Monterey County Health Officials Remind Residents to Protect Themselves from Mosquitoes

April 21 to 27 is California’s West Nile Virus and Vector Control Awareness Week, as declared by resolution of the State Assembly. Monterey County is experiencing rapidly warming and lengthening days. The light spring rains were just enough to leave standing water in gutters and low places. Stagnant rainwater water left in buckets, birdbaths, and tires is warmed by the sun and becomes a breeding ground for mosquitoes.

Mosquitoes are not only a nuisance but also a public health threat. In California during 2012, there were 479 human cases of West Nile virus, including 19 fatalities. Nationally, there were more West Nile virus infections reported in 2012 than there had been since 2003. Mosquitos also carry other diseases. “Warm weather promotes the breeding of mosquitoes that carry West Nile virus,” Monterey County Interim Health Officer Dr. Caroline Kennedy said. “While no predictions can be made about the severity of West Nile virus this season, Monterey County residents should take precautions now to protect themselves from mosquito bites.”

This time of year, mosquitoes breed anywhere and everywhere – in water held by tarps, boat bilges, clogged roof gutters and unmaintained pools, spas and fishponds, as well as ditches, marshes and other natural sites. Ken Klemme, Biologist and Manager of the Northern Salinas Valley Mosquito Abatement District, is focusing on early prevention strategies. "We're anticipating lots of mosquitoes in the sloughs, lakes and coastal marshes, and we are controlling them in the larval stage already. With the combination of the warm weather and all the water in yard containers, we really need the public to do their part and empty any water that might be around their property.” The mosquitoes that hatch now will be the ones that lay eggs and start the cycle going. It is important to diminish the number of mosquitos now to reduce the chance of an infestation later this summer. The district’s main objective is to minimize the disease risk and nuisance to the public created by mosquitoes.

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Health Update: Novel Avian Influenza A(H7N9) Virus - April 25, 2013

Health Update

April 25, 2013                                                                                                                              PDF Version

Novel Avian Influenza A (H7N9) Virus

Health officials urge enhanced surveillance among travelers returning China.

Current Situation

On April 1, 2013, the World Health Organization (WHO) reported the first known human infections with a novel avian influenza A (H7N9) virus in China. As of April 22, 2013, there have been 108 reported cases of A (H7N9) influenza in China, including 22 fatalities. New cases continue to be reported and case counts are likely to increase. Updates are available at: http://www.who.int/csr/don/en/.

It is likely that travel-associated cases outside of China will be reported in the near future. However, influenza A (H7N9) influenza has not yet been detected in people or birds in the United States. Investigations into the possible sources of infection and reservoirs of the virus are ongoing.

Most reported cases had severe respiratory illness, although some mild illness is now being reported. The median age of affected individuals to date is >60 years. While there have been some reports of clusters with the same household, there is currently no evidence of sustained person-to-person transmission. Because this virus is not related to any previously circulating viruses, there is no population immunity. Early reports indicate the virus is susceptible to the antiviral medications oseltamivir and zanamivir.

Recommendations and Guidance

Who should be considered a suspect case of avian influenza A(H7N9)?

A patient with influenza-like illness* (ILI) meeting either of the following exposure criteria:

• Recent travel (within ≤ 10 days of illness onset) to China; OR
• Recent contact (within ≤ 10 days of illness onset) with a confirmed or probable case of infection with novel influenza A (H7N9) virus.

*ILI is defined as fever (temperature of 100°F [37.8°C] or greater) and cough and/or sore throat.

Cases under investigation with severe respiratory illness (including radiographically-confirmed pneumonia, acute respiratory distress syndrome (ARDS), or other severe respiratory illness) of unknown etiology may
be prioritized for diagnostic testing.

Infection control precautions for suspect, probable or confirmed cases

CDC has issued interim guidance for influenza A(H7N9) infection control precautions, which are available at: http://www.cdc.gov/flu/avianflu/h7n9-infection-control.htm

Healthcare personnel providing care for patients with confirmed or probable avian A(H7N9) infection, or cases under investigation should use Standard Precautions, including eye protection, plus Contact and Airborne
Precautions. Aerosol-generating procedures should be performed on such patients only if they are medically necessary and cannot be postponed.

These recommendations are more stringent than the infection control precautions used routinely for seasonal influenza because there is currently:

• No H7N9 vaccine
• A suspected high rate of morbidity and mortality among infected patients
• An unknown potential for person to person transmission
• An absence of confirmed or probable H7N9 cases in the United States

Many primary care clinics will not be able to implement all elements of airborne precautions, i.e., placing patient in airborne infection isolation room. However, all possible precautions should be taken to minimize the risk of
exposure to staff and patients, including the following:

• Receptionists and phone triage personnel should ask all patients with ILI if they have had travel to China within 10 days of symptom onset.
• Patients with ILI and a history of travel to China should be seen at the end of the day or when fewer people are in the clinic, if possible.
• Such patients should be given a surgical mask to wear upon entering the clinic and should be immediately placed in a room with a door that closes, and not remain in waiting areas.
• If a patient has already been evaluated for H7N9 and a respiratory specimen must be collected later, the patient may remain in their vehicle while the specimen is collected.

Testing for avian influenza A(H7N9)

Clinicians should obtain a nasopharyngeal swab or aspirate, place the swab or aspirate in viral transport medium, and contact the Monterey County Health Department Public Laboratory to arrange for testing. Do not send specimens from suspected cases to commercial laboratories.Specimens from all patients with suspected avian influenza A(H7N9) virus infection must be submitted to the Monterey County Public Health Laboratory for testing, irrespective of the on-site rapid influenza testing results and/or usual laboratory procedures for testing suspected influenza patients.

Specimens should be collected using appropriate infection control precautions. For additional guidance on diagnostic testing of patients under investigation for novel influenza A (H7N9) virus infection, please see guidance for avian influenza A(H5N1) testing, which is also applicable to H7N9, at: http://www.cdc.gov/flu/avianflu/guidance-labtesting.htm.

Treatment for suspect, probable or confirmed avian influenza A(H7N9) patients

CDC has issued interim guidance on antiviral treatment of human infections with avian influenza A (H7N9), which is available at: http://www.cdc.gov/flu/avianflu/h7n9-antiviral-treatment.htm. Because of the potential severity of illness associated with this infection, CDC recommends that all confirmed, probable, and cases under investigation, including outpatients with uncomplicated illness, be treated with neuraminidase inhibitors as early as possible. Clinicians should not wait for laboratory confirmation of influenza before initiating treatment.

Reporting suspect cases

Suspected cases of novel influenza must be immediately reported to the Monterey County Health Department (831-755-4521; after-hours 831-755-5100 and ask for the on-call Health Officer).

For additional information, see the Centers for Disease Control and Prevention’s website: http://www.cdc.gov/flu/avianflu/h7n9-virus.htm.

Annual quarantine of sport-harvested mussels begins early this year

The quarantine is in place to protect the public from shellfish poisoning

The annual quarantine of all sport-harvested mussel species along the California coast began April 22, 2013.

The annual mussel quarantine is for the prevention of paralytic shellfish poisoning (PSP) and domoic acid poisoning and is in effect as of April 22 because testing by the California Department of Public Health (CDPH) has detected elevated levels of domoic acid and high numbers of the algae that produce this toxin. Normally the quarantine runs from May 1 through October 31. This quarantine applies to all species of mussels harvested by the public anywhere on the California coast, including all bays and estuaries.

“This quarantine is in place to protect the public against poisoning that can lead to severe illness, including coma and death,” said Dr. Ron Chapman, director of the CDPH and state health officer. “It’s critical that the public honor the quarantine because the toxins found in mussels have no known antidotes and are not reliably destroyed by cooking.”

The quarantine is intended to protect the public from paralytic shellfish poisoning (PSP) and domoic acid poisoning (DAP), both are linked to microscopic plankton that are concentrated in filter-feeding animals, including bivalve shellfish-like mussels. The overwhelming majority of human cases of PSP illnesses occur between spring and fall.

PSP affects the human central nervous system, producing a tingling around the mouth and fingertips within a few minutes to a few hours after eating toxic shellfish. These symptoms are typically followed by a loss of balance, lack of muscular coordination, slurred speech and difficulty swallowing. In severe poisonings, complete muscular paralysis and death from asphyxiation can occur.

Symptoms of DAP, also known as amnesic shellfish poisoning, can occur within 30 minutes to 24 hours after eating toxic seafood. In mild cases, symptoms may include vomiting, diarrhea, abdominal cramps, headache and dizziness. These symptoms disappear completely within several days. In severe cases, the victim may experience difficulty breathing, confusion, disorientation, cardiovascular instability, seizures, permanent loss of short‑term memory, coma and death.

More information about the quarantine, PSP and DAP can be found on the Mussel Quarantine Frequently Asked Questions (FAQ) Web page.  

The quarantine normally lasts from May 1 through October 31. Commercially harvested shellfish are not included in the annual quarantine. All commercial shellfish harvesters in California are certified by the state and subject to strict requirements to ensure that all oysters, clams and mussels entering the marketplace are free of toxins.

For updated information on quarantines and shellfish toxins, call the CDPH shellfish information line at (800) 553-4133.

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More information about marine toxins can be found on the Centers for Disease Control's website