San Bernardino County Department of Public Health Preparedness and Response Program serves a wide range of healthcare professionals, including: physicians, nurses, physician’s assistants, pharmacists, paramedics, veterinarians, epidemiologists, public health practitioners.
 
We provide timely, accurate, and credible information and guidance to healthcare providers related to emergency preparedness and response and emerging public health threats.
 
Our goal is to strengthen information-sharing networks before, during, and after a public health emergency.

The San Bernardino County Department of Public Health (DPH) continues to work with the Centers for Disease Control and Prevention (CDC) and the California Department of Public Health (CDPH) to respond to reports of Novel Coronavirus 2019 (COVID-19) as the situation is quickly evolving.

Residents of San Bernardino County are encouraged to stay home as much as possible while only participating in essential activities, such as critical work functions and shopping for necessities. We know these measures are challenging, but social distancing will help to protect all of our communities. We encourage older adults and those with chronic medical conditions to take additional precautions to avoid getting sick with the disease.

The County Acting Health Officer has ordered the cancellation of all gatherings based on CDPH’s Gathering Guidance and provided other guidance to the public in an effort to protect our population from any possible spread of the virus. Please stay home if ill, regularly wash hands with soap and water, clean frequently touched surfaces and objects daily and practice social distancing. To prevent stigma and discrimination, it is important to remember that the risk of COVID-19 is not related to race, ethnicity or culture. Do not make determinations of risk based on race or country of origin and be sure to maintain confidentiality of people with confirmed COVID-19.

All San Bernardino County residents and visitors are strongly encouraged to continue to practice good public health hygiene and follow guidance from CDC, CDPH and DPH to protect themselves from possibly spreading any illness. 

For the most updated information about COVID-19, visit the Centers for Disease Control and Prevention.

COVID-19 SURVEILLANCE DASHBOARD

DESKTOP VIEW (PDF)
Recommended web browsers: Chrome, Firefox, Safari

MOBILE VIEW
Press the small circle with four arrows on the top right corner of your device screen for an expanded view

• 2019 Novel Coronavirus (COVID-19)
• Tuberculosis
• Zika
• Hepatitis
• Syphilis

• Measles
• Whooping Cough (Pertussis)
• Mumps

2019 Novel Coronavirus (COVID-19)

2019 Novel Coronavirus (COVID-19, formerly known as 2019-nCoV) is a virus that has been identified as the cause of an outbreak of respiratory illness. The first detection of COVID-19 occurred in Wuhan, China. Initially it was thought to be animal-to-person transmission, due to the majority of the infected being linked to the animal and seafood market. However, after a growing number of patients having no ties to these markets, it is indicated that person-to-person transmission is occurring. It is unclear at this time how easily the virus is being spread between people. For the most recent situation summaries and updates please visit the Centers for Disease Control and Prevention web page.

Symptoms and Complications

The symptoms of COVID-19 infection range from little to no symptoms, to individuals being severely ill and dying. Some symptoms of COVID-19 include, but are not limited to:

         • Fever
         • Cough
         • Shortness of breath

Currently the CDC believes that symptoms appear in as little as 2 days or as long as 14 days after being exposed. These times are based off of the previous incubation period of MERS viruses.

Transmission

Coronaviruses come from a large family of viruses that are commonly found in different animal species such as camels, cattle, cats, and bats. It is rare for a coronavirus to infect a person, and then spread from that person to another person, such as cases of MERS and SARS.

In the case of person-to-person transmission it is thought to have been transferred via respiratory droplets that are emitted into the air when an infected individuals coughs or sneezes. This is similar to how influenza and other respiratory illnesses are spread. It is important to look at how easily a virus is able to be spread from person-to-person. Some viruses are extremely contagious, such as measles, while others are much less contagious. COVID-19 is being considered a serious public health threat by the CDC, however, based on the current information, the immediate health risk to the general public in America is considered low for the time being.

Prevention and Treatment

Currently there is no vaccine to prevent COVID-19. The best prevention is avoiding the virus as much as possible. The CDC also always recommends everyday preventative measures be taken to help prevent the virus being spread. These measures include:

          • Hand washing often with soap and water for no less than 20 seconds.
          • If access to soap and water is not available, the use of alcohol base sanitizer is recommended.
          • Avoid touching your eyes, nose, and mouth without first washing your hands.
          • Avoid contact with sick individuals
          • Stay home if you are sick
          • Cover your cough or sneeze with a tissue, then immediately dispose of the tissue in the trash.
          • Clean and disinfect surfaces and objects that are frequently touched as much as possible.

By having these everyday habits you can help to prevent the spread of several different viruses, including COVID-19.

Tuberculosis Prevention and Care

The Tuberculosis Control Program performs disease detection, surveillance, case management, and investigatory activities designed to control the incidence of tuberculosis (TB) in the County. The program provides tuberculosis information and educational resources for the Department, medical community, and general public. Please call (800) 722-4794 to speak to a TB staff member.

Nationwide Shortage of Tuberculin Skin Test Antigens

The Centers for Disease Control and Prevention (CDC) is expecting a nationwide 3-10 month shortage of Aplisol (a product of Par Pharmaceuticals) which is one of two purified-protein derivative (PPD) tuberculin antigens used when performing TB skin tests.

The interruption of Aplisol 5 mL (50 multi-dose vial) supply started in June 2019 with an expected shortage of Aplisol 1mL (10 multi-dose vial) to begin in November 2019. However, the shortage of the Aplisol 1mL could occur sooner than November 2019 depending on the demand.

To obtain up to date information regarding the status of the shortage please visit the FDA’s Center for Biologics Evaluation and Research-Regulated Products website listed below. https://www.fda.gov/vaccines-blood-biologics/safety-availability-biologics/cber-regulated-products-current-shortages

The following link outlines the CDC’s recommendations for dealing with the reduction in TB testing capability. https://www.cdc.gov/mmwr/volumes/68/wr/mm6824a4.htm

Clinical Services Offered

Skin testing for tuberculosis is offered at Department of Public Health clinics throughout the County. For more information. Please call (800) 722-4777 for an appointment and information on clinic locations and times.

Basic TB Facts

• Q: What is TB?
  A: Tuberculosis (TB) is a disease caused by germs that are spread from person to person through the air.
• Q: How is TB spread?
  A: TB germs are put into the air when a person with TB disease in the lungs or throat coughs, sneezes, speaks, or sings. These germs can stay in the air for several hours, depending on the environment. People who breathe in the air containing these TB germs can become infected.
• Q: What is a latent TB infection?
  A: People with latent TB infection have TB germs in their bodies, but they are not sick because the germs are not active. These people do not have symptoms of TB disease and they cannot spread the germs to others. However, they may develop TB disease in the future.
• Q: How do you know if you have latent TB?
  A: A TB skin test is used to test for latent TB.
• Q:Treatment
  A: Both latent TB infection and TB disease can be treated with medication.

Syphilis

Syphilis is a sexually transmitted disease (STD) caused by bacteria
(germs). Syphilis is easy to cure. Without treatment, it can hurt your
body’s organs. Congenital syphilis is when a pregnant woman passes
syphilis to her baby during pregnancy or childbirth. It can cause a
woman to have a baby too early or cause a miscarriage or stillbirth (a
baby born dead). It can also lead to serious health problems in babies.

Symptoms

Often people don’t notice symptoms, so they don’t know they’re
infected. Signs of syphilis may include a sore near the area where the
germ entered the body (vagina, anus, lips, or mouth) or rash on one or
more areas of the body. The symptoms may appear and disappear.
The only way to know for sure is to get tested.

Transmission

You can get syphilis by having contact with a syphilis sore during
vaginal, anal, or oral sex. Sores can be found on the penis, vagina,
anus, or on the lips and mouth. You may not see the sores and they
don’t cause pain. Congenital syphilis spreads from mother to baby
during pregnancy or birth.

Treatment

Syphilis can be treated and cured with antibiotics (medicine that kills
germs). Make sure your sex partner(s) get tested and treated too. This
will help them stay healthy, avoid infecting others, and avoid
re-infecting you.

Prevention and Testing

• Use condoms.
• Go to your doctor for testing and treatment as early as possible.

If you don’t have a regular doctor, call (800) 722-4777 to make
an appointment for clinic services at San Bernardino County
clinics.
Test if you are experiencing symptoms. Test if you are getting tested
for other STDs. If you are having sex without using a condom and/or
have multiple sex partners, get tested every 6 months. If you are a
man having sex with other men, get tested every 3-6 months. Test if
you are a woman and plan to get pregnant. If you’re pregnant, remind
your doctor to test you three times: during your first trimester (1 – 12
weeks), third trimester (28 – 32 weeks), and at delivery.

Measles

What Is Measles?

Measles is an acute, highly contagious viral disease. Symptoms include a high fever, runny nose (coryza), cough, loss of appetite, a rash, and red, watery eyes (conjunctivitis). The rash usually lasts 5–6 days, begins at the hairline, moves to the face and upper neck, and proceeds down the body.

How Long Does It Take to Show Signs of Measles After Being Exposed?

It takes an average of 7-14 days from exposure to the first symptom, which is usually fever. The measles rash appears approximately 14 days after exposure, usually 2–3 days after the fever begins.

What Should Be Done If Someone Is Exposed to Measles?

Notification of the exposure should be communicated to a doctor. If the person exposed has not been vaccinated, measles vaccine may prevent disease if given within 72 hours of exposure. Immune globulin (a blood product containing antibodies to the measles virus) may prevent or lessen the severity of measles if given within six days of exposure.

How Can Measles Be Prevented?

There is a vaccine available to prevent measles. Vaccines are available from your medical provider or the San Bernardino County Department of Public Health clinics. View the Public Health’s Clinic Locations webpage for information about clinic locations and times or call the Communicable Disease Section at 1 (800) 722-4794, Monday through Friday, from 8 a.m. to 5 p.m. to find a location near you. For more information, view the Centers of Disease Control Measles information webpage.

Hepatitis A – Related Resources

Hepatitis A – Guidelines for Disinfection

Hepatitis A – February 6, 2020 Outbreak News Release 

Health Advisory – Hepatitis A Prevention and Recommendations

Centers for Disease Control (CDC) on Hepatitis A

California Department of Public Health – CDPH

Zika-related Resources

SBCDPH News Release on the Zika Virus 2016

Zika Information – California Department of Public Health (CDPH)

Non-native Mosquito Species – California Department of Public Health (CDPH)

Centers for Disease Control (CDC) on Zika

Mosquitos and Vector Control Program – San Bernardino County Department of Public Health (SBCDPH)

Centers for Disease Control – For Healthcare Providers

Pertussis-related Resources

Pertussis – California Department of Public Health

Pertussis – Centers for Disease Control and Prevention

How Pertussis Spreads

Whooping cough (pertussis) is most contagious before the coughing starts. People with pertussis can spread the disease by coughing or sneezing while in close contact with others, who then breathe in the pertussis bacteria. Many babies are infected by parents, older siblings, or other caregivers who might not even know they have the disease.

Pertussis In California

There were 4,705 cases of pertussis with onset in 2015 reported to the California Department of Public Health, for a rate of 12.3 cases per 100,000 population. This includes 271 hospitalizations; 70 (26%) of these required intensive care. Of those hospitalized, 179 (66%) were infants younger than four months of age. Of those with pertussis onset in 2015, there were two deaths: one was a baby that was less than three weeks of age at the time of disease onset, and the other was an elderly woman with underlying health problems. (CDPH Pertussis Report dated June 27, 2016.)

Public Health Clinics in San Bernardino County

Pertussis vaccine is available at County Public Health Clinics. To make an appointment call 1 (800) 722-4777.

Mumps

What Is Mumps?

Mumps is a contagious disease caused by a virus. The virus that causes Mumps primarily affects the parotid glands — one of three pairs of saliva-producing (salivary) glands, situated below and in front of your ears. Mumps is easily spread by airborne droplets from the upper respiratory tract.

What Are the Symptoms?

Mumps is best known for the puffy cheeks and swollen jaws that it causes. This is a result of swollen salivary glands. The most common symptoms include:

• Fever
• Headache
• Muscle aches
• Tiredness
• Loss of Appetite
• Swollen and tender salivary glands under the ears on one or both sides (parotitis)

Symptoms typically appear 16-18 days after infection, but this period can range from 12-25 days after infection. Some people who get mumps have very mild or no symptoms, and often they do not know they have the disease. Most people with mumps recover completely in a few weeks.

How Do I Prevent Getting Mumps?

Mumps can be prevented with MMR vaccine. This protects against three diseases: measles, mumps, and rubella. CDC recommends children get two doses of MMR vaccine, starting with the first dose at 12 through 15 months of age, and the second dose at 4 through 6 years of age. Teens and adults, who do not have evidence of immunity, should also be up-to-date on their MMR vaccination.

Children may also get MMRV vaccine, which protects against measles, mumps, rubella, and varicella (chickenpox). This vaccine is only licensed for use in children who are 12 months through 12 years of age.

Mumps on College Campuses

Mumps – CDC
Mumps – CDPH

• 2019 Novel Coronavirus
• Tuberculosis
• Zika
• Hepatitis

• Measles
• Whooping Cough (Pertussis)
• Mumps

2019 Novel Coronavirus

2019 Novel Coronavirus (2019-nCoV) is a virus that has been identified as the cause of an outbreak of respiratory illness. The first detection of 2019-nCoV occurred in Wuhan, China. Initially it was thought to be animal-to-person transmission, due to the majority of the infected being linked to the animal and seafood market. However, after a growing number of patients having no ties to these markets, it is indicated that person-to-person transmission is occurring. It is unclear at this time how easily the virus is being spread between people. For the most recent situation summaries and updates please visit the Centers for Disease Control and Prevention web page on 2019 Novel Coronavirus, Wuhan, China.

Symptoms and Complications

The symptoms of 2019-nCoV infection range from little to no symptoms, to individuals being severely ill and dying. Some symptoms of 2019-nCoV include, but are not limited to:
           • Fever
           • Cough
           • Shortness of breath
Currently the CDC believes that symptoms appear in as little as 2 days or as long as 14 days after being exposed. These times are based off of the previous incubation period of MERS viruses.

Transmission

Coronaviruses come from a large family of viruses that are commonly found in different animal species such as camels, cattle, cats, and bats. It is rare for a coronavirus to infect a person, and then spread from that person to another person, such as cases of MERS and SARS.

In the case of person-to-person transmission it is thought to have been transferred via respiratory droplets that are emitted into the air when an infected individuals coughs or sneezes. This is similar to how influenza and other respiratory illnesses are spread. It is important to look at how easily a virus is able to be spread from person-to-person. Some viruses are extremely contagious, such as measles, while others are much less contagious. 2019-nCoV is being considered a serious public health threat by the CDC, however, based on the current information, the immediate health risk to the general public in America is considered low for the time being.

Prevention and Treatment

Currently there is no vaccine to prevent 2019-nCoV. The best prevention is avoiding the virus as much as possible. The CDC also always recommends everyday preventative measures be taken to help prevent the virus being spread. These measures include:
• Hand washing often with soap and water for no less than 20 seconds. If access to soap and water is not available, the use of alcohol base sanitizer is recommended.
• Avoid touching your eyes, nose, and mouth without first washing your hands.
• Avoid contact with sick individuals
• Stay home if you are sick
• Cover your cough or sneeze with a tissue, then immediately dispose of the tissue in the trash.
• Clean and disinfect surfaces and objects that are frequently touched as much as possible.
By having these everyday habits you can help to prevent the spread of several different viruses, including 2019-nCoV.

Tuberculosis Prevention and Care

The Tuberculosis Control Program performs disease detection, surveillance, case management, and investigatory activities designed to control the incidence of tuberculosis (TB) in the County. The program provides tuberculosis information and educational resources for the Department, medical community, and general public. Please call (800) 722-4794 to speak to a TB staff member.

Nationwide Shortage of Tuberculin Skin Test Antigens

The Centers for Disease Control and Prevention (CDC) is expecting a nationwide 3-10 month shortage of Aplisol (a product of Par Pharmaceuticals) which is one of two purified-protein derivative (PPD) tuberculin antigens used when performing TB skin tests.

The interruption of Aplisol 5 mL (50 multi-dose vial) supply started in June 2019 with an expected shortage of Aplisol 1mL (10 multi-dose vial) to begin in November 2019. However, the shortage of the Aplisol 1mL could occur sooner than November 2019 depending on the demand.

To obtain up to date information regarding the status of the shortage please visit the FDA’s Center for Biologics Evaluation and Research-Regulated Products website listed below. https://www.fda.gov/vaccines-blood-biologics/safety-availability-biologics/cber-regulated-products-current-shortages

The following link outlines the CDC’s recommendations for dealing with the reduction in TB testing capability. https://www.cdc.gov/mmwr/volumes/68/wr/mm6824a4.htm

Clinical Services Offered

Skin testing for tuberculosis is offered at Department of Public Health clinics throughout the County. For more information. Please call (800) 722-4777 for an appointment and information on clinic locations and times.

Basic TB Facts

• Q: What is TB?
  A: Tuberculosis (TB) is a disease caused by germs that are spread from person to person through the air.
• Q: How is TB spread?
  A: TB germs are put into the air when a person with TB disease in the lungs or throat coughs, sneezes, speaks, or sings. These germs can stay in the air for several hours, depending on the environment. People who breathe in the air containing these TB germs can become infected.
• Q: What is a latent TB infection?
  A: People with latent TB infection have TB germs in their bodies, but they are not sick because the germs are not active. These people do not have symptoms of TB disease and they cannot spread the germs to others. However, they may develop TB disease in the future.
• Q: How do you know if you have latent TB?
  A: A TB skin test is used to test for latent TB.
• Q:Treatment
  A: Both latent TB infection and TB disease can be treated with medication.

Measles

What Is Measles?

Measles is an acute, highly contagious viral disease. Symptoms include a high fever, runny nose (coryza), cough, loss of appetite, a rash, and red, watery eyes (conjunctivitis). The rash usually lasts 5–6 days, begins at the hairline, moves to the face and upper neck, and proceeds down the body.

How Long Does It Take to Show Signs of Measles After Being Exposed?

It takes an average of 7-14 days from exposure to the first symptom, which is usually fever. The measles rash appears approximately 14 days after exposure, usually 2–3 days after the fever begins.

What Should Be Done If Someone Is Exposed to Measles?

Notification of the exposure should be communicated to a doctor. If the person exposed has not been vaccinated, measles vaccine may prevent disease if given within 72 hours of exposure. Immune globulin (a blood product containing antibodies to the measles virus) may prevent or lessen the severity of measles if given within six days of exposure.

How Can Measles Be Prevented?

There is a vaccine available to prevent measles. Vaccines are available from your medical provider or the San Bernardino County Department of Public Health clinics. View the Public Health’s Clinic Locations webpage for information about clinic locations and times or call the Communicable Disease Section at 1 (800) 722-4794, Monday through Friday, from 8 a.m. to 5 p.m. to find a location near you. For more information, view the Centers of Disease Control Measles information webpage.

Hepatitis A – related Resources

Centers for Disease Control (CDC) on Hepatitis A

California Department of Public Health – CDPH

Zika-related Resources

SBCDPH News Release on the Zika Virus 2016

Zika Information – California Department of Public Health (CDPH)

Non-native Mosquito Species – California Department of Public Health (CDPH)

Centers for Disease Control (CDC) on Zika

Mosquitos and Vector Control Program – San Bernardino County Department of Public Health (SBCDPH)

Centers for Disease Control – For Healthcare Providers

Pertussis-related Resources

Pertussis – California Department of Public Health

Pertussis – Centers for Disease Control and Prevention

How Pertussis Spreads

Whooping cough (pertussis) is most contagious before the coughing starts. People with pertussis can spread the disease by coughing or sneezing while in close contact with others, who then breathe in the pertussis bacteria. Many babies are infected by parents, older siblings, or other caregivers who might not even know they have the disease.

Pertussis In California

There were 4,705 cases of pertussis with onset in 2015 reported to the California Department of Public Health, for a rate of 12.3 cases per 100,000 population. This includes 271 hospitalizations; 70 (26%) of these required intensive care. Of those hospitalized, 179 (66%) were infants younger than four months of age. Of those with pertussis onset in 2015, there were two deaths: one was a baby that was less than three weeks of age at the time of disease onset, and the other was an elderly woman with underlying health problems. (CDPH Pertussis Report dated June 27, 2016.)

Public Health Clinics in San Bernardino County

Pertussis vaccine is available at County Public Health Clinics. To make an appointment call 1 (800) 722-4777.

Mumps

What Is Mumps?

Mumps is a contagious disease caused by a virus. The virus that causes Mumps primarily affects the parotid glands — one of three pairs of saliva-producing (salivary) glands, situated below and in front of your ears. Mumps is easily spread by airborne droplets from the upper respiratory tract.

What Are the Symptoms?

Mumps is best known for the puffy cheeks and swollen jaws that it causes. This is a result of swollen salivary glands. The most common symptoms include:

• Fever
• Headache
• Muscle aches
• Tiredness
• Loss of Appetite
• Swollen and tender salivary glands under the ears on one or both sides (parotitis)

Symptoms typically appear 16-18 days after infection, but this period can range from 12-25 days after infection. Some people who get mumps have very mild or no symptoms, and often they do not know they have the disease. Most people with mumps recover completely in a few weeks.

How Do I Prevent Getting Mumps?

Mumps can be prevented with MMR vaccine. This protects against three diseases: measles, mumps, and rubella. CDC recommends children get two doses of MMR vaccine, starting with the first dose at 12 through 15 months of age, and the second dose at 4 through 6 years of age. Teens and adults, who do not have evidence of immunity, should also be up-to-date on their MMR vaccination.

Children may also get MMRV vaccine, which protects against measles, mumps, rubella, and varicella (chickenpox). This vaccine is only licensed for use in children who are 12 months through 12 years of age.

Mumps on College Campuses

Mumps – CDC
Mumps – CDPH

• 2019 Novel Coronavirus
• Tuberculosis
• Zika
• Hepatitis

• Measles
• Whooping Cough (Pertussis)
• Mumps

2019 Novel Coronavirus

2019 Novel Coronavirus (2019-nCoV) is a virus that has been identified as the cause of an outbreak of respiratory illness. The first detection of 2019-nCoV occurred in Wuhan, China. Initially it was thought to be animal-to-person transmission, due to the majority of the infected being linked to the animal and seafood market. However, after a growing number of patients having no ties to these markets, it is indicated that person-to-person transmission is occurring. It is unclear at this time how easily the virus is being spread between people. For the most recent situation summaries and updates please visit the Centers for Disease Control and Prevention web page on 2019 Novel Coronavirus, Wuhan, China.

Symptoms and Complications

The symptoms of 2019-nCoV infection range from little to no symptoms, to individuals being severely ill and dying. Some symptoms of 2019-nCoV include, but are not limited to:
           • Fever
           • Cough
           • Shortness of breath
Currently the CDC believes that symptoms appear in as little as 2 days or as long as 14 days after being exposed. These times are based off of the previous incubation period of MERS viruses.

Transmission

Coronaviruses come from a large family of viruses that are commonly found in different animal species such as camels, cattle, cats, and bats. It is rare for a coronavirus to infect a person, and then spread from that person to another person, such as cases of MERS and SARS.

In the case of person-to-person transmission it is thought to have been transferred via respiratory droplets that are emitted into the air when an infected individuals coughs or sneezes. This is similar to how influenza and other respiratory illnesses are spread. It is important to look at how easily a virus is able to be spread from person-to-person. Some viruses are extremely contagious, such as measles, while others are much less contagious. 2019-nCoV is being considered a serious public health threat by the CDC, however, based on the current information, the immediate health risk to the general public in America is considered low for the time being.

Prevention and Treatment

Currently there is no vaccine to prevent 2019-nCoV. The best prevention is avoiding the virus as much as possible. The CDC also always recommends everyday preventative measures be taken to help prevent the virus being spread. These measures include:
• Hand washing often with soap and water for no less than 20 seconds. If access to soap and water is not available, the use of alcohol base sanitizer is recommended.
• Avoid touching your eyes, nose, and mouth without first washing your hands.
• Avoid contact with sick individuals
• Stay home if you are sick
• Cover your cough or sneeze with a tissue, then immediately dispose of the tissue in the trash.
• Clean and disinfect surfaces and objects that are frequently touched as much as possible.
By having these everyday habits you can help to prevent the spread of several different viruses, including 2019-nCoV.

Tuberculosis Prevention and Care

The Tuberculosis Control Program performs disease detection, surveillance, case management, and investigatory activities designed to control the incidence of tuberculosis (TB) in the County. The program provides tuberculosis information and educational resources for the Department, medical community, and general public. Please call (800) 722-4794 to speak to a TB staff member.

Nationwide Shortage of Tuberculin Skin Test Antigens

The Centers for Disease Control and Prevention (CDC) is expecting a nationwide 3-10 month shortage of Aplisol (a product of Par Pharmaceuticals) which is one of two purified-protein derivative (PPD) tuberculin antigens used when performing TB skin tests.

The interruption of Aplisol 5 mL (50 multi-dose vial) supply started in June 2019 with an expected shortage of Aplisol 1mL (10 multi-dose vial) to begin in November 2019. However, the shortage of the Aplisol 1mL could occur sooner than November 2019 depending on the demand.

To obtain up to date information regarding the status of the shortage please visit the FDA’s Center for Biologics Evaluation and Research-Regulated Products website listed below. https://www.fda.gov/vaccines-blood-biologics/safety-availability-biologics/cber-regulated-products-current-shortages

The following link outlines the CDC’s recommendations for dealing with the reduction in TB testing capability. https://www.cdc.gov/mmwr/volumes/68/wr/mm6824a4.htm

Clinical Services Offered

Skin testing for tuberculosis is offered at Department of Public Health clinics throughout the County. For more information. Please call (800) 722-4777 for an appointment and information on clinic locations and times.

Basic TB Facts

• Q: What is TB?
  A: Tuberculosis (TB) is a disease caused by germs that are spread from person to person through the air.
• Q: How is TB spread?
  A: TB germs are put into the air when a person with TB disease in the lungs or throat coughs, sneezes, speaks, or sings. These germs can stay in the air for several hours, depending on the environment. People who breathe in the air containing these TB germs can become infected.
• Q: What is a latent TB infection?
  A: People with latent TB infection have TB germs in their bodies, but they are not sick because the germs are not active. These people do not have symptoms of TB disease and they cannot spread the germs to others. However, they may develop TB disease in the future.
• Q: How do you know if you have latent TB?
  A: A TB skin test is used to test for latent TB.
• Q:Treatment
  A: Both latent TB infection and TB disease can be treated with medication.

Measles

What Is Measles?

Measles is an acute, highly contagious viral disease. Symptoms include a high fever, runny nose (coryza), cough, loss of appetite, a rash, and red, watery eyes (conjunctivitis). The rash usually lasts 5–6 days, begins at the hairline, moves to the face and upper neck, and proceeds down the body.

How Long Does It Take to Show Signs of Measles After Being Exposed?

It takes an average of 7-14 days from exposure to the first symptom, which is usually fever. The measles rash appears approximately 14 days after exposure, usually 2–3 days after the fever begins.

What Should Be Done If Someone Is Exposed to Measles?

Notification of the exposure should be communicated to a doctor. If the person exposed has not been vaccinated, measles vaccine may prevent disease if given within 72 hours of exposure. Immune globulin (a blood product containing antibodies to the measles virus) may prevent or lessen the severity of measles if given within six days of exposure.

How Can Measles Be Prevented?

There is a vaccine available to prevent measles. Vaccines are available from your medical provider or the San Bernardino County Department of Public Health clinics. View the Public Health’s Clinic Locations webpage for information about clinic locations and times or call the Communicable Disease Section at 1 (800) 722-4794, Monday through Friday, from 8 a.m. to 5 p.m. to find a location near you. For more information, view the Centers of Disease Control Measles information webpage.

Hepatitis A – related Resources

Centers for Disease Control (CDC) on Hepatitis A

California Department of Public Health – CDPH

Zika-related Resources

SBCDPH News Release on the Zika Virus 2016

Zika Information – California Department of Public Health (CDPH)

Non-native Mosquito Species – California Department of Public Health (CDPH)

Centers for Disease Control (CDC) on Zika

Mosquitos and Vector Control Program – San Bernardino County Department of Public Health (SBCDPH)

Centers for Disease Control – For Healthcare Providers

Pertussis-related Resources

Pertussis – California Department of Public Health

Pertussis – Centers for Disease Control and Prevention

How Pertussis Spreads

Whooping cough (pertussis) is most contagious before the coughing starts. People with pertussis can spread the disease by coughing or sneezing while in close contact with others, who then breathe in the pertussis bacteria. Many babies are infected by parents, older siblings, or other caregivers who might not even know they have the disease.

Pertussis In California

There were 4,705 cases of pertussis with onset in 2015 reported to the California Department of Public Health, for a rate of 12.3 cases per 100,000 population. This includes 271 hospitalizations; 70 (26%) of these required intensive care. Of those hospitalized, 179 (66%) were infants younger than four months of age. Of those with pertussis onset in 2015, there were two deaths: one was a baby that was less than three weeks of age at the time of disease onset, and the other was an elderly woman with underlying health problems. (CDPH Pertussis Report dated June 27, 2016.)

Public Health Clinics in San Bernardino County

Pertussis vaccine is available at County Public Health Clinics. To make an appointment call 1 (800) 722-4777.

Mumps

What Is Mumps?

Mumps is a contagious disease caused by a virus. The virus that causes Mumps primarily affects the parotid glands — one of three pairs of saliva-producing (salivary) glands, situated below and in front of your ears. Mumps is easily spread by airborne droplets from the upper respiratory tract.

What Are the Symptoms?

Mumps is best known for the puffy cheeks and swollen jaws that it causes. This is a result of swollen salivary glands. The most common symptoms include:

• Fever
• Headache
• Muscle aches
• Tiredness
• Loss of Appetite
• Swollen and tender salivary glands under the ears on one or both sides (parotitis)

Symptoms typically appear 16-18 days after infection, but this period can range from 12-25 days after infection. Some people who get mumps have very mild or no symptoms, and often they do not know they have the disease. Most people with mumps recover completely in a few weeks.

How Do I Prevent Getting Mumps?

Mumps can be prevented with MMR vaccine. This protects against three diseases: measles, mumps, and rubella. CDC recommends children get two doses of MMR vaccine, starting with the first dose at 12 through 15 months of age, and the second dose at 4 through 6 years of age. Teens and adults, who do not have evidence of immunity, should also be up-to-date on their MMR vaccination.

Children may also get MMRV vaccine, which protects against measles, mumps, rubella, and varicella (chickenpox). This vaccine is only licensed for use in children who are 12 months through 12 years of age.

Mumps on College Campuses

Mumps – CDC
Mumps – CDPH

• Candida auris
• 2019 Novel Coronavirus (COVID-19)
• Tuberculosis
• Zika
• Hepatitis

• Syphilis
• Measles
• Whooping Cough (Pertussis)
• Mumps

A CDC message to infection preventionists:

Candida auris

Candida auris is a fungus that causes serious infections and spreads in healthcare facilities. Infection preventionists, healthcare personnel, and laboratory staff can all help prevent it from spreading.

Why is Candida auris a problem?

• It causes serious infections. C. auris can cause bloodstream and other types of invasive infections, particularly in patients in hospitals and nursing homes who have many medical problems. More than 1 in 3 patients die within a month of being diagnosed with an invasive C. auris infection.
• It is often multidrug-resistant. Antifungal medications commonly used to treat other Candida infections often don’t work for C. auris. Some C. auris isolates are resistant to all three major classes of antifungal medications.
• It is becoming more common. Although C. auris was just discovered in 2009, the number of cases has grown quickly. Since 2009, it has been reported in dozens of countries, including the United States.
• It is difficult to identify. C. auris can be misidentified as other types of fungus unless specialized laboratory methods are used. Correctly identifying C. auris is critical for starting measures to stop its spread and prevent outbreaks.
• It can spread and cause outbreaks in healthcare facilities. Just like other multidrug-resistant organisms such as carbapenem-resistant Enterobacteriaceae (CRE) and methicillin-resistant Staphylococcus aureus (MRSA), C. auris can be transmitted in healthcare settings and cause outbreaks. It can colonize patients for many months, persist in the environment, and withstand some commonly used healthcare facility disinfectants.

Early detection and infection control can limit the spread of C. auris.

Prepare for C. auris in your facility

• Work with your laboratory to ensure the fungus identification method used in your facility can identify C. auris. If it cannot, know when to suspect C. auris and send suspected isolates to your state or local public health department for further identification.
• Begin surveillance. Establish a protocol with your laboratory so that your department is promptly informed when C. auris is suspected.
  • If your laboratory is not equipped to identify C. auris, begin surveillance for the organisms that commonly represent a C. auris misidentification. See https://www.cdc.gov/fungal/candida-auris/recommendations  for common misidentifications by different yeast identification methods.
• Know which patients are at higher risk for C. auris infection or asymptomatic colonization. These include:
  • Patients who have received healthcare in post-acute care facilities (e.g., nursing homes), especially those with ventilator units.
  • Patients recently hospitalized outside the United States, especially in countries with known C. auris cases (visit www.cdc.gov/fungal/candida-auris for a map of countries), and patients infected or colonized with carbapenemase-producing bacteria.
• Have a response plan. Discuss recommendations for infection prevention and control of C. auris with healthcare personnel, including environmental services.

What should I do if there is C. auris in my facility?

• Check the CDC website for the most up-to-date guidance on identifying and managing auris: www.cdc.gov/fungal/candida-auris.
• Report possible or confirmed aurist est results immediately to your public health department.
• Ensure adherence to CDC recommendations for infection control, including
  • Placing patients infected or colonized with C. auris on Transmission-Based Precautions and, whenever possible, in a single room.
  • Making sure gown and gloves are accessible and used appropriately.
  • Reinforcing hand hygiene.
  • Coordinate with environmental services to monitor and ensure the patient care environment is cleaned using a disinfectant with an Environmental Protection Agency claim for C. auris or, if not available, for Clostridioides difficile. These products can be found at www.cdc.gov/fungal/candida-auris/c-auris-infection-control.html. Some disinfectants used in healthcare facilities (e.g., quaternary ammonium compounds [QACs]) may not be effective against C. auris, despite claims about effectiveness against C. albicans or other fungi. Work with the environmental services team to monitor the cleaning process.
• After consulting with public health personnel, screen contacts of case-patients to identify patients with auris colonization. Use the same infection control measures for patients found to be colonized.
• When a patient is being transferred from your facility (e.g., to a nursing home or other hospital), clearly communicate the patient’s auris status to receiving healthcare providers.

CDPH Candida auris Toolkit for Healthcare Facilities (PDF)

2019 Novel Coronavirus (COVID-19)

2019 Novel Coronavirus (COVID-19, formerly known as 2019-nCoV) is a virus that has been identified as the cause of an outbreak of respiratory illness. The first detection of COVID-19 occurred in Wuhan, China. Initially it was thought to be animal-to-person transmission, due to the majority of the infected being linked to the animal and seafood market. However, after a growing number of patients having no ties to these markets, it is indicated that person-to-person transmission is occurring. It is unclear at this time how easily the virus is being spread between people. For the most recent situation summaries and updates please visit the Centers for Disease Control and Prevention web page.

Symptoms and Complications

The symptoms of COVID-19 infection range from little to no symptoms, to individuals being severely ill and dying. Some symptoms of COVID-19 include, but are not limited to:

         • Fever
         • Cough
         • Shortness of breath

Currently the CDC believes that symptoms appear in as little as 2 days or as long as 14 days after being exposed. These times are based off of the previous incubation period of MERS viruses.

Transmission

Coronaviruses come from a large family of viruses that are commonly found in different animal species such as camels, cattle, cats, and bats. It is rare for a coronavirus to infect a person, and then spread from that person to another person, such as cases of MERS and SARS.

In the case of person-to-person transmission it is thought to have been transferred via respiratory droplets that are emitted into the air when an infected individuals coughs or sneezes. This is similar to how influenza and other respiratory illnesses are spread. It is important to look at how easily a virus is able to be spread from person-to-person. Some viruses are extremely contagious, such as measles, while others are much less contagious. COVID-19 is being considered a serious public health threat by the CDC, however, based on the current information, the immediate health risk to the general public in America is considered low for the time being.

Prevention and Treatment

Currently there is no vaccine to prevent COVID-19. The best prevention is avoiding the virus as much as possible. The CDC also always recommends everyday preventative measures be taken to help prevent the virus being spread. These measures include:

          • Hand washing often with soap and water for no less than 20 seconds.
          • If access to soap and water is not available, the use of alcohol base sanitizer is recommended.
          • Avoid touching your eyes, nose, and mouth without first washing your hands.
          • Avoid contact with sick individuals
          • Stay home if you are sick
          • Cover your cough or sneeze with a tissue, then immediately dispose of the tissue in the trash.
          • Clean and disinfect surfaces and objects that are frequently touched as much as possible.

By having these everyday habits you can help to prevent the spread of several different viruses, including COVID-19.

Tuberculosis Prevention and Care

The Tuberculosis Control Program performs disease detection, surveillance, case management, and investigatory activities designed to control the incidence of tuberculosis (TB) in the County. The program provides tuberculosis information and educational resources for the Department, medical community, and general public. Please call (800) 722-4794 to speak to a TB staff member.

Nationwide Drug Shortage

To obtain up to date information regarding the status of the shortage please visit the FDA’s Center for Biologics Evaluation and Research-Regulated Products website listed below. https://www.fda.gov/vaccines-blood-biologics/safety-availability-biologics/cber-regulated-products-current-shortages

The following link outlines the CDC’s recommendations for dealing with the reduction in TB testing capability. https://www.cdc.gov/mmwr/volumes/68/wr/mm6824a4.htm

Clinical Services Offered

Skin testing for tuberculosis is offered at Department of Public Health clinics throughout the County. For more information. Please call (800) 722-4777 for an appointment and information on clinic locations and times.

Basic TB Facts

• Q: What is TB?
  A: Tuberculosis (TB) is a disease caused by germs that are spread from person to person through the air.
• Q: How is TB spread?
  A: TB germs are put into the air when a person with TB disease in the lungs or throat coughs, sneezes, speaks, or sings. These germs can stay in the air for several hours, depending on the environment. People who breathe in the air containing these TB germs can become infected.
• Q: What is a latent TB infection?
  A: People with latent TB infection have TB germs in their bodies, but they are not sick because the germs are not active. These people do not have symptoms of TB disease and they cannot spread the germs to others. However, they may develop TB disease in the future.
• Q: How do you know if you have latent TB?
  A: A TB skin test is used to test for latent TB.
• Q:Treatment
  A: Both latent TB infection and TB disease can be treated with medication.

Syphilis

Syphilis is a sexually transmitted disease (STD) caused by bacteria
(germs). Syphilis is easy to cure. Without treatment, it can hurt your
body’s organs. Congenital syphilis is when a pregnant woman passes
syphilis to her baby during pregnancy or childbirth. It can cause a
woman to have a baby too early or cause a miscarriage or stillbirth (a
baby born dead). It can also lead to serious health problems in babies.

Symptoms

Often people don’t notice symptoms, so they don’t know they’re
infected. Signs of syphilis may include a sore near the area where the
germ entered the body (vagina, anus, lips, or mouth) or rash on one or
more areas of the body. The symptoms may appear and disappear.
The only way to know for sure is to get tested.

Transmission

You can get syphilis by having contact with a syphilis sore during
vaginal, anal, or oral sex. Sores can be found on the penis, vagina,
anus, or on the lips and mouth. You may not see the sores and they
don’t cause pain. Congenital syphilis spreads from mother to baby
during pregnancy or birth.

Treatment

Syphilis can be treated and cured with antibiotics (medicine that kills
germs). Make sure your sex partner(s) get tested and treated too. This
will help them stay healthy, avoid infecting others, and avoid
re-infecting you.

Prevention and Testing

• Use condoms.
• Go to your doctor for testing and treatment as early as possible.

If you don’t have a regular doctor, call (800) 722-4777 to make
an appointment for clinic services at San Bernardino County
clinics.
Test if you are experiencing symptoms. Test if you are getting tested
for other STDs. If you are having sex without using a condom and/or
have multiple sex partners, get tested every 6 months. If you are a
man having sex with other men, get tested every 3-6 months. Test if
you are a woman and plan to get pregnant. If you’re pregnant, remind
your doctor to test you three times: during your first trimester (1 – 12
weeks), third trimester (28 – 32 weeks), and at delivery.

Measles

What Is Measles?

Measles is an acute, highly contagious viral disease. Symptoms include a high fever, runny nose (coryza), cough, loss of appetite, a rash, and red, watery eyes (conjunctivitis). The rash usually lasts 5–6 days, begins at the hairline, moves to the face and upper neck, and proceeds down the body.

How Long Does It Take to Show Signs of Measles After Being Exposed?

It takes an average of 7-14 days from exposure to the first symptom, which is usually fever. The measles rash appears approximately 14 days after exposure, usually 2–3 days after the fever begins.

What Should Be Done If Someone Is Exposed to Measles?

Notification of the exposure should be communicated to a doctor. If the person exposed has not been vaccinated, measles vaccine may prevent disease if given within 72 hours of exposure. Immune globulin (a blood product containing antibodies to the measles virus) may prevent or lessen the severity of measles if given within six days of exposure.

How Can Measles Be Prevented?

There is a vaccine available to prevent measles. Vaccines are available from your medical provider or the San Bernardino County Department of Public Health clinics. View the Public Health’s Clinic Locations webpage for information about clinic locations and times or call the Communicable Disease Section at 1 (800) 722-4794, Monday through Friday, from 8 a.m. to 5 p.m. to find a location near you. For more information, view the Centers of Disease Control Measles information webpage.

Hepatitis A – Related Resources

Hepatitis A – Guidelines for Disinfection

Hepatitis A – February 6, 2020 Outbreak News Release 

Health Advisory – Hepatitis A Prevention and Recommendations

Centers for Disease Control (CDC) on Hepatitis A

California Department of Public Health – CDPH

Zika-related Resources

SBCDPH News Release on the Zika Virus 2016

Zika Information – California Department of Public Health (CDPH)

Non-native Mosquito Species – California Department of Public Health (CDPH)

Centers for Disease Control (CDC) on Zika

Mosquitos and Vector Control Program – San Bernardino County Department of Public Health (SBCDPH)

Centers for Disease Control – For Healthcare Providers

Pertussis-related Resources

Pertussis – California Department of Public Health

Pertussis – Centers for Disease Control and Prevention

How Pertussis Spreads

Whooping cough (pertussis) is most contagious before the coughing starts. People with pertussis can spread the disease by coughing or sneezing while in close contact with others, who then breathe in the pertussis bacteria. Many babies are infected by parents, older siblings, or other caregivers who might not even know they have the disease.

Pertussis In California

There were 4,705 cases of pertussis with onset in 2015 reported to the California Department of Public Health, for a rate of 12.3 cases per 100,000 population. This includes 271 hospitalizations; 70 (26%) of these required intensive care. Of those hospitalized, 179 (66%) were infants younger than four months of age. Of those with pertussis onset in 2015, there were two deaths: one was a baby that was less than three weeks of age at the time of disease onset, and the other was an elderly woman with underlying health problems. (CDPH Pertussis Report dated June 27, 2016.)

Public Health Clinics in San Bernardino County

Pertussis vaccine is available at County Public Health Clinics. To make an appointment call 1 (800) 722-4777.

Mumps

What Is Mumps?

Mumps is a contagious disease caused by a virus. The virus that causes Mumps primarily affects the parotid glands — one of three pairs of saliva-producing (salivary) glands, situated below and in front of your ears. Mumps is easily spread by airborne droplets from the upper respiratory tract.

What Are the Symptoms?

Mumps is best known for the puffy cheeks and swollen jaws that it causes. This is a result of swollen salivary glands. The most common symptoms include:

• Fever
• Headache
• Muscle aches
• Tiredness
• Loss of Appetite
• Swollen and tender salivary glands under the ears on one or both sides (parotitis)

Symptoms typically appear 16-18 days after infection, but this period can range from 12-25 days after infection. Some people who get mumps have very mild or no symptoms, and often they do not know they have the disease. Most people with mumps recover completely in a few weeks.

How Do I Prevent Getting Mumps?

Mumps can be prevented with MMR vaccine. This protects against three diseases: measles, mumps, and rubella. CDC recommends children get two doses of MMR vaccine, starting with the first dose at 12 through 15 months of age, and the second dose at 4 through 6 years of age. Teens and adults, who do not have evidence of immunity, should also be up-to-date on their MMR vaccination.

Children may also get MMRV vaccine, which protects against measles, mumps, rubella, and varicella (chickenpox). This vaccine is only licensed for use in children who are 12 months through 12 years of age.

Mumps on College Campuses

Mumps – CDC
Mumps – CDPH

Three common STDs- chlamydia, gonorrhea, and syphilis have reached a new, all-time high in the United States, according to the Centers for Disease Control and Prevention. San Bernardino County is no exception.  In 2018, there were 13,379 reported cases of chlamydia, 3,904 gonorrhea cases, and 1,536 total syphilis cases.   

Among 2018 total STD cases, as many as 12% of females were reported pregnant. One of the most common STD that is incredibly harmful to infants and preventable is congenital syphilis. In San Bernardino County congenital syphilis has increased a staggering 675% since 2014. In 2018 alone, there were 31 cases of congenital syphilis reported. San Bernardino County is dedicated to reducing the number of babies born with syphilis by increasing provider awareness of congenital syphilis and rising rates of syphilis in women. The Syphilis in Women Action Toolkit includes clinical resources for healthcare providers and educational materials for their patients.  

All STDs can have serious complications including chronic illness, infertility, hospitalization, and death. San Bernardino County aims to prevent these complications by educating County residents and targeting impacted groups, including racial and ethnic minority populations, adolescent and young adults, females of childbearing age, and gay and bisexual men. 

By partnering with schools, medical providers, and other community organizations, the San Bernardino County Department of Public Health works to ensure access to screening, treatment, education, and medical provider training in an effort to reduce STD infections.