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Medical Care Services' Health Professionals Outreach & Education shares information on clinical guidelines, community resources and other services to support you and your practice. Please contact us at MCS@sdcounty.ca.gov.

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*January 2nd telebriefing has been rescheduled to January 16, 2025

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  • NEW! Avian Influenza (H5N1)

    Background:

    The H5 Avian Influenza virus, commonly known as bird flu, has caused outbreaks in US backyard poultry and commercial flocks and is widespread in the wild bird population. As bird flu has been circulating, spillover has occurred in dairy cattle and several wild mammal species including bears, marine mammals, and wild carnivores. Since the spring of 2024, sporadic human infections have been reported in the United States. Most human infections with bird flu have occurred after unprotected exposure to sick or dead infected poultry or dairy cattle.

    Since the virus is shed in the saliva, gastrointestinal tract, respiratory tract, and mammary glands of infected animals, human infections can occur with prolonged and sufficient contact with the eyes, nose or mouth, or when it is inhaled. Individuals with close or prolonged unprotected contact with infected birds (e.g., sick/dead poultry) or other infected animals (e.g., dairy cows) or their contaminated environments are at greater risk of infection. The majority of human illnesses have been mild (e.g., upper respiratory symptoms, conjunctivitis), with a few more significant cases (e.g., pneumonia, multi-organ failure), including one death.

    Risk to Public:

    At this time, the CDC considers the health risk to the U.S. public to be low; however, people with close or prolonged, unprotected exposures to infected individuals, birds, or other animals, or to environments contaminated by infected birds or other animals, are at greater risk of infection. The CDC is monitoring for any human-to-human spread or viral mutation. 

    Prevention:

    • As a general precaution, whenever possible people should avoid close contact with sick or dead wild birds, poultry, and other.
    • If you must have close contact with sick or dead wild birds, poultry, or other animals, wear recommended personal protective equipment (PPE). Wild birds can be infected with bird flu viruses even if they don't look sick.
    • Do not touch surfaces or materials (e.g., animal litter or bedding material) contaminated with saliva, mucous, or feces from wild or domestic birds or other animals with confirmed or suspected avian bird influenza A virus infection.
    • Cook poultry, eggs, and beef to a safe internal temperature to kill bacteria and viruses. Refer to CDC's safer foods table for a complete list of safe internal temperatures. Choosing pasteurized milk and cheese products made with pasteurized milk is the best way to keep you and your family safe. Unpasteurized (raw) milk and products made from raw milk, including soft cheese, ice cream, and yogurt, can be contaminated with germs that can cause serious illness, hospitalization, or death. Pasteurization of milk kills bacteria and viruses, including bird flu.

    Recommendations:

    Please see the County of San Diego Health Advisory for additional details. CDC considers bird flu viruses to have the potential to cause severe disease in infected humans and recommends the following:

    • Clinicians should consider the possibility of bird flu in persons showing signs or symptoms of acute respiratory illness or conjunctivitis who have relevant exposure history within 10 days of symptom onset.

    Clinical Criteria:

    Persons with signs and symptoms consistent with acute upper or lower respiratory tract infection, conjunctivitis or complications of acute respiratory illness without an identified cause. In addition, gastrointestinal symptoms such as diarrhea are often reported with bird flu.

    Symptoms include but are not limited to:

    • Mild illness (e.g., cough, sore throat, eye redness or eye discharge such as conjunctivitis, fever or feeling feverish, rhinorrhea, fatigue, myalgia, arthralgia, headache)
    • Moderate to severe illness: (e.g., shortness of breath or difficulty breathing, altered mental status, seizures)
    • Complications: pneumonia, respiratory failure, acute respiratory distress syndrome, multi-organ failure (respiratory and kidney failure), sepsis, meningoencephalitis.

    Exposure:

    If you suspect exposure to bird flu, contact the San Diego County Epidemiology line at (619) 692-8499 (Monday - Friday 8 AM -5 PM or (858) 565-5255 (after hours and holidays) to determine next steps.

    Infection Prevention and Control Recommendations: 

    Standard, contact and airborne precautions, including the use of eye protection, are recommended when evaluating patients for infection with novel influenza A viruses. If an airborne infection isolation room (AIIR) is not available, isolate the patient in a private room. Health care personnel should wear recommended personal protective equipment (PPE) when providing patient care. For more information on recommended infection prevention and control measures, please visit Infection Control Within Healthcare Settings for Patients with Novel Influenza A Viruses.

    Testing:

    If you suspect bird flu, initiate treatment (see below) and contact the San Diego County Epidemiology line at (619) 692-8499 (Monday-Friday 8 AM-5 PM) or 858-565-5255 (after hours and holidays) for assistance and to arrange appropriate testing.  Testing for other potential causes of acute respiratory illness should also be considered depending upon currently circulating respiratory pathogens, including SARS-CoV-2.

    Treatment and Isolation:

    Treatment recommendations: Initiation of antiviral treatment with oral oseltamivir (twice daily x 5 days) is recommended as soon as possible for any patient with confirmed, probable, or suspected infection with bird flu.

    Treatment should be initiated even if more than 48 hours have elapsed since illness onset and regardless of illness severity (in both outpatient and hospital settings). 

    Antiviral treatment should not be delayed while waiting for laboratory test results. If molecular testing is negative for novel influenza A virus infection and other influenza viruses, but influenza virus infection is still suspected in a patient who is severely ill, antiviral treatment should be continued, and additional respiratory specimens should be collected for repeat influenza testing.

    For patients who are not hospitalized, if molecular testing is negative for novel influenza A virus and other influenza viruses, antiviral treatment can be discontinued.

    Isolation:

    Until infection with bird flu is definitively excluded, symptomatic persons should isolate away from others, including household members, except when seeking medical evaluation.

    Vaccination:

    Seasonal influenza vaccines do not provide protection against human infection with H5 Avian Influenza viruses. No human vaccines for prevention of bird flu are currently available in the United States. The CDC reports that the U.S. Government is developing vaccines against H5N1 in case they are needed.

    References:

    County of San Diego Avian Influenza webpage

    County of San Diego CAHAN: Confirmed Human Cases of H5 Avian Influenza in California, October 4, 2024

    Current Bird Flu Situation, CDPH, December 23, 2024

    CDPH CAHAN Evaluation and Testing for Human Avian Influenza A(H5N1) Infection, December 6, 2024

    Declaration of Emergency State of California December 18, 2024

    Highly Pathogenic Avian Influenza A(H5N1) Virus: Interim Recommendations for Prevention, Monitoring, and Public Health Investigations CDC December 26, 2024.

    Interim Guidance for Employers to Reduce Exposure to Novel Influenza A (Such as H5N1 Bird Flu) for People Working with or Exposed to Animals, CDC November 12, 2024

    Food Safety and Bird Flu, CDC December 31, 2024

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  • Mpox Resources

    Have a heightened suspicion for clade I MPXV for patients with mpox-like symptoms or probable/confirmed MPXV infection who have been in affected Central or Eastern African countries in the previous 21 days and/or have had close or intimate contact with symptomatic people who have been in those countries.

    Follow infection prevention and control recommendations for all patients with mpox symptoms. 

    Immediately report probable, suspected, and confirmed clade I MPXV cases to the County of San Diego Health and Human Services Agency as soon as possible and no later than 24 hours after diagnosis by submitting a Confidential Morbidity Report by fax to (619) 692-8541 or by secure e-mail to phs-hshb-stdreportingfax.hhsa@sdcounty.ca.gov.

    Test for clade I MPXV by submitting clinical specimens for clade-specific MPXV testing if clade I MPXV is suspected. General (i.e., clade-nonspecific) MPXV testing is available through commercial laboratories and the San Diego County Public Health Laboratory (SDCPHL). If clade I MPXV is suspected, refer to SDCPHL Guidelines to obtain approval for clade-specific MPXV testing and for detailed instructions on sample collection, storage, and transport. 

    Encourage vaccination for people who are vulnerable to mpox or who request the vaccine, particularly for people with weakened immune systems due to human immunodeficiency virus (HIV) infection or other conditions, as they are at risk for severe disease.

    The Advisory Committee on Immunization Practices (ACIP) recommends vaccination for people aged 18 years or older who may be at risk for mpox, which now includes people who are traveling to countries with ongoing person-to-person transmission of clade I MPXV who anticipate sexual activities, with two doses of the JYNNEOS vaccine (at least 28 days apart). 

    JYNNEOS may also be given as post-exposure prophylaxis to asymptomatic persons ideally within four days but up to 14 days after exposure if they have not already received two doses of the vaccine or been previously infected with MPXV. 

    Further information regarding vaccine eligibility is available through the CDC. 

    Clinical Treatment of Mpox:

    Currently there is no treatment approved for MPXV infections. For most patients with mpox who do not have severe disease or risk factors for severe disease (e.g., severe immunocompromise), supportive care and pain control will help them recover.

    Interim clinical guidance developed by CDC may assist clinicians in managing patients with protracted or life-threatening manifestations of mpox. Treatment for these patients involves Food and Drug Administration (FDA)–regulated drugs and biologics that are primarily stockpiled by the U.S. government.

    For any questions or to report a suspected case please contact the Epidemiology Unit by phone at (619) 692-8499. For urgent matters on evenings, weekends or holidays, dial (858) 565-5255 and ask for the Epidemiology Unit duty officer.

    Additional Resources

    Mpox Webpage | County of San Diego

    CDC Clinical Overview of Mpox | CDC December 11, 2024

    Mpox in the United States and Around the World: Current Situation | CDC January 8, 2025

    Recommendations for Relief of Pain | CDC        

Page last updated 1/13/2025

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