The Journal of the Arkansas Medical Society Med Journal July 2019 Final 2 | Page 10

by CASEY L. PENN
Public Health Update
I
n an update on public health in Ar-
kansas, Arkansas Department of
Health Chief Medical Officer Gary
Wheeler, MD, touched first on wins
and losses associated with recent leg-
islation. Act 5580, sponsored by Andy Davis, in-
cluded a win for the state according to the ADH. “This
Act puts into law that people under 21 years of age
will no longer be able to purchase tobacco products,”
explained Dr. Wheeler. “We are happy to see this in
the state.”
Presenter: Gary Wheeler, MD, MPS
down to ages as young as seven. “There’s not much
evidence that it increases vaccination rates by hav-
ing pharmacists give the vaccines, but our main
worry is that kids will go to their pharmacists to get
only what they’re required to get for school and not
get their HPV vaccines and not visit their pediatrician
for annual well visits.”
Another big win, Act 829, will fight maternal mor-
bidity and mortality. “Arkansas is #4 in the nation in
maternal morbidity and mortality,” said Dr. Wheeler.
“This legislation puts in place a mechanism to fight
common reasons for maternal morbidity. Maternal
hemorrhage, preeclampsia, and suicide are the three
biggest causes of maternal mortality, and this com-
mittee is going to get to work to make sure every
woman in this state gets a fair chance to survive and
that the resources are distributed. We’re thankful to
Rep. Deborah Ferguson for leading that bill.”
Ongoing Efforts: Hepatitis A,
Antimicrobial Resistance, Tuberculosis,
Ebola, HIV
Gary Wheeler, MD, MPS
“On immunization, Act 676 will require all
schools to post online and locally the number of
people who are not up-to-date on their vaccines,” he
said, of another win. “Under the current law, you’re
not supposed to be able to go to school unless you’re
up-to-date on your immunizations, yet we know that
we don’t get anywhere close to where we need to be.
It’s an issue. The number of kids who are exempted
is less than 2%, so most of the kids are not getting
vaccines because schools aren’t requiring them. Still,
exemptions are a problem. In the Searcy school dis-
trict, 9% of kids are exempt. That’s a hot spot where
measles and other transmissible infections could get
in that could be prevented by vaccines. So that’s an
important bill.”
On the loss side, pediatricians weren’t in favor
of a bill allowing pharmacists to give immunizations
Hepatitis A is a problem in Arkansas. The state
has seen more than 300 cases since the outbreak
began last February. “Most of the patients are white,
most are men,” revealed Dr. Wheeler. “We’ve had a
couple of deaths. I should note we’ve had only two
teens affected. This is because roughly 15-16 years
ago, Hep A vaccines became required for newborns
or infants. They’ve been getting the vaccine, and
we’ve seen virtually no cases. One case was an un-
vaccinated teen.
“It’s been a long haul, but we think our efforts
have been effective at containing the outbreak. A sur-
prising feature is there are a lot of drug users who
catch and spread this. An alarming fact is that about
49% of adults getting this have been hospitalized.
That is unusual with this disease, which is usually a
disease of childhood.”
ADH is working on management of Hepatitis
A through containment strategies like education, a
focus on handwashing, and giving vaccines to those
who had close contact with cases.
“The World Health Organization has identified
antimicrobial resistance as one of the top 10 threats
10 • THE JOURNAL OF THE ARKANSAS MEDICAL SOCIETY
to human wellbeing and survival; it has been rec-
ognized as such here in the U.S. also through White
House and other conferences,” said Dr. Wheeler,
adding that this problem is driven by failure to ex-
ercise antimicrobial stewardship in Arkansas and
worldwide. “As a consequence, there is a rise of
C-diff [Clostridium difficile] that has left the hospital
and is out in the community now and there’s a rise
in drug-resistant organisms, gram negatives, VRSA,
MRSA, and Candida auris. We are seeing high rates
of MSRA and advanced resistance to gram nega-
tives. Recently, we’ve had problems with medical
tourism. One outbreak was related to people get-
ting stomach slings in Mexico and coming back
with infections.”
In response, ADH is working with hospitals
around the state to prevent health-care-associated
infections and to talk about stewardship. “If you have
a resistant gram negative in your office and you’re
not sure what to do with it, you can send that isolate
to us and we can confirm whether it’s a true prob-
lem and suggest an intervention,” said Dr. Wheeler.
“We partner with infection control practitioners in the
state to isolate infected patients so that it doesn’t
spread throughout your institution. We’ve collaborat-
ed with The Journal (See April 2019 issue) recently
to disseminate a letter to promote stewardship also.
When it comes to tuberculosis, there have al-
ways been containment efforts, but there’s been
little elimination activity. “There’s never been a sus-
tained effort to find folks with latent disease and
treat that,” said Dr. Wheeler. “We initiated such an
effort among the Marshallese in northwest Arkansas
and have expanded to south Arkansas. Our efforts
actually preceded similar efforts by the CDC in the
Marshall Islands. We’ve participated in two trips with
them there.”
Eliminating HIV is another big push, and one
that the current federal administration has made
a priority. “President Trump wants to eliminate HIV
in the U.S., and there’s no reason not to,” said Dr.
Wheeler. “We have the drugs, tools, and providers.
All we have to do is make sure there’s the will at the
provider level, at the patient level, and at the federal
support level.”
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