October 2026 by San Diego Physician

THE GERM ISSUE

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Official Publication of SDCMS

Latest Developments in Infectious Diseases

HE ADER HERE

Research shows:

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Contents OCTOBER

Editor: William T–C Tseng, MD, MPH Editorial Board: James Santiago Grisolia, MD; William T-C Tseng, MD; Holly B. Yang, MD, MSHPEd, HMDC, FACP, FAAHPM Marketing & Production Manager: Jennifer Rohr Art Director: Lisa Williams Copy Editor: Adam Elder

VOLUME 113, NUMBER 9

OFFICERS President: Maria T. Carriedo–Ceniceros, MD President–Elect: Karrar H. Ali, DO, MPH Immediate Past President: Preeti Mehta, MD Secretary: Rakesh R. Patel, MD, MBA, FAAFP, CPE Treasurer: Arlene J. Morales, MD GEOGRAPHIC DIRECTORS East County #1: Randall J. Young, MD, FAAEM, FACEP, MMM East County #2: Rachel Buehler Van Hollebeke, MD Hillcrest #1: Vikant Gulati, MD Hillcrest #2: Stephen R. Hayden, MD [DELEGATION CHAIR] Kearny Mesa #1: Anthony E. Magit, MD, MPH Kearny Mesa #2: Dustin H. Wailes, MD La Jolla #1: Toluwalaşé [Laşé] A. Ajayi, MD La Jolla #2: Audra Robertson Meadows, MD, MPH, FACOG La Jolla #3: Emily A. Nagler, MD North County #1: Quinn Kerr Lippmann, MD, FACOG, MPH (Board Representative to the Executive Committee)

North County #2: Theophilos [Phil] E. Yphantides, MD North County #3: Nina Chaya, MD South Bay #1: Paul J. Manos, DO South Bay #2: Latisa S. Carson, MD, FACOG AT–LARGE DIRECTORS #1: Steven L.W. Chen, MD, FACS, MBA (Board Representative to the

Executive Committee)

#2: Kelly C. Motadel, MD, MPH #3: Kyle P. Edmonds, MD #4: Jessica Thackaberry, MD #5: Daniel D. Klaristenfeld, MD, FACS #6: Alexander K. Quick, MD #7: Karl E. Steinberg, MD, FAAFP #8: Steve Sang–Hyun Koh, MD, MPH, MBA ADDITIONAL VOTING DIRECTORS Young Physician: Quinne C. Sember, MD Retired Physician: Mitsuo Tomita, MD Medical Student: Adarsh Jagadish CMA OFFICERS AND TRUSTEES Trustee: Sergio R. Flores, MD Trustee: Timothy A. Murphy, MD Trustee: William T–C Tseng, MD, MPH Trustee: Holly B. Yang, MD, MSHPEd, HMDC, FACP, FAAHPM AMA DELEGATES AND ALTERNATE DELEGATES District I: Mihir Y. Parikh, MD District I Alternate: William T–C Tseng, MD, MPH At–Large: Kyle P. Edmonds, MD At–Large: Sergio R. Flores, MD At–Large: Robert E. Hertzka, MD At–Large: Theodore M. Mazer, MD At–Large: Albert Ray, MD At–Large: Holly B. Yang, MD, MSHPEd, HMDC, FACP, FAAHPM CMA DELEGATES District I: Christopher M. Bergeron, MD, FACS District I: Corrie D. Broudy, MD District I: Puja Chitkara, MD District I: Mojgan Hosseini, MD District I: Yolanda Marzan, MD District I: Bijal V. Patel, MD, MBA District I: Eric L. Rafla–Yuan, MD District I: Ran Regev, MD District I: Kristen N. Rice, MD District I: Kosala Samarasinghe, MD District I: Mark W. Sornson, MD District I: Wynnshang [Wayne] C. Sun, MD District I: Patrick A. Tellez, MD, MHSA, MPH District I: Nicholas [dr. Nick] J. Yphantides, MD, MPH

Opinions expressed by authors are their own and not necessarily those of San Diego Physician or SDCMS. San Diego Physician reserves the right to edit all contributions for clarity and length as well as to reject any material submitted. Not responsible for unsolicited manuscripts. Advertising rates and information sent upon request. Acceptance of advertising in San Diego Physician in no way constitutes approval or endorsement by SDCMS of products or services advertised. San Diego Physician and SDCMS reserve the right to reject any advertising. Address all editorial communications to Editor@SDCMS.org. All advertising inquiries can be sent to DPebdani@SDCMS.org. San Diego Physician is published monthly on the first of the month. Subscription rates are $35.00 per year. For subscriptions, email Editor@SDCMS.org. [San Diego County Medical Society (SDCMS) Printed in the U.S.A.]

FEATURES

Hantavirus: The HighConsequence Diagnosis San Diego Physicians Don’t Want to Miss By Elizabeth Jefferson, BS, PhD, CIC, CDPH

Dengue Fever and Local Transmission in San Diego County By Stephen Waterman, MD, MPH, Mark Beatty, MD, Samantha Hallis, PhD, Willow Cleverly, MPH, Sierra Bregman, MPH, Nikos Gurfield, DVM, PhD, and Seema Shah, MD

Converging on Public Health: How UC San Diego and County of San Diego Public Health Services Are Building a Scalable Model for Rapid Response By Mika Elizabeth Ono, Mark Beatty, MD, and Seema Shah, MD

Strengthening Congenital Syphilis Prevention By Rosemary Garcia, MD and Winston Tilghman, MD

DEPARTMENTS

Briefly Noted: SDCMS

Classifieds

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SDCMS

Physician Social and Mixer Featured Aloha, Pupus, and Mai Tais at Legendary Bali Hai THE SAN DIEGO COUNTY MEDICAL SOCIETY held another successful and fun “Aloha Physician Social and Mixer” at the Bali Hai Restaurant in September. More than 100 physicians and their partners or guests enjoyed pupus and the legendary Bali Hai mai tai. This is always one of our most popular events.

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INFEC TIOUS DISE ASES

HANTAVIRUS The High-Consequence Diagnosis San Diego Physicians Don’t Want to Miss By Elizabeth Jefferson, BS, PhD, CIC, CDPH

IN SAN DIEGO, HANTAVIRUS IS RARELY THE first diagnosis considered when a patient presents with chills, fever, fatigue, and myalgias. However, its nonspecific viral prodrome can progress rapidly to noncardiogenic pulmonary edema and respiratory failure. Missing the diagnosis can have devastating consequences, as reported case-fatality rates have reached 50%.1 Although uncommon, hantavirus remains a plausible diagnosis, particularly in patients with potential exposure to aerosolized rodent excreta. What Are Hantaviruses? Hantaviruses are a group of global zoonotic, single stranded RNA viruses within the Orthohantavirus genus. Each hantavirus is associated with a specific rodent reservoir species, in which the virus causes long-term infection without apparent illness. Although numerous hantavirus species have been identified worldwide, only a small portion are recognized as causes of human illness. Globally, the number of infections is estimated to range from about 10,000 to more than 100,000 annually, with most cases occurring in Asia and Europe.1 Hantaviruses are associated with two major diseases in humans: the hantavirus pulmonary syndrome (HPS) predominantly reported in the Americas, and hemorrhagic fever with renal syndrome (HFRS), mainly reported in Europe and Asia. Human infection usually occurs after exposure to infected rodents or their urine, feces, or saliva. Human-to-human spread is very uncommon and has only been confirmed for the Andes hantavirus (ANDV), which is found in certain regions of the Americas. In the western United States, including California, the hantavirus of greatest concern is Sin Nombre Virus (SNV). The principal animal host for SNV is the deer mouse.2

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Sin Nombre Virus Epidemiology Sin Nombre virus (SNV) is most often spread when people inhale airborne particles contaminated with infected rodent urine, droppings, or saliva. Activities associated with increased risk of HPS include occupying or cleaning rodentinfested buildings, sweeping or disturbing rodent excreta or nests, sleeping on the ground, and handling mice without gloves. Person-to-person transmission of SNV has not been documented.3 The estimated incubation period for SNV ranges from 1 to 8 weeks, with most cases occurring 2 to 4 weeks after exposure. Therefore, obtaining a thorough history of prior rodent exposure is an important part of clinical assessment. In California, hantavirus surveillance is primarily conducted by the California Department of Public Health (CDPH), typically through its Vector-Borne Disease Section,

TABLE 1. Rodent Exclusion Strategies4 Prevention Step

Details

Seal off entry points

Seal any openings larger than a dime.

Control food source

Put away pet food bowls when not in use and keep pet food in rodent-proof containers.

Secure waste containers

Use rodent-proof lids on trash cans.

Trap rodents

Snap traps preferred for rapid control.

Eliminate harborage

Remove wood piles, trash, and debris from property.

Keep stored materials away from buildings

Keep hay and firewood at least 100 feet away from buildings.

Control vegetation

Keep grass and weeds cut short, and trim back shrubs within 100 feet of buildings.

TABLE 2. Cleaning and Disinfection Procedures for Rodent Contaminated Areas 4 Prevention Measure

Instructions

Ventilate

Before cleaning, air out any unused rooms by opening doors and windows for a minimum of 20 minutes.

Use personal protective equipment

Wear latex or rubber gloves with a face mask.

Avoid dry cleaning methods

Do not sweep or vacuum rodent droppings, urine, or nesting materials.

Disinfect with bleach solution

Prepare a disinfecting solution by mixing 1 part bleach with 10 parts water, or use a commercially available bleach-based disinfectant.

Disinfect visibly contaminated areas

Completely soak any areas contaminated by rodent urine, droppings, saliva, nesting materials, dead rodents, or rodent-tainted food with a bleach-based disinfectant, and let sit for 20-30 minutes before cleaning.

Disinfect other potentially contaminated areas

Use sponges are cloths soaked with bleach solution to clean surfaces.

Dispose of waste

Dead rodents, nesting materials, and all used cleaning materials should be placed in sealed plastic bags and discarded immediately.

Perform hand hygiene

After cleaning, remove gloves and discard. Wash hands with soap and water.

in coordination with local health departments and the Centers for Disease Control and Prevention (CDC). From 1980 through 2025, CDPH surveillance data identified 99 cases statewide, including only one reported case in San Diego County. In San Diego, this surveillance is complemented by field monitoring, in which wild mice in San Diego County are routinely sampled and tested for hantavirus antibodies. 4 Approximately 3% of sampled mice test positive for hantavirus. From January 1, 2026 to July 31, 2026, seven mice tested positive, showing that the virus is still present in local rodent populations even though human infections remain rare. 4 Prevention focuses on two key measures: keeping rodents out of the home and cleaning rodent contaminated areas safely. Table 1 provides practical advice physicians can share with patients to reduce exposure to rodents that may carry hantavirus, and Table 2 describes recommended cleaning methods for contaminated areas.

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INFEC TIOUS DISE ASES Sin Nombre Virus Clinical Presentation and Laboratory Diagnosis Early recognition of HPS is essential. Initial symptoms are often nonspecific and may resemble a routine viral illness, but recent rodent exposure along with fever, myalgias, headache, gastrointestinal symptoms, thrombocytopenia, or worsening respiratory symptoms should raise suspicion. The febrile prodrome typically lasts three to six days before progression to severe disease. Once the cardiopulmonary phase begins, clinical decline can be rapid, with death sometimes occurring within 24 to 48 hours. Early recognition and aggressive supportive care, including intensive care management and extracorporeal membrane oxygenation (ECMO) in severe cases, are essential. Point-of-care testing for hantavirus is not currently available, and confirming the diagnosis in the laboratory can be difficult. In a study by Frederick Koster and colleagues, blinded review of peripheral blood smears from 52 patients with HPS and 128 seronegative patients with suspected hantavirus infection identified characteristic hematologic patterns.5 During the prodromal stage, thrombocytopenia was the most consistent abnormality and may help prompt serologic testing for hantavirus. After radiographic evidence of pulmonary edema appears, the presence of four of the five findings listed in Table 3 was associated with a sensitivity of 96% and a specificity of 99% for HPS, with no missed cases among patients who required intensive care. Together, these complete blood count (CBC) and peripheral smear findings may help support earlier recognition and treatment. Definitive diagnosis relies on serologic testing. Enzymelinked immunosorbent assays (ELISA) for IgM and IgG antibodies are the primary confirmatory tests, and these antibodies are usually detectable during the febrile prodrome, before or around the time of rapid progression to shock and noncardiogenic pulmonary edema. In symptomatic patients early in the illness, serologic testing has an estimated sensitivity and specificity of 95% to 100%.

TABLE 3. CBC/Smear Findings Linked to HPS Progression5

Finding

Threshold/Description

Platelet Count

< 150,000/μL

White blood cell count

Elevated with left shift

Neutrophil Morphology

Lack of toxic granulation

Immunoblasts

> 10% of lymphocyte population

Hemoconcentration

Remove wood piles, trash, and debris from property.

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Hantavirus Treatment There is no specific antiviral treatment for hantavirus. Management is supportive and includes careful fluid administration, oxygen supplementation, and mechanical ventilation. Early use of ECMO can improve survival rates to 80%.3 The Yosemite Sin Nombre Hantavirus Outbreak For decades, Yosemite National Park has been one of California’s most iconic natural destinations for its granite cliffs, waterfalls, and broad valleys. But in 2012, it also became the site of one of the largest hantavirus outbreaks among overnight visitors in U.S. history.6 The subsequent investigation identified 10 cases in residents of three states. Eight patients developed HPS, including five who required intensive care and ventilatory support, and three who died. Overnight stay in a signature tent cabin was strongly associated with infection. Investigators found rodent nesting and tunneling within the foam insulation of the cabin walls, and antibodies reactive to SNV were detected in 10 of 73 captured deer mice (14%). All signature tent cabins were closed and later removed. This outbreak highlights the importance of reducing

hantavirus risk in settings where deer mice are present through effective rodent exclusion and control measures. It also underscores the value of a careful exposure history, as details about a patient’s environment, travel, and activities may provide essential clues to support early recognition and diagnosis. Andes Virus vs. Sin Nombre Virus: Why the MV Hondius Outbreak Was Different The MV Hondius is a luxury expedition vessel built for small-group polar travel, offering access to remote Antarctic destinations. What began as an exclusive voyage to one of the world’s most isolated regions ultimately became a complex outbreak of ANDV infection that drew substantial international media attention. ANDV differs in important epidemiologic ways from Sin Nombre virus (SNV). The natural reservoir of ANDV is the long-tailed pygmy rice rat, which inhabits temperate forests, shrublands, and river margins in Chile and southwestern Argentina. Unlike SNV, ANDV has been associated with limited person-to-person transmission.7 Human-to-human transmission of ANDV has been documented in several prior outbreaks and is typically linked to close, prolonged contact, often in shared indoor settings such as households.1 In April 2026, the MV Hondius carried passengers representing 23 nationalities through remote regions of the South Atlantic. Before the outbreak was recognized, infected individuals had already dispersed across multiple continents, greatly complicating the public health response. As of July 2, 2026, 13 outbreak-associated cases had been reported, including 12 confirmed cases and 1 probable case.8 Three deaths were reported, including two among confirmed cases and the one probable case, for an overall case fatality ratio of 23%. Current evidence indicates that the index patient was most likely infected on land before boarding, although the exact source of exposure has not been identified.8 Subsequent person-to-person transmission likely occurred aboard the vessel. The World Health Organization declared the outbreak over on July 2, 2026, after exposed contacts completed a 42-day follow-up period under the supervision of local public health authorities in accordance with WHO guidance.8 This outbreak was particularly challenging because ANDV can spread person to person, the index patient was

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INFEC TIOUS DISE ASES in a crowded travel setting, and medical resources were limited due to the remote location. Delayed recognition of the illness and international dispersal of travelers before the outbreak was identified added additional complexity. Why Andes Virus Matters in San Diego In San Diego, ANDV is primarily a low-probability, travelassociated risk. Because of frequent travel in San Diego County, clinicians may see patients returning from Chile or Argentina, where the virus is endemic. ANDV remains clinically important because it can cause HPS, and limited person-to-person transmission has been documented. Current CDC guidance recommends airborne isolation precautions for suspected or confirmed cases, including gown, gloves, eye protection, and either an N95 respirator or a powered air-purifying respirator, with the duration of precautions determined on a case-by-case basis in consultation with local public health authorities.9 Report Suspected Hantavirus Immediately Suspected hantavirus cases should be reported promptly to County Epidemiology at (619) 692-8499 Monday through Friday from 8:00 a.m. to 5:00 p.m., and at (858) 565-5255 after hours and on weekends. Hantavirus testing is available through local and state public health laboratories, and confirmatory testing is also available through the CDC’s Viral Special Pathogens Branch. 4 References 1. World Health Organization (WHO). Hantavirus. Available online: https://www.who.int/news-room/fact-sheets/ detail/hantavirus (accessed on 8 August 2026). 2. California Department of Public Health (CDPH). Hantavirus Infection. Available online: https:// www.cdph.ca.gov/Programs/CID/DCDC/Pages/ HantavirusPulmonarySyndrome.aspx. (accessed on 24 July 2026). 3. Centers for Disease Control and Prevention (CDC). About Hantavirus. Available online: https://www.cdc. gov/hantavirus/about/index.html (accessed on 4 August 2026). 4. County of San Diego Environmental Health and Quality. Vector Control Program. Hantavirus. Available online: https://www.sandiegocounty.gov/content/sdc/deh/pests/ hantavirus.html. (accessed on 8 August 2026). 5. Koster, F, Foucar, K, et. al. Rapid Presumptive Diagnosis of Hantavirus Cardiopulmonary Syndrome by Peripheral Blood Smear Review, Am. J. Clin. Pathol. 2001; 116: 665-672 https://doi.org/10.1309/CNWF-DC72-QYMR-M8DA 6. Núñez JJ, Fritz CL, Knust B, et. al. Hantavirus infections among overnight visitors to Yosemite National Park, California, USA, 2012. Emerg Infect Dis. 2014; 20(3): 386-

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393. doi:10.3201/eid2003.131581 7. Durante-Mangoni E, Cafarella I, Mercadante S. et. al. Human infection with Andes hantavirus: an update for the general physician European Journal of Internal Medicine, 2026; 149 https://doi.org/10.1016/j. ejim.2026.106946 8. World Health Organization. Hantavirus linked to cruise ship travel, multi-locations. Available online: https:// www.who.int/emergencies/disease-outbreak-news/ item/2026-DON611 (accessed on 1 August 2026). 9. Centers for Disease Control and Prevention (CDC) Health Alert Network, 2026 Multi-country Hantavirus Cluster Linked to Cruise Ship. Available online: 10. https://www.cdc.gov/han/php/notices/han00528.html (accessed on 5 August 2026).

Elizabeth Jefferson is the manager of epidemiology at Scripps Green Hospital in La Jolla. She joined Scripps in 2018 after a 17year career as a medicinal chemist in the biotechnology industry. Throughout her scientific career, she has authored more than 40 peer-reviewed publications. Her distinctive background blends deep scientific expertise with evidence-based infection prevention strategies, helping to advance patient safety and improve quality of care.

INFEC TIOUS DISE ASES

DENGUE FEVER

and Local Transmission in San Diego County

By Stephen Waterman, MD, MPH, Mark Beatty, MD,

Samantha Hallis, PhD, Willow Cleverly, MPH, Sierra Bregman, MPH, Nikos Gurfield, DVM, PhD, and Seema Shah, MD

Introduction Dengue fever is caused by four closely related virus serotypes, DEN1-4, and transmitted by the mosquito vectors Aedes aegypti (urban yellow fever mosquito) and Aedes albopictus (Asian tiger mosquito), usually in tropical and subtropical regions. Both species are also competent vectors for Zika and chikungunya viruses. Dengue viruses are the most important mosquito-borne viruses in terms of worldwide morbidity and mortality, with expanding geographic distribution as a result of introduction of the mosquito vectors into previously uninfested regions with Mediterranean climates like California and southern Europe. Large dengue outbreaks in endemic areas often overwhelm healthcare systems with associated significant economic impact.1 Dengue viruses are single-stranded positive-sense RNA arboviruses in the Flaviridae family encoded for three structural proteins including the envelope protein and seven nonstructural proteins. Dengue viruses are closely related to the flaviviruses, Zika virus, St. Louis encephalitis virus, West Nile virus, Japanese encephalitis virus, and yellow fever virus, and often cross-react with these viruses on serologic testing. Epidemiology The dengue virus transmission cycle in most of the world is human-mosquito-human. A mosquito-primate cycle exists in forests of Southeast Asia and West Africa. The incubation period after a bite from a virus-infected female mosquito is three to 14 days, usually five to seven days. The extrinsic incubation period (time for virus to reach the salivary glands after biting an infected human) in mosquitoes is eight to 12 days and varies with environmental temperatures. About 75% of dengue virus infections are asymptomatic. Asymptomatic infections contribute significantly to virus transmission.2 Second dengue infections are associated with more severe illness thought to be mediated through an immune mechanism known as antibody-dependent enhancement.

Local Epidemiology and Control Before 2024, dengue fever has been a disease of returning international travelers in San Diego County. The county averaged 16 cases per year, with most cases occurring in the summer and tapering off in January. The most common destinations of these travelers were Mexico and Central and South America, with several cases traveling to India, Southeast Asia, and the Pacific Islands. In 2024 a record increase in dengue globally led to the highest number of confirmed and probable dengue cases in San Diego County in a single year, 64, including three locally acquired cases. The first case was in Escondido. Two more cases not linked to the first case occurred a month later in Vista. None of the locally acquired cases could be linked to a travel-associated case and were presumed to be caused by an asymptomatically infected individual living within the 150-meter flight range of the mosquito. The locally acquired cases in San Diego County followed the first locally-acquired cases in California in Long Beach and Pasadena in 2023. Los Angeles County continued to have locally acquired dengue cases in 2024 and 2025, but none have been reported in 2026 as of May 30, 2026.3 The County’s Vector Control Program (VCP) responds to all dengue cases and conducts mosquito abatement and educational outreach to reduce the risk of additional cases in the area. The VCP assesses for Aedes activity and takes preventive action (including trapping, larvicide, and adulticide) as needed.

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INFEC TIOUS DISE ASES

Clinical Manifestations, Diagnosis, and Management Infection resulting in clinical disease (known as breakbone such as measles, influenza, fever) manifests classically with fever, headache with eye hepatitis A, other arboviral pain, body aches, and often an erythematous maculopapular infections, rickettsial disClinical signs and symptoms and laboratory findings to differentiate dengue, rash on the trunk that appears after about three days posteases, bacterial sepsis, and Zika, and chikungunya illness onset. 4 The illness lasts about a week, usually without bacterial diseases such as leptospirosis, depending on sequelae, although some patients have prolonged weakness Signs and Symptoms Certainty of the the epidemiologic context. and depression. A small percentage of patients, about 5% evidence but varying by outbreak, develop severe illness most often Dengue Chikungunya Laboratory Zika diagnosis of dengue is confirmed by characterized by sudden onset of shock as a result of plasma - Thrombocytopenia Pruritus positive PCR and antigen leakage around the fifth day (three to seven days) of Arthralgias illness at HIGH - Progressive increase in tests (NS1) typically in the time of defervescence. Warning signs include abdominal (findings that hematocrit differentiate them) serum samples during the pain, persistent vomiting, bleeding, and lethargy or rest- Leukopenia first seven days of illness. lessness. Laboratory findings include hemoconcentration, - Anorexia or hyporexia Rash ELISA Rash serology for IgM thrombocytopenia, and hypoalbuminemia. Shock can occur - Vomiting Conjunctivitis Conjunctivitis antibody can be positive in children and adults but is seen most frequently in children. - Abdominal pain Arthritis MODERATE as early as day four, and The window is about 48 hours. A suspected Chills Myalgias or bone (findings that of shock -risk provides a presumptive dengue diagnosis should be considered with monitoring for - Hemorrhages (includes pain probably bleeding on the skin, laboratory diagnosis. A hemoconcentration and shock without waiting for laboratory differentiate them) mucous four-fold rise in IgM or diagnostic confirmation. Severe membranes, illness can also be associated or both) IgG titers in paired serum with significant organ involvement of the liver and neurologic is also confirmasystem. Dengue shock- syndrome has a mortality rate of 10% Retro-ocular pain Hemorrhages samples Adenopathies tory. For acute dengue or higher without intervention, but can be treated success- Hepatomegaly (includes Pharyngitis or - Headache bleeding odynophagia CDC recomfully in most cases with careful fluid management. Rates of on thediagnosis, LOW - Diarrhea skin, mucous mends both a nucleic acid severe illness due to shock or other clinical manifestations (findings that may - Dysgeusia membranes, or amplification test (NAAT) can be higher in older persons with chronic disease. differentiate them) - Cough both) and an IgM antibody test or Dengue differential-diagnosis includes viral exanthems Elevated transaminases - Positive tourniquet test

Guidelines for the Clinical Diagnosis and Treatment of Dengue, Chikungunya, and Zika. Washington, D.C.: Pan American Health Organization; 2022 License: CC BY-NC-SA 3.0 IGO. https://doi.org/10.37774/9789275124871

Paz-Bailey G, Adams LE, Deen J, Anderson KB, Katzelnick LC. Dengue. Lancet. 2024;403(10427):667-682. doi:10.1016/S0140-6736(23)02576-X

CS345976-B | PubID 301358 10

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an NS1 antigen test and an IgM antibody test. Dengue PCR has the benefit of identifying the dengue virus serotype. Management of classic dengue fever and severe dengue fever is supportive as no effective antiviral agents are currently available. Hydration should be maintained and salicylates should be avoided to minimize bleeding. Fluid management of plasma leakage/shock syndrome entails administration of intravenous normal saline or Ringer’s lactate while monitoring hemoconcentration. Patients not responding to crystalloid therapy may require intravenous colloids or transfusion when bleeding is severe. It is important to avoid fluid overload. Steroids and platelet transfusions are not effective.5 Dengue Prevention and Control Personal protection measures against mosquito bites are an important aspect of prevention. Such measures entail wearing

Case Report A female in her 20s from Vista reported onset of symptoms on October 10, 2024, with lower back pain, joint pain, rash on legs, and sweats. She first sought medical care on October 15. She had a high fever (104°F), and reported two episodes of syncope that day, dark urine, and black diarrheal stools, but no respiratory symptoms. Her spouse reported feeling ill with similar but less intense symptoms. She was found to be tachycardiac with orthostatic hypotension, to have bilateral lower extremity edema, and mildly elevated transaminases, and thrombocytopenia. Her urine had increased red blood cells and protein, but no white blood cells. Her chest X-ray was unremarkable. She was admitted for sepsis and given empiric ceftriaxone. Blood and urine cultures were ultimately negative. Her orthostatic hypotension persisted despite fluid resuscitation. On October 16, while hospitalized, she reported epistaxis in the morning and bleeding gums after brushing her teeth. Blood samples were collected that day and sent to a commercial laboratory to evaluate for other causes of fever. The thrombocytopenia and the lower extremity edema resolved over the subsequent days, and she was discharged on October 18. The specimen collected on October 16 was positive for anti-dengue IgM antibodies. The case was reported to the County on October 23. Epidemiologic investigation confirmed the case, and her spouse had not traveled out of the county in the weeks preceding symptom onset. The spouse was also anti-dengue IgM antibody-positive, representing the third locally transmitted case. After door-to-door outreach and inspections, the County Vector Control Program applied mosquito larvicide and adulticide in the vicinity of the cases’ residence. Whole genome sequencing by the County Public Health Laboratory led to partial recovery of the DENV genome in the three local cases. The sequencing data showed that these local cases were not linked to any contemporary travel acquired cases in the County, suggesting surveillance gaps due to subclinical or asymptomatic cases.

long-sleeved, light-colored clothing or permethrin-treated clothing during peak mosquito biting hours (early morning and late afternoon/evening) and use of EPA-approved repellants such as DEET and picaridin on exposed areas of skin. Two live attenuated tetravalent chimeric dengue vaccines have been evaluated and licensed by national licensing agencies. CYD-TDV (Dengvaxia/Sanofi Pasteur) was approved by the FDA in 2019, but because the indication is only for children with documented prior dengue infection, demand was negligible and Sanofi has ceased manufacturing the vaccine. A second dengue vaccine, TAK-003 (Qdenga/Takeda), is licensed in many countries but not the U.S., and endorsed by the World Health Organization for children 6 to 16 years in country settings with high dengue transmission intensity. The limited indications for Dengvaxia and Qdenga stem from clinical trial data suggesting that the vaccines are not effective against all dengue serotypes in dengue-naïve individuals.6 Spatial repellants using emanator devices emitting transflutherin have considerable promise for prevention of bites from Aedes and other mosquito species but are not yet licensed in the U.S. Local mosquito control agencies can apply larvicides to difficult-to-empty water containers (e.g., abandoned pools) in areas with high mosquito densities identified by mosquito trapping and citizen reports. When human cases are reported to the Health Department, vector control agencies may apply pyrethroid or organophosphate adulticides via ultra-lowvolume space spraying or residual spraying in areas around the case.7 Nevertheless, reactive vector control provides less effective prevention than sustained systematic mosquito control over time.8 Citizenry can play an important role in Aedes aegypti control by ensuring that water does not accumulate in containers around residences and using larvicides such as Bacillus thuringiensis dunks in containers that may be difficult to keep dry. Larvicide products are readily available from home improvement stores. Conclusion The trend toward more widespread distribution and density of Aedes aegypti in southern California poses the threat of larger dengue outbreaks in the future. Clinicians in San Diego County now need to be aware of both dengue and West Nile virus as local mosquito-borne arboviral threats and diagnostic considerations in acutely febrile patients. Dengue cases should be reported to County Epidemiology electronically within one day of identification. Research aimed at understanding dengue transmission dynamics and drivers in this ecologic setting may enable better and more targeted control efforts.

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INFEC TIOUS DISE ASES References 1. Paz-Bailey G, Adams L, Deen J et al. Dengue. The Lancet, 2024; 403, 667-682. 2. ten Bosch QA, Clapham HE, Lambrechts L et al. Contributions from the silent majority dominate dengue virus transmission. PLoS Pathog 14(5):31006965. https:// doi.org/10.1371/journal.ppat.1006963. 3. Vaughn AM, Park C Ngo VP et al. Investigation of and response to autochthonous dengue, Los Angeles County, California, USA. August-November 2024. Emerging Infectious Diseases. 2026; 32(5):720-727. Doi.10;3201/ eid3205.251812. 4. Waterman S and Gubler D. Dengue Fever. Clinics in Dermatology, 1989; 7(1):117-122. DOI: http://doi. org/10.1016/0738-081X(89)90034-5 5. Dengue Clinical Management Pocket Guide | Dengue | CDC 6. WHO. WHO position paper on dengue vaccines – May 2024. 18(99): 203-224 7. Bethany L and Connelly CR. A review of the control of Aedes aegypti in the continental United States. J Med Entomol 2021. 58(1);10-25. https://doi.org/10.1093/jme/tjaa157

SAN DIEGO ADRC / AD-RCMAR CONFERENCE

BRAIN HEALTH UPDATE: EMERGING EVIDENCE FOR SHAPING BETTER CARE December 3, 2026 7:45 am - 12:30 pm UC San Diego ACTRI Auditorium

8. Achee NL, Gould F, Perkins RA et al. A critical assessment of vector control for dengue prevention. PLoS Negl Trop Dis 2015. May 7;9(5):e0003655. Doi:10.1371/journal. pntd.0003655

Dr. Waterman is a medical epidemiologist and former chief of the U.S. Centers for Disease Control and Prevention’s Dengue Branch from 2016 to 2020, and is now Health Sciences Clinical Professor at the UCSD Herbert Wertheim School of Public Health and Human Longevity. Dr. Beatty was a medical epidemiologist at the U.S. Centers for Disease Control and Prevention’s Dengue Branch from 2004 to 2006 and was senior epidemiologist for the Pediatric Dengue Vaccine Initiative at the International Vaccine Institutes in Seoul, South Korea from 2006 to 2011. Dr Beatty is currently assistant medical director of the County of San Diego Health and Human Services Agency (HHSA), Public Health Services, Epidemiology and Immunization Services Branch. Dr. Hallis is assistant laboratory director at the County of San Diego HHSA Public Health Laboratory, Public Health Services. She oversees genomic epidemiology and sequencing. Willow Cleverly is an epidemiologist, County of San Diego Health and HHSA, Epidemiology and Immunization Services Branch. Sierra Bregman is an epidemiologist, County of San Diego HHSA, Epidemiology and Immunization Services Branch. Dr. Gurfield is the County Veterinarian and head of the Vector Disease and Diagnostic Laboratory and the Outreach group in the San Diego County Vector Control Program, Department of Environmental Health. Dr. Shah is medical director, Epidemiology and Immunization Services Branch, County of San Diego HHSA. Dr. Shah served previously as medical director, Emergency Department, Rady Children’s Hospital San Diego. She is an adjunct professor of pediatrics at UC San Diego.

Join us for this conference, hosted by the UC San Diego Shiley-Marcos Alzheimer’s Disease Research Center and the San Diego Alzheimer’s Disease Resource Center for Minority Aging Research (AD-RCMAR), which brings together internationally renowned faculty from UC San Diego and local partner institutions to present the latest developments in neurodegenerative research. This event is designed to provide clinicians and community practitioners with current, evidence-based data that can be translated into clinical practice, in order to maximize therapeutic goals and optimize healthcare outcomes for patients. Topics to be Covered: Alzheimer’s Disease Treatment & Prevention Updates, LATE, Weight-Loss Drugs & Cognition, Women’s Brain Health, Sleep, and Biomarkers: Returning Results to Patients & Psychosocial Implications

Visit our Website to Learn More: gerigeropal.ucsd.edu/brain-health

From left to right, top row: Dr. Waterman, Dr. Beatty, Dr. Hallis. Bottom row: Sierra Bregman, Dr. Gurfield, Dr. Shah. Not pictured: Willow Cleverly.

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CONVERGING ON PUBLIC HEALTH How UC San Diego and County of San Diego Public Health Services Are Building a Scalable Model for Rapid Response By Mika Elizabeth Ono, Mark Beatty, MD and Seema Shah, MD

WHEN COUNTY OF SAN DIEGO PUBLIC HEALTH officials identify situations where innovation could improve public health response — whether to track a resurgent parasite, a border sewage crisis, or a seasonal virus — they don’t wait for the research pipeline to catch up on its own timeline. Increasingly, they contact Resilient Shield, a UC San Diego initiative built to pair local public health priorities with a shared, adaptable technical infrastructure. “Our central innovation is the true convergence of partner priorities with scalable engineering,” said Eliah AronoffSpencer, MD, PhD, professor of medicine at UC San Diego School of Medicine and faculty member with the UC San Diego Design Lab and Qualcomm Institute, who leads the initiative. “We do not build in a vacuum. Our infrastructure is built directly on the priorities dictated by our partners.” How the Model Works Many universities are advancing artificial intelligence, predictive analytics, and infectious disease modeling, while local health departments are responsible for responding to

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outbreaks and protecting their communities. Historically those two worlds have operated independently, and moving research innovations into operational practice has traditionally taken years. Resilient Shield is one of 13 centers funded nationwide through the U.S. Centers for Disease Control and Prevention (CDC) Center for Forecasting and Outbreak Analytics Insight Net, a national outbreak and disease modeling network. It is also one of only five designated Integrator Centers, reflecting its specific mission of translating analytical tools into operational capabilities that directly support state and local public health practice. Instead of researchers guessing what health agencies need, organizations addressing real-world events explore options with Resilient Shield during collaborative meetings for innovative solutions. “In public health, we always know our most urgent priorities, but too often we don’t have the immediate resources or in-house technical solutions to achieve them,” said Seema Shah, MD, MPH, medical director of the Epidemiology and Immunization Services Branch for the County of San Diego’s Public Health Services Department. “This partnership solves our immediate problem while providing shareable, open-reference designs that demonstrate exactly how public health, academia, and industry can successfully work together.” In addition to San Diego County, Resilient Shield partners range from the California Department of Public Health to the Navajo Nation and the broader Insight Net network. Case Study: New World Screwworm In the 1950s, the New World screwworm cost U.S. livestock producers tens of millions of dollars a year before it was eradicated from the United States. Now the flesh-eating pest has spread north again, reaching Texas and New Mexico and threatening livestock, wildlife, and, rarely, people. Unlike most fly larvae, New World screwworm larvae burrow into living flesh rather than dead tissue. Although human cases are uncommon and not typically transmitted person-to-person, they require prompt medical treatment — making early recognition and referral the relevant concern for physicians who may encounter a case. “Our County public health partners alerted us to the need for better situational awareness of New World screwworm,” said Eliah Aronoff-Spencer, MD, PhD, professor of medicine at UC San Diego School of Medicine and faculty member with the UC San Diego Design Lab and Qualcomm Institute who leads Resilient Shield. “We built a dashboard to generate regional risk profiles. This is just one example of how we are responding to County needs with a focus on real-world issues.” The dashboard combines confirmed detections, environmental suitability data, and media coverage to

estimate county-by-county risk nationwide. In the meantime, the larger response effort is taking a page from the original 1950s eradication campaign. The U.S. Department of Agriculture has reintroduced the sterile insect technique, releasing radiation-sterilized flies to collapse wild populations, combined with pesticides and animal movement quarantines. EPA approval is also being sought for a genetically modified all-male strain, now in field testing, while UC San Diego researchers develop next-generation genetic technologies that could strengthen future control efforts. “The tool gives you a sense of where you might expect to see cases next,” said Mark Beatty, MD, MPH, assistant medical director for the County’s Epidemiology and Immunization Services Branch. “That’s helpful in determining how we should be preparing. Is the threat imminent, or do we have six months? We’re in a very concerning phase right now, and the tool backs that up.” The New World screwworm dashboard is currently available only to project partners and public health officials, although the team hopes to eventually make a public version available. Case Study: Tijuana River Valley South County has faced beach and bay closures from cross-border sewage contamination for decades, along with, more recently, hydrogen sulfide gas complaints from communities near the river valley. Residents reported having to change their daily routines because of the sewage crisis. Beach water quality data, hydrogen sulfide in air, public odor complaints to the San Diego Air Pollution Control District, and sewage spill data from the U.S. Section of the International Boundary and Water Commission were all available on different websites. To help residents plan their day, the County and Resilient Shield built the Tijuana River Valley Sewage Crisis Environmental Dashboard, which maps all the available environmental data together on one website. “This new dashboard reaffirms our commitment to the South Bay communities most impacted by the sewage pollution by providing pertinent information all in one place that they can take action on or be informed about,” said Ankita Kadakia, MD, the County’s interim public health officer, in an announcement when the tool launched. Case Study: Seasonal Respiratory Virus Forecasting Resilient Shield’s very first request, also submitted by Dr. Shah, was a flu-tracking request, co-led by Resilient Shield co-principal investigator Ruy Ribeiro at Los Alamos National Laboratory. That work has grown into an ongoing seasonal respiratory virus forecasting project that models expected levels of COVID-19, influenza and RSV to support County risk communication and public health decision making.

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INFEC TIOUS DISE ASES For physicians, seasonal respiratory forecasts can translate into earlier signals about how intense a given respiratory illness season is likely to be, supporting decisions around staffing, patient outreach and bed capacity before demand peaks — much the same early-warning advantage the screwworm and Tijuana River dashboards aim to provide for their respective threats. A Growing Portfolio The forecasting work now sits alongside a growing portfolio of County-driven projects, including a hepatitis A herd immunity study estimating the vaccination levels needed to slow or stop an outbreak in San Diego County, and a dengue computer- and model-assisted tabletop exercise developed to improve the County’s multi-departmental response to mosquito-borne outbreaks. Resilient Shield also built an electronic transfer form designed to improve information sharing when hospitals and other healthcare facilities transfer patients with multidrug-resistant organisms to ensure that information is shared with the receiving institution. Another tool developed by the Resilient Shield team in response to a county request is the Vaccine Parser, an AIpowered vaccination record verification system. This tool allows users to upload an individual’s immunization records, automatically parsing them and checking features such as providers’ licenses, clinic location, and adherence to federal and state immunization schedules. It also uses secured AI models to look for fraudulent records, helping reduce the burden on school nurses and other personnel who are often overwhelmed by a massive influx of vaccination records at the beginning of each school year. Built to Scale Behind all these projects is a modular, scalable resource hub. Working with technology partners including Google and MITRE, Resilient Shield integrates data across human disease, livestock, environmental and weather sources, national health records, and social listening. When a ticket comes in, the team assembles the tools required from that shared hub, whether public-facing web and social media, secure compute, simulation engines, or AI agent builders — rather than building a one-off solution from scratch each time. That shared foundation is also what allows the team to move quickly: Since the underlying data connections and modeling tools already exist, a new ticket like the screwworm request can move from priority setting to a deployed dashboard in a fraction of the time a standalone research project would take. “Because our platform is built on an open, modular architecture, every solution we develop strengthens the system and makes it more adaptable for the next public

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health challenge,” said Dr. Aronoff-Spencer. The initiative draws on a multidisciplinary coalition that extends well beyond San Diego, including experts in infectious disease, statistics, modeling, biology, epidemiology, ethics, and design from UCLA, UCSF, UC Riverside, Los Alamos National Laboratory, the University of Washington, MIT, Tulane University, and the Nevada Department of Health and Human Services, who all contribute to the shared infrastructure. Why It Matters for Physicians While the dashboards are not typically built for direct physician access, according to Dr. Beatty, the underlying shift from reactive to predictive public health still reaches clinical practice indirectly: earlier situational awareness lets public health officials issue guidance to hospitals and clinics before caseloads build, the same principle that helps emergency departments anticipate seasonal respiratory surges. Dr. Aronoff-Spencer was careful to draw a line around what the technology does and does not do. “None of this replaces clinical judgment,” he said. “Artificial intelligence can’t build relationships with patients, investigate a suspicious wound, or decide when a case warrants urgent referral. What it can do is organize increasingly complex information and put it in front of the public health officials who guide the clinical response, so that guidance reaches physicians sooner.”

Mika Elizabeth Ono is director of communications for the Qualcomm Institute at UC San Diego, leading strategic communications, promotion and public relations for the institute’s research programs. She previously served as chief communications officer at the University of Redlands, navigating challenges including the COVID-19 pandemic, and spent 16 years before that at Scripps Research in La Jolla, where she headed communications as part of the executive leadership team. Dr. Beatty is a medical epidemiologist and assistant medical director in the Epidemiology and Immunization Services Branch at the County of San Diego Health and Human Services Agency. Dr. Beatty is a pediatric and preventive medicine physician. He recently joined the Department of Herbert Wertheim School of Public Health and Human Longevity Science at UC San Diego as a voluntary professor of preventive medicine. Dr. Shah serves as the Epidemiology and Immunization Services Branch medical director for the County of San Diego Health and Human Services Agency. Dr. Shah is a pediatric emergency medicine physician who previously held a role as the medical director of the emergency department at Rady Children’s Hospital San Diego and retains her role as a voluntary professor of pediatrics at UC San Diego.

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STRENGTHENING CONGENITAL SYPHILIS PREVENTION By Rosemary Garcia, MD and Winston Tilghman, MD A preterm infant was hospitalized after birth for evaluation of a dilated bowel. The birthing parent (BP) was diagnosed with syphilis during the third trimester and completed treatment five days before delivery. The infant was diagnosed with congenital syphilis (CS) and neurosyphilis, and treated with 10 days of intravenous aqueous crystalline penicillin G. Another infant born at term remained hospitalized after birth and was tested for syphilis when the BP was diagnosed with syphilis at delivery. The infant had reactive serologic testing for syphilis and died during the neonatal period. Although each of these cases had a different outcome, both were associated with missed opportunities for syphilis screening early in pregnancy. CS is preventable, and strategies supporting timely prenatal care, early screening, and appropriate treatment are critical for prevention of additional morbidity.

Epidemiology Since 2012, rates of syphilis and CS have dramatically increased.3 According to the United States (U.S.) Centers for Disease Control and Prevention (CDC), reported CS cases in the U.S. increased 755% from 335 in 2012 to 2,865 in 2021. 4 In 2024, there were 438 CS cases in California (a 15.4% decrease since 2023 and a 196% increase since 2015) and 36 stillbirths/ neonatal deaths. Risk factors for CS include no or late access to prenatal care, substance use, experiencing homelessness, previous history of syphilis, and incarceration.5 Despite a 14% decrease in cases from 36 in 2023 to 31 (including three syphilitic stillbirths) in 2024, CS continues to be a major public health issue in San Diego County.6

Background CS occurs when a pregnant person transmits syphilis to their fetus during pregnancy, and cases have significantly increased in the past decade. Syphilis is caused by the spirochete Treponema pallidum subspecies pallidum (T. pallidum). Transmission can occur sexually via direct contact with infectious lesions, and there are various clinical stages of infection. During pregnancy, T. pallidum can cross the placenta, and untreated syphilis can result in vertical transmission from a pregnant person to their fetus or, less commonly, exposure to an infectious genital lesion during delivery. CS can lead to miscarriage, stillbirth, or neonatal death. Infants who are not adequately treated could develop multiple health complications.1,2

Clinical Manifestations Risk to the fetus of CS is 50% to 70% in pregnancies complicated by early syphilis but decreases to 15% if the BP was infected more than a year before the pregnancy.7 Ultrasonographic evidence of intrauterine infection, detectable after 18 weeks of gestation, includes fetal hepatomegaly, anemia, placentomegaly, polyhydramnios, and nonimmune hydrops.7 However, absence of ultrasonographic abnormalities does not rule out CS.7 Up to 40% of fetuses with CS are stillborn or die during infancy.8 Neonates with CS are often asymptomatic, but most symptomatic cases occur within the first three months of life. Early onset CS is defined by clinical manifestations appearing within the first two years of life, including

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rhinitis, osteochondritis or periostitis, neurosyphilis, bullous or mucocutaneous rashes, hepatobiliary dysfunction, hepatosplenomegaly, anemia and thrombocytopenia.1, 2, 8 Late-onset CS refers to symptoms that develop after two years of age and include dental abnormalities, sensorineural hearing loss, ocular abnormalities, and bony deformities.1, 2, 8 Diagnosis and Treatment Diagnosing CS can be challenging. Evaluation and treatment decisions are made on the basis of identification of syphilis in the BP, adequacy of treatment in the BP (i.e., appropriate to the stage of syphilis infection and initiated at least 30 days prior to delivery), presence of clinical, laboratory, or radiographic evidence of syphilis in the neonate, and comparison of contemporaneous BP (at delivery) and neonatal nontreponemal serologic titers (e.g., RPR or VDRL) by using the same test, preferably conducted by the same laboratory.9 A treponemal test on neonatal serum is not recommended as passively transferred maternal antibodies can persist for >15 months.9 Any neonate at risk for CS should undergo evaluation and testing for human immunodeficiency virus (HIV).9 National syphilis treatment guidelines provide recommendations for evaluation and treatment of four different clinical scenarios based on probability of CS.9 CS evaluation may include cerebrospinal fluid analysis for VDRL, cell count, and protein; complete blood count with differential and platelet count; long bone radiographs; and other tests as clinically indicated.9 Treatment is based on the clinical CS scenario and results of the work-up. Syphilis During Pregnancy Due to rising syphilis and congenital syphilis rates in California, CDPH issued updated syphilis screening recommendations in 2024 recommending screening all pregnant persons for syphilis three times: (1) at confirmation of pregnancy or first prenatal encounter, (2) early in the third trimester (at approximately 28 weeks gestation or as soon as possible thereafter), and (3) at delivery.10 Universal three-time screening in pregnancy is consistent with recommendations issued earlier in 2024 by the American College of Obstetricians and Gynecologists.11 Syphilis staging and diagnosis are the same in pregnant and non-pregnant individuals. Benzathine penicillin G (BPG) is the only effective treatment for fetal infection and for preventing congenital syphilis. Pregnant patients with syphilis should be treated with the recommended penicillin regimen for their stage of infection. Pregnant patients who report an allergy to penicillin should be desensitized and treated with BPG.9

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Challenges and Opportunities Medication shortage: In 2023–2024, the U.S. Food & Drug Administration (FDA) and CDC reported a Bicillin L-A (penicillin G benzathine injectable suspension) shortage, due to increased demand and multiple recalled lots due to particulates in the prefilled syringes.12 To address the prolonged national shortage of Bicillin L-A in the U.S., Lentocilin (benzathine benzylpenicillin tetrahydrate) powder and diluent for suspension for injection is being temporarily imported by the Mark Cuban Cost Plus Drug Company in coordination with the FDA.13 Healthcare providers should continue to prioritize use of Bicillin L-A and Lentocilin for pregnant people with syphilis infection or exposure, infants exposed to syphilis in utero, and patients with contraindications to doxycycline (e.g., anaphylaxis, hemolytic anemia, Stevens Johnson syndrome).14 Missed opportunities: Cases of CS represent a failure of the public healthcare system.15 CS is preventable, and a single case reflects missed opportunities for prevention, timely diagnosis, and treatment of syphilis during pregnancy.16 Lack of timely testing and adequate treatment during pregnancy contributed to 88% of congenital syphilis cases in the U.S. in 2022. 4 Opportunities to increase syphilis screening: Rapid treponemal syphilis tests, including the first available syphilis self-administered test, are now available and present opportunities to extend screening to people who experience barriers to testing in traditional clinical settings.17 Resources for Healthcare Providers • Contact the HIV, STD, and Hepatitis Branch (HSHB) if you are having trouble obtaining Bicillin L-A® or Lentocilin® by calling (619) 692-8501. For syphilis management questions, call (619) 609-3245. Both numbers are monitored Monday through Friday from 8 a.m. to 5 p.m., excluding County holidays. • HSHB Congenital Syphilis webpage: Congenital Syphilis

References 1. Chevalier FJ, Bacon O, Johnson KA, Cohen SE. Syphilis: A Review. JAMA. 2025;334(21):1927–1940. doi:10.1001/ jama.2025.17362 2. Flores JM, Rochat R, Stafford IA, Heiselman C, Nachman S, Zucker J. State-of-the-Art Review: Congenital Syphilis in the Modern Era: Current Strategies and Future Directions. Clin Infect Dis. 2026 Feb 4;81(6):1023-1035. doi: 10.1093/cid/ciaf504. 3. Fang J, Partridge E, Bautista G M, et al. (December 27, 2022) Congenital Syphilis Epidemiology, Prevention, and Management in the United States: A 2022 Update. Cureus 14(12): e33009. DOI:10.7759/cureus.33009 4. McDonald R, O’Callaghan K, Torrone E, et al. Vital Signs: Missed Opportunities for Preventing Congenital Syphilis — United States, 2022. MMWR Morb Mortal Wkly Rep 2023;72:1269–1274. DOI: http://dx.doi.org/10.15585/mmwr. mm7246e1 5. California Department of Public Health. Office of Sexually Transmitted Infections and Hepatitis C Virus. Sexually Transmitted Infection Data. 2024 STI Surveillance Report, 2024 Executive Summary. https://www.cdph.ca.gov/ Programs/CID/DCDC/Pages/STD-Data.aspx 6. County of San Diego Monthly STD Report Volume 18, Issue 7: Data through February 2026; Report released August 3, 2026. Editorial Note: Congenital Syphilis in San Diego County, 2018-2024. 7. Stafford IA, Workowski KA, Bachmann LH. Syphilis Complicating Pregnancy and Congenital Syphilis. N Engl J Med. 2024;390:242-253. DOI: 10.1056/NEJMra2202762 8. Sankaran, D.; Partridge, E.; Lakshminrusimha, S. Congenital Syphilis—An Illustrative Review. Children 2023, 10, 1310. https:// doi.org/10.3390/children10081310 9. US Department of Health and Human Services, Centers for Disease Control and Prevention. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR, July 23, 2021. Vol. 70, No. 4. 10. CDPH Heath Update: CDPH Updates Syphilis Screening Recommendations. 10/14/2024. https://www.cdph.ca.gov/ Programs/OPA/Pges/CAHAN/CDPH-Updates-SyphilisScreening-Recommendations.aspx 11. Practice Advisory. Screening for Syphilis in Pregnancy. April 2024. The American College of Obstetricians and Gynecologists. https://www.acog.org/clinical/clinicalguidance/practice-advisory/article/2024/04/screeningfor-syphilis-in-pregnancy. 12. CDPH Health Update: Update on Bicillin® L-A (penicillin G benzathine injectable suspension) Shortage: Inventory Review and Clinical Guidance. 02/23/2026. Update on Bicillin® L-A (penicillin G benzathine injectable

suspension) Shortage: Inventory Review and Clinical Guidance 13. Dear Healthcare Provider Letter: Temporary Importation of Lentocilin©, (Benzathine Benzylpenicillin Tetrahydrate) Powder and diluent for suspension for injection, 1,200,000 units with Foreign, non-U.S. Labeling to Address Supply Shortage 02/2026. Microsoft Word - DHCP Letter Lab Atral 18FEB2026 14. California Health Alert Network San Diego, Public Health Services. Health Advisory #5: Update on Bicillin® L-A (penicillin G benzathine injectable suspension) Shortage. 02/26/2026 15. Allan-Blitz LT, Stafford I, Klausner JD. The Rise of Congenital Syphilis as a Public Health Emergency. O G Open. 2024 Jun 27;1(2):14. doi: 10.1097/ og9.0000000000000014. PMID: 41000579; PMCID: PMC12456561. 16. U.S. Department of Health and Human Services. 2020. Sexually Transmitted Infections National Strategic Plan for the United States: 2021–2025. Washington, DC 17. FDA News Release, August 16, 2024: FDA Marketing Authorization Enables Increased Access to First Step of Syphilis Diagnosis | FDA

Dr. Garcia is an internal medicine physician and a medical consultant in the HIV, STD, and Hepatitis Branch (HSHB) of Public Health Services at the County of San Diego Health and Human Services Agency. Dr. Tilghman is the HSHB medical director and STD controller for the County of San Diego. He is board-certified in internal medicine and infectious diseases.

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CRANIO/MAXILLOFACIAL AND HEAD & NECK SURGERY: Accepting new adolescent and adult patients seeking evaluation and management of head and neck masses, multidisciplinary assessment of oral/facial cancers and reconstruction, nasal airway assessment and functional rhinoplasty, corrective jaw surgery including jaw advancement for obstructive sleep apnea, cleft and craniofacial reconstruction, maxillofacial fracture management and secondary facial and jaw reconstruction. We work with Medicare, Tricare, most PPO insurance plans, and some HMO plans. Referrals may be called in to (619) 452-7332, or emailed to jaw@scrippshealth.org. [2887-0808] VIRTUAL SPEECH THERAPY AVAILABLE: Accepting new pediatrics and adult patients. We accept FSA/HSA, Private pay, Medicare, Medi-Cal, and several commercial insurance plans pending credentialing. Visit virtualspeechtherapyllc.org or call (888) 855-1309. PSYCHIATRIST AVAILABLE: Accepting new patients for medication management, crisis visits, ADHD, cognitive testing, and psychotherapy. Out of network physician servicing La Jolla & San Diego. Visit hylermed.com or call (619) 707-1554. PHYSICIAN OPPORTUNITIES SEEKING CARDIOLOGIST: Small private group seeking a board eligible/board certified interventional cardiologist to work in San Diego and Imperial counties. Competitive base salary with performance based bonus. Comprehensive benefits package is available. Send CV to sdpcc@yahoo.com. PART-TIME POSITIONS AVAILABLE: We are seeking a part-time Nurse Practitioner, Physician Assistant, or Family Practice Physician to provide outpatient care at a private practice in the Hillcrest area. The position is 16 hours per week, with scheduled hours on Wednesdays and Thursdays. Candidates must be bilingual in English and Spanish and have experience caring for geriatric patients. Compensation is $100 per hour for Nurse Practitioners and Physician Assistants and $150 per hour for Physicians. For more information, please email fdempsey@drlmmarquez. com or call 858-270-7633. MEDICAL CONSULTANT (MD/DO): SD County Epidemiology and Immunization Services Branch is hiring a Medical Consultant! We seek a California–licensed physician with strong clinical, public health, and medical administration expertise who communicates effectively, collaborates with multidisciplinary teams, and provides clinical consultation on sensitive issues across diverse audiences. The ideal candidate is committed to underserved communities, builds community partnerships, and is board certified or board eligible in a relevant specialty; infection–prevention experience is preferred. The Medical Consultant leads mandated public health surveillance, investigation, and response activities; oversees case investigation, contact tracing, surveillance, and public education; and coordinates with healthcare partners to implement response strategies. Responsibilities include 24/7 on–call physician coverage for emerging infectious diseases, bioterrorism, and complex cases; clinical consultation and prescription oversight for reportable diseases; and physician coverage for programs such as HAI/MDRO, overdose surveillance, BioWatch/bioterrorism, and tribal, rural, military, and base liaison work. The role also includes representing the branch and serving as media spokesperson. CLICK HERE to file your application. [2901-0429] PER DIEM ANESTHESIOLOGIST | NORTH COUNTY (92127): Facial plastics practice seeking anesthesiologist for elective cases in AAAHC– accredited, private, single–OR setting. Healthy patients, no emergencies, tight–knit team, smooth workflow. Typical 1–3 cases/day, 6AM–5PM depending on case load. Flexible per diem role. Compensation structured per case with strong effective hourly rates. Located in 92127. Looking for a reliable, long–term fit. SKY Facial Plastic Surgery | (858) 381-4801 | hello@skyfps.com. [2900-0429]

OC TOBER 2026

PULMONOLOGY PHYSICIAN | PHMG NORTH COUNTY: Palomar Health Medical Group is seeking a board–certified Pulmonology/Critical Care Physician to join our multi–specialty, not–for–profit practice in North San Diego County. The ideal candidate will offer expert pulmonary care in a comprehensive outpatient and inpatient setting, supported by advanced facilities at Palomar Medical Center Escondido and Poway. Responsibilities include diagnosing and treating a wide range of pulmonary conditions, performing both inpatient and outpatient procedures, and collaborating with specialists across the Palomar Health network. Candidates must hold a valid California medical license, be board–certified in Pulmonology, and preferably have at least two years of clinical experience. Per diem roles are also available, offering competitive pay and flexible scheduling. Join us in reimagining healthcare with compassion and excellence. To apply, send your application and CV to clayton.trosclair@palomarhealth. org. [2893-1015] UCSD DEPARTMENT OF FAMILY MEDICINE | FACULTY POSITIONS AVAILABLE: UCSD Department of Family Medicine seeks motivated faculty to join our team in clinical, teaching, and scholarly roles. Faculty participate in comprehensive patient care, resident and fellow education, and research or quality improvement initiatives. We welcome candidates with diverse experiences and a passion for family medicine, community engagement, and academic medicine. Opportunities are available at various academic ranks, with salary commensurate with experience, rank, and step. Join a collaborative, supportive environment committed to excellence in primary care and education. Apply here: https://apol-recruit.ucsd.edu/JPF04341. [2889-0822] FAMILY PRACTICE | INTERNAL MEDICINE PHYSICIAN: La Jolla Village Family Medical Group is seeking a PT/FT primary care physician to join our well–established private practice. We’ve been caring for our La Jolla/UTC area neighbors for 35+ years providing comprehensive, longitudinal care to patients of all ages. Call responsibilities are minor; hours consistent with a healthy work/life balance. Our office is new, clean, modern, and well–appointed. Our clinical team is collegial, passionate, and close–knit, with a supportive, cohesive support staff. A true private practice where physicians practice artfully and build enduring relationships with patients and colleagues. Seeking a Board–certified, California–licensed MD/ DO physician, passionate about medicine and looking to establish roots in a practice dedicated to the art of good medicine. Competitive salary and excellent benefits including medical, dental, vision, and retirement. Send a cover letter and CV to jcataluna@ lajollafamilymedical.com. [2880-0520] VENOUS DISEASE SPECIALIST | NORTH COUNTY: La Jolla Vein & Vascular, the premier vein care provider in San Diego, is seeking a highly skilled and experienced Venous Disease Specialist to join our team at our newest location in Vista, CA, nestled in the stunning coastal region of North County San Diego. This full–time position offers competitive salary and benefits, including profit-sharing and a 401(k). Our state–of–the–art facility operates Monday through Friday, with no weekend or night shifts, promoting an excellent work–life balance. Ideal candidates may also consider a locum or locum–to–hire arrangement. Join us in making a difference in our patients’ lives while enjoying your dream location! Email cv to jobs@ ljvascular.com. [2875-1030] PART–TIME PRIMARY CARE PHYSICIAN: Primary Care Clinic in San Diego searching for part–time physician for 1 to 2 days a week, no afterhours calls. Please send CV to medclinic1@yahoo.com. [28720909] OB/GYN POSITION AVAILABLE | EL CENTRO: A successful Private OBGYN practice in El Centro, CA seeking a board eligible/certified OB/GYN. Competitive salary and benefits package is available with a tract of partnership. J-1 Visa applicants are welcome. Send CV to feminacareo@gmail.com or call Katia M. at (760) 352-4103 for more information. [2865-0809] FAMILY MEDICINE/INTERNAL MEDICINE PHYSICIAN: San Diego Family Care is seeking a

Family Medicine/Internal Medicine Physician (MD/ DO) at its Linda Vista location to provide outpatient care for acute and chronic conditions to a diverse adult population. San Diego Family Care is a federally qualified, culturally competent and affordable health center in San Diego, CA. Job duties include providing complete, high quality primary care and participating in supporting quality assurance programs. Benefits include flexible schedules, no call requirements, a robust benefits package, and competitive salary. If interested, please email CV to sdfcinfo@sdfamilycare. org or call us at (858) 810-8700. PHYSICIAN POSITIONS WANTED PART–TIME CARDIOLOGIST AVAILABLE: Dr. Durgadas Narla, MD, FACC is a noninvasive cardiologist looking to work 1-2 days/week or cover an office during vacation coverage in the metro San Diego area. He retired from private practice in Michigan in 2016 and has worked in a San Marcos cardiologist office for the last 5 years, through March 2023. Board certified in cardiology and internal medicine. Active CA license with DEA, ACLS, and BCLS certification. If interested, please call (586) 206-0988 or email dasnarla@gmail.com. OFFICE SPACE / REAL ESTATE AVAILABLE OFFICE LEASE | IMPERIAL COUNTY: MOVE–IN READY medical office space located at 1501 Ocotillo Drive, Suite B, El Centro. It is approximately 1,435 square feet. Contact Judy at (760) 353-6363 or jbduran@ivfcmg.com for more details. [2905-0901] SCRIPPS MEMORIAL HOSPITAL OFFICE SPACE FOR SUBLEASE | POOLE BUILDING: Beautiful, sunlit office space overlooking the rose garden and hospital plaza. 1,313 square feet ($4.38/sq ft/month). Four offices/Consult rooms. Two separate entrances, each with its own patient reception area. Ensuite bathroom. Immediately adjacent to Browning and Prebys buildings. Ground floor, no elevators, easy access from all parking structures. Available July 2026. Contact Mark Nelson, MD at (858) 777-7917 or info@ marknelsonmd.com. [2904-0819] MEDICAL OFFICE SPACE FOR SUBLEASE | ENCINITAS: Beautiful, modern medical office space available for sublease in Encinitas, conveniently located just minutes from Interstate 5 with ample on–site parking for patients and staff. At approximately 2,000 sq ft it includes six spacious exam rooms to accommodate both clinic visits and minor procedures. Every room features stunning ocean views, creating a bright and welcoming environment. Additional amenities include a dedicated lab area, small break room, modern security system, and keyless entry. The entire office was fully renovated in 2023 and offers a fresh, contemporary design throughout. Flexible leasing options are available, including the opportunity to sublease a portion of the suite or the entire space. The sublease term is flexible, with the current lease running through July 2028, offering the possibility to assume or negotiate a longer–term lease directly with the landlord thereafter. Contact (760) 783-5502 for pricing and availability. [2902-0512] MEDICAL OFFICE FOR LEASE | CHULA VISTA: Former pediatric clinic which closed due to retirement of owner. Can be used for any medical specialty, podiatry, chiropractor, optometry or medical spa office. Located at 890 Eastlake Parkway in Eastlake Chula Vista, 1163 square feet. With waiting room and exam room chairs, exam tables, some basic medical instruments, credit card and telephone units. Free to use or all can be removed to suit your needs and preferences. Contact (619) 274-9904 or fbarbadillo@ cox.net. [2899-0323] MEDICAL OFFICE SPACE TO SUBLEASE IN VISTA: Recently updated and well–appointed medical office space for partial or full sublease in Vista, CA. This approximately 6,000 square foot clinic is located at 2067 West Vista Way, within a prime medical office building. The space is equipped with 16 exam rooms, 3 restrooms, and ample dedicated office and lab space. The building itself is ADA compliant and offers several amenities, including ample parking, an outdoor atrium, elevators, and public restrooms on all floors. For more

information or to discuss sublease terms, please contact Denise at dporter@tpirc.org. [2896-0309] MEDICAL OFFICE AVAILABLE TO RENT | MID– CITY: Practice for sale, medical office available for rent. Centrally located in San Diego’s Mid–City community at 3250 El Cajon Blvd, San Diego, CA 92104. Contact Miguel Losada, MD at (619) 282-2178 or by fax at (619) 282-2179. [2894-1215] AVAILABILITY OF UTC MEDICAL OFFICE: Office in UTC area. 2–3 exam rooms, ample waiting room, 2 private offices. Ground floor location. Just one block from 805 exit. Close to Genesee Ave, all major shopping and restaurants in UTC. Parking available. Ground floor office, handicapped accessible. Six month–one year lease available with possibility to renew. Call (619) 5850476. Ask for Alisha. [2890-0825] OFFICE SPACE FOR LEASE | AESTHETIC SETTING: Take your practice to the next level with this beautifully appointed office space available in a modern, fully equipped clinical environment. Whether you’re already in aesthetics or starting an aesthetic practice, we offer flexible, high–end rental options. Rentals include use of PicoSure Pro Laser and Potenza Microneedling with Radiofrequency, two private treatment rooms and staff breakroom in a professional, clean and serene setting. Available Mondays, Tuesdays, Thursdays & Fridays at $1,000/day between the hours of 8:30am–5:00pm. Ideal for dermatologists/plastic surgeons, cosmetic physicians, nurse injectors or other licensed professionals in the aesthetic field. Must see to appreciate the quality and atmosphere. Contact us today at Vivian@sandiegomobiledoctor.com to schedule an in–person tour of this great opportunity. [2886-0804] OFFICE SPACE FOR LEASE | MEDICAL SETTING: Take your practice to the next level with this beautifully appointed office space available in a modern, fully equipped clinical environment. Whether you’re in primary care or specialty medicine, we offer flexible, high–end rental options. Rentals include use of two medical exam rooms and waiting (lobby) area in a clean, professional setting. Available Mondays, Tuesdays, Thursdays & Fridays at $350/half day or $600/day between the hours of 8:30am–5:00pm. Ideal for primary care physicians and specialists seeking flexible space. Must see to appreciate the quality and atmosphere. Contact us today at Vivian@ sandiegomobiledoctor.com to schedule an in–person tour of this great opportunity. [2885-0804] LA JOLLA/XIMED OFFICE TO SUBLEASE: Modern upscale office on the campus of Scripps Hospital — part or full time. Can accommodate any specialty. Multiple days per week and full use of the office is available. If interested please email kochariann@yahoo. com or call (818) 319-5139. [2866-0904] SUBLEASE AVAILABLE: Sublease available in modern, upscale Medical Office Building equidistant from Scripps and Sharp CV. Ample free parking. Class A+ office space/medical use with high-end updates. A unique opportunity for Specialist to expand reach into the South Bay area without breaking the bank. Specialists can be accommodated in this first floor high-end turnkey office consisting of 1670 sq ft. Located in South Bay near Interstate 805. Half day or full day/ week available. South Bay is the fastest growing area of San Diego. Successful sublease candidates will qualify to participate in ongoing exclusive quarterly networking events in the area. Call Alicia, (619) 585-0476. MEDICAL OFFICE FOR SALE OR SUBLEASE: A newly remodeled and fully built-out primary care clinic in a highly visible Medical Mall on Mira Mesa Blvd. at corner of Camino Ruiz. The office is approximately 1000 sq ft with 2 fully equipped exam rooms, 1 office, 1 nurse station, spacious and welcoming waiting room, spacious reception area, and ADA accessible restroom. All the furniture and equipment are new and modern design. Ample parking. Perfect for primary care or any specialty clinic. Please contact Nox at (619) 776-5295 or noxwins@hotmail.com. Available immediately. RENOVATED MEDICAL OFFICE AVAILABLE | EL CAJON: Recently renovated, turn-key medical office in freestanding single-story unit available in El

Cajon. Seven exam rooms, spacious waiting area with floor-to-ceiling windows, staff break room, doctor’s private office, multiple admin areas, manager’s office all in lovely, drought-resistant garden setting. Ample free patient parking with close access to freeways and Sharp Grossmont and Alvarado Hospitals. Safe and secure with round-the-clock monitored property, patrol, and cameras. Available March 1st. Call 24/7 on-call property manager Michelle at the Avocado Professional Center (619) 916-8393 or email help@ avocadoprofessionalcenter.com.

CLASSIFIEDS

OPERATING ROOM FOR RENT: State of the Art AAAASF Certified Operating Rooms for Rent at Outpatient Surgery of Sorrento. 5445 Oberlin Drive, San Diego 92121. Ideally located and newly built 5 star facility located with easy freeway access in the heart of San Diego in Sorrento Mesa. Facility includes two operating rooms and two recovery bays, waiting area, State of the Art UPC02 Laser, Endoscopic Equipment with easy parking. Ideal for cosmetic surgery. Competitive Rates. Call Cyndy for more information (858) 658-0595 or email Cyndy@roydavidmd.com. PRIME LOCATION | MEDICAL BUILDING LEASE OR OWN OPPORTUNITY IN LA MESA: Extraordinary opportunity to lease or lease-to-own a highly visible, freeway-oriented medical building in La Mesa, on Interstate 8 at the 70th Street on-ramp. Immaculate 2-story, 7.5k square foot property with elevator and ample free on-site parking (45 spaces). Already built out and equipped with MRI/CAT machine. Easy access to both Alvarado and Sharp Grossmont Hospitals, SDSU, restaurants, and walking distance to 70th St Trolley Station. Perfect for owner-user or investor. Please contact Tracy Giordano [Coldwell Banker West, DRE# 02052571] for more information at (619) 987-5498. KEARNY MESA OFFICE TO SUBLEASE/SHARE: 5643 Copley Dr., Suite 300, San Diego, CA 92111. Perfectly centrally situated within San Diego County. Equidistant to flagship hospitals of Sharp and Scripps healthcare systems. Ample free parking. Newly constructed Class A+ medical office space/medical use building. 12 exam rooms per half day available for use at fair market value rates. Basic communal medical supplies available for use (including splint/ cast materials). Injectable medications and durable medical equipment (DME) and all staff to be supplied by individual physicians’ practices. 1 large exam room doubles as a minor procedure room. Ample waiting room area. In office x-ray with additional waiting area outside of the x-ray room. Orthopedic surgery centric office space. Includes access to a kitchenette/indoor break room, exterior break room and private physician workspace. Open to other MSK physician specialties and subspecialties. Building occupancy includes specialty physicians, physical therapy/occupational therapy (2nd floor), urgent care, and 5 OR ambulatory surgery center (1st floor). For inquiries contact kdowning79@gmail.com and scurry@ortho1.com for more information. Available for immediate occupancy. LA JOLLA/UTC OFFICE TO SUBLEASE OR SHARE: Modern upscale office near Scripps Memorial, UCSD hospital, and the UTC mall. One large exam/procedure room and one regular-sized exam room. Large physician office for consults as well. Ample waiting room area. Can accommodate any specialty or Internal Medicine. Multiple days per week and full use of the office is available. If interested please email drphilipw@ gmail.com. ENCINITAS MEDICAL SPACE AVAILABLE: Newly updated office space located in a medical office building. Two large exam rooms are available M-F and suitable for all types of practice, including subspecialties needing equipment space. Building consists of primary and specialist physicians, great for networking and referrals. Includes access to the break room, bathroom and reception. Large parking lot with free parking for patients. Possibility to share receptionist or bring your own. Please contact coastdocgroup@gmail.com for more information. NORTH COUNTY MEDICAL SPACE AVAILABLE: 2023 W. Vista Way, Suite C, Vista CA 92082. Newly renovated, large office space located in an upscale medical office with ample free parking. Furnishings,

decor, and atmosphere are upscale and inviting. It is a great place to build your practice, network and clientele. Just a few blocks from Tri-City Medical Center and across from the urgent care. Includes: multiple exam rooms, access to a kitchenette/break room, two bathrooms, and spacious reception area all located on the property. Wi-Fi is not included. For inquiries contact hosalkarofficeassist@gmail.com or call/text (858) 740-1928. NON–PHYSICIAN POSITIONS AVAILABLE PART-TIME POSITIONS AVAILABLE: We are seeking a part-time Nurse Practitioner, Physician Assistant, or Family Practice Physician to provide outpatient care at a private practice in the Hillcrest area. The position is 16 hours per week, with scheduled hours on Wednesdays and Thursdays. Candidates must be bilingual in English and Spanish and have experience caring for geriatric patients. Compensation is $100 per hour for Nurse Practitioners and Physician Assistants and $150 per hour for Physicians. For more information, please email fdempsey@drlmmarquez. com or call 858-270-7633. NURSE PRACTITIONER | PHYSICIAN ASSISTANT: Open position for Nurse Practitioner/Physician Assistant for an outpatient adult medicine clinic in Chula Vista. Low volume of patients. No call or weekends. Please send resumes to medclinic1@yahoo. com. [2876-1121]

POSTDOCTORAL SCHOLARS: The Office of Research Affairs, at the University of California, San Diego, in support of the campus, multidisciplinary Organized Research Units (ORUs) https://research. ucsd.edu/ORU/index.html is conducting an open search for Postdoctoral Scholars in various academic disciplines. View this position online: https:// apol-recruit.ucsd.edu/JPF03803. The postdoctoral experience emphasizes scholarship and continued research training. UC’s postdoctoral scholars bring expertise and creativity that enrich the research environment for all members of the UC community, including graduate and undergraduate students. Postdocs are often expected to complete research objectives, publishing results, and may support and/ or contribute expertise to writing grant applications https://apol-recruit.ucsd.edu/JPF03803/apply. [2864-0808] RESEARCH SCIENTISTS (NON–TENURED, ASSISTANT, ASSOCIATE OR FULL LEVEL): The University of California, San Diego campus multidisciplinary Organized Research Units (ORUs) https://research.ucsd.edu/ORU/index.html is conducting an open search for Research Scientists (non–tenured, assistant, associate or full level). Research Scientists are extramurally funded, academic researchers who develop and lead independent research and creative programs similar to Ladder Rank Professors. They are expected to serve as Principal Investigators on extramural grants, generate high caliber publications and research products, engage in university and public service, continuously demonstrate independent, high quality, significant research activity and scholarly reputation. Appointments and duration vary depending on the length of the research project and availability of funding. Apply now at https://apolrecruit.ucsd.edu/JPF04449/apply. [2867-0904] PROJECT SCIENTISTS: Project Scientists (nontenured, Assistant, Associate or Full level): The University of California, San Diego, Office of Research and Innovation https://research.ucsd.edu/, in support of the Campus multidisciplinary Organized Research Units (ORUs) https://research.ucsd.edu/ORU/index. html is conducting an open search. Project Scientists are academic researchers who are expected to make significant and creative contributions to a research team, are not required to carry out independent research but will publish and carry out research or creative programs with supervision. Appointments and duration vary depending on the length of the research project and availability of funding: https://apol-recruit. ucsd.edu/JPF04450/apply. [2868-0904]

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Day at the Races

Del Mar Thoroughbred Club - Bob Hope Celebrity Suite

Join us for Champions for Health’s Day

at the Races at the Del Mar Thoroughbred Club. Enjoy an exclusive afternoon of exciting horse racing, delicious food, and refreshing drinks while supporting vital healthcare programs for San Diego’s underserved communities.

Saturday, November 14, 2026 12:00 pm – 4:00 pm (1st race is at 12:30 pm)

Del Mar Fairgrounds 260 Jimmy Durante Blvd, Del Mar, CA 92014

For sponsorship information, please contact Gabriela Stichler at gabriela.stichler@championsfh.org or at 858-300-2789 • Race4Health.givesmart.com