Take action to lower risk for children as RSV & flu cases increase

State health officials are asking people to take immediate, urgent action to protect children and ensure there are pediatric intensive care beds available in Oregon hospitals to treat any child or youth with a serious illness or injury. Oregon health officials expect respiratory syncytial virus (RSV) cases to peak after the Thanksgiving holiday, which will further strain pediatric hospital intensive care units. The graph below was shared on November 18th by OHSU, projecting severe strain on hospitals.

Malheur County is affected by both Oregon and Idaho cases and hospital capacity. Earlier this month, Idaho Department of Health and Welfare reported an early RSV season and the first influenza death of the season. The chart below was shared on the Idaho State Journal on November 16th. Hospitalizations have continued to increase since.

In response to Oregon’s acute shortage of pediatric intensive care beds, state health officials recommend that people:

  • Stay home when sick.
  • Cover coughs and sneezes with the inside of your elbow, or with a tissue that you immediately throw away after use.
  • Clean and disinfect all high-touch surfaces, including doorknobs, faucets, chairs, countertops and tables.
  • Regularly wash hands with soap and water or use hand sanitizer, especially after coughing or sneezing into a tissue.
  • Get a flu shot and stay up to date on COVID-19 vaccinations, including new bivalent boosters. There is no vaccine for RSV.
  • Consider wearing a mask in crowded indoor spaces.

Parents of children younger than 5, especially newborns to 6-month-olds, are especially advised to take precautions that keep their children safe and help to limit the spread of RSV and influenza in coming weeks. Young children, as well as older adults – people 65 and older – are at higher risk of severe illness from these respiratory viruses, including hospitalization and death.

Data showing that the RSV hospitalization rate for children quadrupled between Oct. 29 and Nov. 19, from 2.7 to 10.8 children per 100,000 population. RSV hospitalizations are expected to rise further over the next few weeks.

Hospitalizations are also being fueled by a rapid increase in influenza cases around the state. According to OHA’s weekly Flu Bites influenza surveillance report, the percentage of positive influenza tests has doubled each week since mid-October – it was 1% the week ending Oct. 22, 2% on Oct. 29, 4.5% on Nov. 5, 9.3% on Nov. 12 and 16.4% on Nov. 19.

A 5% positivity rate for influenza tests is considered a threshold for significant influenza circulation.

While cold-like symptoms are more typical of RSV infections, some children can experience severe symptoms requiring immediate care. Parents should call their pediatrician or seek care right away if child has any of the following symptoms:

  • Difficulty breathing or increased work of breathing.
  • Symptoms of dehydration, or fewer than one wet diaper every eight hours.
  • Gray or blue color to tongue, lips or skin.
  • Decreased activity and alertness.

For more information about RSV, visit OHA’s RSV page. Information about influenza is available at OHA’s Flu Prevention page. Follow all OHA news here.

How to talk with others about getting the COVID-19 vaccine

Here is the truth: COVID-19 vaccines and boosters are safe, and they work. They are highly effective at helping prevent hospitalizations and severe COVID-19 illness. Being vaccinated and boosted allows people to move through life with a semblance of normalcy.

Unfortunately, there is a lot of false information out there about COVID-19 vaccines that can lead some of our friends and family members to decide not to get vaccinated. Some may be skeptical of the vaccines’ safety and effectiveness, while others may be afraid of the vaccination process. Even though you may disagree, it can be a touchy subject and daunting to bring up in conversation.

If you want to engage friends and family in a conversation about COVID-19 vaccines, the best approach is a thoughtful approach. With holiday gatherings around the corner, now is the perfect time to prepare.

“It is important to enter the conversation not with the intention of convincing or persuading someone to change their mind, but to learn about their barriers,” said Dr. Ruth Zúñiga, Oregon Health Authority senior health advisor and licensed psychologist. “Once you understand someone’s barriers, maintain trust by trying to support them in whatever stage of their journey they’re in.”

Here are some tips for how to have a respectful and productive conversation about the benefits and safety of being vaccinated and boosted against COVID-19.

Have an open mind

Entering the conversation with an open mind will make it easier to gather information and understand the other person’s perspective. Listen with curiosity and don’t interrupt. Show them you are listening by paying attention, removing distractions like cellphones and keeping your body language relaxed. Even if you don’t agree with their reasoning, try to validate their feelings and show gratitude for their willingness to share: e.g. “I know this conversation can be difficult, and I appreciate you having it with me. I am sorry if this situation is causing you stress or confusion.”

Listen, withhold judgment

If you allow ample time for the other person to talk without reacting or responding, you have a better chance of having a positive and meaningful conversation. Ask open-ended questions to understand their perspective. You can start by asking them about specific concerns and where they get their information. Questions such as, “What are you concerned about?” or “What have you heard?” are respectful and do not expose your own opinions (which could shut them down or, worse, lead to arguing). Show that you are listening by responding to their comments with respect and kindness, and not changing the subject or steamrolling the conversation. If you don’t agree with what they say, avoid challenging or contradicting them.

Connect on shared values

During the conversation, point out where you agree on shared values. Acknowledging common ground between your viewpoints can help remove tension. For example, if someone is expressing fear over the safety of the vaccine, let them know you felt scared at first, too, but you felt better after being vaccinated. The conversation should be one of encouragement, not a fight or competition. Connecting on core beliefs (the desire to have a normal life, prioritizing health, fear of the unknown) can remind them you do not see them as ‘the opposition.’

Work to replace misinformation with new information

If their view is informed by misinformation, ask if it’s OK to share resources with them to address their concerns. But you should use the conversation to gather information first, not to lecture. Be an active listener, jotting down notes if appropriate, so you can follow up later with links to resources they may connect with later. Doing your own focused research for someone shows that you are willing to put in the effort to support them, but don’t overwhelm them with information. Respect their answer if they do not want to receive resources.

Offer in-person support

Depending on the situation, try offering support if they decide to look into getting vaccinated. Whether that means sitting together while you both research vaccination site locations, or joining them when they get the vaccine, can provide comfort. For some people, getting vaccinated is quick and simple. Others may not have the time or ability to access a vaccination clinic, and you could offer practical support such as transportation, babysitting or translating for someone who does not speak English if you can. Whatever stage in the process they are in, ask what would be helpful.  

Show them you care

The willingness to have a tough conversation usually comes from a place of love. When a person you care about acts in a way that you don’t agree with, it can be tempting to feel angry, hurt or frustrated. If you find yourself becoming upset during the conversation, take deep breaths and remind yourself – and your friend or loved one – that you are having this conversation because you care. Coming on too strong, or with the wrong intentions, can make people defensive and unlikely to change their minds.

You may not get the result you’re hoping for right away, but the health of our loved ones and communities is worth working for. By showing up and having the hard conversations, you show others that you’re ready to embrace them with open arms if they ultimately make the decision to get vaccinated.

Recognize when to stop

If you notice the conversation moving into an argument, or they seem overwhelmed or firm in their stance, be willing to retreat gracefully. Be patient with yourself and recognize that even the best intentions may not lead to the outcomes you desire. End the conversation with respect and without judgment. Feel good that you tried and leave the door open for further conversation.


Flu & COVID Vaccine Event This Friday 10/14

Do you need an updated (bivalent) COVID-19 booster or flu shot? Perhaps you’re ready for your first COVID-19 dose. Join us this Friday, October 14th, from 10 a.m. to 6 p.m. at the Four Rivers Cultural Center (676 SW 5th Ave, Ontario) for this free, walk-in, flu and COVID vaccine event. Bring your vaccine card and insurance card if you have it. No one will be turned away, if eligible for vaccine.


Everyone who receives a flu or COVID-19 vaccine will receive a $25 gas gift card for Farmers Supply Co-Op, a food box, and a COVID-19 home test kit. Additionally, anyone who receives a COVID-19 vaccine will also receive a $25 grocery gift card for Albertsons. We will have a prize drawing, snacks, and more!

Vaccine, food boxes, test kits, and gift cards available as long as supplies last. Please share the flyers in English and Spanish and the following details:

COVID-19 Vaccine

  • COVID-19 Vaccines available:
    • Pfizer-BioNTech
      • Primary doses for ages 6 months and up
      • Booster doses for ages 12 and up
    • Moderna (primary and updated boosters)
      • Primary doses for ages 6 months and up
      • Booster doses for ages 12 and up
    • Novavax
      • Primary doses for ages 12 and up
    • Johnson & Johnson’s Janssen (J&J)
      • Primary doses for ages 18 and up
  • Getting a COVID-19 vaccine after you recover from COVID-19 infection provides added protection against COVID-19. Especially because the updated COVID-19 boosters target Omicron subvariants that are responsible for 98% of cases recently, you are best protected with an updated vaccine booster, even if you had COVID-19 and a previous booster.
  • CDC recommends everyone ages 12 years and older get an updated COVID-19 booster to help restore protection that has decreased since your last vaccine.
  • People who are moderately or severely immunocompromised have different recommendations for COVID-19 vaccines. You can self-attest to having a weakened immune system, which means you do not need any documentation of your status in order to receive COVID-19 vaccine.
  • Use CDC’s COVID-19 booster tool to learn if and when you can get boosters to stay up to date with your COVID-19 vaccines.

Seasonal Influenza (Flu) Vaccine

  • Flu vaccines (often called “flu shots”) are vaccines that protect against the four influenza viruses that research indicates will be most common during the upcoming season.
  • There are many flu vaccine options to choose from, but the most important thing is for all people 6 months and older to get a flu vaccine every year. We will have standard flu shots for ages 6 months through age 64 and high-dose flu shots for people aged 65 and over.
  • While some people who get a flu vaccine may still get sick with influenza, flu vaccination has been shown in several studies to reduce severity of illness. The same is true for COVID-19 vaccination. Receiving the vaccine doesn’t guarantee you won’t be infected, but has been shown to greatly reduce the risk of severe disease.
  • Flu vaccination is an important preventive tool for people with certain chronic health conditions, including people with heart disease, chronic lunch disease, and diabetes.
  • Flu vaccine can be lifesaving in children.
  • Getting vaccinated yourself may also protect people around you, including those who are more vulnerable to serious flu illness, like babies and young children, older people, and people with certain chronic health conditions.

Updated COVID-19 booster targets subvariants responsible for 98% of cases today

Get your updated COVID-19 booster and a flu shot at the Vaccine Event at FRCC Friday, October 14, from 10-6, and receive a $25 grocery card AND a $25 gas card. Learn more here.

The fact that we have an updated bivalent booster dose that targets the predominant variants circulating today is a wonder of science, but how do we know it’s safe and effective?

In late June, the U.S. Food and Drug Administration (FDA) weighed administering the original COVID-19 vaccine as the next round of booster doses against asking manufacturers to develop an updated version. The agency evaluated several options.

Moderna and Pfizer had already produced updated bivalent vaccines that targeted the Omicron BA.1 subvariant. These vaccines went through clinical trials, produced more antibodies against Omicron subvariants than the original vaccine, and were ultimately approved and rolled out in the United Kingdom over the summer.

The FDA, however, recommended vaccine manufacturers design updated bivalent boosters to specifically fight the BA.4 and BA.5 Omicron subvariants, in addition to previous subvariants. Let’s examine some of the reasons for that decision.

What is a bivalent vaccine?

A bivalent vaccine targets two things. In this case, it targets two strains of the virus that causes COVID-19. The recently released updated bivalent booster vaccine from Moderna and Pfizer contain messenger RNA (mRNA) that tells our cells to build:

  • The “spike” protein from the first strain of COVID-19 that emerged more than two years ago, which is the target of the original vaccine.
  • The “spike” proteins from the Omicron BA.4 and BA.5 subvariants (identical to each other) that are responsible for about 98% of COVID-19 cases in the United States today.

This means the updated booster vaccine better protects us against the subvariants circulating today than the original vaccine does.

“Adding a component to the boosters that specifically targets the subvariants currently circulating will help restore protection against COVID-19 infections, including hospitalizations, that has decreased over time,” said Dean Sidelinger, M.D. MSEd, health officer and state epidemiologist at Oregon Health Authority. “This is especially important as we head into the fall, when cases across Oregon and the United States are expected to increase.”

Additionally, the bivalent booster still has instructions to build COVID-19’s original “spike” protein for a few important reasons:

  • The original vaccine has been highly effective at preventing COVID-19-related hospitalizations and death over the past two years (including all variants and subvariants).
  • Bivalent vaccines cast a wider net that may better protect us against future variants.
  • A bivalent vaccine may provide higher levels of immunity for a longer period of time.

Why do we need an updated vaccine?

The virus that causes COVID-19 has evolved significantly since it first appeared nearly three years ago. The Omicron spike protein alone has mutated more than 30 times since the original vaccine was designed. These mutations allow the virus to better evade immunity, allowing it to infect people more easily. The updated booster dose, on the other hand, builds more antibodies for the virus strains circulating today.

Are booster doses effective?

Immunity from COVID-19 vaccines (and infection) declines over time. This is why we need a booster dose. While we’ve seen an increase in breakthrough infections since Omicron arrived in Dec. 2021, booster doses have remained incredibly effective at protecting us from COVID-19-related hospitalization and death:

  • During the peak of the Omicron surge from January through March 2022, people age 5 and older who were unvaccinated were 20x more likely to die from COVID-19 compared to somebody who had received at least one booster dose.
  • In June 2022, unvaccinated people age 5 and older were 8x more likely to die from COVID-19 compared to somebody who had received at least one booster dose.
  • In June 2022, unvaccinated people age 50 and older were 14x more likely to die from COVID-19 compared to those who had received at least two booster doses. Also in June, people age 50 and older who had received one booster dose were 3x more likely to die from COVID-19 than those who had received at least two booster doses.

Is it safe?

We know mRNA COVID-19 vaccines are safe. More than 590 million doses have been administered in the United States alone over the past two years, and serious health problems after vaccination are rare. The overall composition of the updated booster dose is the same as the original booster dose, but the spike protein it tells our cells build is slightly different.

Both Moderna and Pfizer held human clinical trials of bivalent vaccines that target the original strain and the BA.1 Omicron subvariant that showed the vaccines to be safe. It is true that the BA.4 and BA.5 version of the bivalent vaccine has only been tested in mice, but there is no reason to anticipate a difference in the safety of this updated vaccine based on limited mutations in the spike protein it creates. COVID-19 vaccines have a “high degree of safety” (slide 67). The updated BA.4 and BA.5 bivalent vaccine, which has been given emergency use authorization by the FDA and the Centers for Disease Control and Prevention (CDC), is currently undergoing human trials now in order to receive full approval from federal health officials.

The flu shot does not have human trials every year. Flu shots are safe.

“This process is not new and is in fact very similar to the annually updated flu shots we receive each year,” Sidelinger said. “Because the circulating strains of flu change, components of the vaccine change to better protect us. These changes don’t impact the well-established safety of the vaccines.”

Updates to authorized vaccines do not require human trials for safety. Their safety is already known. The challenge is matching a vaccine to the most prevalent known strains of a virus.

Additionally, producing the flu vaccine require growing a virus in chicken eggs, and it takes at least six months to produce enough vaccine for the nation’s population. Because the flu virus mutates from year to year, producing multiple strains globally, scientists must decide which strains to target for vaccines months before flu season begins every fall. This is one of the reasons flu vaccines, although still critical to preventing severe illness, are often less than 50% effective in preventing infection.

mRNA speed

One of the incredible aspects of “plug and play” mRNA technology is how fast an mRNA vaccine can be developed once the genetic code of the virus is known.

In late June, the FDA examined the human trials for an updated bivalent booster based on the Omicron BA.1 subvariant. Scientists on the FDA’s advisory panel concluded the bivalent vaccine improved the antibody response to the Omicron variant. However, they predicted that Omicron’s BA.1 subvariant would no longer be predominant by the time the updated vaccine would be available in September. So instead, the FDA panel recommended Moderna and Pfizer manufacture a bivalent vaccine that targets both the original strain and BA.4/BA.5. The result: we have an updated booster dose specifically designed to fight the variants that account for 98% of all COVID-19 cases in the U.S.

The FDA correctly predicted BA.4 and BA.5 would become the predominant subvariants. This ability to rapidly create an updated vaccine targeting new or emerging variants or subvariants showcases the speed of mRNA technology.

If you are interested in knowing more, review the slides from the CDC’s Advisory Committee on Immunization Practices’ Sept. 1-2 presentations on updated bivalent booster doses.

Expanded eligibility for monkeypox vaccine

Oregon Health Authority (OHA) has expanded its eligibility criteria for the monkeypox (hMPXV) vaccine. It now includes “anyone who anticipates having or has had recent direct skin-to-skin contact with at least one other person AND who knows other people in their social circles or communities who have had monkeypox.” Those “communities” may include Idaho or Oregon, which both have rising monkeypox cases.

In its vaccine eligibility criteria, the vaccination guidance no longer refers to sexual orientation or gender identity, which may have been a barrier for people seeking vaccinations. The guidance also clearly states what is known as the most common route of transmission: direct, skin-to-skin contact.

In addition to encouraging vaccination for anyone who anticipates having or has had recent skin-to-skin contact with others and shares a social circle or community with someone who had the virus, the guidance continues to recommend the vaccine for other high-risk persons: anyone who had close contact with someone with monkeypox.

Get a vaccine: If you believe you are at risk of monkeypox or have more questions, please call the Malheur County Health Department at 541-889-7279 and a nurse will talk with you. We have the monkeypox vaccine in stock and want to get it to anyone who meets this expanded criteria.

Get a test: If you have a rash or sore, see your primary care provider — if you don’t have a provider please call 211 or our office at 541-889-7279 and we can help connect you to testing. Keep the rash covered, wear a mask, and avoid skin-to-skin contact with anyone until you have been checked out.

Updated COVID-19 Boosters Approved

Updated COVID-19 boosters can both help restore protection that has decreased since previous vaccination, and provide broader protection against newer variants. The updated, or bivalent boosters, target the most recent Omicron subvariants, BA.4 and BA.5, that are more contagious and more resistant than earlier strains of Omicron. The new updated COVID-19 boosters can be administered in Oregon now that the Western States Scientific Safety Review Workgroup has recommended the vaccine, completing final step in the review and approval process following recommendations from the FDA and CDC.

The CDC is recommending updated COVID boosters, for people ages 12 and older. People are eligible if it’s been at least two months since they received their last COVID vaccine, either a booster or an initial dose.

The boosters can be administered regardless of which vaccine series a person received. Pfizer’s updated booster is available for anyone 12 and older. The Moderna booster is available for anyone 18 and older.

“If you are eligible, there is no bad time to get your COVID-19 booster and I strongly encourage you to receive it,” said CDC Director Rochelle Walensky, in an interview with NPR.

The new boosters should be available in Malheur County this week. The Malheur County Health Department will have news out soon with increased availability for both boosters and first doses of the COVID-19 vaccines. Call our office at 541-889-7279, your local healthcare provider, or pharmacy, to check availability and make an appointment, if available. Find local vaccine providers here.

Malheur County still lags behind every other county except Lake in Oregon for protection against COVID-19 and continues to be the only county in the High Community Level of risk due to recent outbreaks. The best way to prevent serious COVID-19 illness is to stay up to date with your COVID-19 vaccinations and boosters.

Invest in Yourself with Health is Wealth Program

The Malheur County Health Department (MCHD) has a new incentive program, Health is Wealth, to increase recommended surveillance testing, immunization, and awareness of public health services. People can walk in or call MCHD at 541-889-7279 to schedule time for testing, vaccine, and short informative sessions with staff. Participants will receive a Health is Wealth card that will keep track of their progress through 10 core programs. Upon completion, the first 100 participants will receive a $100 gift card.  

The goal is for people to experience public health as an important part of their healthcare, get to know staff, and connect the people in their lives to available services.

Eligibility: Health is Wealth program participants must be 18 years old or older. Participants must be present to receive services, complete paperwork, and present the completed card to MCHD front desk to receive gift card. The Health is Wealth card must be started by June 30, 2023. One hundred gift cards are available and once that supply is exhausted, there is no guarantee a gift card will be provided.

Requirements: Participants must receive a stamp for each of the 10 programs, from MCHD employees on the Health is Wealth card, within 12 months of the start date on card. Immunizations must be up to date, as verified in the Oregon or Idaho immunization registries. Participants must receive testing for HIV, syphilis, hepatitis C, chlamydia and gonorrhea, or have record of tests within the last 12 months. Participants must schedule and complete short educational sessions with each program to receive a stamp.

The Centers for Disease Control recommends all adults get tested for hepatitis C and that everyone should be tested for HIV at least once in their life, regardless of risk factors. With climbing rates of communicable disease, more testing is needed to identify infections, many of show no symptoms. Hepatitis C is a leading cause of liver cancer, however, with treatment, hepatitis C infection is curable. Early detection can save your life. Cases of HIV, syphilis, and gonorrhea are also going up in Malheur County. Testing can give people peace of mind and more information about their overall health.

Along with increased testing, the Health is Wealth program aims to get more adults up to date on recommended vaccines. Immunizations are not just for children. Protection from some childhood vaccines can wear off over time. You may also be at risk for vaccine-preventable disease due to your age, job, lifestyle, travel, or health conditions. All adults need immunizations to help them prevent getting and spreading serious diseases that could result in poor health, missed work, medical bills, and not being able to care for family.

Public health promotes the wellbeing of the entire population of Malheur County and helps to ensure access to safe and quality care. Public health is for everyone! Visit malheurhealth.org or call 541-889-7279 for more information.

MCHD at the Malheur County Fair

The 2022 Malheur County Fair is happening this week, August 2nd through 6th, with the theme of “Just for the Fun of It!” We are proud to be part of one of the county’s best family-friendly events. Come visit our booth in the Commercial Building all week and be sure to stop by on Friday and Saturday for the special COVID-19 vaccine booth near ours. Vaccines available 11 a.m. – 7 p.m. for ages 6 months and older. $25 gift cards for every dose received. Download the flyer here.