Health Officer Monthly Newsletter for Orange County Clinicians
June 2025
June 16, 2025
Almaas Shaikh, MD, MPH
Matthew Zahn, MD Deputy Health Officers
Dear Colleagues,
June Message
As we move into the summer months, we want to take a moment to recognize the tireless efforts each of you continue to make in advancing the health and well-being of our community. June brings not only longer days and warmer weather, but also important moments for reflection and action particularly as we observe Men’s Health Month, National Safety Month, and so many more observations, while continuing to focus on heat-related illness prevention and environmental health awareness.
In this issue, we spotlight emerging public health trends, review clinical updates on communicable disease surveillance, highlight silicosis awareness and resources on silicosis, and learn about the recent Health Officer’s Address on the State of Public Health in Orange County. We also invite you to explore resources to learn about disaster preparedness. All of these are topics that remain relevant as we navigate a continually evolving landscape.
Thank you for your commitment to accessible health care, science-based practice, and compassionate care. We look forward to continuing our collaboration as we prepare for the challenges and opportunities ahead.
June is Silicosis Awareness Month: A Call to Action for Clinicians
First observed in Los Angeles in 2023, Silicosis Awareness Month was established to raise alarm about the growing public health crisis tied to engineered stone fabrication. That same year, the California Department of Public Health (CDPH) released a groundbreaking alert describing the burden of serious lung disease seen in workers in this industry: “A Global Epidemic Comes to California: Silicosis in Countertop Workers.” Since then, awareness has grown especially here in Orange County, where the Board of Supervisors officially recognized June as Silicosis Awareness Month in 2024 following the identification of multiple local cases.
So where are we now?
In January 2025, a community roundtable was convened to bring together providers and public health leaders to better understand this aggressive, preventable occupational disease. The CDPH also launched the Engineered Stone Silicosis Surveillance Dashboard, offering real-time data on case counts across California. According to the dashboard, Orange County now ranks second in the state for identified engineered stone silicosis cases, with 59 confirmed cases. Los Angeles County continues to report the highest number at 180 cases. It's important to note that Orange County had previously identified over 100 potential fabrication sites back in 2023.
This June, we urge clinicians to take an active role in addressing this public health crisis:
• Stay informed: Learn how to recognize, screen, and diagnose silicosis particularly in patients working in countertop fabrication or stonecutting industries. Familiarize yourself with care pathways for those with suspected or progressive disease.
• Promote prevention: Educate at-risk patients and the broader community about ways to reduce silica exposure, including the use of proper respiratory protection and wetcutting techniques.
• Engage locally: Partner with community-based organizations, industry leaders, and public health agencies to enhance outreach, early detection, and timely care for affected populations.
As silicosis continues to emerge in our own backyard, your role in early identification and intervention is critical. Together, we can move from awareness to prevention and ultimately, to action.
Silicosis – Upcoming Learning Opportunities
1. California Labor Occupational Health Program (LOHP) – “Research-to-Practice Toolkit & Community Engagement”
• Date: Wednesday, June 25, 2025 • 12 noon PST
• Overview: Part of the monthly California Labor Lab webinar series, this session presents the Research-to-Practice Toolkit used to engage stakeholders and translate occupational health research (including silica exposure) into practical action
• Register: via LOHP’s webinar page: https://www.lohp.org/events
Community Engagement and Silicosis Resources
1. Silicosis Resources – UCLA Education and Research Center
• Description: A comprehensive hub for educational materials on silicosis prevention, engineering controls, and California’s silica dust emergency standard.
• Link: UCLA UCI Silicosis Resources
2. Natural Stone Institute – Silica Safety Certificate Course
• Description: Offers a 4-hour online course for stone workers on silica safety, silicosis prevention, and creating a jobsite safety culture.
• Link: https://www.naturalstoneinstitute.org/silica/
3. California Department of Public Health (CDPH) – Engineered Stone Silicosis Dashboard
ο Link: Engineered Stone Silicosis Surveillance Dashboard
ο Tracks confirmed silicosis cases and fabrication site surveillance across California counties.
4. Cal/OSHA – Silica Dust Exposure Enforcement and Outreach (ETS)
ο Link: Respirable Crystalline Silica Standards and Resources.
ο Features Cal/OSHA's silica standards, emergency regulations, fact sheets, and compliance materials.
ο Medical Facilities in California Offering Medical Surveillance Exams for SilicaExposed Workers.
Silicosis Data
Information for Employers:
- Updated Workplace Air Monitoring Guide for Silica During Stone Fabrication Work
- Information for Employers — Silicosis Awareness
- Control of Silica Exposure in Engineered Stone Fabrication Facilities - Safety, Health, Environmental Services
Information for Clinicians:
- Silicosis for Health Care Providers
- Silicosis in Countertop Fabrication Workers
- Case Reporting to California Reportable Disease Information Exchange (CalREDIE) via silicosis@cdph.ca.gov or by phone (800) 970-6680.
- Silicosis Medical Examination Reporting
o Under the Cal/OSHA silica standard, employers are required to offer silica medical examinations to silica-exposed workers. Providers who conduct these exams are required to report the results of all examinations to CDPH, whether or not the worker has been diagnosed with silicosis.
o Reports should include:
Patient name and date of birth
Name and location of the facility where they were exposed
Date of the relevant encounter
A copy of the exam report provided to the worker
Exam results can be reported via fax: 916-636-6153 or email silicosis@cdph.ca.gov
Did You Miss the State of Public Health in Orange County Address?
On May 28, 2025, Orange County Health Officer Dr. Regina Chinsio-Kwong delivered the annual State of Public Health in Orange County Address, offering an evidence-based overview of current health trends, emerging threats, and strategic priorities shaping the health of our community. Key highlights from the presentation included:
• Public Health Rankings and Life Expectancy: Orange County continues to rank among the healthiest counties in California, with improving post-pandemic life expectancy. However, disparities by race, ethnicity, geography, and income persist. These disparities underscoring the importance of gathering and sharing health data for specific at-risk community groups and developing targeted interventions for these groups.
• Maternal and Child Health: Clinicians were encouraged to note significant increases in perinatal behavioral health needs and substance-exposed infants. Depression during pregnancy has increased modestly, and early prenatal care access continues to show disparities, particularly among Black and Pacific Islander women.
• Behavioral Health and Overdose Trends: Suicide rates remain highest among adults between the ages of 55 and 64 years. While opioid-related deaths declined slightly in 2023, opioids especially fentanyl continue to drive the majority of drug-related fatalities. Clinicians are urged to engage in overdose prevention and harm reduction efforts, including naloxone distribution. More information can be found at the website: FentanylisForeverOC.org
• Infectious Disease Surveillance: Respiratory viruses dominated the recent winter season, with 2024-25 being the deadliest non-pandemic flu season on record for US children. Tuberculosis rates have improved locally but remain higher than national levels. Congenital syphilis, STIs, and hepatitis C disease burdens remain significant. Congenital syphilis rates have remained elevated for the past several years compared to historic data
• Emerging Issues: Rising recreational nitrous oxide use, outbreaks of measles, and the health impacts of climate change (e.g., valley fever, heat-related illness) were emphasized. Clinicians are encouraged to remain alert to these evolving public health threats.
• Aging Population and Chronic Disease: Alzheimer’s disease is now the third leading cause of death in Orange County. Barriers to care and behavioral health access for older adults were highlighted as priority concerns.
• System Pressures and Readiness: Despite national public health funding reductions, Orange County has maintained effective emergency response coordination. The EMS team was recognized statewide for innovation in data exchange and preparedness.
If you missed the address, you can view the presentation here: https://tinyurl.com/OCHealthOfficer2025
This presentation provides essential context for clinicians to understand the broader health landscape, guide patient care, and align with local initiatives advancing health equity and prevention.
1. Local: OC Health Care Agency Press Releases – June 2025
OC Health Care Agency Communicable Disease Control Division
a. Michelle Aguirre Appointed as Orange County’s County Executive Officer
On June 10, 2025, the Orange County Board of Supervisors appointed Michelle Aguirre as the County Executive Officer (CEO). Aguirre, who has served in various leadership roles within the County of Orange, including Interim CEO and Chief Financial Officer, assumes her new position immediately. The Board will consider her employment contract at the June 24, 2025 meeting. You can read more here.
b. Ocean Water Quality Report Shows Beach Closures Below 38-Year Average
The OC Health Care Agency's biennial Ocean, Harbor, and Bay Water Quality Report for 2023–2024 indicates that the number of beach closures in Orange County caused by sewage spills remains below the 38-year average for the 13th consecutive year. This reflects ongoing efforts to maintain water quality and public health safety. You can read the Ocean Report here.
2. Public Health – Communicable Disease Control Division Updates
A. COVID-19 Vaccine Recommendation Updates
The Centers for Disease Control (CDC) has updated its COVID-19 vaccination recommendations. Under the new guidance, children 6 months to 17 years who are not moderately or severely immunocompromised may be vaccinated using a shared clinical decision-making model between the health care provider and the patient or parent/guardian. The CDC’s pregnancy vaccination table now also indicates that there is “No Guidance” for COVID-19 vaccination for pregnant persons (link here). However, the CDPH continues to recommend that everyone 6 months and older get a 2024-25 COVID19 vaccine, regardless of health status, and the American College of Obstetrics and Gynecology continues to recommend COVID-19 vaccination during pregnancy (link here). The CDPH has indicated that insurance should continue to cover vaccination for everyone 6 months of age and older including pregnant persons.
B. Hand Foot and Mouth Disease: Outbreaks in Daycares
The HCA has had a recent increase in reports of outbreaks of Hand Foot and Mouth Disease (HFMD) in preschool and childcare settings. HFMD is caused by enterovirus, a common childhood virus that generally causes nonspecific febrile illness. More severe manifestations, such as aseptic meningitis, may occur, but the vast majority of enteroviral illnesses are mild and self-resolve. There is no specific treatment. Cases occur most commonly in the summer and fall. Public health recommends that children with HFMD be cared for in the preschool setting in the same fashion as any common febrile viral illness.
C.
Measles
Measles cases counts continue to rise across the country. There have now been over 1,100 cases identified in at least 34 jurisdictions. Only 3% of cases have occurred in persons with two documented MMR (Measles, Mumps, and Rubella) doses. 89% of cases are related to local outbreaks, particularly in communities with low immunization rates. There is no local transmission of measles occurring in Orange County, but as more communities and states see cases, the risk of exposure during travel for county residents increases.
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: https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/Immunization/measles.aspx and https://ochealthinfo.com/services-programs/disease-prevention/diseasesconditions/measles.
D. H5N1 Avian Influenza – Bird Flu
The number of outbreaks of H5N1 in California dairy farms has slowed recently, and the last human case in the state was reported on January 14, 2025
However, the virus continues to be endemic in wild bird populations nationally In this context, human exposure, particularly for high-risk groups such as workers in dairy farms, remains possible. The CDC’s summary of the current H5N1 avian influenza situation can be found here
CDPH Resources:
-CDPH Human Avian Influenza A(H5N1) Quicksheet
-CDPH Toolkit: Bird Flu
-CDPH Avian Influenza A Infection Control for Healthcare Providers
-First cases of human Avian Influenza A (H5N1) in California & Preparation forRespiratory Virus Season (COVID-19, Influenza and RSV)
-Raw Milk and Raw Dairy Products
Additional Website links:
-CDFA - Animal Health - Avian Influenza
-H5 Bird Flu: Current Situation | Bird Flu | CDC
3. Preparedness and Response
As wildfire season intensifies across California, Orange County clinicians play a critical role in both preparedness and mitigation of health impacts associated with wildfire smoke and environmental exposure. Even when fires occur in neighboring counties, smoke can travel long distances and significantly affect air quality in Orange County triggering respiratory issues, cardiovascular events, and exacerbations of chronic conditions such as asthma, COPD, and heart disease. Vulnerable populations, including children, older adults, outdoor workers, and those with preexisting health conditions, are particularly at risk.
Clinicians are encouraged to proactively counsel patients on smoke exposure reduction strategies, including the proper use of N95 masks, creating clean indoor air spaces, and monitoring air quality indices through resources like AirNow.gov. Health care facilities should also review their emergency response protocols to ensure operational continuity in the event of poor air quality or wildfire-related displacement. Public Health will continue to share alerts, guidance, and resources through the HCA website and social media platforms, and the County’s Emergency Management Division.
4. Food & Drug Administration (FDA) Alerts & Recalls
June 2025
Clinicians are advised to monitor the following recent recalls and public health alerts:
Salmonella Outbreak – Brown Eggs
August Egg Company recalled approximately 1.7 million dozen brown cage-free and organic eggs sold in California and elsewhere due to Salmonella Enteritidis contamination. Egg cartons with sell-by dates from March 4 to June 4 should be discarded or returned. For more information click here.
Fungal Contamination – Nasal & Teething Swabs
Church & Dwight Company voluntarily recalled all lots of Zicam Nasal Swabs, Zicam AllClear Swabs, and Orajel Baby Teething Swabs after detecting fungal contamination in the cotton components. Immunocompromised patients should be advised to discontinue use immediately. For more information click here
Ventilator Recall – Medtronic Newport HT70 Series
On June 11, Medtronic issued a Class I recall for specific Newport HT70 and HT70 Plus ventilators, due to potential malfunctions posing serious patient risks. Facilities should remove affected devices immediately and implement alternate ventilation plans. For more information click here.
Salmonella Recall – Cucumbers
A multi-state Salmonella outbreak prompted an FDA recall of cucumbers, linked to illnesses. Clinicians should counsel patients to discard implicated produce and monitor for gastrointestinal symptoms. For more information click here
Sulfite Contamination – Dried Apricots
Turkana Food Inc. recalled 352 cases of dried apricots sold in 19 states (including California) due to undeclared sulfites, which can trigger severe asthma exacerbations or allergic reactions. For more information click here.
For More Information
• FDA Recalls, Market Withdrawals & Safety Alerts: https://www.fda.gov/safety/recallsmarket-withdrawals-safety-alerts
• Sign up for real-time FDA/CDC alerts through your professional networks.
Date Brand Name(s)
06/04/2025 Firehook Crackers Food & Beverages
06/04/2025 Multiple brands Fresh cucumbers and salsa and salads containing fresh cucumbers
06/04/2025 Amneal
Food & Beverages
Undeclared Sesame
Potential to be contaminated with Salmonella
Sulfamethox azole/Trimet hoprim Tablets, USP, 400 mg/80 mg Drugs Microbial contamination
06/03/2025 Aldi brand Casa Mamita Churro Bites Food & Beverages, Allergens Undeclared Milk
Website Links:
Recalls, Market Withdrawals, & Safety Alerts | FDA
CDC Current Outbreak List | Outbreaks | CDC
Recalls, Market Withdrawals, & Safety Alerts | FDA
Recalls & Public Health Alerts | Food Safety and Inspection Service
5. US Food Outbreaks – Overview:
In June 2025, several multistate foodborne illness outbreaks have been reported. Clinicians should maintain a high index of suspicion for these infections, obtain detailed food exposure histories, and promptly report suspected cases to public health authorities to support timely investigation and intervention.
Notable Outbreaks:
• Salmonella Enteritidis – Shell Eggs
A multistate outbreak of Salmonella Enteritidis has been linked to shell eggs distributed by August Egg Company of Hilmar, California. As of early June, 79 cases have been reported across seven states, with 21 hospitalizations. The implicated eggs, including brown cage-free and organic varieties, were distributed between February and May 2025. Patients typically present with diarrhea, fever, and abdominal cramps. High-risk groups include the elderly, young children, pregnant persons, and immunocompromised patients. For more from the CDC click here
• Salmonella – Pre-packaged Leafy Greens
Several states have reported Salmonella infections linked to consumption of prepackaged leafy greens. Symptoms include acute gastroenteritis, and severe illness can occur in vulnerable populations.
• Listeria monocytogenes – Soft Cheeses
Outbreaks associated with soft cheeses made from unpasteurized milk have resulted in invasive Listeria infections. Pregnant patients, newborns, and immunocompromised individuals are particularly at risk.
• E. coli O157:H7 – Ground Beef
Localized outbreaks of E. coli O157:H7 infections linked to contaminated ground beef have been reported. Clinicians should monitor for signs of hemolytic uremic syndrome (HUS), especially in children.
Clinical Recommendations:
• Obtain detailed food exposure histories for patients with gastrointestinal or systemic symptoms suggestive of foodborne illness.
• Report suspected foodborne infections immediately to local or state public health authorities.
• Educate patients on safe food handling, preparation, and consumption, including cooking eggs thoroughly and avoiding unpasteurized dairy products.
• Consider early empirical antimicrobial therapy in high-risk or severely ill patients after appropriate cultures are obtained.
• Monitor for complications such as HUS in E. coli infections and invasive disease in Listeria cases.
For up-to-date details and alerts on foodborne outbreaks, visit the FDA Recalls and Safety Alerts page: https://www.fda.gov/safety/recalls-market-withdrawals-safety-alerts.
6. International Travel Health Notices – Overview:
As of June 2025, several international health threats have been identified by the CDC, posing risks to travelers. Clinicians should advise patients planning international travel to stay informed about these risks and take appropriate preventive measures.
Key Health Threats:
• Chikungunya Virus Outbreaks
Multiple countries in the Indian Ocean region are experiencing outbreaks of chikungunya virus, transmitted by mosquitoes. Affected areas include:
o Kenya
o Madagascar
o Mauritius
o Mayotte (France)
o Réunion (France)
o Somalia
o Sri Lanka
Travelers to these regions should take precautions to prevent mosquito bites, such as using insect repellent and wearing long-sleeved clothing.
• Global Measles Resurgence
Measles cases are rising in many countries worldwide. All international travelers should be fully vaccinated against measles with the measles-mumps-rubella (MMR) vaccine. For more information click here
• Polio Risk
Some international destinations have circulating poliovirus. Before any international travel, ensure that travelers are up to date on their polio vaccinations. For more information click here.
Clinical Recommendations:
• Vaccination: Ensure that travelers are up to date on routine vaccinations, including MMR and polio.
• Preventive Measures: Advise travelers to take precautions to prevent mosquito bites, such as using insect repellent and wearing long-sleeved clothing.
• Stay Informed: Keep abreast of the latest travel health notices and outbreaks through the CDC's Travelers' Health website here
7. Public Health Related Awareness/Education/Observances Topics – June/July
Drowning Prevention
The Clinician’s Role in Drowning Prevention - Small Conversations, Big Impact
Drowning is the leading cause of injury-related death for US children ages 1–4, according to the CDC. The good news is that drowning is preventable. By taking time to counsel families and reinforce water safety measures, you can make a meaningful difference this summer. A simple question — “Do you or your family spend time near water?”— can open lifesaving conversations.
The
ABCs of Water Safety
When speaking with families, especially those with young children, share the ABCs of Water Safety:
• A is for Active Adult Supervision – Always have an adult watching children near water, without distractions.
• B is for Barriers – Install and maintain proper fencing, gates, and covers around pools and spas.
• C is for Classes – Encourage swim lessons for children and CPR training for adults.
Please also encourage families to attend a water safety event happening throughout the county this summer. These events provide valuable education and resources. More information is available at https://drowningpreventionoc.org/safer-summer-pool-party/.
8. Orange County Community Health Improvement Plan Updates
The Orange County Community Health Improvement Plan (OC CHIP) is well underway, with dedicated efforts from each of the six workgroups aligned with our county’s priority areas: Mental Health, Substance Use, Diabetes/Obesity, Housing and Homelessness, Care Navigation, and Economic Disparities.
These collaborative teams comprising public health professionals, health care providers, community-based organizations, and residents are actively advancing strategies to address root causes of health inequities and improve population health outcomes. As members of the medical community, your continued engagement, data sharing, and frontline insight are critical to ensuring that our collective work translates into meaningful, sustainable change for all Orange County residents.
To find out more or to participate in a workgroup, email us at occhip@ochca.com. To access the OC CHIP plan please visit: OC Health Improvement Plan | Orange County California - Health Care Agency.
9. Training and Webinar Opportunities:
• July 10-11 the California Medical Association 2025 Health Equity Leadership Summit –find out more here.
• July 14-18 the NACCHO 360 Bright Lights, Bold Ideas: Shaping the Future of Public Health Practice conference is being held at the Anaheim Convention Center. Learn more here.
• September 19-21 the American Academy of Pediatrics Orange County Chapter is holding their 41st Annual Advances in Pediatrics Conference at the Irvine Marriot Hotel. Find out more here.
Previously Recorded Webinars/Podcasts
• Frameworks How to Counter Public Health Myths and Elevate Science Now (recorded from 2024) Slides for discussion available here.
• California Medical Association (CMA)
Virtual Grand Rounds: Long COVID Update: What We Know Now: CMA Recorded March 11, 2025
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/
Episode 36: March 5, 2025 The New Joint Commission Standards, PPE, and Me Jill Morgan, Emory University Hospital and Brook Henriksen, Sacred Heart Spokane, Washington
• Online on demand courses from the National Special Pathogen System, to H5N1 Town Hall updates and Mpox available at: https://netec.org/education-training/#ceus
• 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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