Health Alerts

CDPH VRDL Orthopox Virus Laboratory Testing Guidance

Direct Link to the CDC Flowchart to Identify and Assess 2019 Novel Coronavirus

For additional information, review the resources below:

Protecting Children From Wildfire Smoke and Ash

Air Quality Guide for Particle Pollution

Both the Health Update and the CDPH Issue Brief are included in the link above.

• OD Alert Flyer

Legionellosis Outbreak at San Quentin State Prison in Marin County: Be alert for possible Legionellosis in patients associated with San Quentin Prison in August 2015.

As of 8/31/15, there were 6 lab-confirmed cases and an additional 67 patients with suspected Legionellosis undergoing observation/testing.

Please be alert to the possibility of Legionellosis in patients with pneumonia who worked at, visited, or were released from San Quentin prison in August 2015. The incubation period is 2 to 10 days.  If the diagnosis is being considered, please obtain urine antigen and sputum culture for Legionella.

Please report any suspected Legionellosis cases to SFDPH, Communicable Disease Control Unit by calling 415-554-2830.

• SFDPH Avian Influenza Quick Guide for Clinicians

Updated Measles Quick Guide for Clinicians

Updated Measles Quick Guide for Clinicians

Please contact SFDPH CDCU (415-554-2830) for any suspected measles cases.

CDC Infection Prevention and Control Recommendations for Ebola Hemorrhagic Fever in U.S. Hospitals

As of June 12, 2014, the CDC has updated its Interim Guidance for testing for MERS-CoV. Testing criteria have been liberalized for individuals who have been in a healthcare facility in or near the Arabian Peninsula in which healthcare-associated MERS cases have been identified. Click here to learn more about updated testing guidance.

Please contact the San Francisco Department of Public Health, Communicable Disease Control Unit at (415) 554-2830 to discuss MERS testing.

Measles Quick Guide for Physicians

FDA Announced a Brief Temporary Shortage of Liquid form of influenza drug oseltamivir (Tamiflu), other formulations still available

This brief temporary shortage only affects the oral suspension formulation intended for small children and others who can’t swallow capsules. It is expected to last from early to mid January according to the FDA. The company expects to have more of the product in mid-January. Oseltamivir remains available in capsules at all three doses (30, 45, and 75 milligrams). Children over 1 year old can be dosed correctly with 30- or 45-mg capsules. For those who can’t swallow capsules, a capsule can be opened and mixed with chocolate syrup or some other liquid as directed by a health professional. Also, professionals can use 75-mg capsules to make a liquid form of the drug. For more information go to the FDA shortages page covering oseltamivir.

• 2 Recent Cases of Meningococcal Disease; Important information for residents in the Tenderloin Neighborhood of San Francisco

• Tubersol Shortage Report Form
• School Health Form

CDC Health Update on MERS-CoV

Updated guidance from CDC states that: 1) testing for MERS-CoV and other respiratory pathogens can be done simultaneously; 2) positive results for another respiratory pathogen should not preclude testing for MERS-CoV; and 3) clusters of patients with severe, unexplained respiratory illness should be considered for MERS-CoV testing. Read the full text of the August 12, 2013 update.

CDC Health Update (HAN)

DC has updated several MERS-CoV evaluation and lab specimen recommendations: 1) the incubation period has been extended to 14 days; 2) the clinical presentation may not initially include respiratory symptoms; 3) co-morbid conditions and immunosuppression may increase risk for infection and/or severe disease; and 4) lower respiratory tract specimens are the highest priority specimens to collect. Read the full text of the June 7, 2013 update.

Product Recall: Methylprednisolone Acetate Compounded by Main Street Family Pharmacy, Tennessee

FDA recommended on May 24, 2013 that clinicians not administer any products labeled as sterile from the Main Street Family Pharmacy, LLC of Newbern, TN. FDA states that 7 adverse events were reported in 2 states (IL and NC) among patients who developed skin and soft tissue infections following IM administration of preservative-free methylprednisolone acetate (MPA) 80 mg/mL in 10 mL vials. For more information, read the FDA News Release.

California Department of Public Health (CDPH) states that 2 clinics in CA are known to have received the recalled products (neither of which is located in San Francisco), and recommends that in evaluating infections possibly linked to contaminated injectable products, diagnostic specimens should be sent for bacterial, mycobacterial, and fungal cultures, and if possible, also for histopathology. Any positive culture or specimen should be retained and the local health department informed.

In light of this and other product recalls due to contamination of injectable products shipped by compounding pharmacies, SFDPH recommends that medical facilities use caution in ordering any injectable medication products from compounding pharmacies, which may not be inspected or regulated as thoroughly as are pharmaceutical manufacturers.

CDC Health Advisory: Human Infections with Novel Influenza A (H7N9) Viruses

The purpose of this advisory is to inform and provide guidance to health care providers in the evaluation of patients for novel Influenza A (H7N9) infection. Read the full advisory or go to the CDC Health Alert Network Page for additional advisories or updates. As of April 4, 2013, 14 cases of human infection with a novel avian influenza A (H7N9) virus were reported from four different provinces in China. All patients were hospitalized with severe respiratory illness and six persons died. These are the first human infections identified with an avian influenza A (H7N9). All illness onsets were from February 19 – March 31, 2013. No person-to-person transmission or epidemiologic link between any of the cases has been identified. Sources of infections are under investigation.

The CDC is not yet issuing any formal travel advisories. No cases of human infection with avian influenza A (H7N9) viruses have been detected in the United States. However, clinicians are reminded to consider influenza as a possible diagnosis when evaluating patients with acute respiratory illnesses, including pneumonia, even outside of the typical influenza season. Read the latest updates, case definitions, and guidance from the CDC on their website. In hospitalized patients or others at high risk of severe disease (i.e, age =65 or underlying medical conditions), treatment with oral oseltamivir or inhaled zanamivir should be started as soon as possible, without waiting for laboratory confirmation. Preliminary information indicates the virus is susceptible to neuraminidase inhibitors.

Clinicians in San Francisco should implement appropriate infection control recommendations and contact the SFDPH/Communicable Disease Control Unit immediately at (415) 554-2830 to arrange testing for Novel Influenza A(H7N9) for suspected cases with a travel or exposure history.

CDC Health Advisory: Updated Guidelines for Evaluation of Severe Respiratory Illness Associated with a Novel Coronavirus

CDC Health Advisory: Updated Guidelines for Evaluation of Severe Respiratory Illness Associated with a Novel Coronavirus

The purpose of this Advisory is to provide guidance to health care providers in the evaluation of patients for novel coronavirus infection. Read the full advisory here or go to the CDC Health Alert Network Page for additional advisories or updates.

CDC does not recommend that anyone change their travel plans because of these cases of the novel coronavirus. CDC recommends that US travelers to countries in or near the Arabian Peninsula monitor their health and see a doctor right away if they develop fever and symptoms such as cough or shortness of breath. They should tell the doctor about their recent travel.

UPDATE: As of March 27, 2013, 17 laboratory-confirmed cases of Novel Coronavirus have been reported to WHO – from Saudi Arabia, Qatar, Jordan, United Arab Emirates and the United Kingdom. Among the 17 cases, eleven were fatal. Two of the 17 cases experienced a mild respiratory illness and fully recovered. Read the latest updates, case definitions, and guidance from the CDC. Doctors in San Francisco should contact the SFDPH/Communicable Disease Control Unit immediately at (415) 554-2830 to arrange testing for suspected cases.

CDC Health Update (HAN): Notice to Clinicians: Continued Vigilance Urged for Fungal Infections among Patients Who Received Contaminated Steroid Injections

CDC is still receiving new reports of fungal infections among patients who were given injections of contaminated methylprednisolone acetate (MPA) from NECC. Most of these recent cases have been localized spinal or paraspinal infections in patients, although new cases of meningitis or arachnoiditis also have been reported. CDC is recommending that physicians seeing patients with mild or even baseline symptoms, consider evaluation with magnetic resonance imaging (MRI) if clinically warranted.

Read the full update here, or go to the CDC Health Alert Network Page for more updates.

NOTE: San Francisco Clinicians did not receive any of the contaminated medication.

CDC Health Update (HAN): New England Compounding Center – Additional Contamination Identified

CDC and FDA identified additional microbial contamination in unopened vials of betamethasone, cardioplegia, and triamcinolone solutions distributed and recalled from NECC. Contamination includes bacteria known as Bacillus, and fungal species including Aspergillus tubingensis, Aspergillus fumigatus, Cladosporiumspecies, and Penicilliumspecies. Healthcare providers should remain alert for the possibility of infections from these medications.

Read the full CDC Health Update, and for updated information go to the FDA website.

Ameridose Voluntary Recall

Health Care professionals should stop using Ameridose products at this time, and return them to the firm.

The US Food and Drug Administration (FDA) recommended a recall of any unexpired Ameridose products remaining in circulation as of October 31, 2012 out of an abundance of caution. As of October 31, the recall is not based on reports of patients with infections associated with any of Ameridose’s products. Therefore, at this time, the FDA is also recommending that health care professionals to not need to follow up with patients who received Ameridose products.

Please refer to the following websites for more information about the recall as information may be updated during the investigation:

Ameridose Issues Recall of All Products
FDA reports voluntary recall of all Ameridose drug products
Ameridose News Webpage

• Quick Guide for Clinicians

Quick Guide for Clinicians

Pertussis Situation Update
Quick Guide for Clinicians

Measles Flyer from the California Department of Public Health
Lab Form
Measles FAQs

Home Page – Novel Influenza A H1N1 (Swine) Flu

(Updated 10/30: Infection Control Precautions for Health Care Settings)

Antiviral Treatment and Chemoprophylaxis, and Infection Control Precautions

Treatment and Chemoprophylaxis, and Infection Control Precautions

Treatment and Chemoprophylaxis, and Infection Control Precautions

Information for Persons Potentially Exposed to Measles
Frequently Asked Questions and Answers about Measles

• What You and Your Physician Should Know About Rabies
• How to Order Rabies Vaccine and Human Rabies Immune Globulin (Updated April 2, 2009)
• Press Release: City Health Officials Issue Bat and Rabies Warning (Oct. 2, 2008)

• Measles Flyer from California Department of Public Health
• Laboratory Form
• Measles FAQs

• Botulism Information and Resources
• Rabies Information and Resources

MRSA Information and Resources

• Influenza disease reporting and control resources

List of Legally Reportable Diseases and Conditions

• Update of Results of N. meningitidis Surveillance in California
• Annual Report of Communicable Diseases in San Francisco 2004-2005

Frequently Asked Questions: Necrotizing Soft-Tissue Infections