Public health information that is vital, time sensitive and specific to an incident or situation. Information posted here warrants immediate action or attention. 

11.9.23 NC  DHHS Division of Public Health Public Health Alert: We Need Your Help Preventing Congenital Syphilis

Congenital syphilis is continuing to rise in North Carolina. Between 2012 and 2022, there was a 547% increase in reported syphilis cases among women with an associated 5600% increase in congenital syphilis infections. Already in 2023, we have experienced 5 congenital syphilis related stillbirths and neonatal deaths. This trend mirrors the national trend as described recently in the CDC’s Vital Signs. This alert describes public health law requirements for syphilis screening during pregnancy and other actions to be taken by healthcare providers to reverse this trend. 

Public health information that is specific to an incident or situation. Information contains recommendations or actionable items. Advisory information may not require immediate attention. 

12-11-23 NC Division of Public Health Human-to-human transmission of Clade I Monkeypox virus in Africa

The North Carolina Division of Public Health and the Centers for Disease Control and Prevention are alerting clinicians to Clade I Monkeypox virus (MPXV) outbreaks involving human-to-human transmission in the Democratic Republic of the Congo (DRC) with potential for international spread. This memo includes background and information about testing, reporting, prevention, control, and  treatment. 

12-8-23  CDC Severe and Fatal Confirmed Rocky Mountain Spotted Fever among People with Recent Travel to Tecate, Mexico

Summary: The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory to notify healthcare providers and the public about an outbreak of Rocky Mountain spotted fever (RMSF) among people in the United States with recent travel to or residence in the city of Tecate, state of Baja California, Mexico. RMSF is a severe, rapidly progressive, and often deadly disease transmitted by the bite of infected ticks, although many patients do not recall being bitten by a tick. Doxycycline is the treatment of choice for patients of all ages. As of December 8, 2023, five patients have been diagnosed with confirmed RMSF since late July 2023; all had travel to or residence in Tecate within 2 weeks of illness onset. RMSF is endemic in multiple border states in northern Mexico, including but not exclusive to Baja California, Sonora, Chihuahua, Coahuila, and Nuevo León. Healthcare providers should consider RMSF in their differential diagnosis of patients who have reported recent travel to Tecate, Mexico, or other areas of northern Mexico and subsequently develop signs or symptoms of an unexplained severe febrile illness. Consider initiating doxycycline based on presumptive clinical and epidemiologic findings, and do not delay treatment pending the result of a confirmatory laboratory test. Early treatment with doxycycline saves lives.

12-7-23 CDC Mpox Caused by Human-to-Human Transmission of Monkeypox Virus with Geographic Spread in the Democratic Republic of the Congo

Summary: The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory to notify clinicians and health departments about the occurrence, geographic spread, and sexually associated human-to-human transmission of Clade I Monkeypox virus (MPXV) in the Democratic Republic of the Congo (DRC). MPXV has two distinct genetic clades (subtypes), and cases of Clade I MPXV have not been reported in the United States at this time (a clade is a broad grouping of viruses that has evolved over decades and is a genetic and clinically distinct group). However, clinicians should be aware of the possibility of Clade I MPXV in travelers who have been in DRC. Clinicians should notify their state health department if they have a patient with mpox-like symptoms, which may include a diffuse rash and lymphadenopathy, and recent travel to DRC. Clinicians should also submit lesion specimens for clade-specific testing for these patients.

Vaccines (e.g., JYNNEOS, ACAM2000) and other medical countermeasures (e.g., tecovirimat, brincidofovir, and vaccinia immune globulin intravenous) are available and expected to be effective for both Clade I and Clade II MPXV infections. However, vaccination coverage in the United States remains low, with only one in four people who are eligible to receive the vaccine having received both doses of JYNNEOS. CDC recommends that clinicians encourage vaccination for patients who are eligible.

6.26.23 CDC Locally Acquired Malaria Cases Identified in the United States

The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory to share information and notify clinicians, public health authorities, and the public about—

• Identification of locally acquired malaria cases (P. vivax) in two U.S. states (Florida and Texas) within the last 2 months,

• Concern for a potential rise in imported malaria cases associated with increased international travel in summer 2023, and

• Need to plan for rapid access to IV artesunate, which is the first-line treatment for severe malaria in the United States.

5.12.23 NC Division of Public Health Xylazine Exposure Guidance

This memo is intended to provide health care professionals with information regarding health impacts and management of patients exposed to xylazine through illicit drug use

5.4.23 NC Division of Public Health Reporting of novel coronavirus and COVID-19 infections and deaths

This memo serves to notify providers and laboratories of changes in requirements for reporting cases and deaths of COVID-19 related to the end of the federal Public Health Emergency. 

4.6.23 NC DPH CDC Health Advisory : Marburg Virus Disease Outbreaks in Equatorial Guinea and Tanzania

Recommendations for Clinicians

Currently, the risk of MVD in the United States is low; however, clinicians should be aware of the potential for imported cases. Clinicians who suspect MVD in a patient should immediately contact the communicable disease epidemiologist on call at 919-733-3419.

MVD should be included as a differential diagnosis for an ill person with history of a concerning exposure while in a MVD affected area (e.g., contact with a symptomatic person with suspected or confirmed MVD or an unknown illness; attending/participating in a funeral; visiting or working in a healthcare facility; having contact with bats or non-human primates; working or spending time in a mine/cave) within 21 days before symptom onset and who have clinical symptoms such as fever, headache, muscle and joint pain, fatigue, loss of appetite, gastrointestinal symptoms, or unexplained bleeding. Alternative diagnoses such as malaria, COVID-19, influenza, or common causes of gastrointestinal and febrile illnesses in a patient with recent international travel should be considered, evaluated, and managed appropriately. The possibility of a concurrent infection should be considered if a patient has a clinical and epidemiologic history compatible with MVD.

Please contact the Communicable Disease Branch epidemiologist on call at 919-733-3419 with any questions.

3.30.23 NC Division of Public Health UPDATE-Candida auris transmission in North Carolina (Replaces version dated February 24)

In light of CDC’s press release about the rise in Candida auris cases and an increase in the number 
of C. auris cases acquired in North Carolina, this memo is intended to update healthcare providers and laboratorians about the current state of C. auris in NC and provide information about recommended screening and response measures.  

3.3.23 CDC Health Alert Network (HAN) No. 488- Measles Exposure at a Large Gathering in Kentucky, February 2023 and Global Measles Outbreaks

The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory to notify clinicians and public health officials about a confirmed measles case at a large gathering. On February 24, 2023, the Kentucky Department for Public Health (KDPH) identified a confirmed case of measles in an unvaccinated individual with a history of recent international travel. While infectious, the individual attended a large religious gathering on February 17–18, 2023, at Asbury University in Wilmore, Kentucky. An estimated 20,000 people attended the gathering from Kentucky, other U.S. states, and other countries during February 17–18, and an undetermined number of these people may have been exposed. This Health Advisory also highlights other recent large global measles outbreaks and associated U.S. importations, and the importance of early recognition, diagnosis, and appropriate treatment. CDC recommends that clinicians be on alert for cases of measles that meet the case definition.

3.2.23 CDC Health Alert Network (HAN) No. 487-  Increased Chikungunya Virus Activity in Paraguay and Associated Risk to Travelers

The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory to notify clinicians and public health authorities of an increase in the number of cases of chikungunya reported in Paraguay. Most cases have been reported in the capital district of Asunción and the neighboring Central department. As of February 24, 2023, the Ministry of Health in Paraguay reported a total of 71,478 suspect chikungunya cases in Paraguay, with 29,362 of those being probable or confirmed cases since the outbreak began in October 2022 [1]. Further spread of the outbreak in Paraguay and to surrounding countries is possible.

This Health Advisory provides information on the current status of the chikungunya outbreak in Paraguay and advises on evaluating and testing travelers returning from Paraguay with signs and symptoms consistent with chikungunya virus infection. It also highlights those at increased risk for severe disease and prevention measures to mitigate additional spread of the virus and potential importation into unaffected areas, including the United States.  

2.24.23 CDC Health Alert Network (HAN) No. 486 - Increase in Extensively Drug-resistant Shigellosis in the United States

The Centers for Disease Control and Prevention (CDC) has been monitoring an increase in extensively drug-resistant (XDR) Shigella infections (shigellosis) reported through national surveillance systems [1]. In 2022, about 5% of Shigella infections reported to CDC were caused by XDR strains, compared with 0% in 2015. Clinicians treating patients infected with XDR strains have limited antimicrobial treatment options. Shigella bacteria are easily transmissible. XDR Shigella strains can spread antimicrobial resistance genes to other enteric bacteria. Given these potentially serious public health concerns, CDC asks healthcare professionals to be vigilant about suspecting and reporting cases of XDR Shigella infection to their local or state health department and educating patients and communities at increased risk about prevention and transmission.

2.24.23 NC Division of Public Health Candida auris identification in North Carolina

This memo is intended to alert healthcare providers and laboratories about the first reported cases of Candida auris (C. auris) in North Carolina. Clinicians and laboratorians should be aware of screening recommendations for C. auris and consider this information when evaluating patients with infections caused by Candida species.

2.1.23 CDC Health Advisory Outbreak of Extensively Drug-resistant Pseudomonas aeruginosa Associated with Artificial Tears

UPDATE: 3.21.23 CDC Outbreak of Extensively Drug-resistant Pseudomonas aeruginosa Associated with Artificial Tears

The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory about infections with an extensively drug-resistant strain of Verona                      Integron-mediated Metallo-β-lactamase (VIM) and Guiana-Extended Spectrum-β-Lactamase (GES)-producing carbapenem-resistant Pseudomonas aeruginosa (VIM-GES-CRPA) in 12 states. Most patients reported using artificial tears. Patients reported more than 10 different brands of artificial tears, and some patients used multiple brands. The majority of patients who used artificial tears reported using EzriCare Artificial Tears, a preservative-free, over-the-counter product packaged in multidose bottles. CDC laboratory testing identified the presence of the outbreak strain in opened EzriCare bottles with different lot numbers collected from two states. Patients and healthcare providers should immediately discontinue using EzriCare artificial tears pending additional guidance from CDC and the Food and Drug Administration (FDA).

9.15.22 NC Division of Public Health Acute Flaccid Myelitis (AFM) and Poliomyelitis Testing and Reporting (Replaces version dated October 24, 2018) 

This memo provides updated information regarding identification and management of suspected cases of acute flaccid myelitis (AFM) and poliomyelitis and to provide guidance on reporting of such cases to public health officials. 

11.15.21 NC Division of Public Health Statewide Increase in Syphilis Infections

This public health advisory describes the continuing increase in syphilis infections in North Carolina, outlines actions for clinicians and provides links to relevant resources.

Updated public health information specific to an incident or situation. Information posted here is unlikely to require immediate action.  

4.3.23 NC DPH Annual Update on Diagnosis and Surveillance for Vector-borne Diseases

Vector-borne diseases in North Carolina are caused by a wide range of mosquito‐ and tickborne bacteria, viruses, and parasites that are both endemic and travel‐associated. Vector-borne illnesses continue to cause significant morbidity in North Carolina, with more than 700 cases in 2022. This update is intended to encourage patient education about the prevention of mosquito- and tickborne illness, as well as to provide a reminder about diagnosis, treatment, and reporting.

• What communicable diseases must be reported?
  • Reportable diseases and conditions in North Carolina
• Who must report communicable diseases?
  • Physicians, school administrators and child care operators, medical facilities and operators of restaurants and other food or drink establishments (G.S. § 130A-135 through 130A-139) must report cases or suspected cases of reportable diseases to their local health department.
• How do you report communicable diseases in Wake County?
  • Report communicable diseases to Wake County Health & Human Services Communicable Disease Surveillance Team
    Call: 919-250-4462
    Fax: 919-212-9291

    • Non-urgent reports. Non urgent reports can be made outside of normal business hours, on weekends or holidays by leaving a message on the Communicable Disease Line, 919-250-4462. Please provide a contact name and number for the CD Nurse to call you back the following business day. This number is checked during weekends and holidays at 9 a.m., 1 p.m. and 5 p.m.

    • Urgent reports. Should you need to alert us of an immediate Public Health threat, specifically as it relates to suspicion or confirmation of the conditions or events noted below, the Emergency CD Line 919-250-1217 will be answered immediately or will return your call within 15 minutes: 

      • Novel and/or highly infectious diseases (measles, mumps, Ebola, Middle Eastern Respiratory Syndrome)

      • Biologic toxins, hazardous chemicals or mass casualties

Confidential Communicable Disease Report Form - Part 1 (fillable form and instructions)

North Carolina Communicable Disease Report Forms

NC Communicable Disease Manual. North Carolina Reportable Diseases and Conditions, Reporting Forms, Case Definitions and more.

Reportable Diseases in North Carolina

• Rabies Resources for the Medical Professional
• Wake County Animal and Rabies Control Ordinances 
•  Educational Materials
  • Stop Rabies (English) 
  • Stop Rabies (Spanish) 
• Be Safe Around Dogs ( A coloring book for children and parents; English and Spanish)

Candida auris
Centers for Disease Control and Prevention 

Candida auris: Information for Laboratorians and Health Professionals
Centers for Disease Control and Prevention 

Emerging Infectious Diseases: Candida auris
Webinar, Statewide Program for Infection Control & Epidemiology

CDC
NC Department of Health and Human Services
NC Division of Public Health
Wake County Government
 

• CRE Prevention and Control Toolkit

Wake County Public Health Data

NC HIV/STD Regulations

STD Assessment, Prevention and Treatment Protocols – NC DHHS

HIV and STD Community Program – Wake County Health & Human Services 

HIV Clinic – Wake County Health & Human Services 

STD and HIV Testing
Wake County Health & Human Services 
HIV/AIDS/STD Program contact information: 
Call: 919-250-4717 
Fax: 919-212-7400 

Immunizations and Foreign Travel
Call: 919-250-3900 

Immunization Outreach & NC Immunization Registry 
Call: 919-250-4518 

Influenza information, surveillance data, information for health care providers (NC DHHS)

Social media resources: 

What to do about the flu social posts (English) 

What to do about the flu social posts (en español​) 

CDC

Monkeypox outbreak information
Monkeypox vaccine information
COCA call for clinicians about the Monkeypox outbreak

NC DHHS

Monkeypox information
Monkeypox Communications Toolkit
Monkeypox Provider Webinar 7.28.22 

Norovirus Outbreak: What to do

• Opioid Crisis (NCDHHS) 
• ​Wake County Drug Overdose Prevention Coalition (WCHHS) 
• Know What's In Your Drugs: TRANQ/Xylazine (NCDHHS). Flyer includes tips for healthcare providers. 

Call: 919-250-3894 

CDC treatment guidelines 

Do You Feel Ill After Exposure to Ticks or Tick Habitats? (Poster, NCDPH) 

Tick-borne Illness Information for Healthcare Providers (Web page, NCDPH) 

Tickborne Diseases of the United States: A Reference Manual for Health Care Providers (CDC) 

• Frequently Asked Questions about TB Skin Testing and Reporting (WCHHS) 
• TB Skin Testing Guidelines (NC TB Policy Manual) 
• NC TB Statistics (NC DHHS) 
• CDC TB Statistics (Centers for Disease Control and Prevention) 
• Educational Materials for Patients (NC DHHS)
• Educational Materials for Patients (WCHHS)  
• Wake County Tuberculosis Control team contact information: Call: 919-250-1228 or 919-212-9508 

• Arboviruses: Information for Health Care Providers (NC DPH) 
• Zika Virus (NCDPH) 
• Zika Virus Fact Sheet (WCHHS) - English
• Zika Virus Fact Sheet (WCHHS) - en Español