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Health Alerts

The Snohomish Health District Health Officer Dr. Gary Goldbaum sends alerts via email to local health care providers. Alerts cover current local, regional or national health threats and important updates on medical care and protocols. Alerts are written as needed to cover urgent or emergent health issues.

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Influenza, mumps, strategies to reduce opioid overdoses

Today’s topics:

  • Influenza
  • Mumps
  • Strategies to reduce opioid overdoses



Action requested:  Take advantage of free resources to promote influenza vaccination. 

Background & Recommendations

The influenza season is here in earnest.  Through the week of November 26, 11 hospitalizations for influenza had been reported in Snohomish County, which is early for so many hospitalizations.  To encourage influenza immunization, the Washington State Department of Health recently launched a statewide influenza prevention media campaign called "Knock Out Flu". This campaign runs from November 14 - December 23 and includes movie theater advertisements (check it out on YouTube), Pandora streaming internet radio advertisements, online information for the lay public (English version at  and Spanish version at, and printable, bilingual calendars and posters for your office.  You can find the printable materials at:

I urge all health care providers to take advantage of these free resources.



Action requested:  Assure that all patients have been immunized against mumps and be alert for signs of mumps in patients, regardless of their immunization status. 


As of December 1, nine cases of confirmed or probable mumps had been reported in King County in the past month and another five cases were under investigation for possible mumps; all of the confirmed or probable cases were current on their mumps-measles-rubella (MMR) immunizations.  As of November 5, 45 states and the District of Columbia had reported mumps infections in 2879 people, the largest number for an entire year since 2006.  One case is under investigation here in Snohomish County.

Two doses of MMR vaccine are estimated to be 88% effective at protecting against mumps, a disease from which most people recover in a few weeks, but can lead to male sterility, meningitis, permanent hearing loss, or encephalitis causing death or permanent disability.  Health care providers should assure that all patients have been immunized against mumps and be alert for symptoms and signs of mumps (e.g., fever, headache, muscle aches, tiredness, loss of appetite, swollen and tender salivary glands under the ears on one or both sides (parotitis). 


  • Instruct reception/triage staff to identify patients who present with symptoms of possible mumps:
    • Such patients should wear a mask covering the nose and mouth.
    • Remove patient from waiting area and place in a single room promptly.
    • Use droplet and standard precautions.
    • Only staff with documented immunity to mumps should be allowed to enter patient’s room.
  • Patients with a clinical picture consistent with mumps (especially 2 or more days of parotitis) should be isolated and avoid contact with others (i.e., not return to work or school) until 5 days after onset of parotitis.
  • Collect specimens on patients with suspected mumps:
    • Buccal swab and urine for PCR and virus isolation
    • Serum for mumps IgG and IgM
  • Contact the Health District at 425-339-5278 to report confirmed or suspected mumps cases and for routing of specimens.

For more information about mumps, see


Strategies to Reduce Opioid Overdoses

Action requested:  Consider participating in a webinar training at 11 AM on Tuesday, December 6. 

Background & Recommendations

When prescribing opioids, risk mitigation strategies can be an effective way to reduce abuse and overdose. In its Guideline for Prescribing Opioids for Chronic Pain, the Centers for Disease Control & Prevention (CDC) recommends reviewing prescription drug monitoring program (PDMP) data, doing urine drug testing (UDT), and co-prescribing naloxone. During this webinar, clinicians will learn steps to take when PDMP checks or UDT suggest problems. Presenters (including Jane Ballantine, MD, and Joseph Merrill, MD, of the University of Washington) will review how to evaluate factors that increase risk for opioid overdose and how to determine when co-prescribing naloxone would be beneficial. A case study of a 46-year-old man with chronic low back pain, on high-dose opioid, will be presented to illustrate how PDMP and UDT results and medical evaluation can be used for opioid treatment decision-making.  Free continuing education credit is available.  For more information, go to   


You can find my recent health alerts posted on the Provider pages of our website, at


Gary Goldbaum, MD, MPH | Health Officer & Director | Administration

3020 Rucker Avenue, Ste 306 | Everett, WA 98201 | 425.339.5210 |


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Communicable Disease


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Health alerts include information about diseases or other health risks or issues that affect Snohomish County.