County of Marin Health and Human Services

MCPH OPIC Newsletter #9 December

MCPH OPIC Newsletter #9 December
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OPIC Monthly Newsletter

Issue 9                                                                    December 15, 2023

MCPH OPIC team provides support to healthcare and congregate care facilities as you mitigate and manage risks due to communicable diseases and emergencies. We collaborate with you to achieve high levels of readiness to ensure effective responses to a wide range of events. Our monthly newsletters include news and guidance updates, community status updates, trainings and educational opportunities for all levels of staff.


CDPH COVID-19 and Respiratory Virus Toolkits

The following toolkits include multilingual handouts, videos, wallet cards and graphics that licensees and providers may find helpful:

COVID-19 Test Kits Allocation- limited ordering opportunities left

The California Department of Public Health (CDPH) at-home testing program will be coming to an end*, effective February 29, 2024.  Eligible organizations, including LTCFs and SNFs, will be able to order at-home tests up until this date using the following ordering timeframe:


Click here to order:

Complete details, including storage requirements, can be found here: SNF/Elder Care/Long Term Care At-Home Testing Resources 

Respiratory Syncytial Virus (RSV) Isolation Question(s) from MCPH LTCF Meeting on 11/28/2023:

  • Q: How long do we isolate if a resident tests positive for RSV? Is the isolation period just like COVID, at least 10 days of isolation?  
  • A: Persons with RSV are contagious for a minimum of 7 days per CDPH (see table below from AFL 23-26).  After that, isolation may be discontinued when symptoms are substantially resolving and the resident is free of fever for 24 hours. However, some infants, and people with weakened immune systems, can continue to spread the virus even after they stop showing symptoms, for as long as 4 weeks.  If the case is not resolving, or have gotten feedback from the provider, please reach out to MCPH. We will verify with CDPH and follow up with a slide or email.

All Facilities Letters (AFLs) from CDPH AFL: 23-26: Recommendations for Prevention and Control of COVID-19, Influenza, and Other Respiratory Viral Infections in California Skilled Nursing Facilities – 2023-24

This AFL notifies facilities of an updated version of the guidance document which includes streamlined guidance that can be broadly applied for the prevention and control of influenza, COVID-19, RSV, and other common respiratory viruses (e.g., adenovirus, parainfluenza virus, etc.) in California SNFs.

In the new AFL, you'll find the table below which can be very helpful to add to your IP checklists and plans.

View AFLs at the All Facilities Letter webpage.  

View PINs from CDSS at the All COVID-19 PINs by Topic webpage.  


Holiday and Winter Surge
Marin County Public Health along with CDPH and CDC are expecting to have a moderate surge in COVID-19, RSV and Influenza cases this winter, which combined are expected to have a greater impacts compared to most pre-pandemic surges.  Ensure to have your residents up to date on their respiratory vaccines. 

Winter Norovirus Surge
Norovirus activity is increasing across the United States, with sharp increases of concentrations observed in wastewater throughout California. Wastewater concentrations of Norovirus (GII) are monitored by the WastewaterSCAN program and California Department of Public Health (CDPH). Data show rising concentrations of norovirus since October 2023.

COVID-19 Hospitalizations on the Rise
The number of people hospitalized with severe COVID-19 disease has increased 70% in Marin County in the past three weeks. This corresponds to increased virus levels in wastewater, signifying increased local transmission.

Marin Public Health Dashboards: Local Data for Local Action Marin County Public Health has ten data dashboards reflecting local public health priorities.


Influencing prescriber behavior to reduce unnecessary antibiotic use for respiratory infections.

A new Cochrane Review has identified three clinician-focused strategies that may reduce antibiotic prescribing for acute respiratory infections (ARIs). ARIs—which include conditions such as bronchitis, sinusitis, pharyngitis, and acute otitis media—are considered a significant driver of antibiotic use in primary care settings and consequently a major factor in antibiotic resistance. In the United States, more than 40 million antibiotic prescriptions annually target respiratory conditions. But since many of these illnesses are viral in nature and don't require antibiotics, ARIs are a major target for antibiotic stewardship interventions. Read the Cochrane Review Article by clicking here.

A multifaceted outpatient antibiotic stewardship intervention implemented at Mayo Clinic hospitals was associated with reduced unnecessary antibiotic prescribing for upper respiratory infections. Described here, the specific interventions were standardized provider education, development of a syndrome-based, pre-populated ambulatory panel, peer comparison reporting, and a provider-facing data dashboard to facilitate self-auditing of cases in which antibiotics were flagged as unnecessary. The intervention also included a patient-facing antibiotic commitment poster and handouts for patients promoting symptomatic management. Read the study here at Open Forum Infectious Diseases.


CDC: RSV Vaccines Approved for Adults  ≥ 60 Years

Arexvy (GSK)

  • One dose, Intramuscular injection.
  • Efficacy: 83% reduction in risk of RSV-associated lower respiratory tract disease* during first RSV season after vaccination.
  • 56% in second RSV season.

Abrysvo (Pfizer)

  • Also approved for pregnant women to prevent severe RSV in infants.
  • One dose, Intramuscular injection.
  • Efficacy: 89% reduction in risk of RSV-associated lower respiratory tract disease* with ≥3 symptoms during first RSV season after vaccination.

*Lower respiratory tract disease signs/symptoms include cough, sputum and difficulty breathing.

CDPH RSV Immunization EZIZ for Long Term Care facilities

CDC: Flu Vaccine Recommendations for Adults ≥ 65 Years
If none of these three vaccines is available at a vaccination opportunity, then any other age-appropriate influenza vaccine should be used.
  • Free, online, Training for staff at LTACHs.
  • Free, online Training for staff at SNFS.
  • Toolkit for Certified Nursing Assistants (CNAs) Training
  • Project Firstline Project Firstline Training Toolkit for EVS Staff
  • Save the Date: 2/29/24-3/1/24:  Free 2-day Course for IPC training hosted in San Rafael by MCPH and CDPH. 14 hours of CEUs provided. Registration opens in January 2024.
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Marin County Public Health's Monthly Updates for LTCFs provide updates regarding guidance, local data and surveillance, and training opportunities. These meetings are held monthly on zoom. Email to be added to the meeting invitation. 

2024 meeting schedule coming soon. 

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

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