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Archived Messages

Messages from State Health Officer Dr. Thomas M. Miller

Prediabetes—Take the Test to Assess Your Risk

While many people are familiar with type 2 diabetes, fewer are aware of prediabetes, a serious health condition that affects 86 million Americans (more than 1 in 3) and often leads to type 2 diabetes. People with prediabetes have higher than normal blood glucose (sugar) levels, but levels that are not high enough yet to be diagnosed with type 2 diabetes.

Nearly 90 percent of people with prediabetes do not know they have it and are unaware of the long-term risks to their health, including type 2 diabetes, heart attack, and stroke. Current trends suggest that, if left untreated, 15 to 30 percent of people with prediabetes will develop type 2 diabetes within five years. This is especially troubling in Alabama, because diabetes was the seventh leading cause of death in the state in 2014, and the Alabama ranks among the five states with the highest prevalence of diabetes in the nation.

The good news is that prediabetes often can be reversed through weight loss, diet changes, and increased physical activity. Diagnosis is key: research shows that once people are aware of their condition, they are much more likely to make the necessary lifestyle changes.

A new national advertising campaign encourages people to take a short online test to learn their risk. The Alabama Department of Public Health joins with partners in the American Diabetes Association, the American Medical Association, the Centers for Disease Control and Prevention, and the Ad Council to encourage everyone to take the one-minute test at DoIHavePrediabetes.org to learn their risk. People can also take the risk test in real-time through interactive television and radio public service announcements to learn more about the risk factors associated with prediabetes.

People who learn they are at risk should talk with their healthcare provider about further testing to confirm their diagnosis to reduce their risk for developing type 2 diabetes. Both diabetes and prediabetes can be diagnosed with a simple blood test. If an individual has prediabetes, he or she should be checked for type 2 diabetes after six months to one year and be retested annually. Effective screening and treatment can help prevent or delay the progression to full-blown diabetes. Prediabetes needs to be taken seriously, and awareness is crucial.

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

(November 2016)


Follow Safe Sleep Practices to Protect Infants from Sudden Death

Every year in the United States, more than 3,500 otherwise healthy babies die suddenly and unexpectedly. Of these deaths, more than 2,300 are diagnosed as Sudden Infant Death Syndrome (SIDS), the leading cause of death for babies 1 month to 1 year of age. According to statistics from the Centers for Disease Control and Prevention, as many as 80 to 90 percent of infant deaths are caused by unsafe sleep practices.

SIDS is a medical disorder that claims the lives of infants younger than 1 year of age in the U.S. Once known as crib death, these infant deaths remain unexplained after all known causes have been ruled out through autopsy, death scene investigation, and medical review. SIDS affects families of all races, religions, and income levels. It occurs during sleep, and strikes without warning. Its victims appear to be healthy.

Sudden Unexpected Infant Death (SUID) is the sudden and unexpected death of an infant younger than 1 year of age. After a full investigation, however, the death may be diagnosed as having a contributing factor or underlying cause such as entrapment, accidental suffocation, cardiac arrhythmia, or a metabolic disease.

Unsafe Sleep is the category of infant death that occurs because of these causes:

  • Co-sleeping in a bed with others or from overlay
  • Suffocation from being placed to sleep on a pillow, soft bedding, or some type of unapproved device to elevate or position the infant
  • Strangulation from entrapment or wedging

Alabama Statistics

  • In 2014, there were 109 sleep-related deaths among infants less than 1 year of age.
     - Sleep-related infant deaths accounted for 21 percent of the total infant mortality rate.
     - The percentages of sleep-related infant deaths were higher among full-term, normal birth weight infants than infants with lower birth weights and gestational ages.
  • For the years from 2011 through 2014 
     - Infant sleep-related deaths were highest in the 1-month to 3-month age group, and bed sharing was the principal risk factor. 
     - For older infants, rolling into objects in the sleep area was the main risk factor.
     - The rate of sleep-related infant deaths for mothers 15 to 19 years of age was almost twice as high as the rate for moms ages 25 to 34.
     - Mothers with birth intervals less than two years apart had the highest percentage of sleep-related infant deaths.

We do not know exactly how or why SIDS happens, and there is no product that can prevent it. However, researchers have identified factors associated with reducing the risk of SIDS and recommend the following:

  • Place baby on his or her back to sleep at night and for naps.
  • Use a firm mattress, covered with only a sheet, in a safety approved crib.
  • Remove all soft and loose bedding from the baby's sleep area. This includes pillows, blankets, comforters, bumper pads, sheepskins, positioners, toys, and all other soft products.
  • Consider using a wearable blanket, or other type of sleeper, as a safe alternative to loose blankets.
  • Do not place the baby to sleep on a sofa, waterbed, pillow, soft mattress, or any other soft surface.
  • Keep the baby's face clear of coverings.
  • Be careful not to overheat the baby with excessive clothing, bedding, or elevated room temperature.
  • Do not allow anyone to smoke around the baby.
  • Educate babysitters, day care providers, grandparents, and everyone who cares for the baby about reducing the risk of infant death.

We urge parents and caregivers to learn about the risk factors that lead to the sudden deaths of infants, and act to help prevent needless loss of life.

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

(October 2016)

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Know the Importance of Newborn Screening

September is Newborn Screening Awareness Month, a time to celebrate newborn screening and the many lives that it has improved, or even saved. In Alabama, newborn screening has been a part of the Alabama Department of Public Health for more than 50 years. It began in 1965 with a single test for phenylketonuria (PKU) and expanded, so that today we screen for 30 primary conditions that can cause disability and death without appropriate, early treatment.

The majority of conditions are identified through the blood spot screen, where a sample of blood is taken at 24–48 hours of age by sticking an infant’s heel and applying several drops on a specialized filter paper for testing at the Bureau of Clinical Laboratories (BCL); however, the hearing screen and the pulse oximetry screen are performed at the hospital prior to discharge. The hearing screen is a simple, non-invasive procedure which detects potential hearing loss, and the non-invasive pulse oximetry screen is performed by checking oxygen levels in the hand and the foot in order to identify potential critical congenital heart defects.

By the end of 2016, the BCL anticipates being able to screen for Severe Combined Immunodeficiency Disease (SCID), a condition which affects the immune system, leaving affected infants vulnerable to fatal infections in the first year of life if they do not receive appropriate treatment.

Through partnerships with pediatric specialists throughout Alabama, we ensure that infants with positive screens for a condition receive appropriate diagnostic testing and follow-up care in a timely manner. These partnerships allow for rapid identification and treatment of an affected infant, which minimizes and/or prevents life- altering complications.

For more information on the Newborn Screening Program, please visit our website at adph.org/newbornscreening or call (866) 928-6755.

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

(September 2016)

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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

(August 2016)

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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

(July 2016)

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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

(June 2016)

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