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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 update; Mumps update; Immunization guidelines; Long acting reversible contraception; Developmental screening; Multidrug resistant organism surveillance


Today’s topics:

  • Influenza update
  • Mumps update
  • Immunization guidelines
  • Long acting reversible contraception
  • Developmental screening
  • Multidrug resistant organism surveillance


Influenza update

Action requested:  Continue to emphasize preventive measures for influenza.

Background & Recommendations

This influenza season continues to prove relatively severe. As of February 4, the Health District had received reports of 397 influenza hospitalizations (more than triple the number reported as of a month earlier), 26 outbreaks in long-term care facilities (more than twice that reported a month earlier), and 33 deaths (more than eight times that reported a month earlier).  The numbers are now higher than for any season since 2009.  However, I believe we are turning the corner on the epidemic. The number of persons hospitalized in the week ending 1/28/17 was 2/3 the number of the previous week, but we are not out of the storm yet.  Please remind patients to wash hands frequently, cover coughs, stay home if ill, and (even at this stage of the season) get vaccinated!

For detailed clinical guidance on testing, use of antiviral drugs, and vaccine recommendations, see


Mumps update

Action requested:  Be aware of updated guidelines for mumps testing.

Background & Recommendations

Mumps remains epidemic nationwide. In 2016, 46 states and the District of Columbia reported 5311 cases to the Centers for Disease Control & Prevention (CDC), the highest number since 2006 and about twenty times the annual average for 2000-2005; 495 cases had been reported in 2017 just through January 28.  As of February 8, 404 confirmed and probable cases had been reported in Washington State, a dramatic increase over the prior month. Most cases have been in King, Spokane, and Pierce counties (176, 165, and 45 respectively).  As of February 15, Snohomish County had four confirmed and three probable cases of mumps reported, but staff have been busy conducting investigations of 48 individuals. 

When mumps is suspected, RT-PCR testing (performed by the Washington State Public Health Laboratory) is most effective within 3 days after parotitis onset, when only a buccal swab is needed.  Both a buccal swab and urine specimen are needed days 4-10 following parotitis onset.  Detailed instructions for handling specimens are at  However, because a high volume of testing requests has overwhelmed the Public Health Laboratory, please contact Communicable Disease staff at 425-339-5278 before submitting specimens.


Immunization schedules

Action requested:  Be aware of updated immunization guidelines.

Background & Recommendations

The CDC just published its annual updated recommendations for immunizations for children and adolescents and for adults.

Summaries of changes for children and adolescents can be found at and for adults at  The complete schedules can be found at


Long Acting Reversible Contraception (LARC)

Action requested:  Consider this training opportunity for yourself or staff.

Background & Recommendations

LARC is an effective option for preventing unwanted pregnancies.  The North Sound Accountable Community of Health has partnered with national trainers to offer a free all-day training on LARC methods, notably insertion of intrauterine devices and subdermal etonogestrel (Nexplanon).  The training will be in Mt. Vernon on Thursday, March 23. CME is available.  Register at:  Details about location and time will be sent after registering.


Developmental Screening

Action requested:  Consider this training opportunity for yourself or staff.

Background & Recommendations

All children in Washington State should have access to high-quality, comprehensive, family-centered medical homes that include regular developmental screenings.  To that end, the Washington State Department of Health (DOH) and the Washington Chapter of the American Academy of Pediatrics are collaborating on the Great MINDS project, offering training on developmental screening and the referral process.  Training conducted by an experienced physician addresses why a screening tool is useful, how to integrate use of a screening tool into practice, how to bill for screening, and how to manage results, resources, and referrals.  Trainings are open to anyone who provides health care for children, including family physicians, pediatricians, naturopathic physicians, PAs, ARNPs, RNs, medical assistants, and support staff.

The next training will be offered at 7-8:30 AM on Friday, March 17, in the Monte Cristo Conference Room at Providence Regional Medical Center (900 Pacific Avenue in Everett).  CME credits are available and breakfast will be provided!  Register at or call Susan Jelovich at 425-353-5656.


Multidrug Resistant Organisms

Action requested:  Be aware of enhanced surveillance for multidrug resistant organisms.

Background & Recommendations

The Washington State Department of Health (DOH) is changing surveillance for multidrug resistant organisms (MDRO). In addition to ongoing surveillance for carbapenem-resistant Enterobacteriaceae (CRE), beginning January 2017 DOH requests submission of:

  • Carbapenem-resistant (CR) Pseudomonas species (non-mucoid isolate from non-cystic fibrosis patients) and CR-Acinetobacter species.
  • Unusual Candida species isolated from sterile body sites, including  C. auris, C. glabrata, C. haemulonii, and any Candida not identified when species identification is performed (i.e. not in laboratory database and excluding these six species: C. albicans, C. dubliniensis, C. krusei, C. parapsilosis, C. lusitaniae and C. tropicalis).

Laboratories have been informed of this enhanced surveillance and provided instructions for managing specimens.  For details about this effort, see


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.