Value Statement ADPH For The Welfare Of All People.
The Alabama Department of Public HealthAnnual Report is published by theBureau of Health Promotion and Chronic Disease.Director, Bureau of Health Promotionand Chronic Disease .James J. McVay, Dr.PAAlabama Department ofPublic HealthAlabama Department of Public HealthAnnual Report 2004MissionTo serve the people of Alabama by assuringDirector, Communications andSocial Marketing Division .Sally Palmerconditions in which they can be healthyDirector, Public Information Division .Arrol Sheehan, MAEditor.Takenya Stokes, JDADPHValue StatementPhotography.Paul RobertsonMark L. WrightThe purpose of the Alabama Department of PublicHealth is to provide caring, high quality and professionalProduction Assistants .Toni PraterRená ReeseKeith Wrightservices for the improvement and protection of the public’shealth through disease prevention and the assurance ofpublic health services to resident and transient populationsFor additional copies of this report contact:Takenya Stokes or Toni PraterAlabama Department of Public Health,Bureau of Health Promotion and Chronic DiseaseThe RSA Tower, Suite 900, 201 Monroe Street,P.O. Box 303017Montgomery, Alabama 36130-3017, (334) 206-5300.of the state regardless of social circumstances or the abilityto pay.The Department of Public Health works closelywith the community to preserve and protect the public’shealth and to provide caring, quality services.Informational materials in alternative formats will be madeavailable upon request.AuthorityThis document may also be obtained through the AlabamaDepartment of Public Health’s web site at www.adph.org.Alabama law designates the State Board of Healthas an advisory board to the state in all medical matters,matters of sanitation and public health. The MedicalState ofAlabamaDepartment ofPublic HealthThe RSA Tower201 Monroe StreetMontgomery, Alabama36104www.adph.orgAssociation, which meets annually, is the State Board ofHealth. The State Committee of Public Health meetsmonthly between the annual meetings and is authorized toact on behalf of the State Board of Health. The StateADPHHealth Officer is empowered to act on behalf of the StateCommittee of Public Health when the Committee is not insession.More than 125 years ago medical leaders inAlabama advocated constitutional authority to overseematters of public health. The purpose of the authority wasto preserve and prolong life; to plan an educational programfor all people on the rules which govern a healthfulexistence; and to determine a way for enforcing health lawsfor the welfare of all people.
State Committee ofPublic HealthPublic Health AreasAlabama is divided into public health areas to facilitate coordination, supervision and development of publichealth services. Area offices are responsible for developing local management programs of public healthservices and programs particularly suited to the needs of each area.ChairGeorge C. Smith, MD . . . . . . . . . . . . . . . . . LinevilleVice ChairSteven P. Furr, MD . . . . . . . . . . . . . . . . . . . . JacksonSecretaryDonald E. Williamson, MD . . . . . . . . . . MontgomeryGeorge C. Smith, MDChair, LinevilleSteven P. Furr, MDVice Chair, JacksonPHA 1Karen Landers, M.D., Area Health OfficerRoger Norris, Area AdministratorBox 929, Tuscumbia, AL 35674-0929(256) 383-1231Donald E. Williamson, MDSecretary, MontgomeryJorge A. Alsip, MD . . . . . . . . . . . . . . . . . . . . DaphneCraig H. Christopher, MD . . . . . . . . . . . BirminghamEdward C. Facundus, MD . . . . . . . . . . . HuntsvilleKenneth W. Aldridge MDTuscaloosaJorge A. Alsip, MDDaphneJames G. Chambers, III, MDHuntsvilleDavid P. Herrick, MD. . . . . . . . . . . . . . . . . MontgomeryPamela D. Varner, MD. . . . . . . . . . . . . . . . Birmingham.MontgomeryCraig H. Christopher, MDBirminghamEdward C. Facundus, MDHuntsvillePHA 6Teresa Childers Stacks, Area AdministratorBox 4699, Anniston, AL 36204-4699(256) 236-3274Richard M. Freeman, MDAuburnCouncil on Dental HealthRichard A. Kean, DDS, MD . . . . MontgomeryAllan R. Goldstein, MDBirminghamDavid P. Herrick, MDMontgomeryA. Ray Hudson, MDJasperPamela D. Varner, MDBirminghamON THE COVERLeft to right:Dallas County Health Department – SelmaMacon County Health Department – TuskegeeMonroe County Health Department – MonroevillePhotograph by Mark L. WrightCouncil on Animal andEnvironmental HealthJim W. Benefield, DVMMontgomeryCouncil on Dental HealthRichard A. Kean, DDS, MDMontgomeryCouncil on Health Costs,Administration and OrganizationRonnie E. Opolka, RPhGuntersvilleCouncil on Prevention ofDisease and Medical CareAshley C. Cousins, PEMontgomeryPhotographs by Paul Roberston PhotographyCouncil on Prevention of Diseaseand Medical CareAshley C. Cousins, PE . . . . . . . . . . . . MontgomeryPHA 8Bobby H. Bryan, Area Administrator6501 US Hwy. 231 North,Wetumpka, AL 36092(334) 567-1165PHA 9Ruth Underwood, Area AdministratorBox 1227, Robertsdale, AL 36567(251) ALHOUNST. WNDESCHOCTAW8MACONRUSSELLBULLOCKWILCOXPHA 7Ruth Underwood, Acting Area AdministratorBox 480280, Linden, AL 36748-0280(334) 295-1000Council on Health Costs,Administration and OrganizationRonnie E. Opolka, RPh . . . . . . . . . . . Guntersville2COLBERTMARIONPHA 5Mary Gomillion, Area AdministratorBox 267, Centre, AL 35960(256) 927-7000A. Ray Hudson, MD . . . . . . . . . . . . . . . . . . JasperJACKSONDEKALBPHA 4Michael Fleenor, M.D., Area Health OfficerGwen Veras, Area AdministratorBox 2648, Birmingham, AL 35202-2648(205) 930-1500Allan R. Goldstein, MD . . . . . . . . . . . . . . BirminghamMADISONLIMESTONEFRANKLINPHA 3Albert T. White, Jr., M.D., Area Health OfficerRoger Norris, Acting Area AdministratorBox 70190, Tuscaloosa, AL 35407(205) 554-4501James G. Chambers, III, MD . . . . . . . HuntsvilleCouncil on Animal andEnvironmental HealthJim W. Benefield, DVM1PHA 2Ron Grantland, Area AdministratorBox 1628, Decatur, AL 35602-1628(256) 340-2113Kenneth W. Aldridge, MD . . . . . . . . . . . TuscaloosaRichard M. Freeman, MD. . . . . . . . . . . . AMBIAMOBILE11PHA 10Russell Killingsworth, Area AdministratorP.O. Box 1055, Slocomb, AL 36375-1055(334) 886-2390PHA 11Bernard H. Eichold, II, M.D., Area Health OfficerBox 2867, Mobile, AL 36652-2867(251) 690-8101BALDWINGENEVAHOUSTON
Letter to theGovernorThe Honorable Bob RileyGovernor of AlabamaState CapitolMontgomery, Alabama 36130Dear Governor Riley:I am pleased to present the 2004 Annual Report of theAlabama Department of Public Health. I am very proud of thededication and commitment demonstrated by our employees overthe past year in protecting the health of Alabama citizens. The year2004 presented unique challenges for public health. The response toHurricane Ivan required the involvement of employees from acrossthe state in activities ranging from protecting food supplies tostaffing shelters. Likewise, the severe shortage of influenza vaccineforced the Department to assume new responsibilities for assuringvaccination of Alabama’s citizens. In addition to providing vaccineto over 150,000 Alabamians through clinics held by the Departmentof Public Health, we were also responsible for assuring the allocationof private-sector vaccine to individuals at highest risk. Theseextraordinary events as well as the daily efforts by HealthDepartment employees described in this report contributed tomaking Alabama a healthier state for our citizens.In 2004, Alabama recorded its lowest infant mortality rate everat 8.7 deaths per 1,000 live births. It also witnessed the lowestpercentage of births to teens in our history at 13.9 percent. Thiscontinued decline in teenage births helped to contribute to theoverall decrease in infant mortality since the teenage mortality rateis 50 percent higher than that of adult mothers. While we madesubstantial progress in infant mortality, challenges remain. Thereremains a substantial racial disparity in infant mortality with a ratefor African Americans being 2.2 times as great as for whites.During 2004, a record number of Alabamians used their seatbelts. At 80 percent, this represents the highest rate of seat belt useever recorded in Alabama and keeps Alabama at the national levelin seat belt use. While not only did Alabama make progress inprotecting the passengers in automobiles, we likewise made progressin protecting the youngest and most vulnerable citizens of our state.In 2004, Alabama joined a growing number of states in expandingthe number of conditions for which newborns are screened.Alabama has increased the number of conditions for whichscreening occurs from 6 to 14. This will allow the identification ofmore children with rare disorders for whom early intervention mayprevent disability or death.Alabama continues to face substantial problems brought on bylifestyle choices. Alabama ranks first in the nation in the percentageof our population that is overweight and/or obese. Likewise, we rankDonald E. Williamson, M.D.in the top five states in the percentage of our population with adultonset diabetes. This combination of obesity and diabetes willcontribute to a growing problem with heart disease and stroke overthe coming decades. In order to identify strategies which will reversethe growing problem of obesity and its secondary consequences, theDepartment plans to create a task force to provide recommendationsabout interventions at both the personal and governmental level.While the problems of obesity represent an ongoing challenge forthe state, 2004 did see improvement in the prevalence of smokingamong high school students. Over the past four years, theprevalence of smoking among high school students has decreasedfrom 30.2 percent to 24 percent. This decline in teenage smokingwill likely result in fewer adult smokers in the years to come.While the Department continues to address problems ofemergency preparedness and lifestyle choices, we also remaincommitted to our mission of controlling communicable diseases.The incidence of pertussis and syphilis increased in 2004 but therewas a decline in chlamydia and gonorrhea. The number of reportedtuberculosis cases in 2004 reached the lowest level in Alabama’shistory. Unfortunately, HIV/AIDS remains a major public healthproblem in our state. Over 800 individuals each year in Alabama areidentified as being HIV infected. In addition to the ongoing problemwith new HIV infections, the state continues to face a significantproblem providing care for individuals already diagnosed with HIVand AIDS. Alabama, through the AIDS Drug Assistance Program,provides medication to over 1,100 individuals but has hundreds ofindividuals on a waiting list for participation in the program. Theability to maintain this program in the coming years is likely torepresent a significant challenge to the Department and state.The Department remains committed to the services andprograms that will prevent death and disability for our citizens. Inthe coming year, we look forward to working with our public andprivate partners to continue to improve the health status ofAlabamians.Sincerely,Donald E. Williamson, M.D.State Health Officer1
Organizationof the AlabamaDepartment ofPublic HealthSTATE GOVERNMENTSTATE BOARD OF HEALTHSTATE COMMITTEE OF PUBLIC HEALTHSTATE HEALTH OFFICERDonald E. Williamson, MDStaff AssistantBureau ofEnvironmental ServicesKathy Vincent, MSW, LCSWBureau of Home &Community ServicesOffice of FacilitiesManagementOffice of Professional& Support ServicesDirectorGrover Wedgeworth,RN, MPHWilliam J. Coleman, BSDirectorFrances Kennamer, MPADirectorWilliam P. Allinder, PE, PLS Community EnvironmentalProtection Food/Milk/Lodging Training & ProgramDevelopment Technical ServicesGeneral CounselJohn R. Wible, JDPersonnel OfficeSandra Wood, MBAOffice ofRadiation ControlKirksey Whatley, MSOffice ofPrimary Care& Rural HealthDevelopmentDirectorClyde Barganier,DrPH Minority Health Primary Care Rural HealthAssistantState HealthOfficer forDiseaseControl &PreventionCharles H.Woernle,MD, MPHBureau ofClinical LaboratoriesDirectorWilliam J. Callan, PhD Administrative SupportServices Clerical Clinical Chemistry Metabolic Microbiology Quality Assurance Respiratory Disease Sanitary Bacteriology/Media Serology Birmingham Microbiology Birmingham Serology Decatur Dothan Mobile2Center forEmergencyPreparednessActing MedicalDirectorCharles H.Woernle,MD, MPHDirector ofOperationsRay Sherer, MBAOffice of Children’sHealth InsuranceDirectorGayle Lees Sandlin,MSW, LCSWOffice of Program IntegrityDirectorDebra Thrash, CPAPublicHealth AreasBureau of HealthProvider StandardsDirectorThomas M. Miller,MD, MPHArea HealthOfficer/AreaAdministratorDirectorRick Harris, JD Administration CommunityDevelopment/Professional Support WIC Women’s &Children’s HealthBureau of HealthPromotion &Chronic DiseaseDirectorCharles H. Woernle,MD, MPHDirectorJim McVay, Dr PA Immunization Infection Control STD Control TuberculosisControl Management Support Nursing Nutrition & Physical Activity Office of Women’s Health Pharmacy Social Work TrainingBureau of FamilyHealth ServicesBureau ofCommunicableDisease Epidemiology HIV/AIDS Prevention& Control Community Services Home Health Care Program Support Professional Development Cancer Prevention Chronic DiseasePrevention Communications &Social Marketing Injury Prevention Public Information Risk Communication Tobacco Video Communications Worksite WellnessCounty HealthDepartments Emergency Medical Services Health Care Facilities Provider Services Managed Care CompliancePublic HealthAdministrativeOfficerReuben E.Davidson, III, MPA Operations SupportBureau ofInformationServicesDirectorLeonBarwick, MSBureau ofFinancialServicesChief Accountant& DirectorThomas L.White, Jr., CPACenter for HealthStatisticsComputerSystems CenterDirectorDorothy S.Harshbarger, MSDirectorJohn Heitman, MS Quality Assurance Record Services Registration Statistical Analysis InformationTechnology Operations SystemsDevelopment Technical Support
Table ofContentsBureau of Communicable Diseases .4Bureau of Health Promotion and Chronic Disease .12Bureau of Clinical Laboratories .20Bureau of Environmental Services .23Office of Professional and Support Services .26Office of Children’s Health Insurance.30Bureau of Family Health Services .31Office of Primary Care and Rural Health Development .37Bureau of Home and Community Services .39Bureau of Health Provider Standards .41Office of Radiation Control .42Bureau of Information Services .43Bureau of Financial Services.47Office of Program Integrity.49Office of Personnel and Staff Development .50County Health Departments’ Services .52ADPH Address Roster.53Public Health Areas .Inside Back Cover3
Bureau ofCommunicable DiseaseThe mission of the Bureau of Communicable Disease is to prevent and control designated communicable diseases andillnesses in Alabama. The bureau consists of the following divisions: Epidemiology, HIV/AIDS Prevention andControl, Immunization, Infection Control, Sexually Transmitted Diseases and Tuberculosis Control.EpidemiologyThe Division of Epidemiology is comprised of threebranches: Communicable Disease Surveillance, ZoonoticDisease and Environmental Toxicology.Communicable DiseaseThe Communicable Disease Surveillance Branch isresponsible for tracking the occurrence of reportable diseasesand conditions and investigating disease outbreaks andtrends. Infections generally associated with foodborne transmission continued to account for the vast majority of diseasereported to the division in 2004, including 764 cases ofsalmonellosis, 187 cases of campylobacteriosis, and 32 cases ofE. coli O157:H7. The number of E. coli O157:H7 casesreported in 2004 represents an 88 percent increase from2003 and a historic high since being monitored.There were significant declines in several diseases during2004. The 16 reported cases of West Nile virus infection in2004 represented a 58 percent decline compared to the 38cases reported in 2003. This decline was seen throughout theeastern United States as the majority of West Nile virusinfections shifted westward. Cryptosporidiosis case reportsdeclined significantly, with 56 percent fewer cases in 2004.The 17 cases of invasive meningococcal disease reported in2004 continued an eight-year downward trend, while the 10cases of hepatitis A reported this year continued a three-yeardownward trend, mimicking a national pattern of decline.Not all diseases demonstrated declines, as Rocky Mountainspotted fever case reports increased to more than double theirnumber in 2003.In 2004, the State Committee of Public Health modifiedRule 420-4-1 Notifiable Diseases to require reporting ofchickenpox (Varicella Zoster Virus or VZV) as a GroupB disease. There were 54 cases of chickenpox reported inAlabama during 2004.Cases of Notifiable Diseases by Year, 1995-2004Notifiable DiseasesCampylobacteriosisChickenpox (Varicella Zoster Virus)CryptosporidiosisE. coli O157:H7Ehrlichiosis (Human Monocytic)GiardiasisH. influenzae invasive diseaseHepatitis AHepatitis BHistoplasmosisLegionellosisListeriosisLyme DiseaseMalariaMeaslesMeningococcal invasive diseaseMumpsPertussisRocky Mountain Spotted FeverRubellaSalmonellosisSevere Acute Respiratory Syndrome (SARS)ShigellosisVibrio vulnificus infectionWest Nile 2*10* Disease not reportable or monitored during this 51621
Zoonotic DiseaseThe Zoonoses Program is charged with monitoring, controlling and preventing diseases transmitted from animals tohumans. The number of cumulative cases of animal rabies in2004 was 66. Raccoons accounted for 35 of the positive cases,and the other major species, bats, accounted for 24 positivecases. Dogs had two positive cases which testify to the effectiveness of the department’s statewide vaccination program.The Zoonoses Program cooperated in a national effort tocontain the northwest migration across Alabama of theraccoon rabies variant by the distribution of approximately400,000 doses of an oral rabies vaccine in portions of fivecounties in northeast Alabama in November of 2004. Furtherbaiting with this vaccine was conducted north of theAlabama River barrier in Autauga, Chilton, Dallas, Elmoreand Lowndes counties.This was the fifth year the Zoonoses Branch collaboratedwith the Centers for Disease Control and Prevention and 17cooperators across Alabama in a West Nile virus surveillanceproject. The effort was extremely successful and allowed forearly public alerts. West Nile virus activity was detected in 17of the state’s 67 counties and 61 of 1,124 dead birds testedwere positive for the virus. In addition, five horses were foundto be positive for West Nile virus. Of the 1,444 mosquitopools tested, 27 were found to be positive for West Nile virus.These figures indicate a high level of West Nile virus circulating among mosquitoes and birds across Alabama.Public Health AssessmentsThe Public Health Assessments program evaluates hazardous waste sites in Alabama to identify actual or potentialhealth hazards, determine the extent of risk and populationsat risk, and to communicate the hazards to the public andother agencies. This includes recommended ways for individuals to avoid or minimize the risk. Hazardous waste sites areusually industrial facilities, landfills or other locations wherehazardous substances or contaminants have been accidentallyor intentionally released into the environment.In 2004, the program responded to concerns at 22 sitesin 17 counties. Completed activities include eight healthevaluation documents, 12 community involvement activitiesand six environmental health education activities. AlabamaDepartment of Public Health produced and distributedstatewide fish consumption advisories. Program personnelcontinued their participation in the Alabama ComprehensiveCancer Control Coalition and the Calhoun County Protocolfor Assessing Community Excellence in EnvironmentalHealth. Personnel furnished presentations on buildingcommunity capacity at a national conference, on riskcommunication at a state training program and on contaminants in fish on television and radio programs.The department has also become involved in the initialaspects of environmental epidemiology investigations wheremembers of the group work from a patient base workingbackward to discover the causes for symptomology. This isthe opposite mechanism that is normally employed, thatbeing from a known situation to identification of individuals/populations that might have become exposed.Infection ControlThe Infection Control Section of the bureau has as itsmission: 1) to provide infection control and infectious diseasetraining and consultation and 2) to develop infection control-related policies and procedures. These services are structured to meet the needs of the Alabama Department ofPublic Health, the medical community and the general public.During 2004, educational training programs were provided via satellite teleconferences and onsite to a total of 6,253participants. These individuals included health care providersfrom the Alabama Department of Public Health, hospitals,extended care facilities, physician and dental offices as well asother sectors (day care and Head Start providers, teachers,nursing students, cosmetologists, penal systems, and variousindustries). The teleconference training programs were transmitted nationally to participants in 37 states.Alabama’s Infected Health Care Worker ManagementAct of 1995 mandates that health care workers who arechronically infected with hepatitis B or the human immunodeficiency virus report themselves to the state health officer.The purpose of the law is to prevent transmission of thesebloodborne viruses from infected health care workers whoperform invasive procedures to their patients. InfectionControl personnel provided consultation, initiated investigations and conducted appropriate follow-up of these reportedindividuals.The Alabama Department of Public Health RefugeeHealth Screening Program ensures newly arriving refugeesinto Alabama are provided appropriate health screenings andhealth education training. This program is coordinated byInfection Control staff to ensure that communicable andinfectious diseases are not introduced into, and transmittedwithin, the state. One hundred sixteen refugees werescreened by this program in 2004. The 116 refugees arrivedfrom the following countries:Africa:Burundi .3 Kenya .3Cameroon .4 Liberia.12Egypt .2 Somalia .15Ethiopia .2 Sudan .1Ivory Coast .6Other Countries:Bosnia.1 Iran.3Burma .3 Philippines .7China .5 Spain .1Cuba .35 Ukraine.3India.2 Vietnam .8The Infection Control Section continues to providedisease education and training programs for body artistswithin the state. This infectious disease/infection controleducational training is mandated by law for body artists tomaintain a license to perform body art procedures such astattooing or piercing in the state of Alabama.5
HIV/AIDS Prevention and ControlThe mission of the Division of HIV/AIDS Preventionand Control is to reduce the spread of HIV infection amongpeople living in Alabama and to raise HIV awareness throughtesting and ongoing educational programs and forums. Thedivision staff has continued to improve implementation ofthese service goals increasingly by working directly withcolleagues, state and private service organizations, peopleliving with HIV, community leaders and other interestedcitizens.Through the Prevention program the division continuedto educate with the goal of preventing new infections.Through the Direct Care program, services were coordinatedto improve the quality of life for persons living with HIV andAIDS. Both programs were able to offer HIV testing to createawareness of current HIV status at no cost to clients. Thedivision’s work with the prison system offers preventionservices to staff and inmates who will one day return to theircommunities. Through the Surveillance program the divisionwas able to create awareness of the growth of the epidemic inAlabama and thereby target services to populations infectedand affected. Surveillance data provide the base that supportsall HIV/AIDS public and private funding initiatives.In 2004, the Centers for Disease Control and Preventionbegan a national HIV prevention initiative for the currentfive-year funding cycle. The division began the year bysponsoring a meeting to introduce the “Advancing HIVPrevention: New Strategies for a Changing Epidemic,”initiative to representatives from AIDS service organizations,community-based organizations, and HIV and STD programstaff. The new direction for prevention is aimed at reducingbarriers to early diagnosis of HIV infection, increasing accessto quality medical care/treatment, and ongoing preventionservices for those diagnosed with HIV.Another major transition for the division was therestructuring of the HIV Prevention Community PlanningGroup (CPG) process. The 11 groups have now become onecentralized group with statewide selection of participantsthrough a formal application process. Members will representgrass root concerns reflected in the Alabama HIV PreventionComprehensive Plan. Most importantly, the division stronglyvalues the community participation process and field staffcontinues to host bimonthly regional HIV PreventionNetwork meetings with community partners to implementprevention programs and events. The Enhanced ReferralTracking System was piloted this year in public health areas 3and 10. HIV positive clients not in care are identified incollaboration with the STD Program and linked by an HIVprogram coordinator to an AIDS service organization. Thereferral tracking system will be fully implemented in 2005.Finally, the Alabama Capacity Building Assistance (CBA)team conducted focus groups and surveys to help the divisiondetermine the skills and educational needs of those engagedin HIV prevention work. The results from these sources willenable the division to access national CBA partners offering6specialized assistance to retool prevention efforts in tandemwith the CDC vision.The goal of the Direct Care Branch is to ensure thatquality care is provided to HIV/AIDS residents in Alabamaby monitoring the quality of HIV clinical and supportiveservices provided by Ryan White Title II f
Richard A. Kean, DDS, MD Montgomery Council on Health Costs, Administration and Organization Ronnie E. Opolka, RPh Guntersville Council on Prevention of . BULLOCK MACON RUSSELL LEE CHAMBERS TALLAPOOSA CLAY CLEBURNE CALHOUN CHEROKEE ETOWAH DEKALB JACKSON MADISON MARS
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