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Archived Messages

Messages from State Health Officer Dr. Thomas M. Miller


‘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
  • Vomiting
  • Nausea
  • Loss of appetite
  • Fatigue
  • Fever
  • Gray-colored stool
  • Abdominal pain
  • Jaundice
  • 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

(May 2016)

1 CDC National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, 2015 State Health Profiles

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'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

(April 2016)

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World TB Day 2016 Emphasizes Working Together to Eliminate Tuberculosis (TB)

"Find TB. Treat TB. Working together to eliminate TB" is the theme the Centers for Disease Control and Prevention selected for World TB Day 2016. TB is an infectious bacterial disease caused by Mycobacterium tuberculosis, which most commonly affects the lungs. It is transmitted from person to person via droplets from the throat and lungs of people with the disease.

World TB Day, annually held on March 24, marks the day in 1882 when Dr. Robert Koch detected the cause of the disease, the TB bacillus. This was a first step toward diagnosing and curing TB. World TB Day can be traced back to 1982, when the International Union Against Tuberculosis and Lung Disease launched World TB Day on March 24 that year, to coincide with the 100th anniversary of Dr. Koch’s discovery.

TB is still a life-threatening problem in this country, and much work is needed to eliminate this devastating disease. Anyone can get TB, but thanks to public health TB control programs, essential services are being provided to prevent, detect, and treat it.

General symptoms of TB include the following:

  • Cough lasting more than two weeks
  • Shortness of breath
  • Fever
  • Night sweats
  • Weight loss
  • Fatigue

A person may be infected with the TB germ, however, and have no symptoms. Children, elderly persons, immunosuppressed persons, and persons with lung disease or diabetes who have been infected with the TB germ are at higher risk of developing TB disease. Fortunately, patients can be treated preventively before becoming ill.

While the number of TB cases reported nationally every year is continuing to decline, TB has certainly vaulted to the forefront of public health awareness in Alabama because of the ongoing TB initiative in Perry County. Dozens of public health employees have been a part of this bold initiative through the Alabama Department of Public Health Division of TB Control in a county with many low-income residents and what was considered a hard-to-reach segment of the population.

From the outset of the Perry County initiative, one goal was to ensure the TB message was conveyed in a way that would not lead to fear within the community. Monetary incentives were offered to encourage screening and treatment, and community leaders were involved. Thanks to this special effort, more than 2,000 people were screened in January 2016, more than 150 patients with latent TB infection in the county are receiving preventive therapy, and individuals with TB infection are receiving life-saving TB treatment.

It is important to note that there were 133 TB cases in 2014 and 119 cases in 2015, so the situation in Perry County might easily have occurred in other areas of the state without prompt identification and evaluation of contacts at risk of exposure. TB services are provided to all people in Alabama, regardless of their ability to pay. For more information about TB, visit Tuberculosis or call 334-206-5330.

Thomas M. Miller, M.D.
State Health Officer

(March 2016)

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Promote Heart Health During American Heart Month

February is American Heart Month, an observance to increase our focus on cardiovascular disease (CVD), the leading cause of death in the United States and Alabama. CVD includes diseases that affect the heart or blood vessels, including heart disease, hypertension (high blood pressure), and stroke.

Consider these facts:

  • More than 1 in 3 U.S. adults have at least one type of CVD.
  • In the U.S., 1 in every 3 deaths is from heart disease and stroke--equal to 2,200 deaths per day.
  • In 2014, the death rate from heart disease in Alabama was 257.6 per 100,000 population, a rate much higher than the rate for the nation of 189.8 per 100,000.
  • The 2014 stroke rate in Alabama was 36.2 per 100,000, while the U.S. rate was 53.6 per 100,000.1

This month, we are highlighting Million Hearts™, a public-private initiative dedicated to preventing the nation's leading killers and empowering everyone to make heart-healthy choices. Million Hearts™ involves many federal agencies and key private organizations.

Launched in September 2011 by the Department of Health and Human Services, Million Hearts™ aims to prevent 1 million heart attacks and strokes in the U.S. by 2017.

Million Hearts™ emphasizes that to decrease CVD, we must make responsible and appropriate long-term lifestyle changes and take fundamental steps as individuals. The good news is that we can modify and control risk factors, which include the following:

  • High blood pressure
  • High blood cholesterol
  • Diabetes
  • Overweight and obesity
  • Smoking
  • Physical inactivity
  • Inadequate fruit and vegetable consumption

CVD and its risk factors are not distributed evenly across the U.S. population, and some risk factors cannot be changed. Certain groups defined by age, sex, race, ethnicity, or geography, have higher levels than others do.

Disproportionately high rates of avoidable CVD deaths are found among black men and among adults aged 30–74 years living in the Southeast, highlighting the need for targeted efforts to alleviate disparities and improve health. Black men experience a death rate attributable to CVD that is about 2.7 times higher than that of the lowest rate, found among white women.

The initiative asks everyone to protect themselves and their loved ones from CVD by understanding the risks, making healthful choices, and taking these steps:

  • Know and follow the ABCS that address the major risk factors for CVD.
        - Ask your doctor if you should take an Aspirin every day.
        - Find out if you have high Blood pressure or high Cholesterol, and if you do, get effective treatment.
        - If you Smoke, get help to quit.
  • Get up and get moving by being physically active for at least 30 minutes on most days of the week.
  • Make your calories count by eating a heart-healthy diet high in fresh fruits and vegetables and low in sodium and trans fat.
  • Take control of your heart health by following your doctor’s prescription instructions.
    To learn more about lowering your risk of CVD and for more information, visit Million Hearts and Cardiovascular Health.

Thomas M. Miller, M.D.
State Health Officer

1 National Center for Health Statistics, Health, 2015

(February 2016)

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National Birth Defects Prevention Month

Birth defects affect one in every 33 infants born in the U.S. each year. This accounts for approximately 120,000 infants that require costly, long-term care annually. Additionally, birth defects are the leading cause of infant deaths in the U.S., accounting for 20 percent of all infant mortality. Each year, total hospital costs for U.S. children and adults with birth defects exceed $2.6 billion, not including costs for outpatient care or many provider charges. The Alabama Department of Public Health Center for Health Statistics for 2013 indicates that the leading causes of death in infants less than 1 year of age are associated with congenital anomalies and birth defects. One hundred sixty-five of the 500 infant deaths in 2013 were attributed to birth defects; affecting one out of every three infants that died before reaching their first birthday.

Birth defects are congenital medical disorders caused by complex factors, which include genetic makeup, health behaviors and lifestyles, and environmental exposures. Examples of birth defects may include heart defects, cleft lip/palate, Down syndrome, and spina bifida. Some births defects have minor life-altering effects, while others cause lifelong disabilities.

January is National Birth Defects Prevention Month and the ADPH wants to make people aware of some steps that can be taken to reduce the risk of having a child born with birth defects. Making an effort to have a healthy lifestyle, visiting a health care provider before planning to get pregnant, planning your pregnancy, and taking a multivitamin every day can go a long way.

Not all birth defects can be prevented. But, women of childbearing age are encouraged to:

  • Consume 400 micrograms of folic acid at least three months before planning to become pregnant and continuing through the early months of pregnancy
  • Reach and maintain a healthy weight before becoming pregnant
  • Talk to a health care provider about taking proper medications
  • Avoid alcohol, smoking, and illicit drugs
  • Discuss family history
  • See a health care provider early and regularly if you think you might be pregnant

Hispanic women are about 20 percent more likely to have a child with a neural tube defect than non-Hispanic white women. Although the reasons for the disparity are not well understood, Hispanic women have lower intake of folic acid overall, compared to white women, according to the National Birth Defects Prevention Network. In 1998, folic acid was added to the grain food supply, resulting in a 26 percent decrease of neural tube defects in the U.S. and an estimated cost savings of over $300 million per year.

Improving the ability to prevent birth defects is an important public health priority that requires commitment. The Alabama Newborn Screening program currently screens for 31 disorders of the newborn and conducts extensive follow-up on infants who have any abnormal results. Early intervention is vital to improving outcomes for these babies.

Please join ADPH as we spotlight National Birth Defects Prevention Month and ways to reduce risk factors associated with birth defects. Reducing the human and economic costs of birth defects is a vital part of improving the overall quality of life for all Alabama families.

Thomas M. Miller, M.D.
State Health Officer

(January 2016)

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