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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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Mumps, Measles, Shigella, Marijuana

April 28, 2017

April 28, 2017

Today’s topics:

  • Mumps
  • Measles
  • Shigella
  • Marijuana


Action requested:  Continue to be alert to potential mumps and encourage all patients to be current on their vaccinations.

Background & Recommendations

The mumps outbreak continues unabated.  As of Friday, April 28, the Health District had investigated 26 laboratory-confirmed cases and 34 probable cases (i.e., having clinical signs and contact with a confirmed case), nearly doubling our numbers since March 17.  Another 114 suspect cases remain under investigation.  Not surprisingly, cases have occurred not only among students, but also among staff and teachers at schools.  We often take for granted that our adult patients are fully vaccinated.  In the current outbreak, it is especially important to assure that everyone is up to date.  Please strongly encourage all patients to know if they have had the mumps-measles-rubella (MMR) vaccine and to get the vaccination if they have not had it.  To encourage compliance, please respond quickly to requests for vaccinations and reduce barriers (such as requiring prior enrollment) to such services.



Action requested:  Be aware of an outbreak of measles placing persons who travel to Minnesota at risk.

Background & Recommendations

As of April 24, 2017, 20 cases of measles have been confirmed in the Minneapolis, Minnesota metropolitan area. At least 10 cases were hospitalized. The age range is 0 to 5 years, and all 20 cases are from the Somali community, which has very low rates (<42%) of vaccination for MMR.  At least 10 of the cases were exposed in two different child care centers. At least 500 persons have been exposed in health care settings and more than 400 in large child care centers.

Please be alert to the increased risk for measles in persons with recent travel to or visitors from the Minneapolis, Minnesota area.  To help with diagnosis and testing, download the Measles Assessment Checklist for Providers.  Highly suspected measles cases should be reported immediately to the Health District at 425-339-5278 for assistance with rapid confirmatory testing.  And please remind all patients about the importance of being vaccinated!



Action requested:  Be aware of increasing antibiotic resistance among Shigella strains and obtain cultures and sensitivities when testing.

Background & Recommendations

The Centers for Disease Control and Prevention (CDC) has identified increased resistance to ciprofloxacin.  When Shigella is suspected:

  • Order stool culture and antimicrobial susceptibility testing. Culture-independent diagnostic testing does not provide an isolate and therefore cannot be used to assess susceptibility. When antimicrobial susceptibility testing is performed by broth microdilution, request ciprofloxacin testing that includes dilutions of 0.12 μg/mL or lower.  Even when treatment is not indicated, ordering susceptibility testing to identify patients with drug-resistant infections will help to inform when to return to work, school, and group settings.
  • Do not routinely prescribe antibiotic therapy for Shigella infection. Reserve antibiotic therapy for patients for whom it is clinically indicated.
  • When antibiotic treatment is indicated, tailor antibiotic choice to antimicrobial susceptibility results as soon as possible. Avoid prescribing fluoroquinolones if the ciprofloxacin MIC is 0.12 μg/mL or higher even if the laboratory report identifies the isolate as susceptible.
  • Obtain follow-up stool cultures in shigellosis patients who have continued or worsening symptoms despite antibiotic therapy.
  • Call the Health District at 425-339-5278 to report cases and for guidance on when patients may return to childcare, school, or work. It is especially important to report cases with a ciprofloxacin MIC of 0.12–1 μg/mL to facilitate further testing of the isolate.
  • Counsel patients with active diarrhea on how they can prevent spreading the infection to others, regardless of whether antibiotic treatment is prescribed.  Remind patients to 1) wash hands with soap and water for at least 20 seconds, especially after using the toilet, after handling a soiled diaper, and before eating; 2) avoid preparing food for others; 3) wait to have sex (vaginal, anal, or oral) until 2 weeks after diarrhea has resolved and use safe sex practices for several weeks after resuming sex, because Shigella may still be in stool for several weeks.  Children with active diarrhea should not attend childcare, school, or group activities while ill.

For additional information, see and



Action requested:  Consider participating in a free online training about marijuana exposure and its effects among children.

Background & Recommendations

Since Washington State legalized marijuana, exposures in young children (ages 1-3) and adolescents have continued to dominate pediatric marijuana calls to the Washington Poison Center (view the trends at  The University of Colorado is offering a timely and free online course appropriate for Emergency Department physicians and pediatric practices.  The course helps providers respond to accidental exposures in young children or intoxication following use by adolescents.  Continuing medical education credit is available.  To learn more and to access the course, 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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Health alerts include information about diseases or other health risks or issues that affect Snohomish County.