Ala. Admin. Code r. 410-2-2-.05

Current through Register Vol. 42, No. 12, September 30, 2024

Section 410-2-2-.05 - Diseases - Prevention And Management

(1) Preventable Diseases

(a) Vaccine Preventable Diseases (Measles, Pertussis, HPV, Influenza, Shingles, etc.). With a more local and global transient population, diseases are resurfacing due to a lack of, and failure to immunize for childhood and seasonal diseases such as influenza.

1. Influenza Problem. Seasonal epidemics of influenza occur every year in the United States, beginning in the fall. Typically, the epidemics cause thousands to tens of thousands of deaths and approximately 200,000 hospitalizations annually.

(i) Since the 1940s, a vaccine has been available to prevent influenza; unfortunately, the vaccine is not used as much as it should be. To prevent hospitalizations and deaths caused annually by the influenza virus, the Centers for Disease Control and Prevention ("CDC") has recommended that all U. S. Citizens more than six (6) months of age receive the influenza vaccine.

(ii) The rate of vaccination is low (25% - 45%).

(iii) The cost of vaccination is minimal ($10 - $18), depending on type (injection vs. nasal).

(iv) Side effects are minimal.

(v) Influenza causes children to miss school, usually up to one week, which in some cases can cause parents to miss work.

(vi) Recommendations:

(I) Consider adding the influenza vaccine to the required immunization schedule outlined in Ala. Admin. Code r 420-6-1-.03.

(II) Vaccinating school aged children would keep more kids in school and potentially save the state millions of dollars.

(2) Adult and Childhood Diseases Preventable with Immunizations. Childhood diseases, such as measles, chicken pox, etc. are once again on the rise due to a mobile society and a failure to vaccinate. Vaccinations continue to be developed to prevent diseases such as shingles, HPV, etc.

(a) The State shall encourage compliance with the recommended vaccination schedules of the American Academy of Pediatrics and the CDC Advisory Council on Immunization Practices ("ACIP") to ensure Alabamians are protected from recognized and costly preventable diseases with a vaccination option.

(3) Obesity

(a) Discussion (source: www.cdc.gov)

1. In 2016, the prevalence of obesity (BMI> or = 30) among U.S. Adults was 39.8%. By contrast, the prevalence of obesity in 2000 was 30.5%.

2. An estimated 300,000 deaths per year in the United States may be attributable to obesity.

3. In 2017, Alabama was one of only seven (7) states with an adult obesity prevalence of over 35%.

4. Even moderate weight excess (10 to 20 pounds for a person of average height) increases the risk of death, particularly among adults aged thirty (30) to sixty-four (64) years.

5. Overweight and obesity are associated with heart disease, certain types of cancer, type 2 diabetes, stroke, arthritis, breathing problems, and psychological disorders, such as depression.

(4) Diabetes

(a) Discussion (sources: www.adph.org and www.cdc.gov)

1. Twelve percent (12%) of people in Alabama were diagnosed with diabetes in 2015. Thousands are unaware that they have the disease.

2. The increased incidence of diabetes often leads to obesity and kidney disease related issues, requiring additional dialysis centers and services for treatment.

(5) Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS)

(a) The Problem

1. By December 2019, transmission of the AIDS virus occurs through sexual contact with an infected person, exposure to infected blood or blood products, and perinatally from mother to baby. Transmission patterns of the HIV virus have shifted over time. As of 2017, homosexual/bisexual men account for 66% of adult AIDS cases, with 3% occurring in homosexual/bisexual men who use intravenous drugs. Diagnoses attributable to injectable drug use alone have declined significantly over time and accounted for only 6% of new diagnoses in 2017. Twenty-four percent (24%) of new diagnoses come from among heterosexuals who have had sexual contact with infected partners. Unfortunately, as of 2016, 15% of people infected with HIV are unaware of their status, and 38% of new HIV infections resulted from individuals who were unaware of their HIV-positive status.

2. By the end of 2016, Alabama had reported 13,437 AIDS cases. Of these, 13,397 were in adults and adolescents and 40 were in children less than age 13. Alabama's AIDS cases by reported risk behavior are as follows: 45.3% homosexual/bisexual male; 3.3% homosexual/bisexual with IV drug user; 5.6% IV drug abuse; 0.2% transfusion related/hemophiliac; 19.9% hetero-sexual contact with an infected person; and 24.9% were reported as undetermined. Additionally, according to the Alabama Department of Public Health, an estimated 1 in 6 people living with HIV in Alabama are unaware of their infection. Based on the current prevalence rate, this means that approximately 2,430 Alabama residents may have been infected and unaware of their positive HIV status at the end of 2016.

3. There are at least one million Americans silently infected with HIV. Most of them will get sick during the next decade. Nationally, over 700,000 people with AIDS have died since the beginning of the epidemic. Fifty-two percent (52%) of Alabama's reported AIDS cases have died. The development of antiretroviral therapy (ART) has substantially reduced AIDS-related morbidity and mortality and has improved long-term outcomes for people with HIV. According to the Kaiser Family Foundation, the age-adjusted HIV death rate has dropped by more than 80% since its peak in 1995. Because of this, people already diagnosed with the disease are living much longer. This, combined with the fact that new infections continue to occur, and more people are diagnosed with HIV than die from complications due to the disease, means that more people are living with the HIV virus than ever before.

4. In November 1987, the Alabama Department of Public Health designated HIV infection reportable by provider and patient name and identifiers. By the end of 2016, ADPH had received reports of 7,460 persons who tested positive for HIV and 5,977 additional persons whose infection had advanced to Stage 3 (AIDS). Each one of these individuals is potentially capable of transmitting the virus to someone else and will ultimately have his/ her life shortened due to virus infection.

5. The lowest cost has been identified in areas, which have strong out-of-hospital support networks to provide services to AIDS and HIV positive patients. In addition to the obvious personal loss experienced by families and friends, the loss of productivity due to deaths of individuals with AIDS represents an economic cost to the state of more than $800 million.

(b) Recommendations

1. The state needs to pursue three primary goals to deal with the problem of HIV/AIDS infection:

(i) The elimination of HIV transmission from the infected population of Alabama to the uninfected population.

(ii) The provision of HIV services, both to prevent infection and to provide care in an environment free of discrimination and stigmatization.

(iii) The provision of appropriate and necessary health care to infected individuals.

2. The State began participation in seroprevalence surveys with the Center for Disease Control (CDC) in 1987. Data from these surveys indicate that the State needs to continue to monitor the prevalence of infection in targeted at-risk individuals, such as homosexual/ bisexual men, IV drug users, clients in Sexually Transmitted Diseases (STD) and Tuberculosis (TB) clinics, and women seeking prenatal and family planning services. Data collected in seroprevalence surveys should be used to target populations and geographic areas in need of HIV/AIDS prevention and educational efforts.

3. The State needs to establish interventions to prevent the transmission of HIV from infected individuals to their sexual and/or needle sharing partners. This need can be addressed by HIV counseling/testing and partner notification services.

4. Since AIDS is only the end of a spectrum of viral infection, the State needs to continue to monitor HIV infection through established reporting mechanisms. Physicians, laboratories, and others required by law to report should do so promptly to the Alabama Department of Public Health.

5. Even if a vaccine were available for HIV/AIDS, efforts to prevent transmission of the HIV virus must rely heavily on education. Educational efforts must be targeted at the general community as well as to designated at-risk individuals and populations. Targeted educational messages must be specific, culturally sensitive and stress how the virus is transmitted and ways to reduce or eliminate the risk of transmission. Information directed at the general populace should not only focus on how the virus is transmitted and ways to reduce individual risk, but also stress how the virus is not transmitted so that discrimination, stigmatization and ostracism of infected individuals are eliminated. The Alabama Department of Public Health should serve as the focal point for HIV/AIDS educational and informational activities.

6. The Alabama Department of Public Health has established a multi-agency task force (Alabama AIDS Prevention Network) which should serve to evaluate the effect of HIV/AIDS infection on the health care needs of Alabama and its impact on the state's health care resources. A system of community-based care for infected individuals must be established and maintained utilizing home health services, Medicaid waiver programs, long-term care facilities, hospice programs, and volunteer agencies.

7. Legislation defining the right of access to HIV information for individuals who have a compelling need to know was passed in late 1991. The State needs to continue to monitor and refine this legislation in order to allow exchange of "needed" information, but in a manner, which will protect confidentiality and prevent discrimination against the HIV infected.

Ala. Admin. Code r. 410-2-2-.05

Amended by Alabama Administrative Monthly Volume XXXIII, Issue No. 03, December 31, 2014, eff. 1/6/2015.

Amended by Alabama Administrative Monthly Volume XXXVIII, Issue No. 06, March 31, 2020, eff. 5/15/2020.

Adopted by Alabama Administrative Monthly Volume XLII, Issue No. 07, April 30, 2024, eff. 6/14/2024.

Author: Statewide Health Coordinating Council (SHCC)

Statutory Authority:Code of Ala. 1975, § 22-21-260(4).