Pages/Immunization/Influenza.aspx
CDC – www.cdc.gov/flu
PUBLIC HEALTH ADVISORY: Facts About Mask Protection October 13, 2017 Northern California Fires Affecting Marin Air Quality: The fires in Northern California are impacting air quality across the region. The best way to protect yourself from health effects of wildfire smoke is to limit your exposure. Will a face mask protect me from wild fire smoke? The following do not protect your lungs from wildfire smoke: ‒ Bandanas or towels (wet or dry) or tissue held over the mouth and nose: this may relieve dryness but won’t protect your lungs from wildfire smoke ‒ One‐strap paper dust mask or a surgical mask that hooks around your ears: these don’t protect against the fine particles in smoke For those who cannot avoid prolonged activities outdoors “Particulate respirator” masks (respirator masks) labeled N95 or N100 may provide some protection: they filter out fine particles but not hazardous gases ‒ The respirator masks do not seal well on people with facial hair or beards -Individuals with respiratory conditions should consult their doctor before using a mask— masks may limit air flow and make it more difficult to breathe. ‒ Respirator masks should not be used on young children: they don’t seal well enough to provide protection What can I do to protect myself? Limiting exposure to wildfire smoke by remaining indoors is the primary goal. Depending on your situation, a combination of the strategies below may work best and give you the most protection from wildfire smoke. Keep indoor air as clean as possible. Keep windows and doors closed. Use a high-efficiency particulate air (HEPA) filter to reduce indoor air pollution. Avoid smoking tobacco, using wood-burning stoves or fireplaces, burning candles, incenses or vacuuming. Minimize the amount of time spent outdoors as much as possible. Avoid vigorous outdoor activities. Drink plenty of water Listen to your body and contact your healthcare provider or call 911 if you experience difficulty breathing, chest pain, severe fatigue, dizziness, or worsening of asthma or chronic respiratory illness PG. 2 OF 2 For those who wish to use an N-95 mask, these may be available at hardware stores or from online retailers As always, if you or someone you know is experiencing an emergency, call 9-1-1. Follow @MarinHHS or MarinHHS.org for updates For up to date information about fires in California go to: http://www.calfire.ca.gov/ For up to date information about air quality in the Bay Area go to: http://www.baaqmd.gov/
AVISO DE SALUD PÚBLICA: Datos sobre la protección con máscara October 13, 2017 Incendios en el norte de California afectan la calidad del aire en Marin: Los incendios en el norte de California están afectando la calidad del aire en toda la región. La mejor manera de protegerse contra los efectos adversos para de la salud del humo de los incendios descontrolados es limitar su exposición. ¿Me protegerá una máscara facial contra el humo de los incendios? ● Los siguientes no protegen sus pulmones del humo de los incendios: - Los pañuelos o toallas (húmedos o secos) o pañuelos desechables colocados sobre la boca y la nariz: estos podrían aliviar la sequedad pero no protegerán sus pulmones del humo de los incendios. - Una máscara antipolvo de papel de una sola cinta o una máscara quirúrgica con cintas que se pasan por atrás de las orejas: éstas no protegen contra las partículas finas en el humo ● Para aquellos que no puedan evitar actividades prolongadas al aire libre las máscaras "respiradoras para partículas" (máscaras respiratorias) etiquetadas como N95 o N100 pueden brindar cierta protección: filtran las partículas finas pero no los gases peligrosos - Las máscaras respiratorias no sellan bien en personas con vello facial o barba - Las personas con afecciones respiratorias deben consultar a su médico antes de usar una máscara - las máscaras pueden limitar el flujo de aire y dificultar la respiración. - Las máscaras respiratorias no deben usarse en niños pequeños: no sellan lo suficientemente bien como para ofrecer protección ¿Qué puedo hacer para protegerme? Limitar la exposición al humo de incendios descontrolados permaneciendo en el interior es el objetivo principal. Dependiendo de su situación, una combinación de las siguientes estrategias puede funcionar mejor y darle la mejor protección contra el humo de los incendios. ● Mantener el aire interior lo más limpio posible. Mantener cerradas las ventanas y las puertas. ● Usar un filtro de aire de partículas de alta eficiencia (HEPA) para reducir la contaminación del aire en el interior. ● Evitar fumar tabaco, usar chimeneas o estufas que queman leña, prender velas o incienso, o utilizar aspiradora. PÁG. 2 DE 2 ● Minimizar la cantidad de tiempo que pasa al aire libre tanto como sea posible. Evitar actividades vigorosas al aire libre. ● Beber abundante agua ● Escuche a su cuerpo y comuníquese con su profesional de la salud o llame al 911 si tiene dificultad para respirar, dolor en el pecho, fatiga severa, mareos o empeoramiento del asma o enfermedad respiratoria crónica ● Para aquellos que deseen usar una máscara N-95, éstas tal vez se puedan conseguir en ferreterías o en tiendas en línea Como siempre, si usted o alguien que usted conoce tiene una emergencia, llame al 9-1-1. Siga a @MarinHHS o MarinHHS.org para las últimas noticias Para obtener información actualizada sobre incendios en California, consulte: http://www.calfire.ca.gov/ Para obtener información actualizada sobre la calidad del aire en el Área de la Bahía, consulte: http://www.baaqmd.gov/
Northern California Fires Affecting Marin Air Quality: Health Tips for Marin Residents The multiple fires currently burning in Napa, Sonoma and other northern counties are affecting our air quality and have created a potential health hazard in Marin County. For General Public: Please be aware that with shifting winds and poor wildfire containment air quality can change drastically in a short period of time. Smoke from wildfires can affect health. The most common symptoms are eye and throat irritation, coughing, and difficulty breathing.
Follow these precautions to protect your health and those with health problems, especially heart or respiratory conditions, should take extra caution:
- Minimize outdoor activities Stay indoors with windows and doors closed as much as possible
- Do not run fans that bring smoky outdoor air inside
- Run your air-conditioner only if it does not bring smoke in from the outdoors
- Consider leaving the area until smoke conditions improve if you experience symptoms related to smoke exposure
For Outdoor Workers:
- Limit exertion
- Take frequent breaks
- If prolonged outdoor activity is unavoidable, proper masks (for example N95 masks) can protect against harmful exposure
Consult with your employer if you have specific concerns For Schools:
- Outdoor activities should be limited
- Windows and doors should be kept shut as much as possible
- When air quality is unhealthy activities such as athletic events or practices should be cancelled or rescheduled
- Watch for symptoms and take action as needed
- Students with asthma should follow their asthma action plans and keep their quick-relief medicine close at hand
When to Seek Medical Attention:
- Contact your health care provider if you experience the following symptoms that do not improve after moving indoors or into a safe air quality environment
- Shortness of breath or difficulty breathing
- Wheezing
- Chest tightness or pain
- Palpitations
- Nausea or unusual fatigue
- Lightheadedness and/or feeling faint
- As always, if you or someone you know is experiencing an emergency, call 9-1-1.
- Follow @MarinHHS for updates
- For up to date information about fires in California go to: http://www.calfire.ca.gov/
- For up to date information about air quality in the Bay Area go to: http://ttp://www.baaqmd.gov/
AVISO DE SALUD PÚBLICA
12 de octubre de 2017
Incendios en el norte de California afectan la calidad del aire de Marin: Consejos de salud para los residentes de Marin
Los incendios múltiples que arden actualmente en los condados de Napa, Sonoma y otros del norte están afectando la calidad de nuestro aire y han creado un posible peligro para la salud en el condado de Marin.
Para el público en general:
Por favor tenga en cuenta que debido a los vientos cambiantes y la expansión descontrolada de los incendios, la calidad del aire de puede cambiar drásticamente en un corto período de tiempo.
El humo de los incendios puede afectar la salud. Los síntomas más comunes son irritación de los ojos y la garganta, tos y dificultad para respirar. Siga estas precauciones para proteger su salud, y las personas que tengan problemas de salud, sobretodo afecciones cardíacas o respiratorias, deben extremar precauciones:
- Minimizar las actividades al aire libre
- Permanecer en interiores con las ventanas y las puertas cerradas tanto como sea posible
- No activar ventiladores que introduzcan el aire con humo del exterior
- Usar su aire acondicionado sólo si no introduce humo del exterior
- Considerar abandonar el área hasta que las condiciones de humo mejoren si tiene síntomas relacionados con la exposición al humo
Para trabajadores al aire libre:
- Limitar el esfuerzo
- Tomar descansos frecuentes
- Si no se puede evitar la actividad al aire libre, las máscaras apropiadas (por ejemplo las máscaras N95) pueden proteger contra la exposición dañina.
- Consultar con su empleador si tiene preocupaciones específicas
- Para escuelas:
- Se deben imitar las actividades al aire libre
- Se deben mantener cerradas las ventanas y puertas tanto como sea posible
- Cuando la calidad del aire es insalubre, las actividades como prácticas o eventos deportivos deben ser canceladas o reprogramadas
- Estar alerta a los síntomas y tomar las medidas necesarias
- Los estudiantes con asma deben seguir su plan de acción contra el asma y tener a la mano su medicina de alivio rápido
Cuándo buscar atención médica:
Comuníquese con su profesional de la salud si tiene los siguientes síntomas que no mejoran después de meterse bajo techo o moverse a un ambiente con buena calidad del aire.
- Falta de aliento o problemas para respirar
- Respiración ruidosa
- Dolor o opresión en el pecho
- Palpitaciones
- Náusea o fatiga inusual
- Mareo y/o sensación de desmayo
Como siempre, si usted o alguien que usted conoce tiene una emergencia, llame al 9-1-1.
Siga a @MarinHHS para las últimas noticias
Para obtener información actualizada sobre incendios en California, consulte: http://www.calfire.ca.gov/
Para obtener información actualizada sobre la calidad del aire en el Área de la Bahía, consulte: http://www.baaqmd.gov
PUBLIC HEALTH ADVISORY: October 09, 2017
Northern California Fires- Smoke Advisory: Current Situation
Air quality in Marin County has been affected by multiple fires in Napa and Sonoma County. While concentrations of smoke vary depending upon location within Marin, all areas have been affected and all residents are being exposed. Smoke from wildfires is expected to continue as the wildfires are not yet contained. There are no fires in Marin County as of this afternoon. Smoke can cause eye and throat irritation, coughing, and difficulty breathing. People who are at greatest risk of experiencing symptoms are: Young children, older adults, pregnant women, or people with respiratory conditions (such as asthma or emphysema) or heart conditions: We are advising these sensitive populations to stay indoors, avoid prolonged activity, and seek medical help if respiratory symptoms worsen. When smoke levels are high, even healthy people may experience symptoms such as coughing, a scratchy throat, irritated sinuses, shortness of breath, headaches, stinging eyes, and a runny nose. All residents should limit outdoor physical activities and stay indoors if at all possible. As a precaution, Health and Human Services has recommended that all outdoor sporting activities for children be cancelled.
For up to date information about fires in California go to: http://www.calfire.ca.gov/
For up to date information about air quality in the Bay Area go to: http://www.baaqmd.gov/
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Hepatitis A Outbreak 
Tdap in Pregnancy 
gs together, and those who are Spanish-speaking are especially needed. Attend an orientation with a social worker and an experienced foster parent to learn more. Visit 
Syphilis 2016: Return of the Great Masquerader
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County fairs are not known for healthy food and drink. The 
Staying Alive 
Shigella isolates across the U.S. are showing new resistance to quinolones. The CDC is now recommending clinicians order a stool culture and antimicrobial susceptibility testing when Shigella is suspected; reserve antibiotic therapy for patients for whom it is clinically indicated or when treatment is advised in an outbreak setting. Marin County Public Health will communicate relevant local incidence and resistance patterns to you, our clinicians. Quinolone-resistant strains are commonly resistant to other standard agents, including azithromycin, trimethoprim-sulfamethoxazole, amoxicillin-clavulanate and ampicillin. For more information, visit the 
Very high potency opioids, such as fentanyl and carfentanil, may pose a contact hazard to medical personnel and first responders who may handle these compounds. Recently in California, fentanyl and its analogs have been found in other drugs, including heroin, methamphetamine, cocaine, and counterfeit pills made to look like prescription medications, such as alprazolam (Xanax). To address this concern, Marin County Public Health issued The California Department of Public Health (CDPH) is urging all Californians, in an effort to prevent Zika and West Nile Virus infections and eliminate mosquito populations, to remove standing water around their homes and businesses. There is also updated guidance from the Centers for Disease Control and Prevention (CDC) for Zika testing in pregnant women. Visit Marin HHS' Zika web page for more information.
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Elephant Tranquilizer New Threat 
End of Life Option
Summer time and pool parties are upon us. As the weather warms up, so does the risk of drowning. (Drowning is a leading cause of injury death for children ages 1 to 4.) As providers, we can encourage parents to prevent
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Kindergarten immunization rates in Marin County are the highest they have been since 2000. This school year, 93.2 percent of Marin kindergarten students have received all of the immunizations required for school, increasing nearly 20% from the 2011/12 school year, when local immunization rates were at their lowest point, or 77.9 percent of kindergarten students. Providers and parents can visit the 
Marin County’s track record of being one of the healthiest counties in California is intact, according to new statistics, but several significant issues remain for those who deliver health care and other wellness services.
Dr. Matthew Willis, the County's Public Health Officer, says known problems with substance use were one contributor to Marin receiving the No. 2 ranking rather than No. 1.
The Robert Wood Johnson Foundation released its annual rankings of California’s 58 counties, and Marin came in at No. 2 this year behind San Mateo County. Marin had been ranked No. 1 in statewide health for seven consecutive years. The County Health Rankings data give a glimpse of a community’s health and provide a starting point for investigating and prioritizing ways to improve health.
“As the safety net for our community, our goal is to create a safe and healthy community for all our residents,” said Board of Supervisors President Judy Arnold. “We have a lot to be proud of, but major challenges remain in the areas of income inequality, affordable housing, binge drinking, and prescription drug abuse.”
Marin retained the top spot statewide in overall health factors such as education, employment, family and social support, and community safety.
Dr. Matthew Willis, the County’s Public Health Officer, said one contributor to the change in ranking is known problems with substance use.
“Compared to other counties, we lose points for having higher rates of adult binge drinking, drunk driving deaths, and drug overdose rates,” Willis said. “This is another sign that these are issues we need to take seriously.”
Marin experienced a spike in accidental drug overdoses from 2012 to 2014, the time period reflected in the latest rankings for that category. In response, the County helped create a grassroots initiative called RxSafe Marin in 2014 to tackle prescription drug abuse. The Marin County Department of Health and Human Services and several other County departments are involved and shepherding positive change.
“We've made some progress since 2014, and we’re losing fewer people to overdoses, but we have long way to go,” Willis said.
Marin was worse than the state average in income inequality and still experiences a large division between the top and bottom ends of the income spectrum. Marin consistently shows a low rate of children in poverty (9 percent), but social inequity came to light as the foundation broke down the statistics by race for the first time. Thirty percent of African-American children and 24 percent of Hispanic children experience poverty compared with 4 percent of white children.
As a countermeasure, the County has made steady progress on many fronts with social equity, and the Board of Supervisors made equity a priority in its 2016 State of the County message. It is working to preserve existing affordable housing, helping underserved residents visit and enjoy parks and open spaces, and making its annual County Fair one of the healthiest of its kind in the country, and improving access for disabled visitors at County-maintained pathways, park trails and buildings.
“Our scores did not change dramatically from last year,” Willis said. “San Mateo has made substantial progress and that’s good news. No one is backsliding here: San Mateo is raising the bar and it’s up to us to meet the challenge.”
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In 2015, scientists reported the emergence of the plasmid-encoded mcr-1 gene, conferring bacterial resistance to the antibiotic colistin, signaling potential emergence of a pandrug-resistant bacterium. The mcr-1 gene makes bacteria resistant to the antibiotic, colistin. Colistin is one of the few "last resort" antibiotics available to treat bacteria that are resistant to many other antibiotics, such as carbapenem-resistant Enterobacteriaceae (CRE). The Centers for Disease Control and Prevention (CDC) Get Smart program offers 
This communication is for those who have been contacted by the Marin County Public Health Department by phone the week of August 19, 2019
For contacts of Bacterial Meningitis case:
The purpose of this letter is to inform you that you may have had contact with a person who had meningococcal meningitis. For that reason, we encourage you to contact your health care provider or go to Urgent Care to discuss possible preventive treatment with antibiotics (post-exposure prophylaxis).
Close contact includes:
- household members
- persons who frequently eat or sleep in the same house
- persons who spent 4-6 hours per day together
- persons who have come in close contact with the saliva or respiratory secretions of an infected person.
Preventive antibiotic treatment is recommended for individuals who are close contacts of someone who had meningococcal disease. Ciprofloxacin 500mg one tablet effectively prevents disease.
Symptoms of meningococcal disease include, but are not limited to:
- Fever
- Headache
- Stiff neck
- Confusion
- Rash
If you experience any of these signs or symptoms, contact your health care provider immediately for evaluation. If you or your provider have additional questions or concerns, please call Marin County Communicable Disease and Prevention Control (CDPC) at 415 473 4163 and ask to speak to a Public Health Nurse. Additional information about meningococcal disease can be found at https://www.cdc.gov/meningococcal/index.html.
Flu Is Here! On December 1st, the California Department of Public Health (CDPH) announced the first influenza-associated fatality in a person under the age of 65 for the 2016-2017 flu season. It is mandatory to report laboratory-confirmed influenza cases who require admission to an intensive care unit (ICU) and/or who die at any location (i.e. home, hospital, ER). Visit www.marinflu.org for the most up-to-date information about current influenza activity in Marin.
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Flu Is Here 
RxSafe Marin
Wash Your Hands!
Tuberculosis Outbreak In the summer, pediatric patients visit their doctors for health examinations for school entry and pre-participation physical examinations. These are opportunities to discuss both required and recommended vaccinations (e.g., HPV, meningitis). With the introduction of SB277, parents may be seeking temporary and/or permanent medical exemptions for required vaccinations. Visit our Immunization Program website for forms and guidance on medical exemptions or call (415 473 3078) or email (dhiser@marincounty.org) Danielle Hiser, RN, PHN, Immunization Coordinator, with any questions.
Many college campuses are experiencing mumps outbreaks. Summer is around the corner, and students from colleges and universities will intermingle, increasing risk for mumps transmission. Contact the Communicable Disease Prevention and Control unit at (415) 473-7805, if you have any questions.
For the seventh straight year, Marin holds the title of the healthiest County in California, according to the Robert Wood Johnson Foundation. Despite the best overall rating, persistent health and social inequities remain a challenge for Marin health officials.
The annual County Health Rankings were released today, and Marin shines in many measures of health. The rankings consider two main health outcomes: premature death and quality of life, and multiple factors that affect health including behavior, clinical care, the physical environment, and social and economic factors.
For example, Marin ranks highest in life expectancy and lowest rates of adults reporting fair or poor health and teen births. Marin is No. 2 among counties with a high number of adults with a healthy body weight and low rate of unemployment and violent crime.
“Community investments such as reserving land for open space and social norms around healthy eating and staying active have helped Marin maintain our ranking,” said Dr. Grant Colfax, Director of Marin County Department of Health and Human Services (HHS). “However, the rankings also reflect major disparities across Marin and help us know where we need to prioritize our work. For example, we need to focus on increasing equity in health care coverage, access to health food, early childhood education, and job training so everyone has an opportunity to optimize his or her health.”
Marin ranked poorly – No. 54 out of 57 counties reporting – in income inequality, a measure that focused on the ratio between those with the highest incomes (above 80 percent of the median) and the lowest incomes (below 20 percent of the median). The County also fared poorly in one of the foundation’s new additional measures: racial segregation between whites and non-whites. Marin came in No. 50 among the 56 counties reporting. Racial segregation can translate to disparities in income, educational opportunities and work opportunities – all three of which lead to poor health outcomes.
When it comes to opportunities to live a long and healthy life, a few miles can make an enormous difference in Marin. There is a 15-year gap between life expectancy in Ross (94) and Marin City (79), a disparity that correlates with the per capita income.
Marin HHS is working in communities to help improve life expectancy. The Nutrition Wellness Program works with schools that have high obesity rates, which is known to drive heart disease and other conditions that lead to premature death. In Marin City, for example, Marin HHS supports nutrition education, walk to school programs, school gardens, and marketing to attract health-conscious grocery stores.
“While there are signs of progress, we’re more vulnerable than these rankings suggest,” said Dr. Matt Willis, the County’s Public Health Officer. “There is much more to do to achieve health equity in Marin. We need to continue to bolster programs and policies that address poverty, jobs, housing, and education.”
The County has made steady progress on many fronts with social equity, and the Board of Supervisors has made equity a priority. For instance:
- It has made a commitment to preserve existing affordable housing, explore ways to acquire more affordable housing and encourage landlords to adhere to voluntary rent guidelines.
- Marin County Parks is in its third year of a program designed to help more Marin residents, especially the underserved, to visit and enjoy parks and open spaces.
- The Marin County Fair and Play Fair Marin have partnered for 14 years to build and maintain a healthy and successful fair as well as create a resource guide for ongoing and future success.
- The Department of Public Works is diligent in its efforts to improve disability access and safety at County-maintained facilities, such as widening a popular pathway in the lower Ross Valley.
- The County has even launched a TV series to promote education on mental health.
Other community efforts working to alleviate poverty and promote success of Marin residents are Rise Together, Marin Promise, and Marin Strong Start.
County fairs are not known for healthy food and drink. The Marin County Fair is an exception. We received the 2015 Merrill Award by the Western Fairs Association for its Play Fair health initiatives. The fair is a strong reflection of the community health values in Marin. The Play Fair team shared their model in this Growing Healthy Events Guide.
The number of reported outbreaks of acute gastroenteritis due to norovirus in Marin County has increased significantly since October, 2015. While this is consistent with the seasonal nature of norovirus, the California Department of Public Health has announced higher than usual activity state-wide. In Marin, affected facilities have included adult congregate living facilities and childcare centers. The duration of most of the outbreaks is a few days to two weeks, reflecting both the natural history of the illness and the control measures taken by the facilities. Information about norovirus can be found here.