MCPH OPIC Newsletter #7 October

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OPIC Monthly Newsletter

Issue 7 October 12, 2023

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

Guidance Updates

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

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

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

All Facilities Letters (AFLs) from CDPH

COVID-19 Treatment Resources for Skilled Nursing Facilites

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

Legal Requirement to submit immunization data

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

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

View AFLs at the All Facilities Letter webpage.

PINs from CDSS

Influenza and RSV Vaccination Recommendations

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

New CDC RSV Vaccination Recommendations

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

Older adults
Adults living in long-term care facilities

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

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

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

Marin Updates

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

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

MDRO NEWS

Enhanced Standard Precautions Readiness Checklist: https://www.cdph.ca.gov/Programs/CHCQ/HAI/CDPH%20Document%20Library/ESP_Readiness_Checklist.pdf
ASP EDUCATION RESOURCE From Johns Hopkins University: Toolkit to Enhance Nursing and Antibiotic Stewardship Partnership (hopkinsmedicine.org)

Stay tuned for upcoming educational opportunities and news.

Upcoming Trainings

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

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

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

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

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

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

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

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

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

Resources

Infectious Disease toolkits

CDC Norovirus Outbreak Control Resource Toolkit for Healthcare Settings
CDC - Influenza Outbreak for LTCF Guidance
CDC Infection Prevention Tools for LTCF Settings - Multiple diseases on this page including CAUTI, C.Diff, CRE, MRSA, MDRO, Norovirus, and Flu

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Marin County Public Health's Monthly Updates for LTCFs provide updates regarding guidance, surveillance updates, and professional training opportunities. Please contact LTCFReport@marincounty.org

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

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

Public Health Newsletter - September 2023

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A message to physicians and other health care providers from Marin County's Public Health Officers.

Wildfire Smoke in Marin

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

COVID-19 Fall Vaccine Update

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

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

Buprenophine for Beginners Training

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

Respiratory Syncytial Virus (RSV)

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

National Preparedness Month

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

World Rabies Day

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

Message from the Deputy Public Health Officer

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

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

Stay well,

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

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

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

Our mailing address is:
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Public Health Newsletter - August 2023

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A message to physicians and other health care providers from Marin County's Public Health Officers.

West Nile Virus Detected Locally

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

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

Aeromonas Causing Rash Illness in Tough Mudder Race Participants

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

National Immunization Awareness Month

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

A New RSV Immunization for Infants

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

Treating Opioid Use Disorder: DEA Training Requirement for All Licensees

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

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

This requirement can be met with multiple options, as long as it totals eight hours.

Pain & Addiction: Essentials Online (6 hours)
Moving Beyond the Barriers of Treating OUD (3 hours)
Treatment of Alcohol Use Disorder (4 hours)
OUD Mini-Course: Treatment in the Emergency Department (1 hour)
Buprenorphine Mini-Course: Building on Federal Prescribing Guidance (1 hour)
54th Annual Conference recordings
See the eLearning Center for more education options to fulfill this training

Please see the DEA notice for additional information or guidance on this matter.

Suicide Prevention Resources

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

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

Message from the Public Health Officer

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

Matt Willis, MD, MPH

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MCPH OPIC Newsletter #6 August

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OPIC Monthly Newsletter

Issue 6 August 9, 2023

Guidance Updates

Responding to COVID-19 in the Workplace - for Employers

Audience: All California employers

Purpose: to help employers understand the steps they can take to prevent the spread of COVID-19 and to respond quickly and appropriately to cases and outbreaks in the workplace.
Brief: updates to the existing guidance include the addition of new resources related to Cal/OSHA COVID-19 Prevention Non-Emergency Regulations, the update of references to outbreak and reporting guidance, and the update of recommendations and links on masking.
Primary Authoring Department: Occupational Health Branch (OHB)

Updated Infection Control Plan Forms (from CDSS)

Beginning July 1, 2023, the Infection Control regulations within the California Code of Regulations (CCR), Title 22, Division 6, were permanently adopted. The updated LIC 9282: Residential Infection Control Plan and LIC 9283: Infection Control Plan – Adult Day Programs are available as courtesy forms to assist licensees in meeting the Infection Control Plan requirements.

All Facilities Letters (AFLs) from CDPH

Extreme Heat Guidance All Facilities Letter (AFL)

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

View AFLs at the All Facilities Letter webpage.

PINs from CDSS

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

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

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

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

MDRO NEWS

An interesting article about ways MRSA can spread in a community.
Cluster of Carbapenemase-Producing Carbapenem-Resistant Pseudomonas aeruginosa Among Patients in an Adult Intensive Care Unit — Idaho, 2021–2022 | MMWR (cdc.gov)
Check out this new ASP EDUCATION RESOURCE From Johns Hopkins University: Toolkit to Enhance Nursing and Antibiotic Stewardship Partnership (hopkinsmedicine.org)

Stay tuned for upcoming educational opportunities and news.

Marin Updates

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

Climate Change and Infectious Diseases

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

Upcoming Trainings
CALTCM Infection Preventionist Orientation Program

Module 1 – Infection Preventionist Duties and Outcome Surveillance
Module 2 – Process Surveillance and Antibiotic Stewardship
Module 3 – Occupational Health & Immunization Program
Module 4 – Infection Preventionist Resources and Tools

Resources

CDSS Emergency Preparedness Regulations presentation slides
Sign-up for the HAI Program mailing list to stay up-to-date on HAI and antibiotic resistance prevention, response, and surveillance across the healthcare continuum.
Improving Ventilation in Buildings
Talking with Older Adults about COVID-19 Vaccines and Treatment Resources
Healthcare worker Infection Control Recommendations from CDC

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

CDC:
- Prevent Tick and Mosquito Bites
- Protecting Vulnerable Groups from Extreme Heat
CDPH:
National Weather Service: Watches, Warnings or Advisories for California
California Office of Emergency Services: for the latest news on emergencies
Office of the Governor of California: Protecting Californians From Extreme Heat: A State Action Plan to Build Community Resilience
Marin Center for Independent Living (MCIL): Powered and Prepared
Register for emergency alerts at both: Alert Marin and Nixle
Shelter plan: Ready Marin’s Grab & Go Checklist and prepare to shelter-in-place Ready Marin’s Build a Kit Checklist
Review evacuation route

Infectious Disease toolkits

CDC Norovirus Outbreak Control Resource Toolkit for Healthcare Settings
CDC - Influenza Outbreak for LTCF Guidance
CDC Infection Prevention Tools for LTCF Settings - Multiple diseases on this page including CAUTI, C.Diff, CRE, MRSA, MDRO, Norovirus, and Flu

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Marin County Public Health's OPIC Monthly Newsletters provide updates regarding guidance, status updates, and professional training opportunities. Please contact Ombudsman, Dan Steckline, to be added to those meeting invitations.
Email: DSteckline@marincounty.org

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

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

Public Health Newsletter - July 2023

Marin County Public Health Newsletter - July 2023
In this Issue: Climate Change & Infectious Diseases | Vaccines & the "Tripledemic" Viruses | Reportable Disease Requirements I Wildfire Information | Preventing Skin Cancer in Marin | Supporting Pediatric Provider Workforce | Message from the Deputy Public Health Officer

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A message to physicians and other health care providers from Marin County's Public Health Officers.

Climate Change and Infectious Diseases

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

Vaccines and the "Tripledemic" Viruses

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

Reportable Disease Requirements and Timeliness

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

Wildfire Information

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

Preventing Skin Cancer in Marin

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

Supporting our Pediatric Provider Workforce

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

Message from the Deputy Health Officer

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

Stay well,

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

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Our mailing address is:
3240 Kerner Blvd
San Rafael, CA 94901

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MCPH OPIC Newsletter #5

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OPIC Monthly Newsletter

Issue 5 July 10, 2023

Guidance Updates

Bookmark this overview of all active COVID-19 AFLs, and all expired AFLs.
ACIP approves/recommends RSV vaccine for older adults. CDC panel recommends RSV vaccine for seniors | CIDRAP (umn.edu). We expect to hear more from ACIP and CDC about upcoming vaccine availability and dosing as we get closer to the fall season.
AFL 23-20 Hot Summer Weather Advisory is now available. This AFL reminds health care facilities to implement recommended precautionary measures to keep individuals safe and comfortable during extremely hot weather. Facilities must have contingency plans in place to deal with the loss of air conditioning, or in the case when no air conditioning is available, take measures to ensure patients and residents are free of adverse conditions that may cause heat-related health complications. Facilities must also report extreme heat conditions that compromise patient health and safety and/or require an evacuation, transfer, or discharge of patients.

The following AFLs are now available:

AFL 23-22 Fiscal Year (FY) 2023-24 Health Care Facility License Fee Schedule - This AFL informs licensees of FY 2023-24 license renewal fees as approved by the Governor and effective on July 1, 2023.
- If you have any questions about this AFL, please contact the Revenue Collection Unit at RCollection@cdph.ca.gov.
AFL 23-23 California Health and Human Services (CalHHS) Data Exchange Framework (DxF) - This AFL notifies GACHs, APHs, and SNFs that maintain electronic records of their obligation to exchange or provide access to health information in real time pursuant to the CalHHS DxF data sharing agreement for treatment, payment, or health care operations on or before January 31, 2024, except for certain specified facilities that must meet this requirement by January 31, 2026.
- If you have any questions or concerns about the requirements of the DxF, please contact the Center for Data Insights and Innovation at cdii@chhs.ca.gov.
AFL 23-24 Revised Licensure and Certification Application (HS 200) and Applicant Individual Information (HS 215A) - This AFL announces that the California Department of Public Health (CDPH) has revised Licensure and Certification Application (HS 200) (PDF) and Applicant Individual Information (HS 215A) (PDF) forms. The revised forms will be effective July 1, 2023.
- For questions concerning this AFL, please contact CAB by email at CAB@cdph.ca.gov or by phone at 916-552-8632.
  You may view other AFLs at the All Facilities Letter webpage.

Multi-Drug Resistant Organisms (MDROs) News, Resources, and Trainings

New tool: CDPH HAI created an Interfacility Transfer Communications Guide. Please review.
Enhanced Standard Precautions Readiness Checklist

Infection Prevention Training for Multi Drug Resistant Organisms (MDROs) Dr. Lael Duncan’s training 4/4/23: View the RECORDING.

Marin Updates

New Public Health Dashboard: Local Data for Local Action

Marin County Public Health launched a new tool to engage and educate the community we serve. Six data dashboards reflecting local public health priorities were posted online, and are accessed via a single landing page. Explore information on Reportable Communicable Diseases, COVID-19, Life Expectancy by Community, Non fatal and Fatal Overdoses, Hepatitis C, and the COVID-19 Community Assessment. Stay tuned as we add more dashboards to address emerging public health priorities.

Minor Heat Event Signals Time to Prepare

As temperatures in the Bay Area rise this weekend, the National Weather Service (NWS) HeatRisk forecasts Moderate/Orange level for Marin County. As a reminder, when NWS heat risk reaches Major/Red level local cooling centers may be activated for relief. Stay updated on availability and locations of cooling centers via Marin County's Emergency Portal. Explore cooling tips from Marin Health & Human Services, and remember hydration is critical for handling hot conditions.

Upcoming Trainings and Opportunities

Facility Evacuation: Lessons Learned

Training held May 4, 2023: RECORDING

Virtual Infection Prevention Train the Trainer Workshops, by CDPH
Trainings are repeated four times per week for each workshop topic to accommodate schedules. Choose one day/time per workshop topic to attend- trainings linked below:

Certified Nursing Assistant IPC Curriculum
Multiple offerings: July 17-21
Register HERE

EVS IPC Curriculum for EVS Managers
Multiple Offerings: August 21-15
Register HERE

NEWS

RSV Vaccine Efficacy Data
GSK today released new results on the vaccine from an ongoing phase 3 trial, which found an overall efficacy of 82.6% against lower respiratory tract disease during the first season, 77.3% for mid-season, and 67.2% over two seasons. Against severe disease, efficacy was 94.1% during the first season, 84.6% at mid-season, and 78.8% over two seasons.

Climate Change and Infectious Diseases

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Marin County Public Health's OPIC Monthly Newsletters provide updates regarding guidance, status updates, and professional training opportunities. The monthly meeting from the Long-Term Care Ombudsman Office in conjunction with OPIC, is held on the fourth Tuesday of the month from 2-3 p.m. Guidance, status updates, resource sharing, and opportunities to ask questions are featured. Please contact Ombudsman, Dan Steckline, to be added to those meeting invitations.
Email: DSteckline@marincounty.org

Next Ombudsman meeting is: Tuesday, July 25 2:00-3:00 PM

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

Public Health Newsletter - May 2023

Marin County Public Health Newsletter - May 2023
In this Issue: Hepatitis C | Xylazine | Vaccine Storage | Back to School | COVID-19 Sniffing Dogs I Message from the Public Health Officer

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A message to physicians and other health care providers from Marin County's Public Health Officers.

Hepatitis C: Lifting Barriers to Screening and Treatment

Hepatitis C is a leading cause of liver failure in Marin County. Effective and affordable treatments a Hepatitis C Poster

re now widely available. Marin Public Health and the c oalition of community providers has set a goal of at least 100 Hepatitis C treatment starts in 2023. The CDC recommends screening all adults for Hepatitis C. Public Health is offering 30 minute primers on the latest screening and treatment guidelines for all Marin healthcare providers, in person or online. Contact nle@marincounty.org to schedule a Hep C primer or to join the Marin Hepatitis C Coalition. You can track progress on our new Hepatitis C dashboard.

Xylazine, an Emerging Overdose Threat, Detected in Marin Wastewater

On April 27, a Marin County Public Health Advisory alerted local providers that Xylazine (Tranq), a powerful veterinary tranquilizer, had been detected in local wastewater signifying increased risk for overdose in our community. Marin’s wastewater-based surveillance has expanded beyond infectious diseases. This is another example of the advantage of wastewater-based surveillance over the alternative of measuring and responding to adverse events after they happen. This one pager on xylazine was developed for patients, and substance use and harm reduction partners.

Protecting Vaccines in Extreme Weather Events and Power Outages

In preparation for wildfire season and extended power outages, all local providers should have protocols to safely transport refrigerated and frozen vaccines, and have backup sites for vaccine storage. CDC’s Vaccine Storage and Handling Toolkit is a valuable guide. Clinics enrolled in the Vaccines for Children (VFC) Program are required to follow protocols for vaccine management, storage, and temperature monitoring.

Prepare for Back to School Vaccinations

This year, Marin County childhood immunization rates have surpassed state averages for the first time on record. To build on this success, as summer approaches, Marin Public Health encourages providers to plan for back-to-school vaccinations. Immunizations are required for childcare, TK/Kindergarten and 7th grade entry (“checkpoints”). Since January 2021, medical exemptions (MEs) must be issued online through CAIR-ME. See CDPH’s Shots For School website, and their Exemptions FAQ for more information and resources.

COVID-Sniffing Canines Gaining Support

COVID Sniffing Dogs - Scarlett & Rizzo

Scarlett and Rizzo, the COVID-sniffing dogs familiar to Marin’s long term care facilities, are gaining national attention. Their effectiveness in school-based screening was described here, and they were featured nationally here. Marin Public Health’s partnership with California Department of Public Health and Early Alert Canines has helped secure another year of state funding for the virus-detecting dog pilot.

Message from the Health Officer

One of the lessons of the pandemic was the unique value of timely and reliable local data to guide local strategy. We’re fortunate to have a strong epidemiology team in Marin, and we continue to expand the use of data to advance local public health. Several “live” dashboards were recently developed and published to describe our progress, including the following: COVID-19; Influenza; overdose; Hepatitis C; life expectancy; and reportable communicable diseases. Please browse these resources and refer to them for your own goal-setting. These data will be updated regularly and referred to in communications with you, our clinicians, as we partner to protect the health of our community.

In gratitude,
Matt Willis

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San Rafael, CA 94901

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MCPH OPIC Newsletter #4

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OPIC Monthly Newsletter

Issue 4 June 22, 2023

Guidance Updates

Bookmark this overview of all active COVID-19 AFLs, and all expired AFLs.
Order of the State Public Health Officer - Adult Care Facilities and Direct Care Worker Vaccine Requirement is no longer active. Meaning, CMS will no longer require HCP to have the primary series of COVID-19 vaccines.
PIN 23-12-ASC, effective July 1, 2023, the Infection Control regulations are permanently adopted of the California Code of Regulations (CCR), Title 22, Division 6, Infection Control regulations for Adult and Senior Care licensees
- Chapter 2, Social Rehabilitation Facilities (SRF), Section 81095.5
- Chapter 3, Adult Day Programs (ADP), Section 82095.5
- Chapter 6, Adult Residential Facilities (ARF), Section 85095.5
- Chapter 8, Residential Care Facilities for the Elderly (RCFE), Section 87470
- Chapter 8.5, Residential Care Facilities for the Chronically Ill (RCFCI), Section 87895.5
PIN 23-13-ASC provides information on the end of the vaccination and booster requirement for all workers in Adult and Senior Care (ASC) facilities and the end of the masking requirement in ASC facilities. This PIN also provides the latest guidance to ASC licensees on screening, testing, isolation and quarantine, visitation, and infection control requirements.

SARS-CoV-2, Influenza Virus and RSV Result Reporting
Report results electronically to the CalREDIE system within 24 hrs.
Facilities certified under CLIA to perform non-waived testing must report:
- All laboratory-based SARS-CoV-2 and influenza virus Nucleic Acid Amplification Tests (NAAT) results, including positive and non-positive (negative, indeterminate, etc.) and are requested to report all RSV NAAT results, including positive and non-positive (negative, indeterminate, etc.).
- All SARS-CoV-2 and influenza virus non-NAAT diagnostic testing (e.g., high throughput antigen testing) results, including positive and nonpositive results of and are requested to report RSV non-NAAT diagnostic testing results, including positive and non-positive (negative, indeterminate, etc.).
Facilities conducting testing with a CLIA Certificate of Waiver (e.g., skilled nursing facilities, schools):
- Reporting of positive and non-positive results for SARS-CoV-2, influenza virus, and RSV is not required.

Please reach out to calrediehelp@cdph.ca.gov with any questions.

Multi-Drug Resistant Organisms (MDROs) News, Resources, and Trainings

New tool: CDPH HAI created an Interfacility Transfer Communications Guide. Please review.
Training Tuesday June 27th: Marin County Nursing Home Virtual Train-the-Trainer Workshop: Enhanced Standard Precautions
- Description: The California Department of Public Health (CDPH) Healthcare-Associated Infections (HAI) Program and Health Services Advisory Group (HSAG) invite all Marin County skilled nursing facilities (SNFs) to participate in this Enhanced Standard Precautions (ESP) train-the-trainer workshop on Tuesday, June 27, 2023, from 2:00 p.m. to 3:30 p.m. This session will review CDPH HAI Program guidance for ESP implementation to reduce the risk of multidrug-resistant organisms (MDRO) acquisition among high-risk residents in SNFs. This session will also review how to identify high-risk residents, develop a plan to educate stakeholders, and implement ESP strategies.
- Participating SNFs in Marin County should designate and register 2–4 representatives to attend this 90-minute workshop (i.e., IP, DON, DSD, NHA, Corporate Leadership). Following completion of this workshop, trainees will be expected to train SNF staff on the ESP practices taught in the workshop. This training is a repeat of the ESP trainings that were provided statewide the week of May 15-19, 2023. If you attended that training, additional CEUs are not available for the same training.
  - More information about that training can be found HERE
  - Register HERE

Enhanced Standard Precautions Readiness Checklist
Infection Prevention Training for Multi Drug Resistant Organisms (MDROs) Dr. Lael Duncan’s training 4/4/23: View the RECORDING.

Marin Updates

Here is a link to the current list of approved and permitted private ambulance providers authorized to perform ambulance transports here in Marin County. NorCal Ambulance is the only provider with an ambulance base here in Marin; however, the other providers are in adjoining counties and often have ambulances in Marin throughout the day.

Public Health Advisory
Marin County Public Health issued this advisory to healthcare providers regarding the increasing availability and use of hemp products that cause intoxication and adverse effects, especially in youth.

Public Health Surveillance Dashboards

Reportable Disease Dashboard (non-COVID-19)
Respiratory Illness Surveillance (non-COVID-19)
COVID-19 Disease Dashboard

Upcoming Trainings and Opportunities

Great opportunity! NHICS Training & TTX. Open to all sites.

Please join us on Zoom for our rescheduled NHICS Tabletop Exercise & Training
Thursday, June 29^th 1:00-2:30pm!

The County of Marin’s Public Health Preparedness’s department is excited to partner with Ray Boudewyn from Prevent and Prepare, LLC for our Nursing Home Incident Command System’s (NHICS) training! It would be most beneficial if you have more than 1 person attend this training from your facility for the Tabletop Exercise.

To register for the training, please email: LTCFReport@marincounty.org to receive the zoom meeting invitation and link.

Facility Evacuation: Lessons Learned

Training held May 4, 2023: RECORDING

Virtual Infection Prevention Train the Trainer Workshops, by CDPH
Trainings are repeated four times per week for each workshop topic to accommodate schedules. Choose one day/time per workshop topic to attend.

Certified Nursing Assistant IPC Curriculum
Multiple offerings: July 17-21
Register HERE

EVS IPC Curriculum for EVS Managers
Multiple Offerings: August 21-15
Register HERE

NEWS

Medical Redeterminations

Continuous coverage and enrollment in Medi-Cal is ending, along with the end of the Public Health Emergency. That means, anyone enrolled in Medi-Cal will be receiving a redetermination packet, and that will need to be completed. If their paperwork is not completed, the person will lose their Medi-Cal. Please help beneficiaries report contact information changes, so they receive paperwork at the right address. Call Center: 877-410-8817 and BenefitsCal.com.

MORE evidence that routine vaccine is particularly important for our elderly; this report describes durability of protection for bivalent COVID-19 vaccination among immunocompromised adults: Estimates of Bivalent mRNA Vaccine Durability in Preventing COVID-19–Associated Hospitalization and Critical Illness Among Adults with and Without Immunocompromising Conditions

Improving Communication From Hospital to Skilled Nursing Facility Through Standardized Hand-Off: A Quality Improvement Project

The U.S. Food and Drug Administration (FDA) approved naloxone hydrochloride nasal spray (Narcan) for over the counter (OTC) nonprescription use. This action allows the life-saving medication to reverse an opioid overdose to be sold directly to consumers. For the specific provisions that must be followed by licensees and staff at adult or senior care facilities, please see PIN 19-20-ASC – The California Overdose Treatment Act.

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We are providing monthly newsletters to provide updates from Marin County Public Health in terms of guidance, status updates, and trainings. Our Ombudsman meetings will be held the fourth Tuesday of each month at 2 PM.
Please contact Dan Steckline to be added to those meeting invitations (DSteckline@marincounty.org).

Next Ombudsman meeting is: Tuesday, July 25 2:00-3:00 PM

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

MCPH OPIC Newsletter #3

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OPIC Monthly Newsletter

Issue 3 May 22, 2023

Our mission is to provide support to healthcare and congregate care facilities as you mitigate and manage risks due to communicable diseases and emergencies. We do this by promoting high levels of readiness, ensuring effective responses, and providing training and educational opportunities.
Our monthly newsletters are for YOU, and they include: news and guidance updates, community status updates, available trainings and other educational opportunities.

Multi-Drug Resistant Organisms (MDROs) News, Resources, and Trainings

News: Experts warn against antibacterial products which could promote antibiotic resistance.
Enhanced Standard Precautions Readiness Checklist: https://www.cdph.ca.gov/Programs/CHCQ/HAI/CDPH%20Document%20Library/ESP_Readiness_Checklist.pdf
New Article: Antibiotic Stewardship Programs essential for limiting C. difficile infections.
Infection Prevention Training for Multi Drug Resistant Organisms (MDROs) Dr. Lael Duncan’s training 4/4/23: View the RECORDING.

NEWS
The end of the Federal Government declaration of the COVID-19 Public Health Emergency Declaration, as of May 11, 2023. Here is a fact sheet about changes from HHS. Additional information about the changes to COVID-19 surveillance data.

Governor Newson proclaimed the month of May to be Older Californians Month!

Celebrate life at every age and stage. Interested in new perspectives on aging? Check out This Chair Rocks, an inspiring book that debunks many myths about aging; and explore Old School, a resource clearinghouse for combating agism. Late life: Wisdom, Dignity, Community–we are focused on helping your residents age well and safely in Marin.

Message from Dr. Lael Duncan, Marin County Deputy Public Health Officer In the wake of the end of the Public Health Emergency declaration, and since the repeal of mask mandates in health- and long term-care settings, we have seen some challenging outbreaks in our LTC community. Though community cases and waste water levels of Covid-19 are lower, they are not zero and Omicron sub-variants are highly transmissible. Overall, cases among residents and staff are down, but outbreaks are large and spread fast! We urge you to consider your policies and to quickly re-implement necessary protective mitigation strategies at the first sign of spread or when any risk indicator is elevated. Contact LTCFreport@marincounty.org for assistance or more information.

NOTICE: Recall of the SD Biosensor, Inc Pilot COVID-19 At Home Tests due to microbial contamination in the liquid buffer solution. You can check the discontinued lot numbers to see if your test kits are recalled. Do not pour the liquid down the drain. Recall Notice here.

AFL 20-43.3 (ca.gov) announces that effective May 12, 2023, CDPH's online COVID-19 Skilled Nursing Facility (SNF) Survey is discontinued. SNFs must continue to submit weekly COVID-19 data to the Department of Health and Human Services (DHHS) via the Centers for Disease Control and Prevention's (CDC's) National Health Safety Network (NHSN) system until December 31, 2024, unless DHHS specifies an earlier date.

COVID-19 Dog Detection Pilot Program in the news: Celebrate the success of our Marin County Pilot Program. Due to our documented success with the Canine program, and with a new LTC CDPH grant, the program will be offered widely across the Bay Area. THANK YOU to participating SNF and RCFE partners!! Read more about the history of the program in California schools. Jama Pediatric Article and Fortune Article

Upcoming Trainings and Opportunities

Great opportunity! NHICS Training & TTX. Open to all sites.

Wednesday, June 7th 10-11:30am

Zoom invitation sent by HPP

contact HPPCoordinator@marincounty.org for questions or invitation

Facility Evacuation: Lessons Learned

Training held May 4, 2023: RECORDING

Virtual Infection Prevention Train the Trainer Workshops, by CDPH
Trainings are repeated four times per week for each workshop topic to accommodate schedules. Choose one day/time per workshop topic to attend.

Urinary Tract Infection Prevention
Multiple offerings: June 20-23
Register HERE

Certified Nursing Assistant IPC Curriculum
Multiple offerings: July 17-21
Register HERE

EVS IPC Curriculum for EVS Managers
Multiple Offerings: August 21-15
Register HERE

MCPH and Early Alert Canines are visiting SNFs. See them in action in this video.

We are providing monthly newsletters to provide updates from Marin County Public Health in terms of guidance, status updates, and trainings. These newsletters will be sent mid month, and our Ombudsman meetings will be held the fourth Tuesday of each month at 2 PM.
Please contact Dan Steckline to be added to those meeting invitations (DSteckline@marincounty.org).
Next Ombudsman meeting is: Tuesday, May 23 2:00-3:00 PM

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

Public Health Newsletter: STI / Hep B / Infant IZ / Opioids

Marin County Public Health Newsletter - April 2023
In this Issue: National Public Health Week | STI Awareness | Perinatal Hep B | National Infant Immuniation Week | OD Free Marin I Message from the Deputy Public Health Officer

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A message to physicians and other health care providers from Marin County's Public Health Officers.

Public Health Week Highlights Equity National Public Health Week 2023 | ICE

National Public Health Week (NPHW) (April 3-9) recognized the importance of collaborating with the communities we serve to address health equity. While Marin County is still ranked the Healthiest County in the State, the rankings highlight health inequities between communities. For example, cardiovascular disease is the primary cause of premature death among Marin’s Black residents, and disproportionately contributes to diminished life expectancy. Health care providers play a key role in addressing racial disparities in health in Marin.

STI’s on the Rise in Marin
This month we partnered with the community to raise awareness about sexually transmitted infections during STI Awareness Week. In Marin, from 2020 to 2022, we have seen a three-fold increase in syphilis rates among residents 25 - 29 years old (from 41 to 119 cases per 100,000). Clinicians can track local STI rates here (Marin County Reportable Disease Dashboard | Marin Health and Human Services (marinhhs.org). Talking about sexual health and taking a sexual history is part of routine care. Test patients according to CDC screening recommendations. Treat patients following current STI treatment guidelines. For more resources on STIs visit the CDC website. #TalkTestTreat

National Infant Immunization Week (NIIW) on April 23-30, 2023 highlights the importance of vaccinating children 2 years and younger from vaccine-preventable diseases such as measles, smallpox, hepatitis B, etc. The CDC advises health care providers to educate parents, especially those who are vaccine hesitant, about the effectiveness and safety of vaccines to ensure commitment towards fully vaccinating their children. There are tips provided to successfully recommend vaccinations while respecting the concerns of the parent.

Perinatal Hepatitis B Updates

On March 10, 2023, the CDC expanded hepatitis screening and testing guidelines to further the goal of reducing hepatitis B morbidity and mortality. For surveillance, the State’s Perinatal Hepatitis B Prevention Program (CDPH PHPP) submits data to Marin’s PHPP program to track HBsAg-positive pregnant women and their infants.

Obstetricians: Report HBsAg-positive lab results to delivery hospitals to ensure hepatitis B immune globulin (HBIG) administration and HBV vaccination at time of delivery.

Pediatricians: Ensure infants born to HBsAg-positive pregnant persons complete HBV series on schedule and have post-vaccination serologic testing (PVST). Marin’s PHPP program will contact pediatricians for PVST results.

X-Waiver No Longer Needed to Treat Opioid Use Disorder
Opioid overdose is the leading cause of accidental death in Marin. OD Free Marin coordinates countywide strategies to prevent overdose deaths, including expanding treatment capacity. In June, treatment for opioid use disorder will become even easier, as clinicians can prescribe buprenorphine without an X-waiver. The California MAT (Medication Assisted Treatment) Expansion Project is offering free Continuing Medical Education and Continuing Education (CME/CE) to support management of opioid use disorders. Subscribe to the monthly OD Free Marin Newsletter.

Message from the Deputy Health Officer

While we have finally seen the end of a long winter of atmospheric rivers, Marin Public Health is now preparing for the wildfire season, which includes extreme heat and extended power outages. Providers play an important role in helping prepare medical frail and vulnerable patients for emergencies and disasters. For example, providers can share disease-specific emergency readiness materials developed by the CDC with their patients. We can also play a role in mitigating climate change. Learn more about MarinCAN, the countywide campaign to reduce greenhouse gas emissions. From buying or leasing an electric or hybrid vehicle to electrifying our homes, there are steps you can take to protect Marin’s future generations. Thanks for all you do each day to keep our communities healthy and safe.

Sincerely,
Lisa Santora

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

Our mailing address is:
3240 Kerner Blvd
San Rafael, CA 94901

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MCPH Monthly Newsletter for SNFs #2

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OPIC Monthly Newsletter

Issue 2 April 21, 2023

Greetings from Marin County Public Health Outbreak Prevention and Infection Control (OPIC) Team. Our mission is to provide support to healthcare and congregate care facilities as you mitigate and manage risks due to communicable diseases and emergencies by promoting high levels of readiness, ensuring effective responses, and providing trainings and educational opportunities.

Guidance Updates

MASKING, SCREENING, TESTING, ISOLATION AND QUARANTINE, VISITATION, AND INFECTION CONTROL REQUIREMENTS:
CDSS Guidance PIN 23-07 (updated 4/6/2023). This guidance instructs Adult and Senior Care (ASC) facilities to implement new practices for COVID-19 mitigation. From the date of this PIN, residents in ASC facilities may follow Community Guidelines on Isolation for COVID-19. Residents will isolate for 5 days and return to usual activities if they are symptomatically recovered and fever free for >24 hours. Testing is not required but may be used to enhance safety when discontinuing isolation. In congregate settings, in the absence of additional measures it is highly likely that Covid will spread without further interventions. Therefore: Residents recovering from Covid should mask for another 5 days following isolation or until 10 days following a positive test or symptom onset. We recommend that exposed residents test twice weekly until 10 days following their last known exposure. Mask use by all residents is strongly recommended during an outbreak.

Vaccine Requirements at Long Term Care Facilities

Federal regulations 42 CFR 483.80(d)(3) and 42 CFR 483.460(a)(4)(i) also require that Long-Term Care (LTC) facilities and Intermediate Care Facilities (ICFs) for Individuals with Intellectual Disabilities (ICFs-IID) must offer COVID-19 vaccines to residents, clients, and staff onsite (incl. bivalent boosters). CMS certified facilities are required to follow QSO-23-02-ALL Oct. 26, 2022 which instructs that all staff are required to receive the COVID-19 primary series of vaccination.

Vaccine Data Collection

Recently enacted legislation (AB 1797) requires California healthcare providers who administer vaccines to enter information about patients, including telephone numbers and race and ethnicity.

Health Care Settings Guidance Updates and Resources

Upcoming Trainings

Infection Prevention and Control for Multi-Drug Resistant Organisms in LTCFs

Presented April 4, 2023 by Dr. Lael Duncan
Recording: IPC MDRO Training Rec 4 4 2023.mp4 - Google Drive

Facility Evacuation: Lessons Learned

Thursday, May 4th 10-11:30am
Zoom invitation sent by HPP
contact HPPCoordinator@marincounty.org for questions or invitation

NHICS Training & TTX

Wednesday, June 7th 10-11:30am
Zoom invitation sent by HPP
contact HPPCoordinator@marincounty.org for questions or invitation

Golden Eagle Exercise--Regional Pandemic Exercise

Save the Date: Thursday, May 18, 2023
contact HPPCoordinator@marincounty.org for questions

One-on-One Virtual Consultant Support (Available for up to 5 SNFs)

Support can focus on facility HVA, EOP, other planning needs
Look for e-mail from Sheana with link to questionnaire
Facilities will be chosen randomly
One-on-ones must be completed no later than June 15th
Contact HPP to schedule: HPPCoordinator@marincounty.org

High Interest Topics

CalOSHA and COVID-19 Isolation

New Non-emergency Standards were released last month:

Most of our LTC facilities do not have Airborne Infection Isolation Rooms (AIIR) / negative pressure rooms. SARS CoV2 is an aerosol pathogen per CA Regulation Title 8 Section 5199. Specific exemptions apply when caring for persons with COVID-19. Application of Exceptions requires careful and regular documentation. Many of our Marin County buildings have older or non-compliant ventilation systems. In these cases you must implement and document specific accommodations when caring for COVID-19 Positive persons (persons with Novel Respiratory Pathogens or Airborne Infectious Pathogen-AirIP). This may include assessment of ventilation, use of in-room HEPA filters, exhaust ventilation via window when done per regulation, and of course proper respiratory precautions for all staff and visitors entering such areas. Additional resource Cal/OSHA - COVID-19 Non-Emergency Regulations FAQs

See also section (d) (2) (E) of 5199: “Specific control measures shall be listed for each operation or work area in which occupational exposure occurs. These measures shall include applicable engineering and work practice controls, cleaning and decontamination procedures, and personal protective equipment and respiratory protection.” This would be included in your Aerosol Transmissible Disease Plan per Section 5199.

When caring for persons with COVID-19 (Air-IP) in Non-Airborne Infection Isolation Room (AIIR) settings (i.e. when not in negative pressure rooms) you are operating under Section 5199 EXCEPTIONS to Subsections (e)( 5) (B). In most instances this will be under Exception #2: “Where it is not feasible to provide [Airborne Infection Isolation - AII] rooms or areas to individuals suspected or confirmed to be infected with or carriers of novel or unknown ATP (aerosol transmissible pathogen).” In this case, “employer shall provide other effective control measures to reduce the risk of transmission to employees, which shall include the use of respiratory protection in accordance with subsection (g) and Section 5144, Respiratory Protection of these orders.” This includes putting into place specific protections. NOTE: Exceptions do not apply for when high risk procedures are performed such as intubation; in such cases AIIR or use of PAPR as additional measures are recommended.

Ventilation: Refer to CA Regulation 3205.1 COVID-19 Outbreaks section (f): (f) Ventilation. In buildings or structures with mechanical ventilation, employers shall filter recirculated air with Minimum Efficiency Reporting Value (MERV)-13 or higher efficiency filters if compatible with the ventilation system. If MERV-13 or higher filters are not compatible with the ventilation system, employers shall use filters with the highest compatible filtering efficiency. The employer shall use High Efficiency Particulate Air (HEPA) air filtration units in accordance with manufacturers' recommendations in indoor areas occupied by employees for extended periods, where ventilation is inadequate to reduce the risk of COVID-19 transmission.

CalOSHA COVID-19 Resources

MCPH and Early Alert Canines are visiting SNFs. See them in action in this video.

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

Marin County Public Health Newsletter - March 2023

Marin County Public Health Newsletter - March 2023
In this Issue: Updated Reportable Disease Dashboards | World TB Day | CAIR Registry Legislation | Monkeypox (MPX) Vaccine Eligibility Update | Message from the Public Health Officer

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A message to physicians and other health care providers from Marin County's Public Health Officer.

Updated Reportable Disease Dashboards

While we remain vigilant in our COVID respon

se, Marin County Public Health is also going back to the basics. You can still stay up to date with COVID surveillance, but you can also review our new reportable disease dashboard. This dashboard shows the counts and rates of the county's most prevalent, reportable communicable diseases, such as chlamydia, hepatitis B, salmonella, tuberculosis, and others. Yearly disease case counts and rates are shown by race/ethnicity, age, and gender.

World Tuberculosis Day is annually recognized on March 24th in honor of the day Dr. Robert Koch discovered Mycobacterium tuberculosis in 1882 (CDC). In 2022, there was a five percent increase in TB cases in California. California’s annual TB incidence was 4.7 cases per 100,000 persons; nearly double the national incidence rate. The vast majority of TB cases (86%) were attributable to progression of LTBI to active TB. Providers should complete a TB Risk Assessment, screen for LTBI when indicated, and discuss the benefits of LTBI treatment with patients when indicated. Health care providers must complete a confidential online report for all suspect and active tuberculosis cases among Marin County residents.

CAIR Registry Legislation

On January 1, 2023, AB 1797 became effective. All health care providers must now enter patient immunization records and demographics, including race and ethnicity, in the California Immunization Registry (CAIR). CAIR integrates millions of patient records and enables providers and pharmacies to submit immunization records, find missing doses for patients, view immunization reports, and more. This database informs local Public Health efforts to increase vaccination rates among undervaccinated populations.

Monkeypox (MPX) Vaccine Eligibility Update

Anyone who wants protection from MPX infection may receive the MPX vaccine. There is no shortage of MPX vaccines now. Anyone at risk of getting MPX can now receive the JYNNEOS vaccine to prevent infection. Healthcare providers can now offer the intradermal or subcutaneous regimen based on patient preference. Due to stigma related to vaccine administration, patient preference of vaccine route should be a consideration. For a detailed list of priority groups for vaccination and a list of providers offering MPX vaccines, please visit the Marin HHS Monkeypox (MPX) webpage.

Message from the Public Health Officer

The past few weeks have been marked by milestones pointing toward the eventual end of the COVID-19 pandemic. Resuming this monthly newsletter after three years is one small example. For historical interest, here's an excerpt from our last pre-pandemic edition.

February 2020: Novel Coronavirus (COVID-19) Update
This week, we saw a rapid change in the global spread of COVID-19 and saw the first possible case of community-acquired COVID-19 in the United States. We also coordinated the transfer of an asymptomatic COVID-19 case, a passenger on the Diamond Princess, from Travis Air Force Base to a local hospital. We understand that you may also be receiving increased inquiries regarding COVID-19. We have created a new website for healthcare providers and continue to update our public website.

Dr. Santora and I are grateful for the remarkable partnership with you, our healthcare providers, as we responded to "increased inquiries" and navigated our community through three years of uncertainty, disease and healing together. Our goal is to build on the strong local relationship between public health and healthcare to create an even healthier Marin.

In Gratitude,

Matt Willis

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Marin County Public Health
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https://www.marinhhs.org/public-health

Our mailing address is:
3240 Kerner Blvd
San Rafael, CA 94901

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Public Health Newsletter - February 2020

Marin County Public Health Newsletter Volume 8 - Issue 2 - February 2020
In this Issue: COVID-19 | Black History Month | Open Spaces | TB | Message from the Deputy Public Health Officer

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A message to physicians and other health care providers from Marin County's Public Health Officer.

Novel Coronavirus (COVID-19)

This week, we saw a rapid change in the global spread of COVID-19 and we saw the first possible case of community-acquired COVID-19 in the United States. We also coordinated the transfer

of an asymptomatic COVID-19 case, who was a passenger on the Diamond Princess, from Travis Air Force Base to a local hospital. We understand that you may also be receiving increased inquiries regarding COVID-19. You can direct patients to call the Marin County Communicable Disease Prevention and Control (CDPC) unit at 415-473-4163, if they have questions or concerns. We have created a new website for healthcare providers and continue to update our public website.

Black History Month

In the 1940s, thousands of African-Americans moved to Marin County to build the merchant marine of World War II and became residents and community leaders in our county. Today, Marin County is beginning to address racism and achieve health equity in our community. One of our community partners in this endeavor is Marin Promise Partnership. Marin Promise Partnership is confronting systemic inequities that limit educational attainment for many children of color and youth living in poverty. We know educational attainment is a key driver of lifelong health and well-being.

Learn more about the actions you can take to help achieve educational equity in Marin.

Wide Open Spaces

Studies have shown that exercise reduces acute respiratory illness by up to 43%, and meditation has an even greater impact. Both activities reduce stress, which can impact your immune system health. Marin County Parks offers a wide variety of activities to connect with nature and boost your immune system. They have also increased recreational opportunities for people using the open space trail system, regardless of their abilities. Encourage patients to visit the P

arks website to identify their next outdoor adventure.

Latent TB

This month, the Centers for Disease Control and Prevention (CDC) released new recommendations for the treatment of latent tuberculosis infection (LTBI). Short course (3-4 months) rifamycin-based treatment regimens are now preferred over the longer course (6-9 months) INH monotherapy for treatment of latent TB infections (LTBI). The preferred LTBI regimens are:

3 months of weekly INH and rifapentine (if available)
4 months of daily rifampin
3 months of daily INH and rifampin

Please ensure your patients have an adequate supply of medications to complete treatment. If you have any questions, contact the Marin County Tuberculosis Control program by phoning 415-473-4163 or email MarinTB@marincounty.org or visit our website.

Message from the Public Health Officer

February has been a dynamic month in the worlds of communicable disease prevention and control and public health emergency preparedness. In Marin County, we have valued community assets that increase our resilience. We have Neighborhood Response Groups (NRGs), Community Emergency Response Teams (CERT), the Marin Medical Reserve Corps (MMRC), Marin County Voluntary Organizations Active in Disaster (VOAD), Disaster Councils, among others -- whose members have invested significant amounts of time and energy to increasing our community's readiness for emergencies and disasters. With wild fire season around the corner, we should follow their lead by visiting ReadyMarin.org and organizing our emergency plans.

Warm Regards,
Lisa Santora

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Matthew Willis MD, MPH

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Public Health Newsletter - January 2020

Marin County Public Health Newsletter Volume 8 - Issue 1 - January 2020
In this Issue: Coronavirus | Pesticide | MAT | Greening | Message from the Public Health Officer

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A message to physicians and other health care providers from Marin County's Public Health Officer.

Novel Coronavirus

Marin County Public Health is working closely with the California Department of Public Health, the U.S. Centers for Disease Control and Prevention, and local health authorities to monitor the emerging outbreak of novel coronavirus (nCOV) and keep you informed of local measures to protect our community. We've established a website dedicated to nCOV response where you can find Marin County public health advisories, guidance for local clinicians, letters sent to schools and parents,

and FAQ's developed for our community. Public Health will continue to post updates as the situation evolves, and we are available to you for guidance at 415-473-4163.

Pesticide Reporting

While pesticide intoxications are rare, they are potentially fatal and may represent ongoing risk to the community. Under California law, any known or suspected pesticide-related illness or injury must be reported within 24 hours. Timely reporting on your part allows the County Agricultural Commissioner to initiate prompt investigation to prevent future cases. The easiest way to report a pesticide-related illness is to call California Poison Control at 1-800-411-8080. The majority of cases are reported in this manner.

Building Bridges to Treatment

MarinHealth Medical Center is joining the California Bridge Program, a state-wide movement to offer Medication-Assisted Treatment (MAT) for Opioid Use Disorder in emergency departments (ED). One of the most important predictors of overdose death is prior non-fatal overdose. Initiating MAT in the ED with follow-up through community-based providers is proven to reduce future overdose events, deaths and other opioid-related harms. This innovative program was highlighted in local media here.

Healthy and Green Medical Practices

Climate change and environmental degradation are threats to health, and clinicians now have a practical tool to demonstrate responsiveness. The Marin County Green Business Program supports and promotes businesses that go above and beyond to conserve energy and limit pollution and waste. Medical practices can promote local green businesses and join other practices that have taken the step to become certified in the California Green Business Network.

Message from the Public Health Officer

One clear theme of the past few months -- with a late end to wildfire season and evacuation shelters, extended power shut-offs, and emerging infectious diseases --- is the need to remain ready and able to respond to crises as a community. These challenges reveal our mutual interdependence as a healthcare system and we're grateful for your ongoing engagement as we build even stronger capacity.

Warm Regards,
Matt Willis

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Matthew Willis MD, MPH

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Public Health Newsletter - Oct/Nov 2019

Marin County Public Health Newsletter Volume 7 - Issue 10 - October/November 2019
In this Issue: EVALI | PSPS | Shelters | AIDS | Message from the Public Health Officer

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A message to physicians and other health care providers from Marin County's Public Health Officer.

Vaping-Associated Death in Marin

This month, a 45-year-old previously healthy Marin County woman died from complications related to the use of e-cigarettes, becoming the state's fourth confirmed case of EVALI (E-cigarette or Vaping Associated Lung Injury). There have been forty-seven deaths and 2,290 EVALI cases nationwide since July 2019, reported to the Centers for Disease Control and Prevention (CDC). This is a reminder for clinicians to ask regarding vaping history in patients with compatible symptoms, and to help guide patients away from these harmful products. Marin County Public Health issued this advisory last month, reminding clinicians to report suspect cases and recommending all residents refrain from vaping. The CDC issued interim recommendations caring for patients with suspected or known lung injury.

Power Shut-Offs

Last month, Marin County

experienced an unprecedented county-wide prolonged planned power shutoff. While all of us were inconvenienced, as healthcare providers, you witnessed many of the health consequences associated with this event. Our 911 ambulance call data helps tell the story of the stress this presented, especially to our older residents. During the five-day outage:

Emergency department visits for fall-related injuries at Marin Health Medical Center tripled.
EMS responses to skilled nursing facilities and residential care facilities in the county more than doubled.
The number of EMS responses for residents over age 80 doubled.

Planning for the next shut-off will take these lessons into account. Read more about the health impacts of the outage on vulnerable Marin County residents in this Marin Voice op-ed. For more information on preparing your family, neighbors and patients for an extended power outage, go here.

Severe Weather Emergency Shelter

As winter comes, Marin County is resuming the Severe Weather Emergency Shelter (SWES) plan as an app

endix to the County's Extreme Temperature Emergency Annex. This service is a seasonal, temporary shelter, opened during extreme weather to augment the existing 190 permanent emergency shelter beds in Marin. Homeward Bound of Marin will operate the SWES at the Marin Health and Wellness Campus in San Rafael. The determination will be made by 3PM on the day prior to opening the shelter, based on forecast conditions. Our goal is to end homelessness and recognize that it is unacceptable that so many of our neighbors are unsheltered any night of the year.

World AIDS Day

December 1 is World AIDS Day. More than 700,000 lives have been lost to AIDS in the U.S. since the condition was recognized in the early 1980's. In 2012, the Federal Drug Administration approved the use of Pre-Exposure Prophylaxis (PrEP) for HIV. By taking one pill a day, individuals can protect themselves from HIV. Undetectable equals untransmissible. Still, between 15-20 new cases of HIV are diagnosed in Marin annually. We can do better. Marin has a strong network of service providers, committed to HIV prevention and treatment. For more information about HIV prevention in Marin, go here.

Message from the Public Health Officer

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.

Warm Regards,
Matt Willis

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Public Health Newsletter - September 2019

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A message to physicians and other health care providers from Marin County's Public Health Officer.

Flu Update

Last year, Marin County was highly impacted by influenza. This month, there have already been two reported deaths in the Bay Area. Vaccination remains our best line of defense for health care providers and patients alike. On November 1st, the Mandatory Influenza Vaccination of All Health Care Workers goes into effect. Marin County's Immunization Program is also offering free flu clinics throughout the county. Visit www.marinflu.org for the most up-to-date information about current influenza activity in Marin.

Standing Up Against Bullying

Bullying has potentially life-long effects on mental health and well-being. The Marin County Office of Education and many local schools are working with Sandy Hook Promise to support safe school environments. Last week, schools across the county participated in Sandy Hook Promise's "Start with Hello" campaign. Students and school staff are increasing awareness about the risks of social isolation, which includes bullying, violence or depression. Marin schools are supporting health by encouraging students to lead a culture of inclusion and connectedness.

Measles

In 2000, the World Health Organization (WHO) declared that the United States had eliminated measles. Recent outbreaks have shown this was sadly premature. Because many providers have not seen active measles, the Centers for Disease Control and Prevention (CDC) has created two videos

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.

World Rabies Day

World Rabies Day is September 28th. Rabies circulates in Marin County wildlife, and one in ten local bats tested are rabid. Clinicians can help by making sure that anyone exposed to domestic or wild animal bites is evaluated for post-exposure prophylaxis (PEP). Marin County Public Health created

a poster to help remind clinicians about how to administer PEP. The poster can be downloaded here.

Public Health Program Spotlight: Stop the Bleed

The Marin County Emergency Medical Services (EMS) Agency's partnership with Marin County schools was recently highlighted in the Marin IJ. This month, EMS distributed more than 600 "Stop the Bleed" kits to high schools across the county. EMS is responsible for the planning, implementation and evaluation of prehospital services. It works with stakeholders to maintain a high quality, coordinated system of emergency medical care for All in Marin. EMS also works in partnership with local hospitals, fire departments and the Marin Medical Reserve Corps on community preparedness activities, including Sidewalk CPR.

Message from the Public Health Officer

This month offered another unwelcome example of the risks of vaping, with more reports of e-cigarette-related deaths. I hope I captured our concerns as a medical community in this op-ed last week. Clinicians can refer interested community members to a public forum on vaping, co-sponsored by Marin Public Health, on October 7. As always, please send recommendations for future topics, and thank you for all you do.

Warm Regards,
Matt Willis

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Public Health Newsletter - August 2019

Marin County Public Health Newsletter Volume 7 - Issue 8 - August 2019
In this Issue: Public Charge | Overdose Awareness | Vaping | STD | Message from the Deputy Public Health Officer

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A message to physicians and other health care providers from Marin County's Public Health Officer.

Public Charge

On August 14, 2019, the U.S. Department of Homeland Security (DHS) published the Inadmissibility on Public Charge Grounds final rule. This rule is a major revision of the legal test for determining eligibility for residency among legal immigrants. Marin County has already seen a chilling effect on Medi-Cal enrollment due to fears of deportation and/or immigration restrictions. This rule, which goes into effect October 15th, is expected to further reduce health care access for Marin's Latinx community. Limiting access to preventative and primary care services is costly and threatens the health and well-being of our neighbors and our community.

Marin Recognizes Overdose Awareness Day

The Marin County Board of Supervisors passed a resolution recognizing August 31st as International Overdose Awareness Day. Our elected leaders have prioritized this issue since the launch of RxSafe Marin, our community-wide opioid safety coalition, in 2014. On August 20th, Board members received a report outlining progress, including a 48% reduction countywide in opioid prescribing over four years. Trauma-informed prevention efforts, including screening; access to addiction treatment; and client-centered pain management are cornerstones to reducing substance use disorders and opioid-related deaths in our community.

Unexplained Vaping-Associated Pulmonary Illness

The California Department of Public Health (CDPH) has reported more than 20 cases in the past two months of severe acute pulmonary disease among previously healthy adults associated with vaping cannabis or cannabidiol (CBD) oils. As of August 27, 2019, the Centers for Disease Control and Prevention (CDC) is investigating 25 possible cases nationwide, including 1 death. Marin County Public Health advises clinicians to remain alert and to report potential cases (by phone 415-473-4163 or email MarinCD@marincounty.org). This outbreak provides an opportunity to counsel patients about the known health risks associated with e-cigarette use and vaping. It also highlights the importance of local efforts to curb the rise in youth vaping.

Public Health Program Spotlight: STD Prevention and Control

Sexually transmitted infections (STIs) in all groups, and particularly among men who have sex with men (MSM), continues to increase in Marin. Marin County's Sexually Transmitted Diseases (STD) Prevention and Control program works to educate the community and provide resources to health care providers. As students return to school, consider using pre-participation physical examinations as an opportunity to complete risk-base STD screening among Marin teens and young adults. This population accounts for more than 1/2 of new STD infections in Marin County.

Message from the Deputy Public Health Officer

This month, we issued a public health advisory regarding a case of meningococcal meningitis. We have confirmed that it was serogroup B disease. Following Centers for Disease Control and Prevention (CDC) recommendations, most colleges and universities require meningococcal conjugate (MenACWY) vaccination prior to admission. But most schools do not require MenB vaccinations. As Marin students prepare to return to colleges and universities across the country, it is a great time to counsel patients on the benefits of MenB vaccination. Have a safe holiday weekend.

Lisa Santora, MD, MPH

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Public Health Newsletter, July 2019

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A message to physicians and other health care providers from Marin County's Public Health Officer.

Acute Flaccid Myelitis

Acute flaccid myelitis (AFM) is a rare but serious syndrome that causes muscle weakness or paralysis, mostly in children. Three national outbreaks have occurred since 2014. Most patients developed AFM in late summer or early fall. AFM typically presents with limb weakness one week after a viral infection. The Centers for Disease Control and Prevention (CDC) believes viruses, including enteroviruses, play a role in AFM. Marin County health care providers should contact Marin County Communicable Disease Prevention and Control (CDPC) if they suspect AFM at 415-473-4163. CDPC will coordinate specimen collection and laboratory testing. The AFM Physician Consult and Support Portal provides clinicians with access to 24/7 neurologist consultation.

PPD Shortage

Due to an expected shortage of APLISOL, the Centers for Disease Control and Prevention (CDC) is recommending that providers:
- Substitute IGRA blood tests for TSTs.
- Substitute TUBERSOL for APLISOL for skin testing.

Please notify Marin County Tuberculosis Control Program if you have any difficulty screening for LTBI (by phone at 415-473-4163 or email MarinTB@marincounty.org). LTBI screening and treatment is a key component of "Getting to Zero" TB cases in California and nationwide. For more information, visit the Marin County Tuberculosis Control Program's website.

Ebola

After an outbreak-related case of Ebola was reported in Uganda, the Director-General of the W

orld Health Organization (WHO) declared the current Ebola outbreak in the Democratic Republic of the Congo a Public Health Emergency of International Concern. As of July 28, 2019, there have been 2,687 confirmed and probable EVD cases and 1,803 deaths connected to this outbreak. While the threat of disease spread to California remains very low, the California Department of Public Health (CDPH) is closely monitoring the outbreak. Health care providers should ask all persons who present with suspected infectious diseases about any travel, domestic or international.

Foster Our Future

Each year, approximately 80 children in Marin County need temporary (foster) homes, but we only have 35 approved homes. Individuals with medical experience, those who can welcome siblings together, and those who ar

e Spanish-speaking are especially needed. Attend an orientation with a social worker and an experienced foster parent to learn more. The next orientation is scheduled for Thursday, August 22, from 7:00 to 8:30 pm at the Marin Health and Wellness Campus (3240 Kerner Blvd., San Rafael, CA 94901). Visit the Foster Our Future Marin website or call 415-473-2200 for more information.

Public Health Program Spotlight: Rabies Control Program

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 Marin Humane, WildCare and other community partners to prevent human rabies. Visit the Marin Rabies Information Page to access a Bite Report and the rabies Post-Exposure Prophylaxis Algorithm.

Message from the Deputy Public Health Officer

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 Shutoffs (PSPS) program. Wildfire season is now here. In addition to preparing your family, neighbors, and patients for extended power outages, it is time to organize your wildfire preparedness efforts. Visit FireSafe Marin and make sure you are Ready to Go. We also encourage health care providers to join the Marin Medical Reserve Corps today. The time and energy you invest in preparedness will increase our community's overall resilience. Thank you!

Warm Regards,
Lisa Santora, MD, MPH

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Public Health Newsletter - June 2019

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A message to physicians and other health care providers from Marin County's Public Health Officer.

Public Safety Power Outages

To prevent forest fires associated with power lines, PG&E will continue to conduct Public Safety Power Shutoff (PSPS) in our region when risk is elevated. While many of us are inconvenienced by these outages, which may last for days, power shut-offs may be life-threatening for others. Many of our residents depend on electrically powered technologies to live safely at home. State and local agencies are planning new supports for vulnerable residents in evacuations and extended power outage scenarios. As health care providers, you can help ensure your family, staff and patients are prepared by sharing these preparedness resources.

Preparing for Measles in Marin

As of June 21st, there have been 53 confirmed measles cases in California this year. Marin County has seen no cases yet in 2019, but remains vulnerable due to pockets of low vaccination rates. Healthcare providers should remain vigilant in testing for and reporting measles. The California Department of Public Health (CDPH) testing guide, Should I Test for Measles, recommends considering measles in patients of any age who have a fever >101 F, plus at least one of the three "Cs" (cough, coryza or conjunctivitis) or a descending rash that starts on the face. CDPH has also released updated Measles Immunization Recommendations.

A Healthy County Fair

County fairs are not known for healthy food and drink. The Marin County Fair

is an exception. Thanks to Play Fair, an initiative supported by all three hospitals and the County, healthcare providers can recommend the fair to their patients, knowing they'll have a happy and healthy experience. Reflecting local values, the fair is smoke-free, all vendors offer at least one healthy option, alcohol use is controlled, and there are healthy activities for all ages. Join the over 100,000 anticipated fair-goers July 3-7 to see why ours was named "the healthiest in the West" by the Western Fairs Association.

Training for Pharmacists in Opioid Crisis Response

As trusted members of the healthcare system, pharmacists play a vital role in opioid epidemic response. New state laws and emerging trends offer pharmacists new opportunities and responsibilities. The

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, "Prescription Drug Abuse and Diversion: What a Pharmacist Needs to Know." Attendees will be awarded 7 hours of CE credit for attending the full session, including the one-hour training to meet the requirements for interested pharmacists to furnish naloxone.

Public Health Program Spotlight: Community Epidemiology

The Marin County Community Epidemiology Program monitors the vital signs of our community. The team, located at Marin County Wellness Campus in San Rafael, collects, analyzes, and translates health data to guide public health strategy in Marin. The program informs evidence-based programming, collaborates with community organizations on their data needs, shares data publicly through interactive dashboards, and conducts disease investigations to protect the community. Metrics and outcomes of select Public Health initiatives are at Marin Livestories: Translating Data into Action.

Message from the Public Health Officer

Recent announce- ments of Immigration and Customs Enforcement raids and proposed mass deportations are unsettling to many clients we serve and can discourage access to medical care among immigrants. As stewards of health, this is an opportunity to remind ourselves of the World Health Organization constitution which states, "the highest attainable standard of health is a fundamental right of every human being." At the Marin County Department of Health and Human Services, all are welcome regardless of immigration status. Interested providers can join us in this simple message and share the resources available at the Canal Alliance Know Your Rights website.

Warm Regards,
Matt Willis

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Public Health Newsletter - May 2019

Marin County Public Health Newsletter Volume 7 - Issue 5 - May 2019
In this Issue: Housing | Hep C | Narcan | Healthy Stores | Message from the Deputy Public Health Officer

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A monthly message to physicians and other health care providers from Marin's Public Health Officer.

Housing and Health in Marin

The

Marin County Whole Person Care pilot program is demonstrating the health benefits of housing the chronically homeless. As of May 2019, 130 previously homeless people in Marin have been housed under this grant-funded program. There has been a corresponding and significant decrease in emergency department visits and days in the hospital among those newly housed. For more information and more complete results from the pilot, visit the Whole Person Care website.

May is Hepatitis C Awareness Month

An estimated 2.4 million people are living with hepatitis C in the U.S., but most are unaware. Hepatitis C is a leading cause of liver cancer and liver transplants. The CDC recommends all people born between 1945 and 1965 get tested. Treatment options have improved dramatically in the last decade. The role of the pharmacist in screening and management is growing. This free CME/CPE activity, Pharmacy Essentials for HCV Screening and Management, provides a comprehensive overview of HCV care.

Medical Reserve Corps Distributing Narcan

Opioid overdose remains a leading cause of accidental death in Marin. The Marin Medical Reserve Corps (MMRC) has mobilized to respond to this crisis. A team of MMRC volunteers has been certified to offer training to community groups in the use of intranasal Narcan and provide free kits to those who may be able to offer bystander assistance in an opioid overdose. To learn more or to schedule a training for your organization, email rxsafemarin@gmail.com.

Public Health Program Spotlight: Healthy Stores for a Healthy Community

The retail environment strongly shapes our choices regarding health. In Marin, a team of youth volunteers and community partners are assessing 182 retail stores to determine the potential impact on youth health behaviors. Led by HHS Community Health and Prevention - Tobacco Control Program, the Healthy Stores for a Healthy Community program assesses marketing practices for tobacco, alcohol, and food and beverage items. The goal of the campaign is to improve the health of all residents and decrease health inequities through influence on the retail environment.

Message from the Deputy Public Health Officer

What seems to have been the longest, wettest winter has ended! Marin County families are now headed out to our beaches and pools. Please consider posting this infographic to educate patients on strategies to prevent unintentional drownings. Drowning continues to be a leading cause of injury and death for young children, ages 1 - 4. Stay safe and have a fun summer!

Lisa Santora, MD, MPH
Deputy Public Health Officer
Marin County

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