There has been an increase in travel-related introductions of clade I mpox into California and the U.S. in 2026, and clade II mpox cases have increased in California. Increases in clade I community transmission in Western Europe suggest that additional travel-related clade I mpox cases should be expected in California. Clinicians should have a heightened index of suspicion for mpox and particularly for clade I mpox in individuals who report recent international travel or sexual or intimate contact with someone who recently traveled internationally, especially to an area where clade I is circulating. Providers and assistants including cleaning staff should wear full PPE (gloves, gown, goggles, and fit tested N-95 respirator). Mpox testing should be considered for patients with compatible signs and symptoms (PDF), regardless of vaccination status or previous infection. Providers should report suspect or confirmed clade I mpox cases immediately to their local health department and/or CDPH. Mpox vaccination with two doses is recommended for individuals whomay be at risk for mpoxincluding immune compromised individuals and is expected to protect against both clade I and clade II mpox or any subclades.
Below are quotes from my otherwise healthy 22-year-old son. He was hospitalized for 4 days last month, after experiencing heat stroke from overexertion while running a half-marathon on a relatively warm day (in the 80’s F).
“I don’t know what happened. I was running and then I woke up in an ice bath. It was so cold, but they wouldn’t let me out because they said my temperature was 106.”
“I was so scared; I couldn’t move my legs. I thought I would never walk again.”
“They gave me back my phone, but I was so confused I couldn’t figure out how to use it.”
Those are NOT the words any mom wants to hear, especially from your child 2,800 miles away that you can’t get to right away to help take care of. On the phone with the emergency room doctor, my mind raced backwards trying to remember how serious heat stroke was and how to treat it. With summer and hotter days coming, this is a good time to review the signs and symptoms of heat-related illness and what to do if you encounter them.
Heat-Related Illnesses
I remember many hot days when my kids were playing soccer, and we worried about heat exhaustion. We gave the kids more breaks, had plenty of water on hand; sometimes the games would get cancelled because it was too hot. I recall one game during which one of our players started feeling dizzy and nauseous. She looked pale and was sweating profusely. We (the moms) got her into the shade, put towels soaked in cold water around her neck and sponged her exposed skin, fanned her, and gave her sips of cool water. Eventually she felt better and was able to sit up and watch the rest of the game from her shaded seat. This was heat exhaustion. Heat exhaustion is not uncommon and is generally not life-threatening but can progress if untreated.
How is Heat Stroke Different from Heat Exhaustion?
A key thing to remember is that heat stroke is a medical emergency and can cause death or permanent disability.Heat exhaustion occurs when the body loses too much water and salt, usually through sweating. Heat stroke occurs when the body becomes unable to control its temperature. This extremely high body temperature can damage multiple organs, including the brain, heart, kidneys and muscles.
While heat stroke can happen to anyone—including young, healthy, and athletic individuals like my son—certain groups are at even higher risk, including:
• People with chronic health conditions (such as heart disease, lung disease, or diabetes) • Very young children • Older adults and seniors • Individuals taking medications that affect hydration or temperature regulation • Pregnant people • Those working or exercising outdoors for prolonged periods
Here is a summary* of some heat-related illnesses, the symptoms to look for and what to do.
Heat-Related Illnesses
Symptoms (may have some or all)
First Aid/What to Do Initially
Heat Stroke (Sunstroke)
High body temperature (103-106 F or higher)
Hot, red, dry or damp skin
Rapid and strong pulse
Headache
Dizziness
Loss of consciousness (passing out and not being able to wake up)
Seizures
Call 911 immediately. Heat stroke is a severe medical emergency.
Move the person to a cooler area.
Remove excess clothing.
Cool with cold bath or sponge, cold compresses (neck, armpits, groin).
Use fans and air conditioners if available.
Do NOT give fluids by mouth if person is unconscious or vomiting.
Stay with person until help arrives and repeat cooling measures if temperature still high.
Heat Exhaustion
Heavy sweating
Cold, pale and clammy skin
Thready/weak pulse
May have normal temperature
Weakness
Vomiting
Dizziness
Fainting (passing out)
Move the person to cool, shaded or air-conditioned area.
Lay them down and loosen clothing.
Apply cool, wet cloths or give a cool bath.
Offer sips of water; stop if nausea or vomiting occurs.
If vomiting continues or symptoms worsen or persist, seek immediate medical attention.
Heat Cramps
Painful spasms in muscles (legs, abdomen, arms)
Heavy sweating
Stop physical activity and move to a cool place.
Apply firm pressure or gently massage cramping muscles.
Encourage drinking sips of water so sports drinks (with electrolytes); stop if nausea or vomiting occurs.
HealthyChildren.org (American Academy of Pediatrics): Extreme Heat English | Spanish
CDC National Institute for Occupational Safety and Health (NIOSH): Fast Facts: Protecting Yourself from Heat Stress English | Spanish | Vietnamese
National Weather Service: Heat Safety – learn about Excessive Heat, the Heat Index and Heat Disorders - Heat -- A Major Killer
About Dr. Michele Cheung Dr. Michele Cheung is board certified in Pediatrics and Pediatric Infectious Diseases and also completed a Preventive Medicine Residency and a master’s degree in public health (MPH). She is the MCAH (Maternal, Child & Adolescent Health) Medical Director for the OC Health Care Agency where she collaborates closely with the community on initiatives to support perinatal, infant, and child health and wellbeing. She has been working in public health, both local and state, in different capacities for the past 25 years. She also cared for children with infectious diseases in the hospital setting until 2024 and regularly teaches pediatricians-in-training about public health and communicable diseases.
(Santa Ana, CA) – The planned removal of neutralized methyl methacrylate (MMA) from the storage tanks at GKN Aerospace did not begin on Thursday, June 4th, due to unavailable resources. Once a removal date is confirmed, advance notice will be provided to the community with important information, including the potential odors during the activity.
As part of routine activity to empty an onsite stormwater/condensation tank located in an area unrelated to the incident site, a spill occurred. As the stormwater was being transferred into a 275-gallon tote for storage and analysis before disposal, as is typical, an overflow occurred and approximately 50 gallons of water flowed into the storm drain. Appropriate state and local notifications were made, and a quantity of the spill was collected during the cleanup effort. The stormwater will be analyzed and the potential for any trace amounts of MMA to be found in the stormwater is low.
An interactive data dashboard is now available on the www.occupainfo.com web page enabling residents to view air monitoring data from the stationary and mobile air monitoring. Air monitoring continues at the facility perimeter and in the surrounding community to ensure public safety and guide response actions.
Cleanup activities related to the GKN Aerospace facility incident in Garden Grove are continuing under the oversight of Unified Command including the OC Health Care Agency, South Coast AQMD and GKN Aerospace.
The first “State of Health in Orange County” focused on health trends and priorities in Orange County; local challenges, initiatives and progress; opportunities to advance health in OC; and a vision for building healthier, more resilient communities.
The overall message is “Safeguarding Public Health is Everyone’s Responsibility.”
(Santa Ana, CA) – Cleanup activities related to the GKN Aerospace facility incident in Garden Grove are continuing under the oversight of Unified Command including the OC Health Care Agency, South Coast AQMD and GKN Aerospace. Between Thursday, June 4 and Friday, June 5, neutralized methyl methacrylate (MMA) from the storage tanks is scheduled to be pumped out and removed. As part of the planned removal process, the material will be transferred directly from the storage tanks and into sealed trucks for transport and disposal. Temporary, intermittent odors may occur during this activity. MMA has a distinctive fruity or plastic-like odor. The product has a very low odor threshold, meaning people may notice a scent even when concentrations are well below levels associated with health concerns. Air monitoring continues at the facility perimeter and in the surrounding community to ensure public safety and guide response actions. The first few days of cleanup included portions of the neutralized MMA being removed, wastewater sampling and testing for proper disposal as well as ongoing air monitoring and tank temperature readings to ensure stability and safety. Daily updates are being posted to www.occupainfo.com.
A large influx of domestic and international travelers is expected into Southern California from June through July 2026, with highest concentration anticipated between June 12 and July 10 in connection with the World Cup.
Healthcare providers should be on increased alert for travel-related emerging and seasonal infectious diseases, including, but not limited to, measles, influenza, mpox, hepatitis A, dengue, chikungunya, and malaria.
Providers should report all mandatory diseases to Orange County Health Care Agency's Communicable Disease Control Division at (714) 834-8180.
Be aware of diseases that are immediately reportable by phone on the List of Reportable Conditions (indicated in red on second page) including any unusual disease, and outbreaks of any disease.
Report cases that are identified in Orange County to Public Health, even if the patient is traveling from another jurisdiction.
Providers can direct patients to public health tips and resources for World Cup matches and large events at Safety for Soccer Fans.
