Health Officer Monthly Newsletter for Orange County Clinicians August 2025
August 15, 2025
Regina Chinsio-Kwong, DO County Health Officer
Summer Heat, Valley Fever, and Calming Fears About H.R. 1
As we move into the late months of summer, the weather has been hotter. The Centers for Disease Control and Prevention (CDC) has a Heat and Health Tracker Dashboard that includes syndromic data pulled from emergency department visits related to heat-related illness as well as other helpful information of past extreme heat events. Find out more here.
Valley Fever Awareness month. During the summer months, the Coccidioides fungus spores thrive in the dirt and dust - and can cause infection when inhaled. Confirmed cases typically rise throughout the fall months (September to November) in California. On August 14 the California Department of Public Health (CDPH) issued a press release reminding residents and visitors that Valley Fever is common in parts of the state and that case counts in 2025 are following the record high rates experienced in 2024. Many resources for the public as well as clinicians are available on the CDPH’s Valley Fever website. The CDPH has also created a Provisional Valley Fever Dashboard that is updated monthly and also includes suspected, probable and confirmed cases throughout the state. The good news for Orange County is that case numbers have decreased compared to 2023. However, it is still important for local providers to be aware of Valley Fever as many can be returning from areas that may be experiencing high rates of Valley Fever or may be in conditions that may place individuals at higher risk (dust storms, firestorms). Of note, Valley Fever should be considered in the differential diagnosis for first responders (firefighters) or anyone at high risk returning from areas with high Valley Fever rates who present with respiratory symptoms, fever and fatigue. Find out more here.
Who is at risk?
- Older adults 60+
- Certain ethnic groups: Black, Filipino
- Pregnant, diabetic, or weakened immune system (cancer, HIV, on chemotherapy, steroids or other medications that affect the immune system, organ transplant)
Signs/Symptoms:
- Symptoms appear 1-3 weeks after breathing fungus from dust
- Fatigue, cough, difficulty breathing, fever, night sweats, muscle or joint aches, chest pain, weight loss, headache, rash
CDC has created the following visual algorithm to assist clinicians:
More information about testing for coccidioidomycosis is available on the CDC website.
Learn more and get free Continuing Medical Education (CME)! Algorithms for Diagnosing the Endemic Mycoses Blastomycosis, Coccidioidomycosis, and Histoplasmosis – CDC Clinician Outreach and Communication Activity (COCA) Webinar
Townhall Held to Calm Fears and Provide Updates About Impacts of the One Big Beautiful Bill Act (H.R. 1) for Local Providers
On August 14, the Orange County Medical Association (OCMA) hosted a recorded Townhall featuring Elizabeth McNeil, VP, Federal Government Relations of California Medical Association (CMA) and Michael Hunn, CEO of CalOptima Health to review H.R.1 and its core provisions, impacts on care delivery and physician reimbursement, and how organized medicine is responding. Recordings to this important townhall are available here
1. National Actions and Recent Events
• The shooting that occurred at the CDC campus on August 8 proves how misinformation can have negative and even deadly consequences. Public health leaders issued a joint statement in response to the attack on CDC. Read more here.
• Health and Human Services (HHS) announced the reinstatement of the Task Force on Safer Childhood Vaccines which will work closely with the Advisory Committee on Immunization Practices (ACIP) to produce vaccine recommendations.
• HHS announced its intent to wind down mRNA vaccine development under BARDA.
• The Senate confirmed Susan Monarez, PhD as the new CDC Director. Monarez previously served as deputy director at Advanced Research Projects Agency for Health under the Biden Administration and was the founding director of the Center for Innovation at the Health Resources and Services Administration.
• The CDC releases Program Operation Considerations for Sexually Transmitted Infection Prevention providing sexually transmitted infections program managers and staff with guidance on planning, implementing and evaluating prevention activities.
Susan Monarez (Photo CDC)
• The Food and Drug Administration (FDA) recommended classifying 7-hydroxymitragynine (7-OH), a concentrated byproduct of the kratom plant that is increasingly recognized as having potential for abuse because of its ability to bind to opioid receptors, as a controlled substance. The Drug Enforcement Administration (DEA) will need to review the FDA’s recommendation. If the DEA agrees, it must initiate a formal rulemaking process under the Controlled Substances Act.
o On August 13, the Orange County Board of Supervisors (Board) approved the first reading of the revised ordinance banning the sale or distribution of products with 7-OH (Agenda Item 54) and summarized reasons for their desire to pass the local ordinance along with concerns brought up by a local addiction specialist.
o Links to Passed Board Item 54: OC Board of Supervisors Meeting and Agenda August 12, 2025 and OC Board of Supervisors Agenda Item 54 August 12, 2025.
• HHS Secretary Robert Kennedy, Jr. and US Department of Agriculture (USDA) Secretary Brooke Rollins announced a joint federal effort to define “ultra-processed foods” in response to rising rates of diet-related chronic disease. Interested stakeholders may submit public comments until September 23.
2. State Public Health Updates
Updates to Mandated Reporting of Certain Diseases and Conditions
California Code of Regulations (CCR), Title 17, Section 2500 mandates that certain communicable and non-communicable diseases/conditions be reported to the local health department. In Orange County, the OC Health Care Agency (HCA) Communicable Disease Control Division (CDCD) monitors reportable conditions and can also provide guidance and assistance to local clinicians. Learn more about the HCA CDCD team here
On June 27, 2025, the CDPH released a letter notifying providers that CCR Title 17 Section 2500 has been updated and includes additional and renamed conditions that must be reported to local health departments as well as modified timelines for certain conditions. The additional conditions are: Melioidosis; Cronobacter sakazakii infections in infants; Multisystem inflammatory syndrome in children (MIS-C); Silicosis. The renamed or modified conditions are: Neisseria meningitidis (invasive disease); Coronavirus disease 2019 (COVID-19 - hospitalizations only. The modified timelines for certain conditions are: Brucellosis, human; cyclosporiasis; hemolytic uremic syndrome; legionellosis; and shiga toxin detected in feces.
For more information, please refer to CDPH Reportable Diseases and Conditions page.
3.
A. Tuberculosis Meningitis (TBM)
Four cases of TB meningitis were reported in Orange County between September 2024 and April 2025 resulting in fatal outcomes. All had varying clinical presentations. Early diagnosis and aggressive treatment are critical to reducing the mortality and morbidity of TBM. Providers should consider TBM in patients with risk for TB (especially those born in countries with high prevalence of TB) in the following clinical situations:
o Unexplained inflammatory neurologic conditions (meningitis, meningoencephalitis, cerebral abscess) WITH
o Classical findings on contrasted MRI (basilar/leptomeningeal enhancement, exudate, hydrocephalus, infarcts, ring enhancing lesions) AND/OR
o Classic findings on lumbar puncture (low glucose, elevated protein, elevated WBC)
Join our local TB Controller – Dr. Helene Calvet for a webinar on TBM on September 10, 2025 from 12 - 1 pm. Registration Link: Click Here to Register
*Note Early in disease, MRI may be normal and LP may have lower WBC with neutrophilic predominance.
Patient with TBM may have a normal chest x-ray, with negative or indeterminant QuantiFERON-TB Gold Plus or T.Spot, and AFB smear and PCR of CSF may be negative! Negative results DO NOT rule out TBM!
Please remember to report any OC patient suspected to have any form of TB disease to the OC Health Care Agency TB Control by submitting a Confidential Morbidity Report (CMR) and calling (714) 834-8790 as soon as possible; it is especially important to report suspect TBM as rapid initiation of appropriate treatment is crucial.
Join our local TB Controller - Dr. Helene Calvet for a webinar on TBM from 12 noon – 1 p.m. on Wednesday, September 10. Click Here to Register
CME credit will be offered for those who view the presentation live (preregistration required). The presentation will also be recorded for viewing at a later date, but CMEs will not be offered for later viewing.
B. COVID
The percent of positive tests for COVID-19 has continued to increase as of the end of July when it was above 11%. This is in line with statewide wastewater data. Locally we have not yet seen substantial increases in emergency department visits for COVID-like illness nor in COVID-19 hospitalizations.
Orange County respiratory virus data can be viewed at Respiratory Virus Data | Orange County California - Health Care Agency. We continue to follow COVID-19 vaccine guidance from CDPH COVID-19 Vaccines
C. West Nile Virus
Orange County is entering West Nile Virus (WNV) season. WNV is a vector-borne virus, transmitted to humans by mosquitoes. Most cases occur in late summer or early fall. Human cases have not yet been reported this season in Orange County, but WNV-infected mosquitos have been identified in OC and surrounding Southern California counties.
About 20% of persons infected with WNV will have symptoms, most often a febrile illness. A small proportion (about 1 in 150) will have neurologic illness with meningitis or encephalitis. People 55 years of age and older are at higher risk of getting sick from WNV and are more likely to develop serious symptoms. People with certain medical conditions (such as cancer, diabetes, hypertension, and kidney disease) are also at greater risk of developing severe illness. All residents are recommended to remove standing water from their place of residence and use insect repellant when outside, particularly at dawn and dusk.
West Nile Virus infection is a reportable disease. Cases should be reported to the HCA Communicable Disease Control Division at (714) 834-8180
Additional information on West Nile Virus infection is available at Clinical Signs and Symptoms of West Nile Virus Disease | West Nile Virus | CDC.
For updated West Nile Virus mosquito and bird activity in Orange County, visit West Nile Virus Activity in the County - Orange County Mosquito and Vector Control District.
D. Measles
Nationally measles activity has been declining. As of August 5, the CDC reports a total of 1,356 confirmed cases across 41 states. As of Wednesday, August 13, nationally confirmed measles cases have not been updated, however per the CDC’s website, the CDC expects to resume posting updates “as soon as possible.” The CDC continues to emphasize that providers should include measles in their differential in the appropriate clinical and epidemiologic settings: Healthcare Providers: Stay Alert for Measles Cases
Local information and resources are available at CDPH Measles Activity and OC Health Care Agency Measles
4. Preparedness/Response
Did You Get the Tsunami Alert Earlier This Month?
Were you prepared? Did you get the tsunami alert? If you have the Federal Emergency Management Agency (FEMA) app, you likely received a direct alert from your smart device! If you didn’t, it’s time to think about signing up to receive alerts!
On August 8, a magnitude 7.4 earthquake near eastern Russia triggered a tsunami watch across the Pacific, including here in coastal Orange County. Thankfully, the alert was lifted quickly, and no local impact occurred — but it was a solid reminder that even distant events can ripple toward our region with little notice.
For those of us working in health care, these moments are more than just headlines. They’re reminders of the critical role we play — not only in response but in preparedness. Whether it’s supporting surge capacity, communicating risk clearly to patients, or staying looped into realtime alerts, our readiness matters.
Here’s what we recommend:
1) If you haven’t already done so, sign up on AlertOC and ReadyOC.org. Additionally consider uploading the following apps to receive immediate alerts and to stay connected: ReadyOC, FEMA, MyShakeApp, Air Quality Management District
2) Make sure your contact information is up to date in your facility’s emergency notification system
3) Encourage your patients - especially the medically fragile ones, to have a go bag ready and a plan:
a. Consider having critical documents ready (ex: passports, photos, deed of your home)
b. Medications that would be difficult to replace if your home is hit by a tsunami or other emergency event
c. Phone charger/external battery
d. Medical devices
4) Brush up on tsunami and coastal evacuation zonesespecially if you practice near the shoreline. You can obtain information from the California Geological Survey and your city emergency manager.
Events like this are a chance to test our systems, check our blind spots, and remind ourselves why preparedness is part of the care we provide — even when the skies are clear. As always, thank you for being part of Orange County’s health care safety net.
5. Alerts/Recalls
FDA Warns of Lead That May Leach From Imported Cookware.
Kadai/Karahi Tiger White Cookware
Description: Imported cookware product made of aluminum, brass and aluminum alloys.
Manufacturer: Saraswati Strips PVT. LTD
The FDA could not identify and contact the distributor or responsible party to facilitate a recall, this product may still be sold as cookware in retail stores.
FDA Alert: August 13, 2025
Hazard:
Lead. FDA is warning retailers retailers and consumers not to sell or use certain imported cookware. Cookware tested by FDA and state partners found lead that may leach into food, making food unsafe. Young children, women of child-bearing age, and those who are breastfeeding may be at higher risk for potential adverse events after eating food cooked using these products.
Link:
FDA Issues Warning About Imported Cookware That May Leach Lead: August 2025 | FDA
• Retailers should discontinue sale, and consumers should not use this product as cookware or food storage.
• Consumers should check their homes for products listed and throw away any cookware that may be able to leach lead into food.
Product Recalls Related to Excess Lead Levels
Parashore Pear Slices in Juice, 15 oz cans
Description:
15 oz cans, UPC #704817164237.
The specific lot found positive for heavy metals was:
Lot: 3700/01172 6122J
Prod: 02/19/2024
Best by: 2/19/2027
Distributed at grocery outlet stores in California and across the United States
Recall Date: July 23, 2025
Hazard:
Parashore Pear Slices in Juice is being recalled because of potential contamination with elevated levels of lead and cadmium. Lead and cadmium are toxic if ingested by young children and can cause adverse health issues.
Link:
W.W. Industrial Group Recalls Pear Slices in Juice Due to Elevated Levels of Lead and Cadmium | FDA
The CDPH and the FDA recommend providers:
- Advise patients/families to:
o Immediately discontinue use of the recalled item.
o Return it to the place of purchase for a full refund or discard it in the trash. Test children for lead exposure if children used the recalled product.
Please help share this information with your families and clients and contact the Orange County Childhood Lead Poisoning Prevention Program (CLPPP) at (714) 567-6220 if you have any questions or concerns.
For additional information and resources, please refer to the OC CLPPP website at: https://ochealthinfo.com/lead and CDPH website at: CLPPP Branch
Product Recalls Related to Other Safety
Bestway (Coleman), Intex, and Polygroup above-ground pools, 48-inch and taller with compression straps on the outside and over the vertical support leg, multiple models.
Description:
See the Consumer Product Safety Commission (CPSC) recall (below) for the complete list of model names.
Sold since 2002 in stores nationwide, including Walmart, Target, Sears, Lowe’s, Kmart, Toys “R” Us, Sam’s Club, The Home Depot, Big Lots, Costco and BJ’s (among others), as well as online at Amazon, Wayfair and Bestway USA, Intex, Funsicle and Summer Waves websites.
Five million pools are being recalled.
Hazard:
The compression strap that surrounds the outside of the pool legs may create a foothold, allowing a child access to the pool, posing a drowning risk. The CPSC believes nine children between the ages 22 months and 3 years old have drowned after gaining access to the pools via the footholds in California, Texas, Florida, Michigan, Wisconsin, and Missouri between 2007 and 2022. Additional incidents have been reported where children used the straps to gain entry to the recalled pools.
Link:
Bestway, Intex, and Polygroup Recall Certain Above-Ground Pools 48 Inches and Taller Due to Drowning Hazard; Nine Deaths Reported; Five Million Pools Sold Since 2002 | CPSC.gov
The CPSC advises families should contact Bestway, Intex or Polygroup to request a repair. In the interim, consumers should ensure that children cannot access the pool unattended, or alternatively, drain the pool until the repair can be installed.
6. Foodborne Illness - Multistate Outbreaks
Recalls, Market Withdrawals, & Safety Alerts | FDA
Date Brand Name(s) Product
Recall Reason Description Company Name
8/12/25 Wegmans Cheeses Food & Beverages, Foodborne Illness, cheese Potential Foodborne illness - Listeria monocytogenes
July: Frozen Sprouted Beans - Salmonella
Website Links:
CDC Current Outbreak List | Outbreaks | CDC
Recalls, Market Withdrawals, & Safety Alerts | FDA
Recalls & Public Health Alerts | Food Safety and Inspection Service
International Travel Health Notices
August 2025
Level 2 – Global Polio
Level 2- Chikungunya in China
7. Public Health Related Observances
August:
National Immunization Awareness Month
Wegmans New York
Health care providers are important trusted messengers when it comes to immunization. A recent randomized clinical trial published in the Journal of the American Medical Association revealed that physician-created videos and infographics resulted in higher influenza vaccination rates by end of the flu season for children. Whether they are primary care specialists, physicians, nurses or assistants, the entire health care team can support the message of immunization. Prepare for the respiratory season now by encouraging the community to get added protection through vaccines!
Resources to help with that communication include:
Talking with Parents about Vaccines
Vaccine Confidence & Addressing Concerns
Training: California Immunization Coalition: August 28 at 12 p.m.
Strengthening Immunization Efforts: Women Infants and Children Program in California
National Breastfeeding Awareness Month
August is the start of National Breastfeeding Month. Women, Infants and Children (WIC) helps families feed their babies with support they can count on. We serve participants and their families from many cultures and communities. Come and meet your local WIC team!
August 22 – 2 p.m. to 4:30 p.m.
14120 Beach Blvd. Suite 145 Westminster, CA 92683
August 29 – 2 p.m. to 4:30 p.m.
2137 E. Ball Rd. Anaheim, CA 92806
Legionella Awareness Month
August is Legionella Awareness Month (Legionnaires’ Disease and Pontiac Fever). Did you know that cases are rising across the state and nationwide? According to the CDC, Legionella cases have been increasing since 2000, and the CDPH reports that the average annual incidence rate of legionellosis in California has increased by 94.9%. The risk of developing the disease rises with age, with most cases in people over 50 years old. Recently, the New York City Health Department has been investigating a community cluster of Legionnaires’ disease with 81 confirmed cases, 3 deaths, and 24 hospitalized.
Cooling towers are a significant potential source of Legionella exposure. Any building with a cooling tower, including a hospital, needs to develop a water management program to reduce the risk of Legionella growing and spreading within water systems and devices. Locally, the OC Environmental Health Division is called to investigate when a cluster of cases is identified, or if a likely community source is identified. During an investigation, OC Environmental Health Specialists conduct comprehensive inspections as needed of cooling towers, water systems, and water management plans, and analyze water sample data. In coordination with the CDC and the OC Communicable Disease Control Division, these environmental investigations can take place at a variety of buildings, including health care centers, hospitals, private residences, businesses (amusement parks or gyms), public swimming pools and spas.
Please click here (Controlling Legionella | Control Legionella | CDC) to learn more about preventing Legionella.
September Awareness days:
• Fungal Disease Awareness Week (September 16-20)
• National HIV/AIDS and Aging Awareness Day (September 18)
8. Orange County Community Health Improvement Plan Updates
At the National Association of County and City Health Officials (NACCHO) 360 Conference held in Anaheim this July, the OC Health Care Agency was proud to share our work through an abstract presentation titled “A County’s Approach to a Unified Community Health Assessment.”
The presentation drew strong engagement from attendees across the country and was praised for its collective efforts, equitable approach and meaningful impact. The session highlighted our collaborative approach to unifying assessments across sectors — laying the groundwork for a more integrated, equitably driven Community Health Improvement Plan. We’re energized by the national interest in our model and look forward to building on this momentum locally.
To find out more or to participate in a workgroup, email us at occhip@ochca.com To access the OC Community Health Improvement Plan (OC CHIP) please visit: OC Health Improvement Plan | Orange County California - Health Care Agency.
9. Training and Webinar Opportunities:
• California State Association of Counties – R.I.S.E.: August 19 at 11:45 a.m.
CSAC R.I.S.E. Medi-Cal at a Crossroads
• The California Endowment: August 20 at 10 a.m.
What’s Ahead for Medi-Cal and California’s Health Landscape
• NACCHO and Public Health Law Center: August 27 at 12 p.m.
Building Policy, Supporting Families: Advancing Breastfeeding Initiatives Together
• California Medical Association (CMA): August 28 at 12:15 p.m.
What Physicians Need to Know About Changes to Medicaid and the ACA
• Coalition of OC Community Health Centers – Coffee Connection: September 5 at 9 a.m.
Navigating Care in Uncertain Times: Scenario Planning for Safety Net Organizations
• CMA: September 9 at 12 p.m.
Provider Consultation Programs for Supporting Youth and Maternal Mental Health
• The American Academy of Pediatrics Orange County Chapter is holding their 41st Annual Advances in Pediatrics Conference at the Irvine Marriot Hotel from September 19-21. Find out more here.
OC Health Care Agency Director Dr. Veronica Kelley addressed NACCHO on funding challenges faced by local health departments.
Previously Recorded Webinars/Podcasts
• Frameworks How to Counter Public Health Myths and Elevate Science Now Slides for discussion available here. Recorded in 2024.
• California Medical Association (CMA)
From Capitol Hill to CA: Policy Trends Shaping Healthcare in 2025-2026
Recorded June 2025
• CMA: Virtual Grand Rounds: Tickborne Disease
Recorded July 2025
• CMA: Southern California Wildfire Response- What Clinicians Need to Know
Recorded from January 29, 2025
• National Emerging Special Pathogens Training and Education (NETEC)
Podcast: Transmission Interrupted: https://netec.org/podcast/
Special Pathogen Preparedness: A Guide to the NETEC Viral Hemorrhagic Fever (VHF)
Preparedness Checklist
Recorded August 6, 2025
• Center for Infectious Disease Research and Policy Offers daily news headlines, and newsletters for specific communicable disease topics Podcast: Osterholm Update
Dr. Michael Osterholm discusses the latest infectious disease developments. Link: https://www.cidrap.umn.edu/osterholm-update
National Association Webinar Webpages
• American Public Health Association (APHA) APHA Webinars
• CMA Recorded Webinars Virtual Grand Rounds (cmadocs.org)
• National Foundation for Infectious Disease Webinars https://www.nfid.org/education-events/webinars/
• Infectious Disease Society of America Public Health Page Public Health (idsociety.org)
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