Five AZ Measles Cases from a Disneyland Exposure

January 23rd, 2015 by Will Humble No comments »

MeaslesBy now you’ve probably heard about the measles outbreak associated with travel to Disneyland.  CDC is reporting about 50 measles cases (in multiple states) who had been to Disneyland in late December.  Arizona joined the list this week.

This week we had 5 measles cases associated with the Disneyland outbreak, one in Maricopa County and 4 in Pinal County.  The Pinal County cases (confirmed today) were members of the same unvaccinated family.  Today’s confirmed cases greatly increase the chances that we will continue to have additional cases in coming days and weeks.

We’re following our standard protocols for measles investigation to make sure we reduce the chance of disease spread and rapidly identify new cases.  Epidemiology and nursing staff here and at county health departments are making sure healthcare providers are on the lookout for measles cases and rapidly report any suspect cases to public health for follow up and testing.

Anyone who may have been in contact with a measles case will be contacted to determine whether they have immunity or if they need to be on the watch for symptoms.  And of course, we’ll continue to remind folks to get vaccinated so they can protect themselves and their community from future outbreaks.

The US has had more measles cases last year (over 644) than in any other year since 2000, a year when measles had been eliminated.  There’s one basic reason for the increase in cases: a decrease in the percentage of kids that are vaccinated in the US, Europe and other parts of the world.

Measles is very contagious…90% of non-immune people in close contact with a measles case will get sick.  Because other parts of the world haven’t eradicated measles, international travelers from Europe, Africa, and Asia can bring measles into the US (or US travelers can contract the disease abroad), and spread it to people here who aren’t vaccinated.  By our most recent count, 94% of Arizona kindergarteners are completely vaccinated against measles, so the threat of an outbreak looms large for pockets of Arizona where people are unvaccinated.

Further complicating the issue are people right on the cusp of measles immunity.  About 95%-98% of people born before 1957 are considered immune to measles because the disease was so widely circulating during their childhood (they almost surely had measles as a kid)…but the vaccine wasn’t licensed until 1963. Adults born on or after 1957 should talk to their provider about getting vaccinated.

 

Alcohol Treatment & Interventions in Arizona

January 23rd, 2015 by Will Humble No comments »

WSubstance abuse causes a host of bad public health outcomes including unintentional injuries, accidents, risk of domestic violence, medical problems, and even death…and alcohol abuse is at the top of the list.  Drinking too much increases your chances of being injured or even killed.  Alcohol is a factor in about 60% of homicides, 50% of severe trauma injuries, and 40% of car crashes and suicides.  Clearly, alcohol abuse prevention is key to improving public health outcomes in Arizona.

Last year alcohol remained the most common substance used by those in treatment for substance abuse in Arizona.  Thirty-one percent (31%) of folks that receive substance abuse services through our behavioral health programs sought help for alcohol dependence or abuse.

For most people, a combination of medication and behavioral therapy is most successful.  Medication Assisted Treatment is an approach that includes drug intervention as part of a comprehensive substance abuse treatment plan.  Additional behavioral therapies include peer and family support groups, outpatient counseling, or residential treatment.

Arizona’s substance abuse treatment services are funded through a variety of sources including private insurance, Medicaid, grants as well as state dollars.  ADHS spent about $128M in service funding for substance abuse treatment and prevention last year via Medicaid and a number of federal grants including the Substance Abuse Prevention and Treatment Block grant, Projects for Assistance in Transition from Homelessness grant, Screening, Brief, Intervention, and Referral to Treatment (SBIRT) grant, and the State Youth Treatment Grant, Prevention Framework Partnership for Success grant.

Our 2015 substance abuse prevention and treatment program goals include: 1) Using SBIRT in emergency rooms and with primary care physicians in Northern Arizona; 2) Increasing the use of evidenced-based practices in substance abuse prevention and treatment; 3) Improving the network of substance abuse prevention services providers; 4) Continuing to expand the availability and use of medically-assisted treatment options using federal grant funds; 5) Implementing interventions in the Arizona Prescription Drug Misuse and Abuse Initiative; and 6) Continuing to integrate peer and family support services and self-help participation.

In 2015 we’ll also be implementing a statewide media campaign targeted at reducing underage drinking.  The campaign will be designed to increase awareness around the dangers of alcohol use as well as to provide statistics and relevant laws.

Alcohol Poisoning in Arizona

January 22nd, 2015 by Will Humble No comments »

alcoholpoisoningExcessive alcohol use is the 4th leading preventable cause of death in the US.  In fact, excessive drinking causes about 10% of deaths among 20–64 year olds…with binge drinking responsible for about half of that 10%.  Nationally, alcohol is a factor in about 60% of homicides, 50% of severe trauma injuries, and 40% of car crashes and suicides.  Yet, about 13% of Arizonans (780,000 adults) said that they binge drink in our 2013 survey.  Interestingly, only about 10% of binge drinkers are alcohol dependent.

A report published by the CDC this month found that there were 2,221 alcohol poisoning deaths in the US in 2012.  Keep in mind that alcohol poisoning deaths are just a small subset of alcohol attributable deaths.  Most of the deaths (1,681 or 76%) were among 35–64 year olds (mostly men).  The highest death rate from alcohol poisoning was among men aged 45–54 years old.  Surprisingly (at least for me), only 2% were under 21.

Recently we took a deeper dive into the Arizona data.  We found that about 2.5% of all emergency room visits and 4.5% of inpatient hospitalizations (4,500/100,000) were related to excess alcohol use in 2013.  Emergency department visits, hospitalizations and deaths were most common in the 45-54 male age group.  Interestingly, we found that unmarried men 45-54 years old were at the highest risk for all categories.  In fact, unmarried men represented more than 30,000 of the approximately 40,000 emergency department visits for causes related to alcohol in 2013.

Being married decreased the odds of an ER visit for alcohol by 40% after adjusting for age, gender, race and ethnicity, and insurance status (as a proxy for income).  Odds for an alcohol related ER visit was highest among American Indian population (7 times) compared to other race and ethnicities.

Tribal Legislative Day to Focus on Suicide Prevention

January 21st, 2015 by Will Humble No comments »

navajonationSince 1995, the Arizona Commission of Indian Affairs, in cooperation with representatives from the state’s Indian nations, hosts an Indian Nations and Tribes Legislative Day. This year’s event will focus on the health and wellness of native youth and will take place Tuesday, January 20th on the Capitol lawn in Phoenix.

This year’s program will include a panel discussion on suicide prevention among American Indian teens.  The conversation is being organized by ADHS and will include panelists from the Substance Abuse Mental Health Services Administration, the Northern Arizona Regional Behavioral Health Authority, the Suicide Prevention Resource Center and more.

We’ll be encouraging attendees to discuss the impact of suicide on their reservations and dialog about culturally competent solutions.  For more information visit: http://azcia.gov/intld.asp.

Intervention Snapshot: SBIRT

January 20th, 2015 by Will Humble No comments »

SONY DSCThrough our Screening, Brief Intervention and Referral to Treatment (SBIRT) grant, folks are given a brief assessment which inquires as to individual’s substance use in primary care and emergency room settings.  People who screen positive (or who are self-referred) are able to access an array of treatment services.  In general, services can be grouped into seven categories: Crisis, Support, Inpatient, Outpatient, Medical/Pharmacy, Residential and Rehabilitation.

Outcomes have shown a reduction in alcohol use, improvement in quality-of-life measures (like employment), housing stability, lower arrest rates, and a reduction in risky behaviors, including fewer unprotected sexual encounters.

Influenza Now Widespread in Arizona

January 20th, 2015 by Will Humble No comments »

influenzaBy now, it’s likely you know someone who’s gotten the flu this year.  Last week, Arizona joined the ranks of 46 other states that are having “widespread” influenza activity.  We’ve had 2,316 cases reported so far this season, with 761 of those being reported in the last week. That’s 130% more cases than this time last year.  With H3N2 the predominant strain (a particularly dangerous one), this flu season could be a hard one…especially given that the H3N2 component in this year’s flu vaccine isn’t perfectly matched with the strain in the community.  Flu vaccines, even if imperfectly matched, are still the best protection against influenza.

Arizona has some pretty big events (like the Super Bowl) coming up, and thousands of visitors will be arriving from places where flu has been widespread for weeks.  There’s still time to get vaccinated before the influx of visitors (the flu shot takes two weeks to provide protection).  But as always, remember to wash your hands often, cover your mouth and nose when you cough and sneeze, and stay home when you’re sick.  If you’re feeling sick, call your doctor instead of heading straight to the ER – many of our emergency departments are experiencing long wait times.

Respiratory syncytial virus (RSV) is also active right now.  So far, Arizona has had 819 cases reported this season, a 208% increase from this time last year.  Like every year, most of our cases are in kids under the age of 5, so it’s really important to keep your little ones healthy by washing their hands often, keeping them away from other sick kids, and keeping them at home when they’re sick.

Medical Marijuana Sales Tripled in 2014

January 16th, 2015 by Will Humble No comments »

DWe published our end-of-year annual medical marijuana report this week.  Dispensary marijuana sales were three times higher than in 2013.  Dispensaries sold over 9 metric tons (about 10 US tons) of marijuana in 2014 for an estimated gross revenue of about $110M.  There were 1,433,808 individual sales in ‘14 (among the 55,000 patients), with an average of 26 transactions/patient/year.  The average patient bought 166 grams of marijuana in 2014.  At 2 joints/gram, that’s an average of 1 joint per patient per day last year.

Transaction data is broken down by age group in the report.  Patients in the 18-30 age range had more transactions and sales than any other age group, representing 26% of total sales.  Fridays are the busiest day of the week at dispensaries, and New Year’s Eve was the busiest sales day in 2014.

The large increase in sales at dispensaries is probably because fewer patients were authorized to cultivate their own marijuana in 2014 (compared to 2013).  The Arizona Medical Marijuana Act allows patients that live further than 25 miles from a dispensary to cultivate their own marijuana.  Now that we have more than 85 dispensaries operating throughout the state, about 98% of patients live within 25 miles of a dispensary, and very few patients are now allowed to self-cultivate.

Ebola Epidemic Index Case Identified?

January 15th, 2015 by Will Humble No comments »

ebolaA 2 year-old boy from Guinea appears to be what we call in our business the “Index Case” for the West African Ebola epidemic.  In epidemiology, an Index Case is the first documented case of an illness that spreads to others.  The 2 year-old appears to have been infected by playing in a hollow tree that housed a colony of free-tailed fruit bats (Mops condylurus).

A group of scientists made the connection on an expedition to Meliandou, the boy’s tiny village of 31 houses.  They took samples and collected and analyzed a host of evidence and concluded that the boy contracted Ebola from the bats or their droppings in the hollow tree.  The team’s findings are published in EMBO Molecular Medicine this week.

Arizona’s Paramedic Training: Excellent Results

January 14th, 2015 by Will Humble No comments »

PArizona’s Paramedic training programs are taught by a combination of colleges, private training centers, and fire departments.  A typical Paramedic course is over 1,000 hours of class room, hospital and ambulance time covering anatomy, physiology, pathophysiology, pharmacology, terminology, and hours and hours of assessment and proficiency tests on a multitude of skills.

To become certified as a Paramedic in Arizona, a student needs to pass a national certification exam.  The written and practical test assesses comprehension and performance of the course material.  In 2014, 95% of the students that took the national certification exam passed (327/345).  That’s an improvement from 2013 when the Arizona pass rate was 89%…and a testament to Arizona’s Emergency Medical Services (EMS) training programs.  The national pass rate has remained steady at 86% for the past two years.  Great Job, Arizona EMS Training Programs.

ADHS: A Gold Fit Friendly Worksite

January 13th, 2015 by Will Humble No comments »

fit-friendly-workplaceEach year the American Heart Association recognizes employers who go above and beyond when it comes to their employees’ health…and we were recognized as a Gold Fit-Friendly Worksite for 2014.  We’re among an elite group of nationally-recognized awardees for our efforts to promote a healthy workplace.  As a Gold Level award recipient, we’ve been recognized for valuing the importance of a healthy workplace for our employees and taking the critical steps in creating a culture of wellness – as evidenced by our Wellness Ambassador Program.

This is the 4th year in a row that we’ve received the Gold Fit-Friendly Worksite award.  Thanks go out to all of you that helped plan our efforts, conduct brown bag sessions, become Wellness Ambassadors, and participated in our programs.  A special thanks to Kimberly O’Neill who provided steadfast support in the form of weekly updates and overall administrative support to the program.

Maybe you can join us in receiving the Gold Fit-Friendly Worksite award on Friday, January 16th, at 11:15 a.m. in the lobby of the 150 building.  Immediately afterwards, there’ll be a 15 to 20 minute Walk for Wellness.