Posts Tagged ‘infectious disease’

New Year, New MEDSIS

January 14th, 2013

Over the past two years, folks in ITS and Epidemiology and Disease Control have been working together to enhance our state’s electronic communicable disease surveillance system called MEDSIS.   This week the new version of MEDSIS went live. Major enhancements include the integration of tuberculosis reporting, case management and surveillance; expanded case management capabilities for all diseases; and additional functionality to better meet the needs of all users. This system isn’t just used by ADHS staff- it’s used by folks across the healthcare system. 

All 15 county health departments and four tribal public health organizations use MEDSIS to monitor cases of infectious disease and manage their case investigations; infection preventionists at hospitals enter infectious disease cases to satisfy our requirements for reporting selected infectious diseases; and laboratories electronically report positive test results directly into the system. There’s even a Spanish version of MEDSIS to allow us to share bi-national cases with our counterparts in Sonora to improve public health on both sides of the border. Thanks to all of those involved in making MEDSIS a success including Raghu Ramaswamy, Ravikumar Pitti, Sara Imholte, Lloyd Kalicki, Srinivasa Venkatesan, Paula Mattingly, Michael Conklin, Javed Mukarram, Arup Sinha, Teresa Jue, Jessica Rigler, and Shoana Anderson.

Vaccines & the Social Contract

December 14th, 2012

At the core- vaccines are really about community protection.  Our public health system depends on a solid network of providers that are available to vaccinate kids for all of the nasty infectious diseases that have plagued humanity for millennium. It’s not just access to care and a solid network of providers that vaccinate that are important- we also need folks to fulfill their social contract. In other words, we need just about everybody to participate and get vaccinated in order to get the herd immunity we all need to eliminate the spread of infectious vaccine-preventable diseases.  Vaccinating yourself and your kids is more about community protection than personal protection.  It’s a social contract that we have with each other to keep all of us healthy- just like it’s everyone’s responsibility to be a Good Samaritan when you see a car crash. 

For decades vaccination rates in the US and AZ have been pretty good.  The problems we had were due to the lack of access to care.  Low vaccination rates were mainly in low income areas where folks weren’t able to get to the doctor on time to get their shots or didn’t have insurance.  Over the decades, the public health and healthcare systems have closed many of those gaps- and immunization rates responded.  But now we have a new problem- more and more parents are purposely deciding to not vaccinate their kids.  The trend is increasingly jeopardizing us all.  It’s called a “personal exemption”. 

In order to figure out what to do next, we began working with the UA College of Public Health to find out the who, what, when, where, and why of this group of parents that are increasingly deciding to not vaccinate their kids.   Today the UA investigators published a preliminary report in the Journal Vaccine that gives us some insight into this population. 

The research team used data about personal exemptions from our 2010- 2011 kindergarten Immunization Data Report and linked it to data about education statistics to determine if there are similarities between the areas where there are more exemptions.  They found that schools where mostly white students attended, those with fewer students who use free and reduced lunch, and charter schools were more likely to have high exemption rates.  There are geographic differences too – those in the northern part of the state were more likely to have personal exemptions than those in the south – and the number of exemptions increased from west to east. 

These geographic and demographic details are important in designing the right intervention to help bring up herd immunity in the state.  This information will help the AZ public health system to improve the vaccination uptake and pay close attention to those areas if there is a disease outbreak.  A follow-up study is on the way that’ll look in more depth into why parents are increasingly choosing “personal exemptions” over vaccination.  We hope to use the combined data to develop intervention strategies to improve immunization rates moving forward.

Introducing Our New Licensing Director & Agency CMO

August 22nd, 2012

Please join me in welcoming Cara Christ, MD as our new Division of Licensing Services chief.  Cara has agreed to share her talents as the new Assistant Director for Licensing as well as serving as the Agency Chief Medical Officer.  Also, thanks a million to Colby Bower who’s been doing an excellent job serving as interim director for licensing since Alan passed away. 

Cara started her public health quest about a dozen years ago when she worked in our infectious disease epidemiology shop.  While there, she developed a passion for both medicine and epidemiology- so she left to study medicine with a goal of working as a CDC disease detective.  I can remember being disappointed when we lost her to medical school 10 years ago  but alas, she returned to us after graduating- and she’s been working in our Bureau of Epidemiology and Disease Control (EDC) for the last few years…  most recently serving as the EDC Bureau Chief (one of my old jobs). 

I think Cara will be perfect for this job- bringing value added from her solid leadership and management style to her eye for public health “leverage points”- and most of all her passion for improving outcomes and using public health principles to change lives and communities.  Our Licensing Division is perhaps our greatest leverage point for achieving these elements of our strategic map

Cara will also be providing Agency leadership in her new role as the ADHS Chief Medical Officer.  Dr. Nelson has been serving in the Agency CMO role for the last couple of years- doing an excellent job.  I’m certain that we can count on Cara to continue to carry that torch effectively for Arizona. 

Thanks!

Biomedical Roadmap

February 21st, 2012

A decade ago, AZ launched a plan to create an internationally competitive bioscience sector.  This roadmap is the long-term plan to combine leaders in business, basic sciences & research, and political entities in order to create an infrastructure and climate that would be ideal to propel AZ forward in the biosciences. 

The Flinn Foundation invested in this mission and hired Battelle to create this plan or roadmap.  The report recommended specific areas of focus for short-term growth in 3-5 years (bioengineering, cancer research, neurosciences, and bio-imaging) that needed to be implemented.  They also identified other areas for long-term growth (agricultural biotech, asthma, diabetes, and infectious disease) over the next 5-10 years that would help strengthen AZ’s medical research base and create new jobs that would be safe from cyclical fluctuations in the economic market.  This implementation effort is being led by the steering committee. 

The core of the initiative: 1) builds research infrastructure; 2) develops a critical mass of firms and new cutting edge businesses;  3) enhances the business environment to generate funding; and 4) prepares the workforce with educational initiatives www.azbiobasics.com

The latest status report on the roadmap shows major progress (95%) on the goals in the last 10 years.  Bioscience employment in AZ increased 32%, the number of firms has grown 28%, wages in bioscience fields have increased 47%, NIH funding grew 65% faster than other states, and R&D expenditures by academic research institutions grew 52%.  Venture capital investment dropped 11%, however the entrepreneurial initiatives to license and patent intellectual property increased steadily.  Check out the full report, Arizona’s Bioscience Roadmap Performance Assessment 2002-11 and a calendar of upcoming events at www.flinn.org.  The list of organizations involved in bioscience can be found at www.azbiobasics.com.

To Sample or Not to Sample…

November 22nd, 2011

…  is often the question when it comes to common indoor air quality questions or in response to a communicable disease outbreak (or diagnoses) in the workplace.  The answer is not to sample (almost without exception).  A good case study came up this week when a library and high school were closed after some environmental sampling (conducted after somebody was diagnosed with a communicable disease) found commonplace bacteria in the environment. 

When dealing with indoor environmental concerns or in response to a diagnosis of a communicable disease, the first step isn’t to sample the environment.  There are other first steps that should be taken.  For example, if somebody is diagnosed with an infectious disease in the workplace you can emphasize the importance of good handwashing among all staff and encourage everybody to stay home if they feel ill.   Environmental sampling following the diagnosis of an infectious disease in the workplace will be of little value- and will often turn up common microorganisms of no public health consequence…  and sometimes these decisions lead to poor decisions about what to do about the results. 

Most of us spend a lot of time indoors, whether it is at work, home, or school.  People are often concerned that their symptoms or health conditions are related to where they spend a lot of time.  The best approach to investigating concerns expressed by workers are common sense measures. If the concern is about indoor air quality generally- you can use helpful indoor air quality checklists or other indoor air quality assessment tools.  By looking at simple fixes first, such as changes to the air conditioning or heating system, carpet cleaning, or new cleaning products, many environmental concerns can be identified immediately. This may fix the problem immediately before having to wait for test results.

Valley Fever Week

November 4th, 2011

This is Valley Fever Awareness Week- an annual event to provide awareness  of coccidioidomycosis (also known as Valley Fever)- the second most commonly reported infectious disease in Arizona.  Events for the general public include a “Learn about Valley Fever – Ask the Doctor Your Questions” held in Tucson on Sunday, Nov. 6 and the Walk for Valley Fever in Sun City West on Sunday, Nov. 6.  Healthcare providers can receive continuing medical education in Tucson on Saturday, Nov. 5:  “Coccidioidomycosis for the PCP” and “Advanced Clinical Aspects of Coccidioidomycosis”.  To find out more about valley fever awareness week events visit: http://www.vfce.arizona.edu/

Our epidemiology staff work closely with the Valley Fever Center for Excellence to promote education and awareness.  The Center is based at the U of A and will be opening a center in Phoenix in January.  Check out our home-grown video that’s designed help people understand the disease and how to talk to their doctors about it. To read more about valley fever and what has been done during past valley fever awareness weeks, please visit my blog.  I also wrote a piece about the effects that the large dust storms may have on valley fever, which by the way, we’re still investigating…

Building a Healthier Border

October 28th, 2011

You can think of the border public health advocacy network as a binational matrix of public health partners that collaborate to improve conditions along the US-Mexico border.  The network includes national organizations like the U.S.-Mexico Border Health Commission along with state based partnerships like the Arizona-Mexico Commission and the annual U.S.-Mexico Border Governor’s Conference.  Community based binational partnerships are also a key component for setting public health priorities and implementing effective interventions.  The acronym, COBINAS, stands for Consejos Binacionales de Salud, or Binational Health Councils, in English.  Our partnerships span the full width of public health- from infectious disease work (like TB control), to substance abuse, physical activity & nutrition (like Cinco Pasos), tobacco cessation, environmental disease work (likeValley Fever), prescription drug misuse, lab capacity- even developing regional licensing standards. 

As part of my job as the Director, I’m a member of the U.S.-Mexico Border Health Commission, whose mission is to provide international leadership to optimize health along the U.S.-México border.  The Commission is comprised of the federal secretaries of health, the lead health officers of the ten border states, and prominent community health professionals from both nations. As a member, I help to educate folks (including policy-makers) about the unique challenges at the border through outreach efforts and conduct joint collaborative public health initiatives with public and private partners in the border health community.  The primary goal of the Arizona Delegation is to strengthen and support bi-national public health projects and programs along the Arizona-Sonora border.  

I was fortunate to be able to spend a couple of days this week for a meeting of the U.S.-Mexico Border Health Commission Arizona and Sonora Delegation Outreach Offices.  The COBINAS workshop meetings (in Magdelena de Kino, Sonora) developed community priorities and updated program developments within the binational health councils.  We’ll also be using their input as we develop our work plans through the November 7, 8 US-Mexico Border Health Commission meeting, as well as the December Arizona-Mexico Commission, and next year’s U.S.-Mexico Border Governor’s Health Worktable joint resolutions.  By the way, the 3 local COBINAS for the AZ-Sonora region are San Luis Rio Colorado, Sonora/Yuma County; Ambos Nogales; and Noreste de Sonora/Cochise County, Arizona and the Tohono O’odham Nation/Western Pima County/Sasabe, Caborca, and Sonoyta, Sonora binational community health council.

AZ Data to Drive Public Health Interventions

October 24th, 2011

Making good decisions about prioritizing which public health issues to tackle and how to target our interventions rests on our ability to collect and analyze public health data.  For infectious disease surveillance that means have a base of solid reporting and surveillance so we can analyze infectious disease trends.  For chronic diseases, we need to know the behavioral trends and the demographic background so that we can target our resources effectively.  That’s where our annual Behavioral Risk Factor Survey plays a role… our brand new 2010 Report provides key data that can be used to monitor and plan health promotion and help our public health system to better target our intervention strategies for chronic disease prevention in Arizona. 

The (federally funded) Behavioral Risk Factor Survey is conducted throughout the year and examines the self-reported habits of 4,700 Arizonans.  The report contains key data on lifestyle risk factors contributing to the leading causes of death and chronic diseases- and measures the public health system’s progress on smoking, overweight, high blood pressure, exercise, flu/pneumonia vaccination, cholesterol, seat belt use, fruit/vegetable consumption and other risk factors.  These data give us some of the tools we need to set priorities and craft intervention strategies.  Judy Bass was the point person for this year’s report.  Well done Judy!

Contagion

September 9th, 2011

In all my years in public health this is the first crack I’ve taken at being a movie critic- so give me a little slack on this one.  I checked out the new movie called Contagion- and really liked it. I won’t give up too much information and spoil the film, but it’s basically a fictional drama that portrays CDC and other public health folks responding to a new disease outbreak that ends up causing a pandemic.  While I thought some of the human behavior and public policy decisions in the film were over the top- I was pleasantly surprised that the Director made good efforts to capture the essence of epidemiology, surveillance and disease control, public health interventions, and laboratory science and how they fit together as part of a public health response.

Ok, so you might wonder as you leave the theater- “Could this really happen?”  The answer is “yes” and it kind of already has.  The 2002-03 Severe Acute Respiratory Syndrome (SARS) epidemic was remarkably similar to the core of what happens in ContagionSARS- which was a easily transmitted and had a case-fatality rate of more than 10% – rapidly spread from Hong Kong to 37 countries.  Fortunately, a robust international public health response that included effective public health interventions was able to prevent the virus from becoming a devastating global pandemic.

Public health from around the world worked to identify and isolate the virus and good and swift public health interventions were able to limit the spread of the disease.  Because of the quick and robust initial public health response it was fully contained – but it won’t ever be eradicated because it could still live in an animal reservoir and spread to people.  By the way- civet cats were the likely intermediate host for direct transmission of SARS to humans, but bats, or some other host, are likely the natural reservoir for the virus.

The good news is that you should still be able to sleep after you watch the film because you’re aware that a global, national, state and local public health system is in place that’s designed to quickly identify emerging infectious diseases.  Plus, we get better every day at crafting and implementing public health interventions.  Here’s a website called Contagion and CDC which was created by the CDC Foundation to help separate fact from fiction and to highlight CDC’s role in preparedness and response… Contagion Movie:  Fact and Fiction in the film, a CDC website….and CDC 24/7 – which is a website that includes information you may find useful on how the public health system protects us from outbreaks.

By the way- all the locations in the movie that depict the CDC were all taken on their campus.  I recognized their Emergency Operations Center in the movie- and have even been in meetings in the conference room you’ll see in the movie.  The lab’s you see are actually the CDC labs too… as are the rooms you see where staff are talking about the outbreak.

Border Health Partnerships

July 12th, 2011

A few weeks ago I blogged about the June plenary session of the Arizona Mexico Commission called Arizona & Sonora: Gateway for Innovation.  The conference provided an opportunity to move forward a bi-national agenda supported by Arizona and Sonora.  The health committee discussed regional approaches to valley fever surveillance, burn patient infrastructure, substance abuse, TB, border first aid services and Sonora’s upcoming efforts to provide licensing and quality assurance services for assisted living in Sonora (and how we can partner with them as they set up their program).

 A couple of weeks ago I was in Washington DC working on another border partnership called the US-Mexico Border Health Commission.  The Commission was created in July 2000 and is comprised of the federal secretaries of health, the health officers of the 10 border states and appointed community health professionals from both nations. The Commission provides a unique opportunity to bring together the two countries and its border states to solve border health problems.

 Each year the Commission establishes strategic objectives.  This year’s priority areas include TB, physical activity and nutrition, infectious disease and public health emergencies, access to care, data collection, and academic alliances.  We develop action items for each of the strategic objectives.  Through the Commission, each of our border states are able to directly communicate with our respective federal agencies so that we can better align federal priorities with our border strategic objectives.  A couple of weeks ago we were able to meet with several sub-cabinet agency decision-makers as well as several members of the House of Representatives and made real progress toward synchronizing federal policy with our strategic objectives for the border.