Messages from State Health Officer Dr. Thomas M. Miller
Support Adequate Funding of Alabama Medicaid
Our mission in public health is to serve the people of Alabama by assuring conditions in which they can be healthy. A fundamental prerequisite for an individual to achieve optimal health is to have access to healthcare. Medicaid provides such access to Alabama’s most vulnerable residents - pregnant women, infants, children, the disabled, and the elderly, covering more than half the births and almost half our children’s healthcare. Our eligibility thresholds reflect the bare minimum allowed by the federal government for individuals to qualify. There are essentially no frills or excesses in the program.
Medicaid requested funding of $785 million to continue existing services in 2017. The $700 million appropriation represents a shortfall of $85 million which translates into a much larger amount due to federal matching dollars at 3 to 1. Cuts to live within the appropriation began this month with discontinuation of the “primary care bump.” Non-bump rates paid to private physicians are very low, barely covering the cost for many providers to see Medicaid patients.
With these cuts, physicians serving a high number of Medicaid patients may struggle to stay in business if they cannot afford to run their offices. Some are expected to reduce or eliminate Medicaid caseloads. Others may choose to leave the state, compounding Alabama’s longstanding shortage of primary care physicians which is already severe in our rural areas.
Medicaid may have to stop paying for eyeglasses and outpatient dialysis, among other services. As each cut looms, the infrastructure of our state’s healthcare delivery system becomes more precarious. Lack of access to pediatricians and family medicine physicians will further burden emergency rooms and patients will be sicker when they show up. Many rural hospitals rely on Medicaid to stay afloat and several have closed in recent years. Having fewer physicians and hospitals impacts more than just Medicaid patients. Those with private insurance may be forced to seek care elsewhere if their current provider goes out of business.
Of particular concern to public health is the impact on our infants and children. For years, Alabama has struggled with one of the nation’s highest infant mortality rates. Covering over half the births in the state, Medicaid is absolutely critical to our efforts to improve infant mortality. For example, the American Academy of Pediatrics recommends newborn follow-up care 48 to 72 hours after hospital discharge to assess the baby’s progress and answer questions for the family. Issues addressed during this important visit include normal infant behavior, feeding, weight, jaundice, and safe sleeping. Missing this and other recommended visits will result in infants not receiving important follow-up care and may lead to serious illness, neonatal intensive care unit admission, or even death, further worsening our infant mortality rate.
As a bright spot, Alabama ranked high on children’s vaccination rates with the 2014-2015 National Immunization Survey showing 93.5 percent of kindergarteners completely up-to-date. Immunization is a vital component of well-child care and has prevented countless deaths. With routine childhood vaccination, pediatricians in our state saw vaccine-preventable diseases either eradicated or significantly decline over the past 60 years. Although many younger pediatricians have never seen these deadly diseases, we cannot rest in the belief that they are no longer a problem and represent no danger to Alabama’s children. We must maintain high immunization rates. Vaccine-preventable diseases such as tetanus, whooping cough, and measles are top causes of death in children worldwide.
Medicaid is a major cornerstone of infrastructure for health in Alabama. Adequate funding helps protect those who depend on it for healthcare, especially our children and other vulnerable citizens. The alternative is allowing them to suffer preventable disease, disability, or death.
Thomas M. Miller, M.D.
State Health Officer
back to top
Parents Reminded It's Time for Back-to-School Immunizations
The month of July is a good time to make sure your children are up to date on their vaccines.
One of the most important things parents can do to help protect their children’s health, the health of their classmates, and their community is to ensure their children receive all recommended vaccines on time. In addition, Alabama state law requires all children to present an up-to-date Certificate of Immunization (COI) upon entrance to childcare centers and school.
Parents are the key to ensure their children are vaccinated according to the Advisory Committee on Immunization Practices Schedule, endorsed by the American Academy of Pediatrics.
Childhood vaccines protect against serious and potentially life-threatening diseases. For example in Alabama in the past 12 months, there were 174 pertussis or whooping cough cases. Many of these cases could have been prevented with vaccines given on schedule.
When children are not vaccinated, they are at risk of disease and can spread diseases to others in their classrooms and community. Communities with groups of unvaccinated people are vulnerable to preventable diseases. Vaccine protects the people who received the vaccine, as well as children too young to be vaccinated, persons with medical conditions preventing vaccination, and those who do not respond to the vaccine.
Childcare-age children need vaccine to prevent diphtheria, tetanus, pertussis, varicella, measles, mumps, rubella, polio, Haemophilus influenzae type b, and pneumococcal disease.
Children entering school need booster doses of diphtheria, tetanus, pertussis, varicella, measles, mumps, rubella, and polio vaccines.
Preteens and teenagers need tetanus, diphtheria, pertussis, human papillomavirus, and meningococcal conjugate vaccines.
All children 6 months and older are recommended to receive annual flu vaccines.
The 2015-16 Alabama School Entry Survey found the following:
- More than 26,845 (3.43%) students did not have a COI on file.
- 13,531 (1.72%) students had an expired COI.
- 6,450 (0.82%) students had a Religious Exemption on file.
Please check with your child’s health care provider or local health department to find out what vaccines they need this year. Parents can find out more about the immunizations children need at adph.org/immunization.
Thomas M. Miller, M.D.
State Health Officer
back to top
Prevent Foodborne Illnesses
Foodborne illnesses are more prevalent in warmer weather when harmful bacteria multiply and create a perfect environment for foodborne illnesses. This is the season when the number of outdoor activities such as picnics, backyard grilling, barbecues, camping, and family reunion meals increase. The Centers for Disease Control and Prevention (CDC) estimates that one in six Americans suffer from a foodborne illness each year and 3,000 deaths result.
Following safe food preparation and storage practices can lessen the likelihood of foodborne illnesses. Cross contamination of food can occur any time harmful germs, such as bacteria, viruses, or parasites are transferred from one food to another. As food heats up with soaring temperatures, bacteria multiply rapidly.
Some important food handling tips are summarized here.
Clean: Food safety starts at the time food is purchased. Wash hands and food-contact surfaces often. Bacteria can contaminate cutting boards, knives, sponges, and food preparation surfaces. Rinse all fresh fruit and vegetables under running water before packing them in a cooler. Make sure hands and serving surfaces are clean in both indoor and outdoor settings. If there is no access to running water, bring a jug of water to wash hands with soap and dry them with paper towels or use disposable moist towelettes to clean hands. Keep cooking utensils and platters clean when preparing food and do not reuse them without washing them thoroughly.
Separate: Do not cross-contaminate—do not let bacteria spread from one food product to another. Be sure to separate raw food from ready-to-eat food during transport, storage, and preparation. This is especially true for raw meat, poultry, and seafood which need to be wrapped securely. Keep these foods and their juices away from ready-to-eat foods. Use different cutting boards for raw meats and fresh vegetables. Pack raw food that will be cooked in a separate cooler from food that is ready to eat. Pack coolers correctly to maintain a temperature of 40° F or lower. It may help to pack beverages in another cooler to keep food from being exposed to outdoor temperatures.
Cook: Cook food to proper temperatures. Food is properly cooked when it is heated for a long enough time and at a high enough temperature to kill the harmful bacteria that cause foodborne illness. Often meat and poultry cooked on a grill brown on the outside quickly, so use a meat thermometer. Place the thermometer in the thickest, most dense part of the food. Cook poultry to a minimum temperature of 165°degrees F, ground meat to 160° degrees F, and steaks and chops to 145° degrees F. Do not rely on color alone. Hamburger meat can turn brown before it reaches the minimum temperature required.
Chill: Refrigerate foods promptly, because cold temperatures keep most harmful bacteria from growing and multiplying. Refrigerate or freeze foods within two hours or just one hour if the outdoor temperatures are above 90° degrees F to slow harmful germ growth. To be safe, discard any food left out longer. Limit the number of times the cooler is opened to help keep ice and cold packs from melting. Place coolers out of the sun when possible and replenish ice when it starts melting.
Report: Report suspected foodborne illnesses to your local health department. Calls from concerned citizens are often the way foodborne outbreaks are first detected. County health department telephone numbers are found on this website. If a representative from public health contacts you to find out more about an illness you had, your cooperation is important. Representatives will provide their name and a call-back number.
People at greatest risk of acquiring foodborne illness are infants and young children, pregnant women, older adults, and those with weakened immune systems caused by cancer treatment, diabetes, AIDS, and bone marrow and organ transplants.
CDC recommends that people seek medical care if they have these symptoms of foodborne illness:
- High fever (temperature over 101.5° F, measured orally)
- Blood in the stools
- Prolonged vomiting that prevents keeping liquids down (which can lead to dehydration)
- Signs of dehydration, including a decrease in urination, a dry mouth and throat, and feeling dizzy when standing up
- Diarrheal illness that lasts more than three days
The time-proven rule of keeping cold foods cold and hot foods hot applies. For more information on food safety during hot weather, visit FoodSafety.gov.
By handling potentially hazardous foods properly, hosts can help ensure both their family and guests have a safe and healthful spring and summer season.
Thomas M. Miller, M.D.
State Health Officer
back to top
‘Be #HepAware’ during May, Hepatitis Awareness Month
May is Hepatitis Awareness Month, an annual observance to emphasize the elimination of viral hepatitis through raising awareness, capacity building, policy and advocacy, and increased access to care. The Centers for Disease Control and Prevention (CDC) encourages populations at risk, especially those born between 1945 and 1965, to become more aware of viral hepatitis. The hashtag “Be #HepAware” aims to bring awareness to the impact of viral hepatitis and promote an online risk assessment tool that will help guide a person’s decision to be tested for hepatitis C or vaccinated for hepatitis A and B.
Hepatitis means “inflammation of the liver” and is often caused by a virus. The three common viruses seen in the U.S. are hepatitis A, B, and C. Hepatitis A (HAV) is usually transmitted via fecal–oral route from person to person or consumption of contaminated food or water. HAV is an acute infection and is highly contagious. The best way to prevent transmission is by getting vaccinated.
Some common ways Hepatitis B (HBV) is transmitted include sexual contact of a person who is infected; sharing needles, syringes, or other drug preparation equipment; or from mother to infant at birth. For some, HBV is a short-term illness. However, it can become a long-term, chronic infection. Chronic HBV can lead to serious health problems. The CDC recommends children and unvaccinated at-risk adults get vaccinated.
Hepatitis C (HCV) is perhaps the most notable because the vast majority of people with the virus are unaware they have it and are undiagnosed. While anyone can get HCV, more than 75 percent of adults infected are people in the baby boom generation (born between 1945 and 1965). Baby boomers are five times more likely to have HCV than others are. The reason for their high rates of HCV is not completely understood. Most boomers are believed to have become infected in the 1970s and 1980s when rates of HCV were the highest.
Since people with HCV can live for decades without symptoms, many people who are now in their fifties and sixties are unknowingly living with an infection they got many years ago. The longer people live with the disease, the more likely they are to develop serious, life-threatening liver disease. HCV is spread primarily through contact with blood from an infected person. Many baby boomers could have become infected from contaminated blood and blood products before widespread screening of the blood supply in 1992 and universal precautions were adopted. Others may have become infected from injecting drugs, even if only once in the past. Still, many baby boomers do not know how or when they were infected.
Getting tested can help everyone learn if they are infected and get them into lifesaving care and treatment. For many people, treatments are available that can cure HCV and prevent liver damage, cirrhosis, and even liver cancer.
Breakthroughs of new curative treatments have helped to make some progress towards elimination of the virus, but HCV remains a serious health problem.
Today, people sharing needles or other equipment to inject drugs get most new HCV infections. For some, it is a short-term illness, but for 70 to 85 percent of people who become infected with HCV, it becomes a long-term, chronic infection which can result in death. Most people might not be aware of their infection because they are not experiencing symptoms and there is no vaccine to prevent HCV. The best way to prevent it is by avoiding behaviors that can spread the disease, especially injecting drugs.
Generally, when a person comes in contact with viral hepatitis he or she may have very few symptoms or no symptoms at all. If symptoms develop they can include the following:
- Flu-like symptoms
- Loss of appetite
- Gray-colored stool
- Abdominal pain
- Joint pain
Chronic HBV and HCV account for more than half of new cases of chronic liver disease—a leading cause of death. At least 4.4 million people in the U.S. are estimated to be living with chronic HBV and HCV and most do not know they are infected. The year 1989 marked the discovery of HCV. After implementation of CDC guidelines such as screening of blood products and donated organs via organ donors, rates of HCV decreased between 1990 and 2009. However, the nation experienced a rise in HCV rates during 2009-2013. In Alabama, reported rates of acute HCV increased by 200 percent during this time period.1
Routine medical checkups do not include testing for viral hepatitis, so persons at risk are urged to talk with their medical provider about getting tested. A medical provider can determine if a person has HAV by discussing symptoms and evaluating a blood sample for immunoglobulin M (IgM) antibody to HAV. HAV does not become chronic, and if a person comes in contact with the disease after initial contact, he or she will not be reinfected. The individual will develop IgG antibodies that provide lifelong protection against the disease.
Several antiviral medications are available to treat chronic HBV, and today many people can benefit from curable treatment for HCV. The Alabama Department of Public Health Bureau of Communicable Disease aims to inform Alabamians about risks associated with transmission of viral hepatitis.
To assess risk, visit Hepatitis Risk Assessment or adph.org/hepatitis and take the online risk assessment to get a personalized report.
Thomas M. Miller, M.D.
State Health Officer
1 CDC National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, 2015 State Health Profiles
back to top
'Talk, Test, and Treat' to Prevent Sexually Transmitted Disease (STDs) and Their Progression
April is STD Awareness Month, an annual observance to call attention to the impact of STDs and promote STD testing across the nation. This year's theme, which was selected by the Centers for Disease Control and Prevention (CDC), is “Talk, Test, and Treat.” This month-long observance provides an opportunity to correct misperceptions about STD prevention and testing, and confront the unique challenges that young people face when it comes to preventing these infections. Because half of the estimated 20 million STDs that occur in the United States each year are among young people, STD Awareness Month 2016 focuses on this population.
According to the CDC, cases of syphilis and other STDs have increased for the first time since 2006, which has led to the need for better diagnosis, treatment, and prevention. STDs remain a problem in Alabama, and their health consequences can last a lifetime. Of particular concern in Alabama are recent increases in primary and secondary syphilis; these are the earliest and most transmissible stages of syphilis. In 2015, the number of syphilis cases in these two stages reported to the Alabama Department of Public Health increased by 68.3 percent (276 cases) compared to the number of cases (164) reported in 2014.
Home remedies or over-the-counter drugs will not cure syphilis; however, syphilis is easy to cure in its early stages with the correct antibiotics. Treatment will not reverse any damage the infection has already caused, so it is very important to get early treatment from a health care provider. If left untreated, syphilis can have very serious complications. Please check the STD website for information about the signs and symptoms of syphilis.
The simple recommendations below will help protect sexual health by minimizing the negative and sometimes lifelong consequences of these infections:
Talk openly and honestly to your partner(s) and your health care provider about sexual health and STDs. Talk with your partner before having sex, and make sure your discussion covers several important ways to make sex safer:
- Talk about when you were last tested and suggest being tested together. If you have an STD (like herpes or HIV), tell your partner.
- Agree to maintain monogamous sexual relationships.
- Use latex condoms the right way every time you have sex.
- Talk with your health care provider about your sex life, and ask what STD tests you should be getting and how often.
Not all medical checkups include STD testing, so unless you discuss whether you are being tested, do not assume that you have been. Vaccines for Hepatitis B and Human papillomavirus (HPV) are available.
Many STDs have no symptoms, so get tested to be certain you do not have an STD. If you are having sex, getting tested is one of the most important actions you can take to protect your health.
Find out which STD tests CDC recommends and remember, pregnancy does not protect against STDs. If you are having sex, you are still at risk. If you are not comfortable talking with your regular health care provider about STDs, find a clinic near you that provides confidential and free or low-cost testing.
If you test positive for an STD, work with your health care provider to get the correct treatment. Some STDs can be cured with the right medicine, and it is important that you take all of the prescribed medication. To make sure your treatment is effective:
- Do not share your medicine with anyone, and
- Avoid having sex again until you and your sex partner(s) have each completed treatment.
- Other STDs are not curable, but they are treatable. Your health care provider can talk with you about which medications are right for you.
We encourage sexually active people to get themselves tested to control STDs. Free testing and treatment is provided for syphilis, chlamydia, gonorrhea, and HIV at county health departments.
The mission of the Alabama Department of Public Health Division of STD Prevention and Control is to identify populations at increased risk for infection in order to reduce their chances of developing a sexually transmitted disease, transmitting it to others, and developing related complications. Trained public health staff statewide provide screening, diagnostic, education, treatment, partner notification, and referral services in all Alabama counties. These public health staff members include registered nurses, nurse practitioners, physicians, and disease intervention specialists. Keep in mind that all services are confidential.
Check the STD website for additional information about STDs.
Thomas M. Miller, M.D.
State Health Officer
back to top