Archived Messages from the State Health Officer
Donald E. Williamson, M.D.
Prevent Recreational Water Illnesses
Swimming is an enjoyable way to be physically active and keep cool during the hot days of summer, but it is important that you protect yourself and other swimmers by following practices to prevent the transmission of infectious disease in community swimming pools and other recreational water venues.
Recreational Water Illnesses, or RWIs, are caused by germs spread to people by swallowing, breathing in vapors of, or having contact with contaminated water in swimming pools, water parks, hot tubs, fountains, lakes, rivers, springs, ponds, or oceans. Germs on and in swimmers’ bodies end up in the water and can make other people sick.
Diarrhea is the most common RWI, and germs like Crypto (an abbreviation of Cryptosporidium), Giardia, norovirus, Shigella, and E. coli O157:H7 often cause it. Other common RWIs include skin, ear, respiratory, eye, neurologic, and wound infections. Children, pregnant women, and people with weakened immune systems are most at risk.
RWIs cause several types of health problems including gastrointestinal illness; eye infections and irritation; hepatitis; wound infections; skin infections; respiratory illness; ear infections and even neurologic infections.
Even healthy swimmers can get sick from RWIs, but young children, elderly people, pregnant women, and those with weakened immune systems are at special risk. Taking steps to keep germs out of the pool is best, so follow these recommendations to help prevent RWIs:
- Never swim if you have diarrhea.
- Shower with soap before and after swimming.
- Wash your hands after using the toilet or changing diapers.
- Take children on frequent bathroom breaks and check diapers often.
- Check and change diapers in a bathroom or a diaper-changing area, not at poolside.
- Do not swallow the water.
Past outbreaks have emphasized the importance of parents being alert to symptoms of illness after a child swims. If the child has nausea, vomiting, diarrhea, or abdominal cramps, parents should seek medical attention for their child. Symptoms can appear up to 10 days after exposure. People with diarrhea caused by potential waterborne pathogens should not use swimming pools, water slides, and water parks for two weeks after symptoms resolve.
A recent national study found that more than half of pools tested had evidence of fecal contamination. It is important that pool operators keep pools clean with the use of chemicals to control the growth of pathogens and regulate the pH, and read and follow directions for pool chemical use and storage.
Knowing the basic RWI facts and observing healthy recreational water rules can make the difference between a fun-filled day at the pool, beach or water park, and having diarrhea, getting a rash, or even developing serious illnesses. Be smart, safe, and prevent RWIs.
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Ebola - What You Need to Know
The 2014 Ebola outbreak is the largest Ebola outbreak in history, and is of great concern to many people. At this time, there are no confirmed cases of patients with Ebola in Alabama. Ebola is not spread through the air, by water, or in general, by food. While the likelihood of an outbreak occurring is very low, the Alabama Department of Public Health is working with other partners and is taking several steps to ensure that if a case occurs in our state we will be prepared to respond.
According to the Centers for Disease Control and Prevention (CDC), people who are at highest risk of contracting Ebola include those who travel to countries with active Ebola outbreaks and are:
- Healthcare workers
- Family and friends of an Ebola patient that are in direct contact with the person who was infected with the virus.
If you are a health care provider and have a patient who has traveled to an Ebola affected area, and the patient is experiencing symptoms of fever (subjective or ≥ 100.4˚F), severe headache, muscle pain, weakness, vomiting, diarrhea, abdominal pain, lack of appetite, or unusual bleeding within three weeks of travel, please complete the Ebola Consultation Record and call the Epidemiology Division immediately at 1-800-338-8374.
For more information, please visit www.adph.org/ebola.
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Alabama’s Statewide Trauma System Maximizes the Benefits of Rapid Intervention
Alabama’s statewide trauma system offers a unique opportunity to positively impact the lives of the citizens of Alabama. Trauma is a major problem in the state of Alabama, and is the leading cause of death in people under age 45 in our state.
After a traumatic injury, transporting the most severely injured patients to the closest, most appropriate hospital that meets their needs means lives can be saved and serious disabilities prevented. For the great majority of injured people, time isn’t so important, but for the 5 to 10 percent of those with life-threatening or life-limiting injuries, this improved system can make tremendous positive changes in mortality, length of hospitalization, and quality of life.
Alabama has been on a nearly decade-long journey to address trauma by building a statewide trauma system. State leaders discussed the need for an organized response to managing and improving the care of severely injured people by implementing a trauma system. In 2007, the Alabama Legislature passed an act establishing a trauma system, and on August 21, 2014, we were happy to announce the activation of the final portion of the state’s 18-county southeast region, meaning the entire state is now covered.
Our system improves the chances of survival, regardless of the patient’s proximity to an urban trauma center. This is the way the system works: After emergency medical services personnel arrive on the scene and evaluate a patient, the trauma communications center will be contacted. Most patients will be taken to the closest hospital for treatment; however, for those with severe injuries the system will centrally route them in real time to the closest and most appropriate trauma center. Minutes saved have been shown to reduce the death and disability rate in patients for whom prompt medical treatment can make a difference. Now patients needing rapid, specialized treatment go directly to a hospital with the capacity to provide definitive therapy.
Rather than having multiple dispatch locations, all Alabama cases are routed from a single site in Birmingham. The trauma system we use allows a hospital to inform us if they are overloaded with trauma cases, and whether the neurosurgeons, orthopedic surgeons, or other specialists are already occupied and are not available to care for the patient. Through improved communication, the patient then is routed to a hospital where care is available.
Alabama is the only state in the United States with the capability to constantly monitor the status of every trauma hospital and route the trauma patient to the right hospital every time. This system that matches the patient with the hospital in real time is the model for the rest of the nation.
In addition to providing the best care, this system makes the most efficient use of scarce resources. While other states have spent tens of millions of dollars to establish a trauma system, Alabama has enjoyed the voluntary participation of physicians and hospitals in the creation of the system.
Prior to the inception of the trauma system, the average hospital length of stay for trauma patients in Alabama was 5.72 days, compared to 5.15 days after the system began operation. This is approximately a 10 percent reduction in the length of hospital stays for traumas that have been reported to the Office of Emergency Medical Services. Reduced hospitalization times lead to reduced health care costs per patient and improved patient outcomes.
All hospitals are invited to participate and are designated as levels I, II, or III, depending on their resources and availability of services. Hospitals are inspected to verify that they can provide the level of care for which they have applied. Alabama has 6 EMS regions, 54 trauma centers, 1,166 ground units, and 12 air units statewide. In addition, 8 out-of-state air units are operating in Alabama.
We applaud the progressive hospitals of Alabama, emergency medical services personnel, Alabama physicians, and Alabama Trauma Communications Center partners for voluntarily working together to provide needed access to care. We look forward to the positive outcomes in saving lives and improving the quality of lives that will follow as a result of our statewide trauma system.
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Tick Season is Here—Avoid Tick Bites
Ticks aren’t just a nuisance, they carry many diseases that can have devastating effects. These spider-like insects are second only to mosquitoes in transmitting disease. Although it may be no larger than a pinpoint, a single tick can lay 3,000 eggs, and our unusually cold winter didn’t reduce their numbers.
Three species of ticks are endemic in Alabama, and they are commonly known as Deer, American Dog, and Lone Star ticks. Tick bites can cause anaplasmosis, babesiosis, ehrlichiosis, Lyme disease, rickettsiosis, Rocky Mountain spotted fever, Southern tick-associated rash illness, and tularemia. In 2013, the Alabama Department of Public Health Epidemiology Division conducted 1,137 investigations of tickborne diseases with 290 confirmed cases. However, the actual number may be greater because not all tickborne diseases are reportable in Alabama.
Reducing exposure to ticks is the best defense against the diseases they carry. While you should take preventive measures against ticks throughout the year, be extra vigilant in the warmer months of April through September when ticks are most active.
People most at risk from tick-borne diseases are outdoor enthusiasts, outdoor workers, pet owners and veterinarians, and anyone else who ventures into tick-infested areas.
The following are some tips to avoid tick bites:
- Stay away from wooded and bushy areas with high grass and leaf litter, and walk in the center of trails.
- Tuck pants into socks to keep ticks off your legs and wear light-colored clothing to help you spot ticks.
- Use insect repellants that contain 20 percent or more DEET on exposed skin and permethrin on clothing. Permethrin should not be used directly on the skin.
- Pay special attention when applying insect repellent products to children’s skin, being sure to avoid their hands, eyes, and mouths. Repellents that contain DEET must be reapplied every few hours.
- Use available products to help prevent tick infestations on pets.
After outdoor activity:
- Inspect children, pets, clothing, and outdoor gear, such as backpacks, for ticks.
- Bathe within two hours.
- Conduct a full-body check with a mirror, including hair and scalp.
How do I remove a tick?
- Use fine-tipped tweezers to grasp the tick as close to the skin's surface as possible.
- Pull upward with steady, even pressure.
- Do not twist or jerk the tick, because it may cause the mouth to break off and remain in
the skin. If this happens, remove the mouth with tweezers.
- If you are unable to remove the mouth easily with tweezers, leave it alone, and let the
- After removing the tick, thoroughly clean the bite area and your hands with rubbing
alcohol, an iodine scrub, or soap and water.
- Do not paint the tick with nail polish or petroleum jelly, or use heat to make the tick
detach from the skin. Your goal is to remove the tick as quickly as possible.
- Tumble dry clothing on a high heat setting for one hour to kill any missed ticks.
Where can I find more information?
Go to cdc.gov and type Ticks in SEARCH box, and if you suspect you may have a tickborne infection, please contact your health care provider.
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Fifty Years After the Landmark Surgeon General’s Report on Smoking, the Habit Still Harms Millions
Fifty years after Alabama native Dr. Luther Terry issued the landmark Surgeon General's Report on smoking and its health consequences, smoking is still the number one cause of preventable death and disease in the nation. Since the report was published in 1964, more than 20 million Americans have died because of smoking.
In fact, if current smoking rates continue, 108,000 Alabama children living today will die prematurely because of smoking, according to a new report, The Health Consequences of Smoking: 50 Years of Progress. The report, issued in January, calls the epidemic of cigarette smoking over the past century an enormous and avoidable public health tragedy.
Smoking kills more than 7,500 adults over age 35 in Alabama each year, and costs the state nearly $5.6 billion in medical care costs and productivity losses, according to the report.
These numbers are alarming, but the effects of tobacco use are entirely preventable. If we can pass smokefree protections for everyone, increase the price of tobacco, and fully fund tobacco prevention programs, more people will quit and more children will never start. We need to reduce tobacco consumption in pregnancy, a factor associated with higher infant mortality.
Alabama has one of the highest rates of smoking prevalence in the nation, with nearly one in four adults and more than 19 percent of high-school youth who are smokers.
The new report updates estimates on the human and financial tolls of the cigarette smoking epidemic, finding that it kills close to half a million Americans a year and costs more than $289 billion a year in direct medical care and economic loss.
Since the 1964 report, evidence has linked smoking to diseases of nearly all the body’s organs. The report establishes more new links, finding that cigarette smoking causes diabetes, colorectal cancer, and liver cancer.
The report also said smokers today have a greater risk of developing lung cancer than they did in 1964, even though they smoke fewer cigarettes. Changes in the design and composition of cigarettes may have contributed to this increase in risk, the report said. At least 70 of the chemicals in cigarette smoke are known carcinogens.
New findings in this report conclude that smoking causes the following:
- Rheumatoid arthritis and immune system weakness
- Increased risk for tuberculosis disease and death from TB
- Ectopic pregnancy and impaired fertility
- Cleft lip and cleft palates in babies of women who smoke during early pregnancy
- Erectile dysfunction in men
- Age-related macular degeneration
- Increases in the failure rate of cancer treatment
The report also concludes that secondhand smoke exposure is now known to cause strokes in nonsmokers.
Tobacco marketers spend more than $1 million an hour to promote their products. More youth have turned to other forms of tobacco as well. According to the 2012 Alabama Youth Tobacco Survey, both cigarette and smokeless tobacco user numbers are up nearly a percentage point from the 2010 survey.
Studies show that about 70 percent of all smokers want to quit, and research indicates that nicotine replacement patches have been effective in assisting individuals enrolled in tobacco cessation programs to successfully quit smoking.
In Alabama, smokers can get free help by calling 1-800-QUIT-NOW (1-800-784-8669) or visiting www.alabamaquitnow.com.
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Your Assistance is Needed for Comprehensive Community Health Assessment
The Alabama Department of Public Health is seeking survey input from diverse organizations, agencies, businesses, programs, individuals, consumers and others in identifying appropriate and relevant health issues that they would like to have considered for inclusion in a statewide and local health assessment. Names of participants are not requested in the survey. The brief online survey can be responded to by visiting http://bit.ly/1cqyvEr. Please respond by January 15, 2014.
We need the assistance of interested groups and individuals from different backgrounds and parts of the state to respond to the survey. By better understanding the health concerns and needs of the state, identifying partners that we can work with, and focusing our efforts, we can effectively improve the health status of Alabamians.
The assessment that is being developed through this survey and other related activities will help identify and prioritize the health needs of the state, establish a measurable starting point for tracking progress, and serve as a foundation for a statewide health improvement plan. In addition to other benefits, the health assessment will position the Health Department to apply for accreditation through the Public Health Accreditation Board (PHAB). Accreditation will advance the quality and performance of the agency. It provides a means to identify performance improvement opportunities, improve management, develop leadership, and improve relationships with other community components.
PHAB is a nonprofit organization dedicated to advancing the quality and performance of public health departments by providing a national framework of standards and a process to achieve voluntary accreditation. PHAB was created to serve as the national public health accrediting body. It is jointly funded by the Centers for Disease Control and Prevention and the Robert Wood Johnson Foundation.
We hope you will carefully consider your responses, and will take the online survey as soon as possible. We want and need your input.
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Protect Alabama Workers from Secondhand Smoke: Smoke-free Policies Save Lives
The Alabama Department of Public Health seeks to serve the people of Alabama by assuring conditions in which they can be healthy. Tobacco use continues to be our leading cause of preventable death, and reports confirm there is no safe level of exposure to tobacco smoke.
In a recent study, Alabama Department of Public Health staff and local coalition volunteers measured the air quality in restaurants and bars in seven Alabama communities. This study found that, in those tested bars and restaurants that allowed smoking, workers were exposed to air pollution levels up to 55 times higher than smoke-free restaurants and bars in the same city. The unhealthy amounts of pollution are far above the safe annual level set by the U.S. Environmental Protection Agency.
Secondhand smoke contains at least 250 chemicals that are known to be toxic and cause cancer. Breathing secondhand smoke boosts nonsmokers' risk for heart problems, and even relatively brief exposure can potentially lead to a heart attack. A 2009 report from the Institute of Medicine said smoke-free ordinances are effective at reducing the risk of heart attacks and heart disease associated with exposure to secondhand smoke.
In these difficult economic times, people may be concerned about the impact smoke-free policies have on businesses. A recent study of Alabama and eight other states conducted by an independent, nonprofit institute reinforced the findings of previous studies, which have shown that smoke-free laws do not have a negative economic impact on restaurants and bars.
Many cities and towns in Alabama have passed comprehensive ordinances to protect workers. I commend the city councils of Anniston, Satsuma, and Troy for recently enacting policies that protect all workers from secondhand smoke. In fact, 25 cities in Alabama protect their workers from secondhand smoke. Studies show more than 78 percent of Alabamians favor smoke-free workplaces, and more city councils are considering the issue.
According to a 2006 U.S. Surgeon General’s Report, a smoke-free environment is the only way to protect nonsmokers from the dangers of secondhand smoke. Separating smokers from nonsmokers and ventilating buildings does not eliminate exposure to secondhand smoke. Not allowing smoking indoors could save as many as 820 Alabamians who die every year as a result of someone else’s smoke.
As State Health Officer, I applaud the progress that has been made in reducing exposure to secondhand smoke and encourage communities to continue to expand protections to nonsmokers.
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Do What You Do Best. Be a Man. Be Healthy.
June is National Men’s Health Month, and the Alabama Department of Public Health joins with the U.S. Department of Health and Human Services to promote the importance of men making health a priority in their lives. We want to promote early detection and treatment of disease among men and boys by encouraging them to seek regular medical advice and early treatment for disease and injury.
Risks to the health and well-being of the nation’s men (and our families) are on the rise, due to a lack of awareness and pursuit of preventive screening and care. Men are often the family bread winners, and as a result, forget to make their own health a priority because of their jobs and lifestyle.
Some additional reasons why men are at an increased risk for poor health include:
- A higher percentage of men have no health care coverage.
- Men make half as many physician visits for prevention as compared to women.
- Men are more often employed in dangerous occupations, such as policemen, military personnel, construction workers, industrial workers, and farmers and ranchers.
- Research on male-specific diseases is minimal.
- Men are more likely to engage in risky behaviors at younger ages.
The top causes of death for men in Alabama are as follows:
1. Heart Disease
4. Chronic Lower Respiratory Disease
5. Cerebrovascular Disease (Stroke)
8. Nephritis (Kidney Disease)
9. Influenza and Pneumonia
10. Septicemia (Blood Infections)
We encourage all men to become positive role models in their own families and communities by setting the example of eating right, exercising regularly, and getting routine medical check-ups. Our families and friends rely on us to be there and to live a long, healthy life. For more information about the leading causes of death for men in Alabama and a list of events raising awareness about Men’s Health, please visit our Men’s Health website.
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Regional Medicaid managed-care bill could save money, provide better care
Op Ed by Donald E. Williamson, M.D., State Health Officer and Chair, Alabama Medicaid Advisory Commission
Medicaid reform proposals now in the Alabama Legislature could help save hundreds of millions of taxpayers’ dollars and improve medical care that the agency provides to about 940,000 lower-income and disabled Alabamians. Medicaid is vital to meet the health-care needs of our citizens.
Roughly one in five Alabamians received services from Medicaid last year. Alabama Medicaid covers about 53 percent of births, 47 percent of our children, and almost two-thirds of nursing-home residents. However, Medicaid’s huge costs must be controlled.
Medicaid in 2009 accounted for an estimated 16 percent of all health-care spending in Alabama. The agency is budgeted to spend $5.98 billion in this fiscal year, about 22 percent of all state, local, and federal dollars appropriated by the Legislature for 2013.
Medicaid is taking growing portions of the state’s General Fund for non-education services, from 25 percent in the 2008 fiscal year to a budgeted 35 percent this year. Many factors driving this growth are beyond our control. For instance, the number of people served by Medicaid grew from about 750,000 people in 2008 to 938,000 last year, probably because of the recession.
But we can take steps to improve care and save money. Alabama’s Medicaid agency now has little managed care, in which a case worker, doctor, or other professional oversees and coordinates the care of a Medicaid patient to find his or her best and most efficient treatment.
Legislation sponsored by state Sen. Greg Reed, R-Jasper, and state Rep. Jim McClendon, R-Springville, would open the door to locally controlled managed care. It would let hospitals, doctors, and other Alabama health providers form groups called regional care organizations that could sign contracts to provide medical care to Medicaid beneficiaries on the state’s behalf in return for negotiated payments per beneficiary.
If a regional care organization could provide care that met Medicaid’s quality standards for less money than it was getting from Medicaid, it would make money. If it couldn’t, it would lose money.
Each organization would have an incentive to oversee and improve patient care to reduce costs: A patient who isn’t readmitted to the hospital because she had regular follow-up checks with her doctor likely is a less-costly patient and a healthier person.
The near-identical Medicaid managed-care bills, Senate Bill 340 by Sen. Reed and House Bill 454 by Rep. McClendon, say that Alabama’s Medicaid agency could sign a contract with a regional care organization only if it judged that care of Medicaid beneficiaries would be better, more efficient, and less costly than existing care.
Medicaid’s actuary estimates that a managed-care system created by either bill would reduce projected Medicaid spending in Alabama by $750 million to $1 billion in total Medicaid spending from fiscal year 2015 - 2019. This would save Alabama taxpayers $250 to $350 million over that time period compared to what would have been necessary if no changes were made.
A 33-member advisory committee formed by Gov. Robert Bentley, which the Governor asked me to chair, recommended in January that Alabama be divided into regions, and that a community-led network coordinate the health care of Medicaid patients in each region, with networks bearing the risks of contracting with Alabama to provide that care.
The legislation sponsored by Sen. Reed and Rep. McClendon and endorsed by the Governor and me would help bring those recommendations to life. The Medicaid agency would have to draw regions by October 1. Regional care organizations would have to be ready to sign contracts no later than October 1, 2016.
Sen. Reed and Rep. McClendon have worked long hours, talking with other lawmakers and with dozens of people representing hospitals, doctors, civic coalitions, and other groups, in an effort to pass a law that would protect Medicaid patients, health-care providers, and Alabama taxpayers. Both SB 340 and HB 454 will do that.
I want to thank them and Governor Bentley for their leadership on this legislation. This legislation is the start of a journey which will result in Medicaid transformation in Alabama.
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Public Health Indicators in Alabama
It is my honor to share with you a brief summary of Alabama’s public health indicators. The Alabama Department of Public Health continues our efforts to reduce chronic disease and improve chronic disease outcomes; however, the need for many improvements remains.
Alabama’s leading causes of death continue to be attributed to preventable chronic diseases. Below you will find information on chronic conditions of particular concern, but for a more detailed summary on these and additional public health indicators, please view Public Health Indicators.
- Cigarette smoking among both adults and youth in Alabama continues to be nearly 5 percent higher than the national average.
- Obesity rates continue to exceed the national average. Thirty-three percent of Alabamian adults are obese, compared to the United States at 27.5 percent.
- Heart disease is the number one killer in Alabama, and kills at a rate higher than the national average (235.5 in Alabama versus 190.9 in the United States per 100,000 population).
- Hypertension must be reduced among Alabamians, as the number of individuals living in Alabama with high blood pressure exceeds the national average by nearly 9 percent.
- Diabetes affects 13.2 percent of Alabamians, compared to the national average at 8.7 percent.
Reducing the burden of chronic disease in our state will improve and save lives. By reducing this burden, we can also ease the financial impact of chronic disease. I recommend all of you address the chronic disease conditions in your home and in your community. For information on how to prevent and treat chronic diseases, please visit our Chronic Disease Website.
Generations to come have the opportunity to live a life less burdened by chronic disease, but the efforts must start with you today!
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Alabama Has Heart: Promote Heart Health
While most Alabamians enjoy access to high-quality health care in some of the best institutions in the world, we as a state must work to lower our risk of preventable diseases. Heart disease is the leading killer of men and women in Alabama and the nation. Diseases of the heart in Alabama resulted in a mortality rate of 247.4 deaths per 100,000 population and almost 37,000 years of potential life lost in 2011.
The Million Hearts national initiative, a public-private partnership, has a goal of preventing 1 million heart attacks and strokes over five years. To assist with this initiative, the American Heart Association has set a challenging goal of improving the cardiovascular health of all Americans by 20 percent while reducing deaths from cardiovascular disease and stroke by 20 percent by the year 2020.
Heart disease is the most common form of cardiovascular disease, and the good news is that coronary artery disease is highly preventable by modifying risk factors, which include:
- High blood pressure
- High blood cholesterol
- Overweight and obesity
- Physical inactivity
- Inadequate fruit and vegetable consumption
To decrease heart disease, we must make responsible and appropriate long-term lifestyle changes and take fundamental steps as individuals.
Tobacco use is a major risk factor for cardiovascular disease. The Alabama Tobacco Quitline offers free assistance for any Alabamian who is ready to quit tobacco use. For more information, visit AlabamaQuitNOW.com or call toll free at 1-800-QUIT-NOW (784-8669).
Two-thirds of Alabamians are overweight or obese, and this risk factor contributes to our high rates of coronary artery disease, Type 2 diabetes, stroke, sleep apnea, osteoarthritis, and the list goes on. Losing weight is an ongoing lifestyle struggle for many of us, but we must form healthier habits to decrease food intake and increase exercise. We must eat a minimum of five servings of fruits and vegetables as a part of our daily diets.
Some risk factors, such as age, sex, and heredity, cannot be changed, so it is even more important for individuals to manage modifiable risk factors. The Cardiovascular Health website contains a wealth of useful information about cardiovascular health. Included are real-life personal stories of heart disease survivors who share their stories of fighting heart disease to help increase awareness. Read their testimonials.
Nurse Cindy Haney of Millbrook tells her moving story of discovering she had heart disease that resulted in stents and bypass surgery while still in her twenties. She is acutely aware that heart disease is no respecter of age or gender.
Retiree Howard Robinson of Tuskegee discusses his 1995 heart attack and its aftermath that resulted in quadruple bypass surgery and stroke, and later a pacemaker and defibrillator. He describes how doctors presented him with his options to live, and he decided to give up his Scotch, cognac, and cigarettes. While it was tough at first, Robinson made the commitment to take care of his health and is enjoying life.
I urge you to take control of your heart health by making healthier choices to live better lives.
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Alabama Child Death Review System: Learning from the Past and Protecting the Future
The death of any child is a tragedy, not only for the child’s family but for all of us. To prevent future cases of unexpected and unexplained child deaths, an act creating the Alabama Child Death Review System, or ACDRS, was signed into law on September 11, 1997. Under this law, local and state teams review child deaths in order to fulfill the mission of the ACDRS which is “To understand how and why children die in Alabama, in order to prevent future child deaths.”
Over time, these reviews have helped identify risks and trends which serve to inform efforts to prevent similar tragedies from happening to other children, families, and communities.
ACDRS has been involved in several prominent statewide prevention efforts in its first 15 years of existence. Child death review findings have influenced the introduction and passage of several child injury and fatality prevention laws over the years. These include the following:
- The Secret Safe Place for Newborns
- Child Passenger Restraint, Booster Seat, and Graduated Driver License laws
- The Sudden Unexplained Infant Death Investigation (SUIDI) law, which passed just last year
ACDRS data published in the first annual report revealed that in 1998 and 1999, approximately 500 infant/child deaths per year met criteria for case review. We are extremely gratified that the latest annual report indicates the number of such deaths has decreased by approximately 40 percent since then.
While the Alabama Department of Public Health has recently concentrated on improving data collection and analysis, it has also participated in multiple outreach, awareness, and education campaigns related to vehicular safety and safe infant sleep. Local teams have also gone beyond the review process alone, implementing local prevention strategies as well as efforts to improve collaboration among the local agencies involved.
Several challenges remain and there is still much work to be done in the following areas.
- Vehicular deaths still account for far more preventable child deaths in Alabama than any other category, and Alabama is cited as having the second-highest teen driver fatality rate in the nation.
- In spite of our progress in that regard, our child passenger restraint and graduated driver’s license laws could still be strengthened to comply with federal guidelines, and all-terrain vehicles remain wholly unregulated in Alabama regardless of the driver’s age.
- Despite the clear evidence and strong recommendations regarding safe infant sleeping environments, infant sleep-related deaths continue to be the second-leading cause of preventable child deaths in Alabama.
- For other categories, particularly fire, poisoning, and drowning deaths, public awareness and understanding of the risks and basic prevention measures remains a challenge.
- Perhaps the most challenging of all, we are still faced with child deaths that are not only preventable but also intentional – cases of child abuse and neglect, homicides, and, sadly, youth suicides.
The ACDRS could not exist or operate without the diligent work of state and local teams which continue to use what we learn to try to protect Alabama’s children from preventable injuries and fatalities. Those involved with ACDRS at every level remain committed to the mission.
For additional information, visit Alabama Child Death Review System.
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Men: Take Preventive Steps to Improve Your Overall Health
June is National Men’s Health Month, and the Alabama Department of Public Health joins with the U.S. Department of Health and Human Services to promote the importance of men making their health a priority in their lives. We want to promote early detection and treatment of disease among men and boys by encouraging them to seek regular medical advice and early treatment for disease and injury.
Men need to focus on putting their health as a priority as we routinely put ourselves at high risk due to our jobs and lifestyle. Of special concern is the physical, mental, and emotional well-being of military service members returning from war zones and veterans. Their needs and the needs of their families must be addressed. Some common reasons why men are at an increased risk for poor health are as follows:
- A higher percentage of men have no health care coverage.
- Men make half as many physician visits for prevention, compared to women.
- Many men are employed in dangerous occupations, such as firemen, policemen, military personnel, construction workers, aircraft pilots and flight engineers, mining, iron and steel workers, and farmers and ranchers.
- Men are less likely to have healthy lifestyles and are more likely to engage in risky behaviors at younger ages.
The top ten causes of death for men in Alabama are as follows:
1. Heart Disease
4. Chronic Lower Respiratory Disease
5. Cerebrovascular Disease (Stroke)
9. Influenza and Pneumonia
10. Alzheimer’s Disease
Men are often the family bread winners, and as a result, forget to make their own health a priority. Risks to the health and well-being of the nation’s men (and our families) are on the rise, due to a lack of education, awareness, and pursuit of preventive screening and care.
We encourage all men to step up to the challenge and be positive role models in their own families and communities by setting the example of eating right, exercising regularly, and routinely getting medical checkups. Our families and friends rely on us to be there and to provide for them, but if we do not take the steps now to ensure that we live a long and healthy life, who will be there to care for our loved ones when we are gone?
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Embrace Preventive Measures To Limit Disease and Prevent Early Death
Each year, chronic diseases such as heart disease, cancer, and diabetes are responsible for millions of premature deaths and cause Americans to miss 2.5 billion days of work, resulting in lost productivity totaling more than $1 trillion.1 The theme of National Public Health Week 2012 is "A Healthier America Begins Today: Join the Movement." National Public Health Week 2012 is April 2-8.
We are met with a growing public health problem. If we fail to embrace preventive measures to limit disease and early death, the toll, measured in lives lost and health care dollars spent, is only going to get worse in the years to come.
The focus of National Public Health Week is improved awareness of the need for preventive measures to ensure longer and healthier lives. We know that many illnesses and deaths can be prevented. If Americans did simple things—exercised more frequently, had healthier diets, avoided alcohol, tobacco, and other drugs, practiced proper hand-washing and food preparation, practiced safe sex, and provided proper treatment to those suffering from mental illnesses—we could dramatically reduce the burden of disease and death moving forward, helping to save lives.
For example, reducing foodborne illness by just 10 percent would keep about 5 million Americans from getting sick each year.2 Cigarette smoking, which is the most common form of tobacco use, causes approximately 443,000 deaths and costs about $96 billion in medical expenditures and $97 billion in productivity losses in the United States annually.3
Mental and emotional well-being can help limit the amount of suffering and financial burden on our society. Everyone has a role to play, and each action, no matter how small, can make a big difference in creating a healthier community. Some examples of successful efforts in Alabama include:
- Communities creating new walking paths.
- Communities enhancing farmers markets by leading efforts to establish regular hours of operation, thus providing more access to locally grown fruits and vegetables.
- Communities establishing tobacco-free zones in parks and other recreation areas.
- Worksites establishing teams of employees and forming wellness committees to create healthier workplaces.
- Schools revamping physical education testing procedures to improve student health.
Of course, we can’t make significant improvements unless all of us play a part in creating a healthier nation. That means everyone needs to take small steps to improve the well-being and health of their own communities.
It is time we shift our paradigm from being a nation that cares for the sick to one that encourages preventive measures to improve our nation’s health.
1 Kessler RC, Greenberg PE, Mickelson KD, Meneades LM, Wang PS. The effects of chronic medical conditions on work loss and work cutback. J Occup Environ Med. 2001;43: 218–225.; DeVol R, Bedroussian A, Charuworn A, Chatterjee A, Kim I, Kim S,Klowden K. An Unhealthy America: The Economic Burden of Chronic Disease. Santa Monica, Calif.: Milken Institute. 2007.
2 Morris JG Jr. How safe is our food? Center for Disease Control and Prevention. Emergency Infectious Disease. 2011.
3 Adhikari B, Kahende J, Malarcher A, Pechacek T, Tong V.
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"Stop TB In My Lifetime" is the Theme for World TB Day 2012
Each year, the Centers for Disease Control and Prevention (CDC) observes World TB Day on March 24. On that day in 1882, Robert Koch identified the germ that causes TB, making possible all of the advances used today to control this infectious disease.
The theme for World TB Day this year is “Stop TB In My Lifetime.” I would like to use this occasion to recognize and commend the physicians, nurses, and outreach workers who are actively pursuing this goal in Alabama. Through their efforts, the citizens of our state have witnessed an historic reduction in TB, as evidenced in the table below.
The decline in cases noted above was achieved by the following: (1) identifying and treating persons with active TB disease, and (2) identifying contacts to those with active disease and offering them preventive treatment. Nurses and outreach workers across the state monitor and document treatment for cases and contacts, thus assuring compliance with treatment and reducing the risk for acquired drug resistance.
At the close of 2011, a total of 161 cases of active TB disease were confirmed and reported in our state. While furthering the decline is good, we must remain vigilant as nearly two-thirds of the counties in Alabama reported at least one case of TB in 2011—our work is not complete until each and every case of active tuberculosis is found, treated, and cured.
Your individual and community support for public health has made a difference. Armed with good science, supported by physicians, nurses, and outreach workers, we can continue to make a difference.
If you would like to learn more about tuberculosis, and our decades-long battle to protect public health, please contact Pam Barrett, Director of the Division of TB Control for the Alabama Department of Public Health. Ms. Barrett may be reached at (334) 206-5330.
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Heart Disease Remains Alabama's Leading Killer of Women
Heart disease is still the No. 1 killer of women age 20 and older, causing 1 in 3 deaths each year. Cindy Haney of Millbrook could have been one of them. A 31-year-old registered nurse, Ms. Haney recently shared her story of fighting heart disease in order to make others, especially young adults and women, aware that coronary artery disease is not a respecter of age or gender and is the leading killer of men and women. Fortunately, Ms. Haney was able to receive needed care, has educated herself, and has modified her lifestyle to live with heart disease. Read her testimonial.
According to the American Heart Association:
- 90 percent of women have one or more risk factors for developing heart disease.
- 80 percent of cardiac events in women may be prevented if they make heart healthy choices.
- Only about 50 percent of women are aware of the signs and symptoms of a heart attack.
- Only slightly more than half of women are likely to call 911 if experiencing symptoms. And yet, 79 percent of women said that they would call 911 if someone else were having a heart attack.
Even though heart disease is still commonly believed to be a man’s disease, nearly half of deaths in American women each year are caused by a heart attack or stroke. In Alabama, cardiovascular diseases cause more deaths in women than cancer, chronic lower respiratory diseases, Alzheimer’s disease, and accidents combined.
Sixty-four percent of women who die suddenly from coronary heart disease have no previous symptoms. Most people are familiar with the symptoms of a heart attack in men, but the symptoms of a heart attack that are seen more often in women include the following:
- Dizziness, nausea, or vomiting
- Indigestion or gas-like pain
- Unexplained weakness, fatigue
- Discomfort or pain between the shoulder blades
- Recurring chest discomfort
- Sense of impending doom
- Extreme fatigue
- Sleep disturbances
(American Academy of Family Physicians, 2006)
It is important to learn the warning signs of heart disease and not to ignore them. Everyone should call 9-1-1 if experiencing symptoms.
To become heart healthier, women need to make personal lifestyle changes. These include becoming active, eating a healthier diet, losing weight, stopping smoking, controlling cholesterol, managing blood pressure, and reducing blood sugar. Lifestyle change is a journey, not a destination. After assessing your health, incrementally change your behavior to make better choices.
Making small changes helps to ensure you will sustain them, and over time small successes will add up to better health. For example, you may choose to eat a greater variety of colorful fruits and vegetables, drink more water and fewer sweetened drinks, and engage in regular physical activity. Physical activity can improve your mood, reduce your blood pressure, and strengthen your cardiovascular system.
Tobacco smoking is a major risk factor for cardiovascular disease. Quitting smoking is one of the best behavior modifications women can make to improve their health. Quitting tobacco is a personal decision you must make. The Alabama Tobacco Quitline offers telephone and online counseling services for any Alabamian who is ready to quit tobacco. If you are ready to quit, visit AlabamaQuitNow.com or call toll-free at 1-800-QUIT-NOW (784-8669).
For additional information on ways to make lifestyle changes that can reduce your risk of heart disease and stroke, visit our Cardiovascular Health Program.
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Test for Radon in the Winter to Protect Your Health
Do you know that radon is the second leading cause of lung cancer in the U.S. after smoking, and it’s the leading cause of lung cancer in nonsmokers? The Environmental Protection Agency estimates that radon causes 21,000 lung cancer deaths per year. If you smoke and your home contains radon, your lung cancer risk is especially high.
You can’t see, smell, or taste radon, but there is an easy and affordable way to test for radon in your home. The best time to test for radon gas is in the colder winter months when your home is closed and radon levels are likely to build to their highest concentrations.
High levels of indoor radon have been found in many areas of Alabama; however, radon appears to occur most frequently in homes across the Tennessee Valley and in the foothills of the Appalachian Mountains from Jefferson and Shelby counties to Cleburne County. Because radon is a colorless, odorless gas that occurs naturally in soil and rocks through the breakdown of uranium, testing is the only way to know the radon level in a home.
Radon test kits weigh only a few ounces and typically cost about $15. Kits are available at many larger home improvement stores. As a public service, many local offices of the Alabama Cooperative Extension System also sell homeowners a kit to test their own homes at a wholesale price of $5.
Most people can easily complete the radon test on their homes themselves by following simple directions on the kit. It takes only a few days to obtain a sample. If test results are above the U.S. Environmental Protection Agency’s national action level of 4.0 picoCuries of radon per liter of air, the Alabama Department of Public Health recommends homeowners install a radon remediation system.
The average cost of a radon remediation system is between $800 and $1,200, depending on the square footage of the residence and the difficulty in finding a suitable pathway for a radon removal pipe. The price may be more for some homes.
Helpful information is available by reading “A Citizen’s Guide to Radon: The Guide to Protecting Yourself and Your Family from Radon” on the EPA Web site at www.epa.gov, and radiation and health information is available at Radiation Control.
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Use Extra Caution in Cold Weather
As we enter the winter season, Alabamians need to be alert to the serious health problems associated with cold weather. When exposed to cold temperatures, our bodies begin to lose heat faster than it can be produced. This results in abnormally low body temperature, called hypothermia. Body temperature that is too low makes someone unable to think clearly or move well.
Every year an estimated 600 deaths in the United States are caused by hypothermia. In Alabama, an average of 11 residents died each year of the past decade as a result of hypothermia.1 Despite Alabama’s usual extremely hot temperatures and high humidity in summer, more deaths are associated with cold than heat in this state.
Authorities report hypothermia can occur at outside temperatures as high as 58 degrees F. Body temperature falls even faster if there is a wind chill or if a person’s clothing is wet. The signs and symptoms of hypothermia include the following:
- Impaired judgment
- Impaired vision
A special risk to older persons: Most hypothermia victims are older adults. As the body ages, its ability to maintain a constant internal temperature decreases. Hypothermia risk is even greater when an older person has a chronic condition that affects the circulatory or neurologic systems, or the thyroid. When the core temperature falls, bodily functions shut down.
To provide protection, older adults’ living quarters should be heated to at least 65 degrees F, they should wear suitable clothing, have plenty of warm blankets available, and eat nutritionally balanced food.
Please check on your elderly neighbors, friends, and relatives to make sure they are keeping warm and discourage them from going outside if it is cold, especially if it is windy or wet.
Others at risk: In addition to advanced age, common risk factors for hypothermia are substance abuse and mental impairment. Certain commonly used drugs such as tranquilizers may contribute to the onset of hypothermia. Furthermore, many deaths from hypothermia are complicated by alcohol consumption, which can lead to dehydration and impaired judgment.
Everyone should remember that extra precautions are needed, and it is important to follow these recommendations:
- Dress in multiple layers to help retain body heat.
- Limit your time outdoors, and remove wet clothing immediately.
- Watch for signs of hypothermia in babies, people drinking alcohol, and others.
- Call for emergency help immediately if you suspect someone has hypothermia, and keep the victim warm until assistance arrives.
Knowing what to do in cold weather can help prevent hypothermia.
1 Center for Health Statistics, Alabama Department of Public Health
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Labels Help Convey the Message: Quit Smoking
"Over the top, gruesome, startling” are adjectives some observers have used to describe the nine graphic health warnings set to appear on all cigarette packaging and advertisements starting in September 2012. These prominent warnings, mandated by the U.S. Food and Drug Administration, are intended to serve as a reminder of the negative health consequences of smoking every time someone picks up a pack of cigarettes or views a cigarette ad. Warnings depict a smoker with a tracheotomy, a sewn-up corpse of a smoker, ravaged teeth and gums, diseased lungs, a mother and baby with smoke swirling by, and other images to illustrate the health risks of tobacco use.
These warning labels offer a remedy; they carry a toll-free number to direct smokers to the help they need to quit. The number for the Alabama Tobacco Quitline will be printed on every cigarette pack along with the warning labels.
The toll-free tobacco cessation number is1-800-Quit-Now (or 1-800-784-8669). Tobacco users can get free counseling and support materials. In addition, up to four weeks of free nicotine replacement therapy patches are available to persons who are medically eligible and participating in Quitline counseling. Health care providers may also use the fax referral system to refer a patient to the Quitline. Counselors are there to help Monday through Friday from 8 a.m. to 8 p.m. and on Saturday from 9 a.m. to 5:30 p.m.
For those who prefer the computer, we offer the same services via www.alabamaquitnow.com. Since the site launched in June 2010, more than 1,600 Alabamians have registered for the service. Log on to get information about smoking or to register for the quitting process. Tobacco users are helping each other every day to successfully quit.
Quitting smoking is one of the most important things you can do for your health and the health of your family. Tobacco use is the single most preventable cause of death and disease in the United States. Smoking kills more people than alcohol, AIDS, car accidents, illegal drugs, murders, and suicides combined. More than one in five adult Alabamians smoke, ranking our state in the top 10 in the nation in tobacco use.
Not only does tobacco use cause death and disease, but it is costly in dollars, too. Alabama spends $1.49 billion in smoking-caused health costs and loses $2.24 billion in productivity due to tobacco use. Each year, 7,500 smokers in Alabama die and another 820 nonsmokers die from exposure to secondhand smoke.
Nicotine found in tobacco products is addictive, making quitting difficult. Yet more than half of the individuals who smoke say they want to quit.
We know it’s hard to quit using tobacco. We know it’s a personal decision that only you can make. When you are ready to quit, call the Quitline at 1-800-Quit Now or visit the website at www.alabamaquitnow.com. Protect your health and the health of others around you.
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Protect Yourself from Skin Cancer
It should be no surprise to anyone that sun exposure significantly increases the risk of skin cancer, the most common cancer diagnosed in the United States. Becky Carlee of Chelsea, Alabama, decided to have a doctor check out some spots on her arm and back that she had been noticing for about six months.
When she was enjoying a weekend getaway with her husband, her physician called to tell her she had Stage 1 melanoma. While the news was shocking to the 37-year-old avid "sun worshipper," she was relieved to know the cancer had not spread. But she still needed two surgeries to remove the tumors. Mrs. Carlee now respects the sun and the damage it can do, so she wears sunscreen every day.
Hers is not an isolated case. An estimated 930 state residents were diagnosed with melanoma in 2009. Melanoma is responsible for 75 percent of all skin cancer deaths, even though melanoma is the third most common form of skin cancer after basal cell and squamous cell carcinomas. About 65 to 90 percent of melanomas are caused by exposure to ultraviolet light. Unprotected exposure to ultraviolet light, a known human carcinogen, is the most preventable risk factor for skin cancer.
The rate of new melanoma cases among white residents of Alabama and the melanoma death rate in the state is higher than the national average. About 140 state residents die of melanoma every year. The death rate for melanoma is rising faster than that of any other cancer type among men over the age of 50 in Alabama. People with light skin, light-colored hair, and blue or green eyes may be more predisposed to skin cancer; but anyone, regardless of race or ethnicity, is susceptible to it.
The U.S. Centers for Disease Control and Prevention makes these recommendations for sun protection:
- Use sunscreen with sun protective factor (SPF) 15 or higher and both UVA and UVB protection.
- UVA protection prevents the damage associated with Aging; UVB protection prevents the damage associated with burning.
- Wear clothing to protect exposed skin. Wear a hat with a wide brim to shade the face, head, ears, and neck.
- Wear sunglasses that wrap around and block as close to 100 percent of both UVA and UVB rays as possible.
- Seek shade, especially during midday hours between 10 a.m. and 4 p.m.
Parents should take particular care to prevent damaging sunburns in their children. The American Academy of Pediatrics recommends that children under 6 months of age never be in direct sunlight and children 6 months or older should always wear sunscreen to lower their risks.
To educate Alabamians about the need to protect themselves from the harmful effects of overexposure to the sun, the Division of Cancer Prevention and Control promotes its slogan, "Red Is Not Your Color: Put On Your Sunscreen," at sports venues throughout the state. Protection from the sun is important not only at the beach or pool, but when playing tennis, golfing, fishing, and at spectator events like football and baseball games.
Becky Carlee is thankful to have a second chance and freely shares her message that damage done today puts your future, and possibly your life, at risk: "Wear sunscreen every day and regularly check for any changes in your skin."
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Making a Difference in the Aftermath of Powerful Tornadoes
In the past few weeks I have had the opportunity to visit numerous areas of the state which were struck by tornadoes, and I have seen firsthand devastation more immense than I have seen ever before. The magnitude and scope is incredible—two-thirds of our counties were declared federal disaster areas and approximately 250 people were killed.
I want to express my sympathy to the many people who suffered the loss of family members and friends, to those who were injured, and to others who lost their homes, schools and businesses as a result of these powerful tornadoes.
Also, I appreciate those who have gone to the aid of their neighbors. Over the past few weeks many of you have been directly or indirectly involved in tornado response activities, and your contributions have been invaluable. Donations of all kinds have been sent to the impacted areas, but there are still significant needs. Many Alabamians are struggling with the aftermath of the storms and will continue to do so in the weeks, months, and years to come.
On this website we offer recommendations about safety issues with regard to chain saw use, poisonous snakes and other wildlife, food safety, heat-related problems, and environmental hazards associated with debris removal. I urge each of you working with any type of cleanup activity to please be cautious and keep safety in mind.
Through the recovery process, we will build stronger communities.
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Silence the Sounds of Pertussis: Immunize to Help Vanquish Vaccine-Preventable Diseases
In 2011 children still suffer long-term complications and even death from pertussis, also known as whooping cough. According to the Centers for Disease Control and Prevention, pertussis causes 10 to 20 deaths each year in the U.S. Pertussis is currently circulating in Alabama, and immunization is the best protection.
This highly contagious bacterial infection can strike at any age, but pertussis is particularly dangerous for babies who are too young to be fully vaccinated. Its common name comes from the classic "whoop" sound made when kids gasp for breath after a severe coughing attack.
Vaccines offer the best-known protection against pertussis and many other infectious illnesses. Since the start of widespread vaccinations in the United States, cases of once common childhood illnesses such as measles and diphtheria have declined dramatically.
Measles is one of the most infectious diseases in the world, and Alabama has enjoyed a marked improvement in its incidence. In 1971, for example, 2,000 cases of measles and two deaths were recorded in Alabama. The state has seen no indigenous measles cases since 2002. Smallpox has been eliminated worldwide, and cases of other communicable diseases such as polio, diphtheria, and Hib (Haemophilus influenzae type b) are at all-time lows. The incidence of varicella (chicken pox) has decreased markedly since a vaccine became available, but it is also now circulating in Alabama.
April is an excellent time of year for parents to prepare their children and adolescents for the upcoming school year by making sure their immunizations are current. Properly timed immunizations provide protection both for your children and for others who come into contact with unvaccinated individuals.
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A relatively new immunization requirement is that adolescents receive a tetanus-diphtheria-acellular pertussis (Tdap) vaccine. To help provide protection, all students 11 years of age and older entering the sixth and seventh grades in Alabama schools in the fall of 2011 must have been vaccinated with Tdap prior to entering school.
Other vaccines recommended but not required at this age are meningococcal, varicella, hepatitis A, and hepatitis B. HPV vaccine is also recommended for females ages 9 to 26.
Our youngest children must also be protected. April 23-30 is National Infant Immunization Week, an annual observance to promote the benefits of immunization and to focus on the importance of immunizing infants against vaccine-preventable diseases by age two.
Many vaccinations for children in Alabama are administered by private providers through the Vaccines for Children (VFC) program, a federal entitlement program that provides vaccine at no cost to children under 19 years of age who meet eligibility requirements. Approximately 550 public and private providers are currently enrolled in the program. Immunizations also are available at county health departments.
Adults also need immunizations for influenza, tetanus, varicella, shingles, measles, mumps, and rubella. If other risk factors are present, immunizations are needed for pneumococcal pneumonia, meningococcal meningitis, hepatitis A, and hepatitis B. HPV vaccination is also recommended for females aged 9 to 26. View the 2011 adult immunization schedule.
Alabama has been a recognized leader in immunization. America’s Health Rankings listed high immunization coverage in Alabama as a strength in its 2010 rankings. Maintaining high immunization rates protects our state by interrupting the transmission of disease-causing bacteria or viruses. Protecting the majority of the population with safe, effective vaccines also protects those who cannot be immunized for medical reasons.
Immunizations have protected millions of people from potentially deadly diseases and saved thousands of lives. By following immunization guidelines, you can help make your child healthier than was possible in earlier generations.
The goal of our Immunization Division is to stop the spread of vaccine-preventable diseases by providing vaccine to the citizens of Alabama; educating medical personnel and the public on the importance of vaccinations; investigating vaccine-preventable disease outbreaks; and ensuring children in day care, Head Start, and schools are adequately immunized against diseases that are harmful and sometimes deadly.
For additional information on protection from vaccine-preventable diseases, visit Immunization on this site.
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