Public Health Newsletter

Flu Is Here! On December 1st, the California Department of Public Health (CDPH) announced the first influenza-associated fatality in a person under the age of 65 for the 2016-2017 flu season.  It is mandatory to report laboratory-confirmed influenza cases who require admission to an intensive care unit (ICU) and/or who die at any location (i.e. home, hospital, ER).  Visit www.marinflu.org for the most up-to-date information about current influenza activity in Marin. 

In the summer, pediatric patients visit their doctors for health examinations for school entry and pre-participation physical examinations.  These are opportunities to discuss both required and recommended vaccinations (e.g., HPV, meningitis).  With the introduction of SB277, parents may be seeking temporary and/or permanent medical exemptions for required vaccinations. Visit our Immunization Program website for forms and guidance on medical exemptions or call (415 473 3078) or email (dhiser@marincounty.org) Danielle Hiser, RN, PHN, Immunization Coordinator, with any questions.

Many college campuses are experiencing mumps outbreaks. Summer is around the corner, and students from colleges and universities will intermingle, increasing risk for mumps transmission.  Contact the Communicable Disease Prevention and Control unit at (415) 473-7805, if you have any questions. 

For the seventh straight year, Marin holds the title of the healthiest County in California, according to the Robert Wood Johnson Foundation. Despite the best overall rating, persistent health and social inequities remain a challenge for Marin health officials.

The annual County Health Rankings were released today, and Marin shines in many measures of health. The rankings consider two main health outcomes: premature death and quality of life, and multiple factors that affect health including behavior, clinical care, the physical environment, and social and economic factors.

For example, Marin ranks highest in life expectancy and lowest rates of adults reporting fair or poor health and teen births. Marin is No. 2 among counties with a high number of adults with a healthy body weight and low rate of unemployment and violent crime.

“Community investments such as reserving land for open space and social norms around healthy eating and staying active have helped Marin maintain our ranking,” said Dr. Grant Colfax, Director of Marin County Department of Health and Human Services (HHS). “However, the rankings also reflect major disparities across Marin and help us know where we need to prioritize our work. For example, we need to focus on increasing equity in health care coverage, access to health food, early childhood education, and job training so everyone has an opportunity to optimize his or her health.”  

Marin ranked poorly – No. 54 out of 57 counties reporting – in income inequality, a measure that focused on the ratio between those with the highest incomes (above 80 percent of the median) and the lowest incomes (below 20 percent of the median). The County also fared poorly in one of the foundation’s new additional measures: racial segregation between whites and non-whites. Marin came in No. 50 among the 56 counties reporting. Racial segregation can translate to disparities in income, educational opportunities and work opportunities – all three of which lead to poor health outcomes.

When it comes to opportunities to live a long and healthy life, a few miles can make an enormous difference in Marin. There is a 15-year gap between life expectancy in Ross (94) and Marin City (79), a disparity that correlates with the per capita income.

Marin HHS is working in communities to help improve life expectancy. The Nutrition Wellness Program works with schools that have high obesity rates, which is known to drive heart disease and other conditions that lead to premature death. In Marin City, for example, Marin HHS supports nutrition education, walk to school programs, school gardens, and marketing to attract health-conscious grocery stores.

“While there are signs of progress, we’re more vulnerable than these rankings suggest,” said Dr. Matt Willis, the County’s Public Health Officer. “There is much more to do to achieve health equity in Marin. We need to continue to bolster programs and policies that address poverty, jobs, housing, and education.”

The County has made steady progress on many fronts with social equity, and the Board of Supervisors has made equity a priority. For instance:

• It has made a commitment to preserve existing affordable housing, explore ways to acquire more affordable housing and encourage landlords to adhere to voluntary rent guidelines.
• Marin County Parks is in its third year of a program designed to help more Marin residents, especially the underserved, to visit and enjoy parks and open spaces.
• The Marin County Fair and Play Fair Marin have partnered for 14 years to build and maintain a healthy and successful fair as well as create a resource guide for ongoing and future success.
• The Department of Public Works is diligent in its efforts to improve disability access and safety at County-maintained facilities, such as widening a popular pathway in the lower Ross Valley.
• The County has even launched a TV series to promote education on mental health.

Other community efforts working to alleviate poverty and promote success of Marin residents are Rise Together, Marin Promise, and Marin Strong Start.

County fairs are not known for healthy food and drink. The Marin County Fair is an exception. We received the 2015 Merrill Award by the Western Fairs Association for its Play Fair health initiatives. The fair is a strong reflection of the community health values in Marin. The Play Fair team shared their model in this Growing Healthy Events Guide.

 

The number of reported outbreaks of acute gastroenteritis due to norovirus in Marin County has increased significantly since October, 2015. While this is consistent with the seasonal nature of norovirus, the California Department of Public Health has announced higher than usual activity state-wide. In Marin, affected facilities have included adult congregate living facilities and childcare centers.  The duration of most of the outbreaks is a few days to two weeks, reflecting both the natural history of the illness and the control measures taken by the facilities. Information about norovirus can be found here.  

This month there was an outbreak of influenza A at a local skilled nursing facility.  During our investigation, the first influenza-associated fatalities were announced for California, which included an infant, an adult and an elder. These events remind us that influenza can cause serious illness or death across the lifespan.  Visit marinflu.org for links to clinical information and surveillance reports.  The first of our regular seasonal influenza surveillance reports for 2015-2016 will be released in early December.

Since 2009, Marin County has seen an increase in syphilis cases, as is being seen regionally.  In 2014, there were 20 cases reported. 19 of these were men, and most were men who have sex with men (MSM). USPSTF recommends that providers screen those at increased risk for syphilis infection, including MSM.  The CDC recently updated its Sexually Transmitted Diseases Treatment Guidelines, which are now available as a mobile app.

 

FREE flu shots! October 17th at Novato High School from 10 a.m. to 2 p.m. Available while supplies last, regardless of insurance, ages 3 years and up. Kaiser patients will have their information updated for them. The school is at 625 Arthur Street, and the clinic is open from 10 a.m. to 2 p.m

Dr. Matthew Willis, the County’s Public Health Officer, says a flu shot is the single best defense against influenza, which can lead to a lot of time missed at school or work. The flu virus can spread one day before symptoms develop and up to a week after someone becomes sick, so protect yourself, your family and friends by getting your flu shot.  

Marin HHS staff and emergency medical personnel will be on hand to administer the vaccine. All County staff members are disaster service workers as well, and they are treating the Novato flu shot clinic as a “point of dispensing” to simulate an emergency need to dispense medicine to, or vaccinate, the whole community. The recent wildfires in Lake County and the 2014 earthquakes in Napa have reminded us all about the need for training and preparedness.

“Leadership plays a great role in responding to any disaster, and Health & Human Services is committed to preparing staff for emergency response,” said HHS Projects Coordinator Kristen Seatavakin. “We are looking forward to using this chance to improve the department’s ability to respond and to recognize where we may need to build larger capacity.”

The flu begins with an abrupt onset of fever, muscle aches, sore throat and cough that often make people sick enough to keep them in bed for several days. Flu can be especially dangerous for young children, seniors, pregnant women and people with chronic illnesses such as heart disease, diabetes and asthma.

The California Department of Public Health (CDPH) recommends basic steps to prevent and stop the spread of influenza and other respiratory illnesses in addition to getting the flu vaccination. These include:

• Stay home when you are sick to avoid spreading illness to those around you.
• Do not go to work when ill, particularly if you work with vulnerable populations.
• Wear a face mask when coming within six feet of a sick person.
• If you are sick, wear a facemask before going near other people.
• Restrict visitation with vulnerable populations while you are ill.
• Cough or sneeze into your elbow or a tissue and properly dispose of used tissues.
• Wash your hands thoroughly with soap and warm water or use an alcohol-based hand sanitizer to get rid of most germs.
• Avoid touching your eyes, nose and mouth.
• Stay healthy with a balanced diet, plenty of water and adequate rest and exercise.

Stay up to date with information regarding this season’s flu activity and additional options for flu vaccination by visiting www.marinflu.org.

Marin County is known for high average life expectancy and wide health disparities between communities.  Differences in cardiovascular mortality rates drive the 17 year gap in life expectancy within our county.  In order to focus our understanding of this complex problem and to prioritize programs toward early prevention, a new Health Equity initiative concentrates on 1) childhood healthy weight and 2) access to primary care for all.  The initiative is summarized here.

Any providers in the state Vaccines for Children (VFC) program, and any healthcare workers who would like to learn more about childhood vaccines and vaccine preventable diseases are invited to an Immunization Update Conference. Co-sponsored by the health departments of Marin and Sonoma counties, this event features speakers from the California Department of Public Health Immunization Branch. Join us Friday, June 19, 8:00 -11:30 AM, at the Petaluma Health Center.  For more information or to RSVP, please call Danielle, our Marin Immunization Coordinator, at 415-473-3078 or click here.

In 2014, 21 Marin County residents were diagnosed with HIV.  In recent years, an increasing proportion of those newly diagnosed are Latinos or African-Americans and individuals under the age of 30.  Over the past four years, approximately one in four people diagnosed with HIV in Marin had AIDS upon entry into care.  Health care providers should remain aware of HIV trends and screening standards to ensure timely diagnosis and early intervention.  Please see the Marin County HIV fact sheet here. 

Throughout 2024, Marin County has been experiencing an outbreak of pertussis (aka whooping cough). Outbreaks are commonly occur every 3 to 5 years. As of September 30, 2024, Marin County Public Health (MCPH) has investigated 355 cases. The number of cases have been declining since September.  In October and November, MCPH has investigated 14 pertussis cases.

Pertussis is a common, highly contagious bacterial disease. Most adolescents and adults recover without complications, but it can be deadly for infants. Within 3-5 days of antibiotic treatment, the disease is no longer transmissible to others. 

Pertussis vaccines are effective, but not perfect. They offer good levels of protection during the first two years after getting the vaccine, but the protection decreases over time (“waning immunity.”)  For this reason, we tend to see pertussis more in middle and high school age populations. Those who are vaccinated tend to have less severe disease.

Vaccination remains the best defense against pertussis, along with appropriate screening, treatment, and prophylaxis for high risk contacts.  Anyone who is around an infant less than one year of age should have current pertussis vaccination.

Marin County Public Health recommends:

It is most critical for ill persons who are either high risk or may expose someone who is high risk to be evaluated by their health care provider.  Persons considered at “high risk” of pertussis include infants (< 1 year old), pregnant women (especially in the third trimester), and anyone who spends time with infants or pregnant women.  Health care providers may prescribe antibiotics to treat ill individuals or to prevent illness in healthy high risk household members who have been in contact with a person who is sick.

1. Vaccinate infants, children, adolescents, and adults according to the ACIP schedule and implement cocooning around infants. Most importantly, pregnant women should receive the Tdap vaccine between 27-36 weeks of pregnancy to protect infants.
2. Think pertussis. If other household members are or have been recently sick with a respiratory illness, particularly if with violent coughing fits and vomiting after coughing, discuss with your health care provider. People who have been vaccinated for pertussis often present with mild symptoms.    
3. Test for pertussis. People who have been vaccinated for pertussis often present with mild symptoms. Have a high index of suspicion and a low threshold for testing and evaluating individuals for pertussis.  Testing is most critical for symptomatic persons who are either high risk or may expose someone who is high risk. Persons considered at “high risk” of pertussis include infants (< 1 year old), pregnant women (especially in the third trimester), and anyone who may expose infants or pregnant women.
4. Treat pertussis cases with a course of appropriate antimicrobial therapy. The recommended antimicrobial agents for treatment or chemoprophylaxis of pertussis are azithromycin, clarithromycin, and erythromycin.
5. Stop the spread.  If you or your child is sick with pertussis, prevent spreading the illness to others by:

• Staying at home until at least 3 days of antibiotics are completed, or if the sick person did not receive antibiotics, stay at home until 21 days since the cough started.

• Coughing and sneezing into the elbow, not the hand.  Use tissues and put used tissues in the waste basket.

• Wash hands frequently.

Please contact Marin County Public Health, Monday through Friday 8:30 a.m. through 5:00 p.m., if you have any questions or concerns.  

P 415 473 4163
F 415 473 6002
MarinCD@marincounty.org 

Marin County Public Health contacts cases to determine if there are high risk individuals who need chemoprophylaxis. High risk household contacts will be referred to their usual source of care for chemoprophylaxis.

Additional Information

Centers for Disease Control and Prevention (CDC). Pertussis (Whooping Cough) 
California Department of Public Health (CDPH). Pertussis (Whooping Cough)

On October 6, 2022, Centers for Disease Control and Prevention (CDC) issued this Health Alert Network (HAN) Health Advisory about a recently confirmed outbreak of Ebola virus disease (EVD) in Uganda caused by Sudan virus (species Sudan ebolavirus).  Currently, neither Centers for Disease Control and Prevention (CDC) nor WHO recommend any restrictions for travel in relation to this current outbreak. While the risk of EVD into California remains very low, infectious diseases are regularly imported into California.  We encourage providers to maintain their routine practice of asking patients with acute, febrile illness about recent travel, including international travel to Africa.

There is no Ebola in Marin County. 

Marin is prepared to respond to a communicable disease outbreak, including Ebola.  Marin County Health and Human Services (HHS) is working with local hospitals and the California Department of Public Health (CDPH) to ensure that clinicians and hospitals countywide are educated and prepared.

It is very unlikely that a case of Ebola virus will occur in Marin. However, should a suspect case arise in Marin County, Public Health and our health care partners are prepared to intervene quickly, safely and effectively. We work collaboratively with our emergency medical services, hospitals, clinics and private providers to practice countywide response plans that assure the safety and health of our community. 

As the global situation evolves, Public Health will provide updates that may be relevant to Marin County here and through local Advisories and Alerts. 

Updated:  October 16, 2022

Influenza transmission in health care settings presents risk to both health care workers (HCW’s) and their patients, many of whom are vulnerable to severe influenza disease. Influenza vaccination of HCW's protects against influenza infection, illness, and mortality. Marin County health care facilities, in agreement with Health Officer orders, have joined other Bay Area health facilities in adopting policies requiring HCW’s to be vaccinated or to wear a mask in patient care areas.  Read more.

Marin healthcare providers see the impact of excessive calorie consumption every day, across the age spectrum. Diabetes and obesity are model conditions for partnership between public health and clinical medicine because most cases are both preventable and curable. Health practitioners in Marin County are working to limit the harmful consumption of sugar-sweetened beverages (soda sweetened with sugar, corn syrup, or other caloric sweeteners including sweetened juices, sports and energy drinks).

According to the CDC, consumption of sugar-sweetened beverages is a major driver of the obesity epidemic. Over the past decade, per capita intake of calories from sugar-sweetened beverages has increased by nearly 30% nationally, partly due to marketing strategies targeted to children and adolescents.

This summer, Marin County Public Health, supported by a resolution from the county Board of Supervisors, will again be promoting the “Soda Free Summer.” The Soda Free Summer includes measures to educate residents on how to read labels for the amount of sugar in beverages and how to make healthier drinks with water, fresh fruit and herbs. “Rethink Your Drink” events will be held through the summer at a variety of community-based organizations and summer programs for youth.

Health care providers play a vital role in reinforcing healthy eating and active living messages in each encounter. Combined with upstream interventions like the Soda Free Summer, we can begin to reverse the growing burden of obesity as a more integrated health system.

Between 3/5/18 and 4/3/18, measles has been confirmed in six unvaccinated patients who are residents of Santa Clara County (5) and Alameda County (1). One additional linked case has been confirmed in Nevada. All cases are linked to an unvaccinated traveler who was exposed in Europe and developed measles after returning to the San Francisco Bay Area.

Measles is very infectious, and airborne transmission can occur in settings with large numbers of people like healthcare facilities, schools, child care facilities, shopping centers, public transportation, airports, and amusement parks. Marin County Public Health is advising physicians to be vigilant in identifying and appropriately managing suspected measles cases to avoid ongoing transmission and ensuring that their patients and staff are up-to-date with immunizations.

If you, a family member, or friend develop a rash with a fever ≥101°F (38.3°C) contact your health care provider immediately.  

Additional Resources

Centers for Disease Control and Prevention.  Measles (Rubeola)

California Department of Public Health.  Measles

Marin County EMS Agency has achieved the 2014 Mission: Lifeline® EMS Silver Level Recognition Award. This award is based upon the achievements in care delivered in 2013.

ST elevation myocardial infarction (STEMI) is among the most critical emergencies that Emergency Medical Services routinely respond to.  Timely and well coordinated response between all aspects of the response system is critical for survival. As an EMS agency that delivers education in ST elevation myocardial infarction (STEMI) identification, access to 12 lead ECG and develops protocols derived from STEMI Guidelines, our medics are driving improvements in the care and outcomes of STEMI patients.

Collaboration among pre-hospital and hospital providers is the essence of Mission: Lifeline. The American Heart Association recognizes the vital importance Emergency Medical System providers provide to the overall success of Mission: Lifeline STEMI Systems of Care. The correct tools and training allow EMS providers to rapidly identify the STEMI, promptly notify the destination Center and trigger an early response from the awaiting hospital personnel.

The criteria to achieve the Mission: Lifeline EMS Silver award is based on meeting the achievement measures for at least one and up to three calendar quarters with no single measure scoring below 75%. The individual measures are as follows:

• Percentage of patients with non-traumatic chest pain > 35 years of age, treated and transported by EMS who receives a pre-hospital 12 Lead ECG.
• Percentage of STEMI patients transported to a STEMI Receiving Center, with pre-hospital First Medical Contact (FMC) to Device (PCI) < 90 Minutes.
• Percentage of STEMI patients transported to a STEMI Referring Center with arrival (to Referring Center) to Fibrinolytic Therapy administration in <30 Minutes.

For more information and for a listing of all Mission: Lifeline EMS Award Recipients, please visit : www.heart.org/mlemsawards 

Marin County has seen a consistent elevation in pertussis incidence during the past year. Since April 1, 2013, 224 pertussis cases have been reported to Marin County Public Health.  This is compared to five cases in 2012.

The vast majority of cases are among school-aged children and most are associated with school-based clusters. Providers can help limit further spread of disease by following these simple steps. These are especially important in limiting transmission in schools.

• If pertussis is suspected, test, treat and isolate cases for 5 full days of antimicrobial therapy or until testing is able to rule out pertussis.
• Post-exposure antimicrobial prophylaxis is recommended for symptomatic and asymptomatic close contacts.
• Symptomatic close contacts are to be excluded from school or work until a minimum of 5 days of effective antibiotic treatment.
• After 21 days of cough, antimicrobial therapy is no longer indicated for treatment of pertussis, regardless of whether treatment was offered earlier in the course of disease.

Ensure that all children and adults are up to date with recommended pertussis vaccine.

For more information on pertussis diagnosis, treatment and infection control, please visit: http://www.cdph.ca.gov/HealthInfo/discond/Documents/CDPH_Pertussis%20qui...

For information on pertussis laboratory testing: see http://www.cdph.ca.gov/programs/immunize/Documents/PertussisLaboratoryTe...  

Report pertussis cases to Marin County Communicable Disease Prevention and Control by fax (415) 473-6002 or phone (415) 473-7805 within 24 hours.