Sunday, December 17, 2017

OCMA Blog

OC In+Care Newsletter - Issue 6


In this issue of the In+Care newsletter, we are going to discuss the Medi-Cal renewal process and some key things that may help your client(s) with their Medi-Cal redetermination packet. In Orange County, Medi-Cal is also called CalOptima.

What is Medi-Cal redetermination?

Medi-Cal recipients must have their eligibility assessed and verified every 12 months1. This process is to make sure clients are still eligible to receive Medi-Cal benefits. This process is different from Ryan White eligibility screening. If someone is receiving Ryan White services, they must continue to be screened for Ryan White eligibility every 6 months.

What will happen and what must be done?

Beginning in 2015, Medi-Cal will do a prescreening of recipients’ files to see if they are still eligible to receive services under Medi-Cal1. Clients may have received a Request for Tax Household Information (RFTHI) that must be completed for Medi-Cal to gain access to income information. If the information show that the individual is still eligible to receive Medi-Cal, their eligibility will automatically renew. Clients will receive a letter that states they are renewed for another year1. This means that they will not need to submit any information to continue being eligible for Medi-Cal.

However, if current or updated information is needed, a redetermination packet will be sent to the client asking for specific documents. Information needed is on a case-by-case basis1.

My client does not have a stable address, how can they complete the redetermination process?

Clients can call (800) 281-9799 or visit any Social Services Agency office (listed at the end of the newsletter) to complete the process.

My client received a redetermination packet, what are they supposed to do with it?

If the client receives a redetermination packet, provide all the required information before the due date indicated in the packet.

My client does not have a stable address or the address on file is wrong; what should they do?

Individuals can call (800) 281-9799 to see if they need to complete the redetermination process. If so, they can go to a Medi-Cal office (locations listed at the end of the newsletter) and find out what you need to do to get or keep coverage. If they need to update their address, they can call (800) 281-9799.

If my client has questions about the requested information who should they contact?

If there are questions, clients can contact their Medi-Cal worker or the contact person indicated in the redetermination packet.

Clients can also contact (800) 281-9799 for general Medi-Cal coverage questions.

When do clients have to return the completed redetermination packet?

The redetermination packet should have the due date when and all of the requested information must be provided. Make sure you do this as soon as possible before the due date.

What if clients do not submit their documents on time?

Medi-Cal benefits will be stopped. Clients will receive a Notice of Action that explains why their benefits have been stopped1.

The Notice of Action will also state that they have 90 days from the date of the Notice of Action, also called a “cure period”, to provide requested information2.

If the client provides the requested information within the 90 days after the notice, their benefits may be reinstated and there should be no break in Medi-Cal coverage. However, there may be delays in benefit claims if they are reinstated during the 90 day period.

If clients do not provide the information or the information submitted is not acceptable, their benefits will be stopped and they will have to reapply for Medi-Cal.

Can my client get ADAP for their medications if they are in the 90-day “cure” period?

No. Currently, ADAP guidelines states that clients cannot receive ADAP during the 90-day period. If clients receive a denial letter from Medi-Cal, they can apply to receive ADAP services with a Ryan White eligibility worker.

Can my client get Ryan White medical care if they are in the 90-day “cure” period?

No. Ryan White services are provided as payer of last resort. In order to receive Ryan White medical care a denial letter from Medi-Cal would be needed.

Should my client apply for Ryan White if they have Medi-Cal?

Yes. Ryan White covers services that are not covered by Medi-Cal (for example, food pantry, housing services, or legal services). Ryan White covers services that are partially covered by Medi-Cal (for example dental care). It is important to be screened for Ryan White eligibility to ensure they can access all the services they need and are eligible to receive.

Reminders:

  • Call (800) 281-9799 for Medi-Cal questions.
  • Clients should check and open your mail!
  • If clients change their address, they should let their Medi-Cal worker know.
  • If clients received a redetermination packet, they should provide the requested information as soon as possible to prevent a loss in coverage.
  • Clients can use https://www.mybenefitscalwin.org/ to help manage their Medi-Cal account online!

1 Department of Health Care Services. (2014, September 19). Medi-Cal Annual Redetermination Process for MAGI Beneficiaries (Reference ACWDL 14-18) Letter No. 14-32.

2 Department of Health Care Services. (2014, December 10). Medi-Cal Eligibility Division Information Letter No.: I14-60. Medi-Cal Renewal Process-The 90-Day Cure Period Job Aid.

 

Medi-Cal Locations
Hours of Operation: 7am-5pm, Monday-Friday

(800) 281-9799

Anaheim Regional Center
3320 E. La Palma Ave.
Anaheim, CA 92806


Garden Grove RegionalCenter
12912 Brookhurst St.
Garden Grove, CA 92840

Aliso Viejo RegionalCenter
115 Columbia
Aliso Viejo, CA 92656

Santa Ana Regional Center
1928 S. Grand Ave., BLDG. B
Santa Ana, CA 92705

 


OC In+Care Newsletter-Issue 5

Newsletter for providers serving people living with HIV/AIDS in Orange County

In the last issue of the In+Care newsletter, we discussed the importance of engaging clients in medical care. In this issue, we will talk about the Continuum of Care, also known as the Treatment Cascade, and how you can help your patients/clients understand the importance of HIV viral load suppression.

The Continuum of Care explains the following stages of HIV care:

  • HIV Infected the total number of people who are estimated to be HIV positive.
  • HIV Diagnosed is the total number of people who have been diagnosed with HIV disease.
  • In HIV Care is the total number of people who see their doctor regularly (at least once every 6 months).
  • Undetectable HIV Viral Load is a HIV viral load count below 200 copies/mL in the blood.stages of HIV care:

According to the Centers for Disease Control and Prevention (CDC), an estimated 14% (or about one in seven) of all people living with HIV disease (PLWHD) in the United States (US) do not know they are positive. Furthermore, about half (52%) of all PLWHD are in HIV care and only 40% of all are virally suppressed in the US.

In Orange County, an estimated 6,698 individuals were living with HIV as of 2014. Of that, 67% (4,492 of 6,698) were linked to a HIV primary care provider and 58% (3,912 of 6,698) had an undetectable HIV viral load. In comparison to national and California data, Orange County fairs better in all stages of the cascade.d count below 200 copies/mL in the blood.stages of HIV care:

Orange County goal for PLWHD by the end of 2015 are:

  • 85% will be in HIV care 
  • 67% with undetectable HIV viral load

Viral load suppression is the key to staying healthy. If your patients/clients have been prescribed antiretroviral therapy, help remind them the importance of taking their HIV medication as prescribed.

According to the CDC, those who are currently on HIV medication will live more than twice as long as individuals who are not on HIV medication.1 Furthermore, suppressed viral load reduces the risk of transmitting the virus to others. A suppressed viral load may also slow the progression towards AIDS.2

In late 2014, Orange County implemented a campaign to remind PLWHD of the importance of seeing their doctor regularly. Due to the implementation of the Affordable Care Act (ACA), nearly 700 PLWHD have transitioned from Ryan White-funded medical care to public and private insurance. This transition has significantly changed how PLWHD access medical care. As a service provider, it is important to support and facilitate continued medical care access and adherence. The following are simple tips to promote medical care adherence:

If you are a medical provider, ask your patients...

  • What Questions do you have about your health?
  • Do you understand your numbers (viral load, CD4, etc.)?

As a provider, you can also...

  • Do reminder calls before visits
  • Follow up on missed visits
  • Coordinate care/adherence with the patient's Ryan White case manager, when appropriate

If you are a support service provider, ask your clients... 

  • When did you last see your HIV doctor?
  • Do you know your numbers (HIV viral load and CD4)?
  • Is your next appointment with your HIV doctor within 6 months?
  • Do you have any questions for your doctor?

The HIV Planning and Coordination website has resources for persons living with HIV. The website can be accessed via the link below:
http://ochealthinfo.com/phs/about/dcepi/hiv/libehiv

1 Centers for Disease Control and Prevention, Vital Signs, November 2014
2 http://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-arv-guidelines/458/plasma-hiv-1-rna--viral-load--and-cd4-count-monitoring

Our+Care OC is a project of the Orange County HIV Quality Management Committee. The HIV Quality Management Committee works to increase the quality of Ryan White services. For more information about the committee, please call (714) 834-8063. If you have feedback or suggestions for future newsletters, please contact Mindy He at MHe@ochca.com.

Tamarra Jones, DrPH

Program Manager

HIV Planning and Coordination

Orange County Health Care Agency 

 


Measles Outbreak Update February 2015

Measles Outbreak Update
February 17, 2015


Measles cases have continued to occur in Orange County with 35 cases confirmed this year. In California, as of February 13, 2015, 113 cases have been confirmed since December 2014; 20% of those with known hospitalization status have been hospitalized. Of those with known vaccination status, the majority are unvaccinated, with most of these because of personal belief exemptions.

Orange County Cases
Of the 35 Orange County cases, 14 are children, 13 of whom were not vaccinated.
Thirteen of our cases spent time at the Disneyland Parks since mid-December, 2014. Sixteen cases had no known source, signaling ongoing transmission in the community. The most recent cases were contacts to previously known cases.

Vaccination is Key to Prevention
Although some of the confirmed cases occurred in people with a history of vaccination, their illness is generally milder and typically not as infectious. Vaccination is critical to prevent the ongoing spread of disease.

  • Although the overall risk of getting measles in Orange County remains low, residents who have not received any measles-containing vaccine and do not have any other evidence of immunity should get a dose of MMR vaccine.
  • Two doses of measles-containing vaccine (MMR vaccine) are more than 99% effective in preventing measles. The first dose is routinely given at 12-15 months of age, with the second dose usually at age 4-6 years. The second dose may be given any time ≥28 days after the first dose.
  • All healthcare workers (HCW), including those born before 1957, should have two documented doses of MMR or serologic evidence of measles immunity. HCW who are exposed to a case of measles may be excluded from work until they provide evidence of immunity.
  • If exposed to measles, all, children and school/child care staff without documented immunity will be removed from work/school/child care from day 7 after the first exposure to day 21 after the last exposure.

Report any suspect case of measles to the Orange County Health Care Agency immediately at 714-834-8180 (714-628-7008 after hours).

For more information on measles, see www.ochealthinfo.com/measles. Information on vaccination recommendations by age group is available in the previous advisory dated 1/26/2015 and guidance on clinical presentation, infection control, reporting, and testing is in the 1/21/2015 advisory.

click here to download this measles outbreak update.


Measles Outbreak Update

Measles has now been confirmed in 22 Orange County (OC) residents, signaling ongoing transmission in the community and at the Disneyland Parks. Thirteen of these cases spent time at the Disneyland Parks since mid-December, 2014. In California, as of today, 59 cases of measles have been confirmed since the end of December; 42 of these had an exposure in December at Disneyland or California Adventure Park. Additional cases have been identified that were at the park while infectious in January, including within the last week. Nine of the OC cases have no Disney or other known measles exposure. Additional cases are expected in Orange County.
 

Of the 22 Orange County cases, five are children, of whom four were not vaccinated and two were hospitalized. Although some of the confirmed cases occurred in people with a history of vaccination, their illness is generally milder and typically not as infectious. Vaccination is critical to prevent the ongoing spread of disease.

  • Although the overall risk of getting measles in Orange County remains low, residents who have not received any measles-containing vaccine should get a dose of MMR vaccine.
  • Two doses of measles-containing vaccine (MMR vaccine) are more than 99% effective in preventing measles. The first dose is routinely given at 12-15 months of age, with the second dose usually at age 4-6 years. The second dose may be given any time ≥28 days after the first dose.
  • All healthcare workers (HCW) should have two documented doses of MMR or serologic evidence of measles immunity. HCW who are exposed to a case of measles may be excluded from work until they provide evidence of immunity.
  • If exposed to measles, all, children and school/child care staff without documented immunity will be removed from work/school/child care from day 7 after the first exposure to day 21 after the last exposure.

Measles is highly contagious and people can be exposed by just being in the same room as a measles case during their infectious period (4 days before onset of rash until 4 days after). Several of the cases have potentially exposed patients in healthcare facilities, resulting in large contact investigations and persons needing immune globulin administration, post-exposure vaccination, or serologic testing for immunity.

  • Any patient suspected of having measles should be masked immediately and promptly moved to a negative pressure room when available. Providers seeing patients in an office or clinic setting should consider options such as arranging to see suspect measles cases after all other patients have left the office, or assessing patients outside of the building to avoid having a potentially infectious patient enter the office.
  • Notify Orange County Public Health Epidemiology immediately at 714-834-8180 (or 714-628-7008 after hours) about any suspect cases. Do not wait for laboratory confirmation before reporting a suspect case. Do NOT refer patients to Public Health without first discussing with one of our staff.
  • DO NOT send potentially infectious suspect measles patients to a reference laboratory for specimen collection.

For more information on measles, see www.ochealthinfo.com/measles.


Updated Ebola Guidance from the OC Health Care Agency

The Ebola epidemic of West Africa has led to 13268 cases as of November 7, with 8168 confirmed cases and 4960 deaths. The epidemic seems likely to continue for at least the next several months. There still have been no suspect Ebola cases in Orange County.

To date, there have been no confirmed Ebola cases in California.
 The Orange County Health Care Agency will be monitoring persons returning from countries with widespread Ebola virus transmission (currently Liberia, Guinea, and Sierra Leone) or who have had contact with a confirmed Ebola case within the previous 21 days.  The risk of Ebola in the U.S. remains low, and the risk of a symptomatic (infectious) patient that we are not following presenting unannounced for health care is even lower, but something we all continue to prepare for.  The following recently released documents may be of assistance to you in your preparations:

1)      Algorithm for Ambulatory Care Evaluation of Patients with Possible Ebola Virus Disease – CDC document, modified by OCHCA with Orange County contact information (attached)

2)      Algorithm for Emergency Department Evaluation and Management of Patients with Possible Ebola Virus Disease:  http://www.cdc.gov/vhf/ebola/pdf/ed-algorithm-management-patients-possible-ebola.pdf 

3)      Web-based training- Guidance for Donning and Doffing PPE during Management of Patients with Ebola in US Hospitals:  http://www.cdc.gov/vhf/ebola/hcp/ppe-training/index.html 

Traveler Assessment
Travelers coming from a country experiencing widespread Ebola disease will be assessed upon arrival to one of five airports in the United States. Information about the traveler will be passed on to local public health departments. The Orange County Health Care Agency will monitor any such travelers in our county daily to assess for symptoms. A hospital will be pre-designated for each of these travelers, based on factors such as a patient’s insurance type and proximity to a facility. That facility will be contacted ahead of time, to assure that the patient receives prompt care if needed. However, it is not certain that this system will identify all travelers from the affected areas, so area hospitals need to be prepared in the event that a suspect case arrives at their facility without prior warning.

Healthcare providers should assess all patients for a history of travel to countries experiencing widespread Ebola disease, which includes Guinea, Sierra Leone, and Liberia at this point. Providers should report any suspect Ebola cases to the Orange County Health Care Agency immediately at 714-834-8180 during regular hours, or 714-628-7008 after hours.

All Orange County hospitals need to prepare to isolate and evaluate a potential Ebola patient.

There is no designated Ebola hospital in Orange County. University of California-Irvine Medical Center has indicated that it will accept one confirmed Ebola case. However, suspect cases identified at a different hospital will need to be cared for at that facility until the case is confirmed, which may take from 24-72 hours. For suspect cases that present to an outpatient clinical setting not associated with a hospital, Orange County Public Health will facilitate transfer of the patient to the closest appropriate facility.

Orange County Health Care Agency can assist with testing a patient for possible Ebola disease.

The test of choice for Ebola is serum PCR. Tests can be falsely negative if performed in the first three days of illness. Patients who test serum PCR negative but have a clinical and exposure history consistent with Ebola may need repeat testing performed. This test is currently performed at selected public health laboratories.

For more information, see http://ochealthinfo.com/phs/about/dcepi/epi/disease/ebola . For healthcare worker recommendations, see www.cdc.gov/vhf/ebola/hcp/index.html. A hospital checklist for Ebola preparedness can be found at www.cdc.gov/vhf/ebola/pdf/hospital-checklist-ebola-preparedness.pdf.

Please let us know if you have any questions.

If you have any comments or questions or would like to be added to the distribution list, please email us at epi@ochca.com 

HCA/Epidemiology & Assessment
1719 W. 17th St., Bldg. C/79
Santa Ana, CA 92706
(P) 714-834-8180
(F) 714-834-8196


Ebola Resources from the OC Health Care Agency

The first case of Ebola Virus Disease (EVD) diagnosed in the United States was confirmed on September 30, 2014 in Dallas, Texas. However, the risk of an Ebola outbreak in the United States remains low. Health care providers should remember to obtain a travel history for any patients with febrile illness, and be familiar with Ebola's clinical presentation and infection control requirements.  Any suspect cases meeting the clinical and epidemiologic criteria for EVD should be reported immediately to Orange County Public Health Epidemiology at 714-834-8180. 


For more information, see www.ochealthinfo.com/ebola

For specific health care-related guidance including infection prevention and environmental infection control precautions, see www.cdc.gov/vhf/ebola/hcp/index.html

To receive alerts, updates and newsletters on communicable disease issues affecting Orange County, email epi@ochca.com.


OC In+Care Newsletter

Beginning in August 2014, the Orange County Health Care Agency (OCHCA) will be taking a closer look at the medical visit frequency of PLWHD in Orange County. OCHCA is interested in increasing the percentage of HIV-positive clients who are maintained in continuous medical care. It is important for patients to stay in continuous care and see their doctor(s) regularly because it may lead to suppressed viral loads and ultimately overall better health outcomes2. In April 2014, the HIV/AIDS Bureau (HAB) published quality management performance measures and recommended that all individuals living with HIV disease should see their medical provider at least once every six months.

Orange County has a goal to increase the percent of PLWHD who are in continuous HIV medical care. Currently 83% of HIV-positive clients in Ryan White–funded medical care are seeing their doctor regularly. Only 60% of all HIV-positive clients in Orange County are maintained in continuous care3. With the implementation of the Affordable Care Act, more clients will access medical care outside the Ryan White system; therefore, the goal is to increase the percentage of HIV-positive clients in continuous medical care for Orange County to 72% by the end of 2015.

The following table provides an overview of the percent in continuous care compared to the 2015 goal.

In Medical Care  Ryan White  All OC 
2010  79%  N/A
2013  83%  60%
2015 (goal)  84%  72%

Orange County-Wide Quality Improvement Goal

Maintenance in medical care is the primary goal of the Ryan White program and all services provided should help ensure HIV medical care adherence. In order to meet the 2015 goal for Orange County, all service providers should ask their clients “When was the last time you saw your doctor?” and “When is your next doctor’s appointment?” Whether you are a mental health provider, or a case manager, food bank provider, or other service provider, you should be asking your clients about their medical care and help them make it to their medical appointments, as appropriate. This quality improvement activity intends to engage patients in HIV medical care from all points of access.

Providers are also encouraged to create their own quality improvement activities to increase retention in care. For example, medical providers can try different reminder alerts to remind clients of their appointment. Case managers may use a strength-based approach to assist clients in attending their next medical appointment.

It is very important to have a good relationship between case managers and doctors. A good relationship allows for better coordination of care between providers. A client’s case manager and medical provider should be communicating about the client’s care on a regular basis.

From PLWHD
Each client is unique and has different needs and different views of what they would like to see from their doctor. See “My Doctor is the Best Because” box for some of the things clients look for in a medical provider.

How to engage PLWHD
  • Ask them if there are any barriers to attending medical appointments. Link them to support services, if applicable.
  • Acknowledge their personal strengths and help them apply it to their treatment plan.
  • Show that you care about their general well-being.
  • Listen to their concerns and respond to their questions.
  • Encourage clients to ask questions.
  • Create a quality improvement activity to retain clients in care.
  • Use posters, brochures, reminder cards to help clients remember to attend their medical appointment.
  • Explain how important it is to attend medical visits even if they are feeling healthy so they can monitor changes in their health, get their medications and review their CD4 and Viral Load.

OC In+Care is a project of the Orange County HIV Quality Management Committee. The HIV Quality Management Committee works to increase the quality of Ryan White services. For more information about the committee, please call (714) 834-8063. If you have feedback or topic suggestions for future newsletters, please contact Mindy He at Mhe@ochca.com.


OC Health Care Agency Mumps Advisory

Mumps Advisory

September 12, 2014

An adult male living in Anaheim has been diagnosed with mumps. The case has no recent history of international travel or exposure to a known case of mumps. Orange County has 0-3 cases of mumps reported each year, and a mumps case occurring without a history of travel or known contact to a mumps case is unusual.

Providers should consider the diagnosis of mumps in patients with an appropriate clinical presentation, particularly in those with a history of international travel. Providers should notify Orange County Public Health Epidemiology at 714-834-8180 with any suspect cases. The incubation period is usually 16 to 18 days, but cases may occur 12 to 25 days after exposure. Prodromal symptoms are nonspecific and may include myalgia, anorexia, malaise, headache and low-grade fever. The most common manifestation is unilateral or bilateral swelling of one or more of the salivary glands, usually the parotid glands (parotitis). Parotitis tends to occur within the first 2 days and may be first noted as earache and tenderness on palpation of the angle of the jaw. Symptoms tend to decrease after 1 week and usually resolve after 10 days.

Complications include orchitis (testicular swelling), which may occur in as many as 50% of postpubertal males. 10% have symptoms of aseptic meningitis. Treatment is supportive care.

Laboratory Testing
Testing for the mumps virus can be performed by sending serum for mumps IgM and IgG and buccal swab specimens for mumps polymerase chain reaction (PCR) and virus culture to Orange County Public Health Laboratory. Mumps IgM response may be absent or short lived in immunized patients. Orange County Public Health can help coordinate testing of patients.

Infection Control
Mumps virus is transmitted by exposure to respiratory secretions or droplets of infected persons, and is generally transmitted via face-to-face contact. Communicability is probably highest from 2 days before to 5 days after onset of parotitis; the virus has been isolated in saliva from 7 days before through 9 days after onset of swelling. Suspect cases should be cared for using standard and droplet precautions.

Vaccination
Mumps vaccine is given as part of measles, mumps and rubella (MMR) vaccine. All children are recommended to receive a first dose of MMR at 12-15 months and a second dose at 4-6 years of age. Post-licensure data estimate the effectiveness of one dose of mumps vaccine at approximately 80% and two doses at 90%. Health care providers can be presumed to be immune with any of the following evidence: documented administration of 2 doses of MMR vaccine, birth before 1957, positive serum mumps IgM, or laboratory confirmed disease.

See http://ochealthinfo.com/phs/about/dcepi/epi/disease/mumps or www.cdc.gov/mumps/prev-control-settings/index.html for further information.


Communicable Disease News: Pertussis Epidemic in OC & Ebola Virus Update

Update on California's Pertussis Epidemic

Pertussis activity continues at epidemic levels in Orange County and statewide.
As of 8/16/2014, 250 pertussis cases have been reported in Orange County, compared with 43 cases at this time last year. Pertussis peaks in incidence every 3-5 years as the number of susceptible people in the population increases; the last epidemic in California was in 2010.

Infants under 12 months of age are at highest risk for severe infection and death. To protect this vulnerable population the following is recommended:

  • Immunize pregnant women with Tdap during every pregnancy at 27-36 weeks gestation. This dose protects mom and provides the infant with high levels of protective transplacental antibodies.
  • Encourage close contacts of infants to be up-to-date with their pertussis vaccine (cocooning).
  • Vaccinate infants and children with DTaP followed by Tdap according to the childhood immunization schedule: http://www.cdc.gov/vaccines/vpdvac/pertussis/recssummary.htm

Diagnostic Testing: Suspect pertussis cases should be tested by nasopharyngeal PCR. PCR is most sensitive within 3 weeks of the onset of the cough (up to 6 weeks for infants). Consider obtaining a CBC: a WBC count that is ≥ 20,000/mm3 with ≥ 10,000 lymphocytes/mm3 in a young infant with a cough illness is strongly suggestive of pertussis infection.

Management of Cases:

  • Treatment: Antimicrobial treatment should begin as soon as possible after diagnosis, particularly in infants. Treatment may lessen symptoms if begun early during illness and will shorten the period of infectivity.
  • Prophylaxis: The CDC and AAP recommend post-exposure prophylaxis for all close contacts of a pertussis case. However, during widespread community outbreaks, OCHCA will focus its efforts on postexposure prophylaxis for high-risk contacts, including infants under 1 year of age, pregnant women, and their contacts.
  • Infection control: Health care workers should use standard and droplet precautions, including a surgical or procedure mask and eye protection when evaluating suspect pertussis patients. Droplet precautions should be maintained until 5 days after the patient is placed on effective therapy, or if no treatment until 21 days after cough onset.
  • Management of cases in school settings: Cases should be excluded from childcare settings until completion of 5 days of antibiotic treatment, from K-12 grade schools until completion of 3 days of antibiotics, and for 21 days if no antibiotic treatment.

Resources:

General pertussis info for clinicians: http://www.cdc.gov/pertussis/
Tdap for pregnant women: http://www.cdc.gov/vaccines/vpd-vac/pertussis/tdap-pregnancy-hcp.htm

Click here for full Pertussis Newsletter.


Ebola Outbreak In West Africa

West Africa has been experiencing a large outbreak of Ebola Virus Disease (EVD) since December of 2013. As of August 15, 2,127 confirmed or suspect cases of disease including 1,145 suspected case deaths have been reported in Guinea, Liberia, Sierra Leone and Nigeria. It was reported last night (August 19) that Kaiser Permanente in Sacramento is testing a patient for suspected Ebloa Virus, aside from that, two United States citizens were transported to Emory University for further care after contracting the disease while caring for patients with EVD in Liberia. Though the risk of Ebola to the United States or Orange County is small, the potential exists for imported disease in persons traveling from countries where EVD is active. Medical providers should keep up to date on this outbreak and know which patients merit evaluation for EVD.

Providers should contact Orange County Public Health at 714-834-8180 (714-628-7008 after hours) immediately upon identifying any patient with potential EVD. Orange County Public Health can assist with assessment and testing of any case meeting the CDC-defined criteria for a Person Under Investigation, which includes:

1. Clinical criteria:

a. Fever of greater than 38.6 degrees Celsius or 101.5 degrees Fahrenheit, and
b. Additional symptoms such as severe headache, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained hemorrhage

AND

2. Epidemiologic risk factors within the past 21 days before the onset of symptoms, such as:

a. Contact with blood or other body fluids or human remains of a patient known to have or suspected to have EVD or
b. Residence in-or travel to-an area where EVD transmission is active* or
c. Direct handling of bats, rodents, or primates from disease-endemic areas.

Persons who have had direct contact with Ebola cases through healthcare work or social exposure in West Africa are at particularly high risk for developing disease. For further description of risk factors and clinical recommendations to prepare for or manage Ebola, see www.cdc.gov/vhf/ebola/hcp/index.html.

*As of August 15, countries where EVD is active include Guinea, Liberia, Sierra Leone and Nigeria.

Infection Prevention and Control
Standard, contact and droplet precautions are indicated for suspected EVD. Personal protective equipment (PPE) should include gloves, gown, eye protection (goggles or face shield) and facemask. Additional PPE is necessary if copious blood or other fluid is present in the environment, including double gloving, disposable shoe covering, and leg covering. PPE should be discarded on leaving room taking care to avoid contamination when removing.

Laboratory Testing
The diagnostic test of choice for EVD is PCR testing of the blood. The virus is generally PCR-detectable from 3-10 days post-onset of symptoms. If the onset of symptoms is less than 3 days prior to specimen collection, a subsequent specimen will be required to completely rule out EVD. Testing is available through the CDC. Orange County Public Health can assist with assuring appropriate transport of specimens.

For updated information on the outbreak, including countries where EVD is active, go to: www.cdc.gov/vhf/ebola/outbreaks/guinea/index.html.

Contact Orange County Public Health at 714-834-8180 with any questions.


The County of Orange, Health Care Agency is seeking an experienced Public Health Medical Officer I

Program Emphasis:

The Public Health Medical Officer I provides culturally sensitive, medically indicated care (and supervision of clinical services provided by Family Health nurse practitioners), including clinical assessments, physical exams, diagnostic and medical management, and coordination of case management. The Public Health Medical Officer I also supports on-site program activities in other co-located ambulatory care clinics.

LOCATION:

Santa Ana - 1725 W. 17th St., Santa Ana, CA 92706 

The Opportunity:

The County of Orange, HEALTH CARE AGENCY is seeking an experienced Public Health Medical Officer I who can utilize their education and skills to:

  • Examine, diagnose and treat pediatric patients for both acute care and periodic health screenings (CHDP) seen in our Family Health Clinics (Child Health, Immunizations)
  • (In the case of a family medicine physician) provide in the Family Planning Clinic individual reproductive health education and counseling; initiation and management of all FDA-approved methods of contraception, including emergency contraception; clinical and preventive services to maintain reproductive health
  • Prescribe medications to suitable patients; initiate and/or continue medical regimes for new patients; chart treatment records and monitor results; provide medical patient consultations/referrals to other physicians in the community
  • Provide clinical supervision and consultations to nurse practitioners in Child Health (Pediatric or Family Medicine Physicians) and Family Planning (Family Medicine Physicians only)
  • Consult with other program clinical staff regarding care of patients and treatment given
  • Conduct nurse practitioner peer reviews, patient care-coordination and case management
  • Develop, review and update clinical policies and procedures, clinical practice guidelines, developmental screenings
  • Provide clinical oversight of travel immunization clinic, provide consults (including malaria) for travelers; monitor travel and/or health-related advisories
  • Present in-service education and trainings to clinic staff (including new and updated policies and procedures, vaccines)
  • Stay current with care and treatment guidelines; ensure compliance with requirements from Childhood Prevention and Disability Program (CHDP), Family Planning (FPACT), Vaccines for Children (VFC) Program
  • Review billing records for accuracy and appropriate documentation.
  • Participate in staff meetings, problem solving groups, and continuing education programs sponsored by the clinic or other designated agencies.
  • Identify client's medical or psychosocial issues that fall outside the scope of Family Health and refer such cases to appropriate resources for treatment with follow-up.
  • Participate in quality improvement activities, review charts for compliance with established standards, policies, and procedures.

MINIMUM QUALIFICATIONS:


License Required:
  • Possession of a valid Physician's and Surgeon's Certificate issued by the Board of Medical Examiners of the State of California.
Education:
  • Possession of a masters degree in public health from an accredited school of public health (one year of experience as a Medical Officer in a public health agency with a generalized program may be substituted for the masters degree).

 

For more information and to apply, click here.


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