AZ Disease Detective Software Overhaul

January 14th, 2014 by Will Humble No comments »

Our statewide disease detectives (whose job it is to slow the spread of communicable diseases) need real-time electronic surveillance in order to get the job done.  Our I.T. folks and the people in Public Health Preparedness have been working on an upgraded system to help them for the last several months- and our new Medical Electronic Disease Surveillance Intelligence System (MEDSIS) went online last  week.  

MEDSIS allows all 15 county and 4 tribal health departments to monitor and manage infectious diseases.  Some hospitals in the state are tapping into the system as well.  This newest edition has a Spanish version so our counterparts in Sonora can enter data and we can track diseases that may pop up on both sides of the border – like influenza, Valley Fever and TB. 

The bottom line is we can now track these diseases more quickly and more accurately and we have something new in the toolbox to quickly discover an outbreak.  Many thanks to all the staff who worked so diligently on this project- including Nita Surathu, Javed Mukarram, Michael Conklin, Shandy Odell, Lloyd Kalicki and Victor Sanchez, Arup Sinha, Joe Enos, Noel Ramirez, Robert Howard, and Srinivasa Venkatesan.

Sochi Public Health Tips

January 13th, 2014 by Will Humble 2 comments »

I know that some of you out there are going to attend  the Winter Olympics – so I put together the blog post below over the weekend for folks that might be going.  Here goes in case you’re interested: Let’s start with the good news first- then the health tips… 

Sochi Games to be Smoke Free-

Russians are 4th in the world in cigarette consumption at about 2,800 cigarettes/person/year (the U.S. is 34th at about 1,000 cigarettes/person/year)… so it’s great that the Russian Federation has made the commitment to make the games smoke-free.  BTW: here’s a country by country listing of cigarette consumption per capita

Smoking will be prohibited in all the Olympic and Paralympic venues, including all bars and restaurants in the  Olympic park. No tobacco will be sold in any of the venues and the anti-smoking policy will be broadcast during all events on the scoreboards.   

Get Vaccinated-

Make sure you’re up to date up-to-date on all your routine vaccines- especially this year’s influenza vaccine.  Many adults haven’t had their Hepatitis A and B vaccine- both of which will come in handy- especially the Hep A vaccine.   There’ll be folks from all over the world there, bringing all sorts of viruses with them in a cold climate- so make a sure you don’t leave any protective vaccines on the table.  

Measles is still fairly common in that part of the world, so everyone under 55 years old should make sure they’re fully vaccinated for the measles.  People over 55 years old probably had the measles as a kid, so they’re at low risk.  More information on recommended vaccines is on CDC’s Russia destination page.   Also, DTaP or TDaP (depending on your age) is a good idea since diphtheria is still circulating in the region. 

Pack Smart-

Be sure to pack a travel health kit, including all your medications.  Pack them in your carry-on luggage and take extra in case of travel delays.  Be sure to pack plenty of warm clothes and sensible shoes with traction so you avoid falls.  The climate in Sochi is about like Prescott in February… but the competitions held uphill on snow and ice and any competition at night will be downright cold.  The right waterproof and windproof clothing will help too because it can rain there in February. 

Stay Hydrated-

It’s a lot easier than you think to get dehydrated in cold weather because cold air holds so little moisture.  Make sure you drink at least a couple of liters of water every day- more is better.   From what I’ve read, the water that leaves the Sochi treatment plant is OK to drink- but some of the underground pipes pre-date the revolution and the water can get contaminated on the way to the tap- so it’s best to seek bottled water or bring your own micro-filter. 

Traffic & Crowds-

Traffic will probably be heavy- so be careful when you’re a pedestrian.  Russian drivers don’t necessarily yield to pedestrians- and cars almost always have the right-of-way there.  Keep your thinking cap on while you’re walking around- not just looking out for cars but watching the ground for ice and stuff.  You don’t want to end up in a Russian hospital instead of enjoying the games!

Spectator crowds are sometimes tricky. Choose a place to meet if you get separated from your group (you probably won’t have your cell service to find each other), and pay attention to where emergency exits are when indoors at large events.  Above all- stay clear headed and don’t over-indulge on alcohol when in crowds or where the footing is slippery. 

Check Your Health Insurance-

Russia requires you to show proof that you have health insurance that’s valid in the Russian Federation in order to get a visa ($50).  Many domestic insurance plans won’t cover you if you need medical care overseas, so check with your insurance provider to find out the extent of your coverage outside the US.  You might want to buy supplemental travel health insurance that will cover any unexpected emergencies while you’re in Russia. 

Safety and Security-For more information about safety and security travel you can check out the State Department’s guidance for travel to the Sochi 2014 Olympic Games.

MERS Update

January 10th, 2014 by Will Humble No comments »

Back in the fall I mentioned the new SARS-like virus, MERS-CoV, which has been causing severe illness, and sometimes death, mainly in the Arabian Peninsula. Four months ago, 103 cases had been reported worldwide, about half of them fatal. Now, 177 cases have been reported, with 74 deaths. The cases are almost all located in the Arabian Peninsula, with 80% of them in Saudi Arabia. We haven’t seen any cases in the US yet. 

In August, The Lancet reported that MERS-CoV is commonly found in camels in the Arabian Peninsula. A follow-up study published in The Lancet a few weeks ago found that a camel farm in Qatar was linked to human cases. MERS was not only detected, but the genetic sequence was similar to the strain infecting the human cases on the farm. This study doesn’t tell us whether the camels infected the people or vice versa, but it does suggest that it’s circulating between camels and people. 

We’ve been encouraging health care providers to keep an eye out for patients with severe acute respiratory illness who have recently returned from the Middle East. Our Arizona State Public Health Laboratory can test for MERS, and we actually did test one patient in December (the test came back negative). Hopefully, we’ll never have a positive case here, but if we do- our state and local epidemiologists are ready to respond to prevent disease spread.

Behavioral Health Efficiency Moves

January 9th, 2014 by Will Humble No comments »

This week we’re making 3 efficiency changes in our behavioral health system.  Instead of having providers bill us and AHCCCS for different services, all the bills will go to AHCCCS- and we’ll get statements from them.  It’ll be the same with enrollment- all paperwork is processed through AHCCCS and we’ll get a standard report that will keep the system up-to-date.  The 3rd change should make it more efficient for determining whether someone has a Serious Mental Illness in the greater Phoenix area.  The Crisis Response Network will evaluate the information based on our standards. 

Once again – thanks to the amazing number of people who came together from IT and Behavioral Health to make these changes a reality including Ravi Pitti, Geetanjali Bandi, Nasrin Akhter, Laxma Veeravelly, Desi Grosso, and Vickie Kropp, Kumar Mani and Serghei Scafaru.


Historic Arnold vs. Sarn Agreement Reached

January 8th, 2014 by Will Humble No comments »

The Governor today announced a final agreement has been reached in the Arnold vs. Sarn case regarding care and services for individuals with serious mental illness.  Litigation that commenced in 1981, the settlement ends a more than three-decade long lawsuit against the state and establishes a blueprint for a successful community-based behavioral health system in Arizona.   You can read more about the Agreement and get links to the documents filed today on Cory Nelson’s blog.

Combatting Killer Painkillers

January 8th, 2014 by Will Humble 3 comments »

Poisoning (including alcohol and prescription drugs) causes more deaths than car crashes in Arizona.  A recent report issued by the Trust for America’s Health ranked Arizona as having the 6th highest death rate for drug overdose in the country in 2010.  Arizona also had one of the highest rates (4th highest at 5.7%) of nonmedical use of prescription pain relievers for people aged 12 years and older for 2010-2011.   National Survey of Drug Use and Health indicates that the age group with the highest percent of nonmedical use in Arizona was 18 to 25 year olds.  

Committed folks across the state are taking action on this issue.  We’re part of the Arizona Prescription Drug Misuse and Abuse Initiative, a multi-agency, multi-systemic approach to addressing the epidemic.  As part of this initiative, new guidelines have been issued for prescribing controlled substances in Emergency Departments and dispensing of controlled substances by pharmacists.  In addition to statewide strategies the initiative has also piloted community-based actions in Yavapai, Pinal, Graham, and Greenlee Counties.  

Preliminary results from the pilots have been impressive: 

  • 34 drop boxes are operational in the pilots and ten take-back events have been held, collecting 3,100Kg of drugs;
  • 5 of 6 hospitals are implementing the Emergency Department Guidelines in the pilot communities;
  • Over 1,400 prescribers are receiving quarterly report cards from the Board of Pharmacy;
  • 201 Law Enforcement Officers have received Rx Crimes curriculum;
  • 8,628 youth and 893 adults have received the Rx360 curriculum;
  • 53,272 people have been reached via community events;
  • Over 353,000 people have been reached via public messaging and media methods;
  • Prescription Drug Monitoring Program (PDMP) sign up has increased 58%, 86% and 50% for prescribers in Yavapai, Pinal and Graham/Greenlee Counties, respectively;
  • 32%, 28%, and 41% of prescribers are signed up for the PDMP in Yavapai, Pinal and Graham/Greenlee Counties, respectively vs. 25% at the state; and
  • PDMP use has increased 60% for prescribers in Yavapai County. 

We also recently pledged our commitment to participate in the Association of State and Territorial Health Officials (ASTHO) 2014 President’s “15×15” Challenge to reduce both the rate of nonmedical use and the number of unintentional overdose deaths involving controlled prescription drugs 15% by 2015. Here are just a few of the strategies we committed to, along with the partners in the Arizona Prescription Drug Misuse and Abuse Initiative

  • Convene key stakeholders to develop prescribing guidelines for community practitioners to complement the dispensing guidelines and emergency department prescribing guidelines already developed and in use;
  • Design professional and public education strategies to support implementation of these guidelines and to increase patient literacy related to expectations of pain, and adherence to treatment;
  • Require licensed healthcare facilities to develop a policy regarding prescribing controlled substances;
  • Issue report cards to each individual prescriber in the pilot sites of the Arizona Prescription Drug Misuse and Abuse Initiative- compare the practitioner’s prescribing habits to their peer and identifying “outliers”;
  • Promote the use of Screening, Brief Invention, and Referral to Treatment (SBIRT) protocols among hospitals and community providers; and
  • Create a searchable online database of treatment resources.

ADVICE Collaborative II: Turning the Tide on Infections

January 7th, 2014 by Will Humble No comments »

Back in 2013 our Licensing team joined with our Infectious Disease Services shop and our Healthcare Associated Infections Advisory Committee to put together a day-long conference aimed at improving infection control practices in our dialysis facilities. The ADVICE collaborative brought together licensed dialysis providers, the dialysis network, federal partners, and public health professionals to find new ways to promote infection control, build relationships, and identify how public health can assist our providers. Our collaborative was identified as a Best Practice Pilot and featured at the CMS Conference Roadmap to Eliminate HAI: 2013 Action Plan Conference.

From the collaborative, the End-Stage Renal Disease subcommittee of our Healthcare Associated Infections Advisory Group was developed- and they’ve already started to work on some of the ideas that came out of the collaborative. The subcommittee consists of dialysis providers, public health professionals, and experts in infection control. They’re working on staff/patient infection control, best practices, vaccination educational projects, and identifying resources that may be useful to the dialysis providers.

A follow-up ADVICE collaborative is scheduled for May 16, 2014 and will be held at the Black Canyon Conference Center. It’ll be another day long conference focused on the needs identified at the last meeting, the progress made by the advisory committee on meeting those needs, and identifying best practices and new innovative ideas that are occurring in Arizona and around the country.

Speakers from the Colorado Department of Public Health and Environment and Mayo have been invited to discuss some of their current and future projects with dialysis facilities. The facilities will also be surveyed to identify current needs in infection control practices, and experts will be brought in to discuss these topics in breakout sessions and to identify challenges and opportunities for improving infection control. Keep on the lookout for the registration if you would like to join the collaborative.

Electronic Birth Certificate Rollout Going Smoothly

January 6th, 2014 by Will Humble No comments »

We rolled out a new electronic birth certificate system this week that will be a game-changer for public health.  Our system (which took about 18 months to plan, create & launch) will help us collect better surveillance data for our Winnable Battles like obesity, tobacco use, substance abuse, and better data about birth outcomes that will help with our maternal and child health interventions.  It’ll also help us do a better job ensuring that our licensed professional midwives are meeting our expectations.  And of course the reason we keep track of data is to find interventions that work to improve outcomes, like the home visiting program

Hospitals, birthing centers, county health departments and several state agencies will be able to enter and retrieve information more efficiently and quickly.  With the various levels of access, there are more protections for parents and babies alike.  

The system uses a standard that’s consistent with the National Center for Health Statistics- producing critical information on public health topics like teenage births and birth rates, prenatal care and birth weight, risk factors for adverse pregnancy outcomes, infant mortality rates, leading causes of death, and life expectancy. 

Thanks to the Office of Vital Records led by Krystal Colburn, our Vital Statistics Bureau and more than a dozen IT folks who made this happen including (but not limited to) Dimiter Pekin, Shobha Vaddireddy, Ellen Rayer, Michael Conklin, Shandy Odell, Michael Shaw, Alan Landucci-Ruiz, Matthew Marshall, Gordon Esra, Loretta Jackson, Smita Sahoo, Avinash Veerlapati, Cameron Pulcifer and Carl Farmis.


Influenza Season Officially Arrives

January 3rd, 2014 by Will Humble No comments »

Flu season is here!  Parts of the country (mostly in the south) have had more intense flu activity in the last few weeks, and 25 states reported widespread flu activity for the week ending December 28th.   Meanwhile, in Arizona we are seeing an increase in the number of lab-confirmed flu cases reported to ADHS- but 50% fewer cases than we saw last year at this time.  Not only are we seeing rising numbers of flu, CDC has also received reports of severe respiratory illness among young and middle-aged adults, which we also saw during the H1N1 pandemic. 

In Arizona, as in the rest of the U.S., three different strains are circulating including the same virus that caused the 2009 pandemic.  The H1N1 virus is part of this year’s seasonal influenza vaccine.  Don’t forget — it’s not too late to get your flu vaccination if you haven’t already! 

Like flu, respiratory syncytial virus (or RSV), is off to a slower start this year compared to last year. We’ve had 182 lab-confirmed cases reported so far (as of December 28th), compared to 601 cases at this same time last year. As we see every year, RSV is more common in kids 4 and younger this year, with 84% of our cases in this age group. Check out the weekly surveillance reports for  Arizona and for the U.S. online.

Public Health Poem to end the Year

December 27th, 2013 by Will Humble 6 comments »

The Ambulance Down In The Valley

A Poem About Public Health Prevention

by Joseph Malins (1895)


‘Twas a dangerous cliff, as they freely confessed, though to walk near its crest was so pleasant; but over its terrible edge there had slipped a duke and full many a peasant.

So the people said something would have to be done, but their projects did not at all tally; some said, ‘Put a fence ’round the edge of the cliff, ‘

some, ‘An ambulance down in the valley.’


But the cry for the ambulance carried the day, for it spread through the neighboring city; a fence may be useful or not, it is true, but each heart became full of pity for those who slipped over the dangerous cliff; 

And the dwellers in highway and alleygave pounds and gave pence, not to put up a fence, but an ambulance down in the valley.


‘For the cliff is all right, if you’re careful, ‘ they said, ‘and if folks even slip and are dropping, it isn’t the slipping that hurts them so much as the shock down below when they’re stopping.’

 So day after day, as these mishaps occurred, quick forth would those rescuers sally to pick up the victims who fell off the cliff, with their ambulance down in the valley.


Then an old sage remarked: ‘It’s a marvel to me that people give far more attention to repairing results than to stopping the cause, when they’d much better aim at prevention.

Let us stop at its source all this mischief, ‘ cried he, ‘come, neighbors and friends, let us rally; if the cliff we will fence, we might almost dispense with the ambulance down in the valley.’