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Contra Costa Measles Case Highlights Local Risk and Early MMR Guidance
 A measles case confirmed in Contra Costa County this week was not travel related, suggesting possible local measles activity in the Bay Area. This follows a large U.S. measles resurgence (over 2,000 cases nationwide) and recent airport exposures during the holiday travel period, increasing the risk of regional spread. Measles is highly contagious, can spread before symptoms appear, and can remain airborne or on surfaces for hours. Marin County Public Health urges providers to counsel families on early MMR vaccination for children with upcoming travel. Infants 6–11 months should receive one early MMR dose before travel; children 12 months and older should follow the routine 2-dose schedule (minimum 28 days apart). Review travel plans, confirm immunity, and vaccinate at least two weeks before departure when possible. Suspect measles in patients with fever and a generalized maculopapular rash, especially when accompanied by cough, coryza, or conjunctivitis. Contact Marin County Public Health immediately to report and coordinate testing: 415-473-4163 (business hours) or 415-479-5305 (after hours).
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New Vaccine Resources for Marin Parents
Marin County Public Health has launched www.marinhhs.org/vaccine-resources to support clinicians in addressing vaccine questions and misinformation amid recent federal messaging. The site provides a concise, evidence-based summary of vaccine safety and effectiveness, with a focus on parent-facing fact sheets designed for use in clinical conversations. These fact sheets explain how vaccines work, what families can expect, and common misconceptions in clear language that supports efficient, effective counseling. Please visit the page, share fact sheets with patients and caregivers, and use it as a reference during vaccine counseling. Clear, consistent clinician messaging remains essential to informed decision-making and preventive care, and we welcome your feedback at healthofficer@marincounty.gov.
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Winter Respiratory Season Has Arrived; Encourage Patients to Get Vaccinated
 Winter respiratory viruses are increasing in Marin, raising the risk of serious illness especially for young children, older adults, and individuals with chronic conditions. Vaccination remains the most effective way to prevent severe disease and hospitalization. Clinicians should strongly recommend routine and seasonal vaccines and provide clear, evidence-based answers to patient questions. Kaiser members can find convenient, no-cost vaccine locations at https://mydoctor.kaiserpermanente.org/ncal/flu-and-covid-19-vaccine-locations/. If you don’t offer vaccines at your clinic, please direct patients to Marin County Public Health’s Vaccine Finder, which provides up-to-date information on available vaccines and sites across the county: https://coronavirus.marinhhs.org/vaccinefinder.
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Clinical Guidance: Hepatitis B
Hepatitis B is a serious, vaccine-preventable liver infection that can lead to chronic disease, cirrhosis, or cancer. Routine vaccination beginning at birth and continuing through all age groups remains the most effective prevention strategy. Most people develop protective immunity, but an estimated 5–15% may not respond and need evaluation and counseling about repeat vaccination or post-exposure prophylaxis. Providers should screen for Hepatitis B, vaccinate eligible patients and address non-response appropriately.
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Preventing TB Disease Starts in Primary Care
Latent tuberculosis infection (LTBI) should be managed like other chronic conditions identified in primary care. Without treatment, LTBI can progress to active TB, leading to preventable hospitalizations and complications. Treating LTBI markedly reduces reactivation risk, especially in higher-risk populations such as Asian American, Black, and Latino patients. California law now requires TB risk-based screening in adult primary care, reinforcing the role of PCPs in identifying, treating, and preventing TB disease.
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Message from the Health Officer
Dear Colleagues,
 I was vaccinated against hepatitis B in medical school and, like many adults, required more than the standard three doses to develop immunity; 5–10% of adults do not fully respond to initial vaccination. Because hepatitis B vaccination is required for healthcare providers, I am protected. Most adults, however, are not required to be vaccinated, and the majority remain unprotected. Compounding this risk, nearly half of the 2.4 million Americans living with chronic hepatitis B do not know they are infected. In 2023 alone, an estimated 14,400 new acute infections occurred in the U.S., along with 17,650 newly reported chronic cases.
My children were vaccinated against hepatitis B at birth, protecting them in infancy and providing immunity into adulthood, when sexual exposure becomes a risk. Weakening the universal hepatitis B birth dose recommendation puts infants at immediate, preventable risk and strips away lifelong protection from infection. Screening alone fails because most people with hepatitis B don’t know they are infected and others can become infected after a negative test. As a result, infants and children may still be exposed through household or community contact, since the virus can survive on surfaces for days. Before universal birth-dose vaccination, U.S.-born children of uninfected immigrant parents still had 7–11% infection rates from community exposure alone, underscoring that screening cannot substitute for early universal vaccination.
Hepatitis B continues to disproportionately affect Asian and Pacific Islander (≈21%), non-Hispanic Black (≈11%), Hispanic (≈4%), and non-Hispanic White (≈2%) communities. As local clinicians, our role in screening, education, and vaccination is essential to countering the effects of changing federal vaccine policy and preventing avoidable infection, liver disease, and lifelong complications.
Stay strong and kind!
Lisa M. Santora, MD, MPH
Health Officer
HealthOfficer@marincounty.gov
This newsletter was reviewed for language and readability using AI-assisted editing tools.
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