Information for Healthcare Providers

Public Health Alerts, Advisories and Updates

Advisories

Public health information that is specific to an incident or situation. Information contains recommendations or actionable items. Advisory information may not require immediate attention.

8.23.24 NC Division of Public Health Oropouche Provider Memo

In 2024, an increase in Oropouche virus (OROV) cases in both endemic areas and new, non-endemic regions, including Cuba has been reported. There is also a reported increase in severity of illness and potential vertical transmission. While travel-associated cases have been identified in the United States, there has been no evidence of local transmission to date. For more information, please see the CDC HAN.

This memo includes additional background for North Carolina clinicians about Oropouche virus as well as information about transmission, clinical presentation, testing, treatment, and control measures.

8.16.24 CDC HAN Advisory Increased Oropouche Virus Activity and Associated Risk to Travelers

The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory to notify clinicians and public health authorities of an increase in Oropouche virus disease in the Americas region, originating from endemic areas in the Amazon basin and new areas in South America and the Caribbean

12.8.23 CDC Severe and Fatal Confirmed Rocky Mountain Spotted Fever among People with Recent Travel to Tecate, Mexico

Summary: The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory to notify healthcare providers and the public about an outbreak of Rocky Mountain spotted fever (RMSF) among people in the United States with recent travel to or residence in the city of Tecate, state of Baja California, Mexico. RMSF is a severe, rapidly progressive, and often deadly disease transmitted by the bite of infected ticks, although many patients do not recall being bitten by a tick. Doxycycline is the treatment of choice for patients of all ages. As of December 8, 2023, five patients have been diagnosed with confirmed RMSF since late July 2023; all had travel to or residence in Tecate within 2 weeks of illness onset. RMSF is endemic in multiple border states in northern Mexico, including but not exclusive to Baja California, Sonora, Chihuahua, Coahuila, and Nuevo León. Healthcare providers should consider RMSF in their differential diagnosis of patients who have reported recent travel to Tecate, Mexico, or other areas of northern Mexico and subsequently develop signs or symptoms of an unexplained severe febrile illness. Consider initiating doxycycline based on presumptive clinical and epidemiologic findings, and do not delay treatment pending the result of a confirmatory laboratory test. Early treatment with doxycycline saves lives.

6.26.23 CDC Locally Acquired Malaria Cases Identified in the United States

The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory to share information and notify clinicians, public health authorities, and the public about—

Identification of locally acquired malaria cases (P. vivax) in two U.S. states (Florida and Texas) within the last 2 months,
Concern for a potential rise in imported malaria cases associated with increased international travel in summer 2023, and
Need to plan for rapid access to IV artesunate, which is the first-line treatment for severe malaria in the United States.

5.12.23 NC Division of Public Health Xylazine Exposure Guidance

This memo is intended to provide health care professionals with information regarding health impacts and management of patients exposed to xylazine through illicit drug use

final_xylazine_clinician_memo_may_16_2023.pdf

5.4.23 NC Division of Public Health Reporting of novel coronavirus and COVID-19 infections and deaths

This memo serves to notify providers and laboratories of changes in requirements for reporting cases and deaths of COVID-19 related to the end of the federal Public Health Emergency.

providerlabmemo_endingphe_050423_final.pdf

4.6.23 NC DPH CDC Health Advisory : Marburg Virus Disease Outbreaks in Equatorial Guinea and Tanzania

Recommendations for Clinicians

Currently, the risk of MVD in the United States is low; however, clinicians should be aware of the potential for imported cases. Clinicians who suspect MVD in a patient should immediately contact the communicable disease epidemiologist on call at 919-733-3419.

MVD should be included as a differential diagnosis for an ill person with history of a concerning exposure while in a MVD affected area (e.g., contact with a symptomatic person with suspected or confirmed MVD or an unknown illness; attending/participating in a funeral; visiting or working in a healthcare facility; having contact with bats or non-human primates; working or spending time in a mine/cave) within 21 days before symptom onset and who have clinical symptoms such as fever, headache, muscle and joint pain, fatigue, loss of appetite, gastrointestinal symptoms, or unexplained bleeding. Alternative diagnoses such as malaria, COVID-19, influenza, or common causes of gastrointestinal and febrile illnesses in a patient with recent international travel should be considered, evaluated, and managed appropriately. The possibility of a concurrent infection should be considered if a patient has a clinical and epidemiologic history compatible with MVD.

Please contact the Communicable Disease Branch epidemiologist on call at 919-733-3419 with any questions.

3.30.23 NC Division of Public Health UPDATE-Candida auris transmission in North Carolina (Replaces version dated February 24)

In light of CDC’s press release about the rise in Candida auris cases and an increase in the number
of C. auris cases acquired in North Carolina, this memo is intended to update healthcare providers and laboratorians about the current state of C. auris in NC and provide information about recommended screening and response measures.

updated_c_auris_provider_memo_033023_final.pdf

3.3.23 CDC Health Alert Network (HAN) No. 488- Measles Exposure at a Large Gathering in Kentucky, February 2023 and Global Measles Outbreaks

The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory to notify clinicians and public health officials about a confirmed measles case at a large gathering. On February 24, 2023, the Kentucky Department for Public Health (KDPH) identified a confirmed case of measles in an unvaccinated individual with a history of recent international travel. While infectious, the individual attended a large religious gathering on February 17–18, 2023, at Asbury University in Wilmore, Kentucky. An estimated 20,000 people attended the gathering from Kentucky, other U.S. states, and other countries during February 17–18, and an undetermined number of these people may have been exposed. This Health Advisory also highlights other recent large global measles outbreaks and associated U.S. importations, and the importance of early recognition, diagnosis, and appropriate treatment. CDC recommends that clinicians be on alert for cases of measles that meet the case definition.

3.2.23 CDC Health Alert Network (HAN) No. 487- Increased Chikungunya Virus Activity in Paraguay and Associated Risk to Travelers

The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory to notify clinicians and public health authorities of an increase in the number of cases of chikungunya reported in Paraguay. Most cases have been reported in the capital district of Asunción and the neighboring Central department. As of February 24, 2023, the Ministry of Health in Paraguay reported a total of 71,478 suspect chikungunya cases in Paraguay, with 29,362 of those being probable or confirmed cases since the outbreak began in October 2022 [1]. Further spread of the outbreak in Paraguay and to surrounding countries is possible.

This Health Advisory provides information on the current status of the chikungunya outbreak in Paraguay and advises on evaluating and testing travelers returning from Paraguay with signs and symptoms consistent with chikungunya virus infection. It also highlights those at increased risk for severe disease and prevention measures to mitigate additional spread of the virus and potential importation into unaffected areas, including the United States.

2.24.23 CDC Health Alert Network (HAN) No. 486 - Increase in Extensively Drug-resistant Shigellosis in the United States

The Centers for Disease Control and Prevention (CDC) has been monitoring an increase in extensively drug-resistant (XDR) Shigella infections (shigellosis) reported through national surveillance systems [1]. In 2022, about 5% of Shigella infections reported to CDC were caused by XDR strains, compared with 0% in 2015. Clinicians treating patients infected with XDR strains have limited antimicrobial treatment options. Shigella bacteria are easily transmissible. XDR Shigella strains can spread antimicrobial resistance genes to other enteric bacteria. Given these potentially serious public health concerns, CDC asks healthcare professionals to be vigilant about suspecting and reporting cases of XDR Shigella infection to their local or state health department and educating patients and communities at increased risk about prevention and transmission.

2.24.23 NC Division of Public Health Candida auris identification in North Carolina

This memo is intended to alert healthcare providers and laboratories about the first reported cases of Candida auris (C. auris) in North Carolina. Clinicians and laboratorians should be aware of screening recommendations for C. auris and consider this information when evaluating patients with infections caused by Candida species.

c_auris_provider_memo_022423.pdf

2.1.23 CDC Health Advisory Outbreak of Extensively Drug-resistant Pseudomonas aeruginosa Associated with Artificial Tears

UPDATE: 3.21.23 CDC Outbreak of Extensively Drug-resistant Pseudomonas aeruginosa Associated with Artificial Tears

The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory about infections with an extensively drug-resistant strain of Verona Integron-mediated Metallo-β-lactamase (VIM) and Guiana-Extended Spectrum-β-Lactamase (GES)-producing carbapenem-resistant Pseudomonas aeruginosa (VIM-GES-CRPA) in 12 states. Most patients reported using artificial tears. Patients reported more than 10 different brands of artificial tears, and some patients used multiple brands. The majority of patients who used artificial tears reported using EzriCare Artificial Tears, a preservative-free, over-the-counter product packaged in multidose bottles. CDC laboratory testing identified the presence of the outbreak strain in opened EzriCare bottles with different lot numbers collected from two states. Patients and healthcare providers should immediately discontinue using EzriCare artificial tears pending additional guidance from CDC and the Food and Drug Administration (FDA).

9.15.22 NC Division of Public Health Acute Flaccid Myelitis (AFM) and Poliomyelitis Testing and Reporting (Replaces version dated October 24, 2018)

This memo provides updated information regarding identification and management of suspected cases of acute flaccid myelitis (AFM) and poliomyelitis and to provide guidance on reporting of such cases to public health officials.

2022_afp_clinician_guidance_091522_final.pdf

11.15.21 NC Division of Public Health Statewide Increase in Syphilis Infections

This public health advisory describes the continuing increase in syphilis infections in North Carolina, outlines actions for clinicians and provides links to relevant resources.

Alerts

Public health information that is vital, time sensitive and specific to an incident or situation. Information posted here warrants immediate action or attention.

11.9.23 NC DHHS Division of Public Health Public Health Alert: We Need Your Help Preventing Congenital Syphilis

Congenital syphilis is continuing to rise in North Carolina. Between 2012 and 2022, there was a 547% increase in reported syphilis cases among women with an associated 5600% increase in congenital syphilis infections. Already in 2023, we have experienced 5 congenital syphilis related stillbirths and neonatal deaths. This trend mirrors the national trend as described recently in the CDC’s Vital Signs. This alert describes public health law requirements for syphilis screening during pregnancy and other actions to be taken by healthcare providers to reverse this trend.

Updates

Updated public health information specific to an incident or situation. Information posted here is unlikely to require immediate action.

8.15.24 NC Division of Public Health Memo Human-to-human transmission of Clade I Monkeypox virus in Africa. This memo alerts clinicians to ongoing Clade I Monkeypox virus (MPXV) outbreaks involving human-to-human transmission in the Democratic Republic of the Congo (DRC) with spread to neighboring countries.

Related:
12-11-23 NC Division of Public Health Human-to-human transmission of Clade I Monkeypox virus in Africa

8.7.24 CDC HAN Health Update Mpox Caused by Human-to-Human Transmission of Monkeypox Virus in the Democratic Republic of the Congo with Spread to Neighboring Countries.

7.17.24 NC Division of Public Health Annual Update on Diagnosis and Surveillance for Vector-borne Diseases

In North Carolina, both endemic and travel-associated vector-borne diseases contribute to significant morbidity and mortality. In 2023, approximately 900 cases of mosquito- and tick-borne illnesses were reported throughout the state. Most locally acquired vector-borne infections occur between June and September, as warmer temperatures encourage increased outdoor activity. Over the past two years there has been an increase reported cases of dengue and local transmission of malaria in the US. Travel associated cases have increased in NC as well. This memo encourages clinicians to be prepared and includes:

Actions for North Carolina clinicians
Annual and quarterly surveillance data for North Carolina.
Special information regarding Dengue and Malaria.
North Carolina Vector-borne Disease Reference Tables

vector-borne_disease_memo_for_hcp_2024.pdf

7.16.24 NC Division of Public Health Xylazine Update for North Carolina Clinicians

This communication updates the May 2023 Xylazine Exposure Guidance and offers new insights with immediate implications for clinical practice and frontline public health. Source article.

Below are links to additional public health alerts, advisories and updates as well communicable disease prevention information and resources you need.

CDC Health Alert Network (HAN)

Communicable Disease Resources

Communicable Disease Reporting

What communicable diseases must be reported?
- Reportable diseases and conditions in North Carolina
Who must report communicable diseases?
- Physicians, school administrators and child care operators, medical facilities and operators of restaurants and other food or drink establishments (G.S. § 130A-135 through 130A-139) must report cases or suspected cases of reportable diseases to their local health department.
How do you report communicable diseases in Wake County?
- Report communicable diseases to Wake County Health & Human Services Communicable Disease Surveillance Team
  Call: 919-250-4462
  Fax: 919-743-4905
  - Non-urgent reports. Non urgent reports can be made outside of normal business hours, on weekends or holidays by leaving a message on the Communicable Disease Line, 919-250-4462. Please provide a contact name and number for the CD Nurse to call you back the following business day. This number is checked during weekends and holidays at 9 a.m., 1 p.m. and 5 p.m.
  - Urgent reports. Should you need to alert us of an immediate Public Health threat, specifically as it relates to suspicion or confirmation of the conditions or events noted below, the Emergency CD Line 919-250-1217 will be answered immediately or will return your call within 15 minutes:
    - Novel and/or highly infectious diseases (measles, mumps, Ebola, Middle Eastern Respiratory Syndrome)
    - Biologic toxins, hazardous chemicals or mass casualties