The Journal of the Arkansas Medical Society Med Journal May 2020 Final 2 | Page 14

by Nathaniel Smith, MD, MPH
Secretary of Health
Case Study
The State of Public Health in Arkansas in 2019
T
he activities of the Arkansas Department
of Health in 2019 were driven by its mis-
sion of protecting and improving the
health and well-being of all Arkansans.
ADH sought opportunities for innovation, effi-
ciency, and improvements in its operations and
responded to unexpected challenges. ADH’s ‘‘Be
Well Arkansas’’ initiative continued its outreach
to Arkansans in assisting them with tobacco ces-
sation, hypertension, and diabetes resources.
ADH also embraced the President’s HIV elimina-
tion challenge in Arkansas while responding to
ongoing outbreaks due to Hepatitis A, Legionel-
la, and Mumps.
While ADH launched ‘‘Be Well Arkansas’’
initiative in November 2018, the year 2019 saw
it grow to its full potential by reaching out to Ar-
kansans across the state for tobacco cessation
and referral to community hypertension and di-
abetes resources. A total of 3,376 Arkansans were
enrolled in the tobacco cessation counseling pro-
gram, with an estimated 34% quit rate. Nine-hun-
dred and thirty-two Arkansans were referred to
community hypertension resources, and 433
Arkansans were referred to community diabetes
resources. The Arkansas Legislature also passed
the Tobacco-21 legislation, which increases the
minimum age of purchase for tobacco products
in Arkansas to age 21 by the year 2021.
Arkansas ranks first and seventh, respective-
ly, among states for fatal complications of hyper-
tension, heart attack, and stroke. In 2019, efforts
to address stroke included: (a) increasing partic-
ipation in the Arkansas Stroke Registry, now in-
volving 77 of the state’s acute care hospitals; (b)
coordinating efforts to ensure over 800 health-
care providers received certification with the Ad-
vanced Stroke Life Support (ASLS) credential; (c)
orchestrating educational and quality improve-
ment efforts for EMS agencies, hospitals, and
emergency departments; (d) releasing a stroke
care quality improvement toolkit for EMS and (e)
integrating “stroke bands” into Arkansas’s sys-
tem of care to tie together EMS and hospital data
and support quality improvement efforts. Pro-
grams to reduce ST-segment elevation myocar-
254 • The Journal of the Arkansas Medical Society
dial infarction (STEMI) fatality in 2019 included:
(a) increasing participation in the Arkansas Heart
Attack Registry now involving 27 percutaneous
coronary intervention hospitals; (b) supporting
a real-time mobile communications platform in
three regions (Northeast, Arkansas Valley, and
Southwest) to improve STEMI care coordination
between EMS and hospitals; and (c) providing
educational materials to EMS and hospital teams
to share with the community to help the public
know the signs and act in time by calling 911
when heart attack is detected. In addition, hospi-
tal teams are connecting patients with the ADH’s
“Be Well Arkansas” initiative to give them online
and text resources to help address risk factors for
both stroke and heart attack. environment, like showerheads, hot tubs, and
cooling towers. Of the 68 cases identified, 64 were
confirmed, three were suspected, and one is on-
going. Inhalation of aerosolized water containing
gram-negative bacteria of the genus Legionella
spp. can cause Legionnaires’ disease. Persons at
increased risk of infection include persons over
50 years of age, current or former smokers, per-
sons with chronic lung conditions, or immuno-
compromised persons. Garland county had the
most investigations (15) of any county with 14
confirmed cases. Water management plans for
the built environment are the most effective way
to reduce exposures to Legionella. When appro-
priate, ADH encourages and assists building own-
ers with water management plan development.
The Arkansas Department of Health contin-
ued its response to an outbreak of Hepatitis A
among high-risk individuals, including people
who use drugs, persons experiencing homeless-
ness, and men who have sex with men (MSM).
Since February 2018, 471 cases, predominantly
among men (64%), white individuals (93%), and
recreational drug users (60%), have been report-
ed to ADH. ADH has responded to the outbreak
by providing targeted vaccination campaigns in
counties and risk populations that are dispropor-
tionately impacted. Thus far, more than 35,000
individuals have been vaccinated at mass clin-
ics, jails, homeless shelters, substance misuse
treatment centers, and other settings. The ADH
outbreak response section also worked on a
mumps outbreak at the University of Arkansas at
Fayetteville in 2019. The outbreak was declared
to be over on February 10, 2020, after complet-
ing two incubation periods (52 days) without a
new case associated with the U of A Fayetteville
campus.  All students and faculty/staff have been
back to normal campus activity since then. A total
of 3,692 MMR vaccines were given at U of A Fay-
etteville to both students or campus employees/
faculty/staff in relation to this outbreak. There were 254 persons reported as new-
ly-infected with Human Immunodeficiency Virus
(HIV) in Arkansas in 2017. In that same year an
additional 152 persons were reported as new
cases of Acquired Immuno-Deficiency Syndrome
(AIDS). During his 2019 State of the Union ad-
dress before the U.S. Congress in on Feb. 5, 2019,
President Trump challenged the country to work
towards the elimination of the HIV epidemic in
the U.S. by 2030. The President’s goal, simply
stated, is to ensure a 75% reduction in new HIV
infections in five years, and at least 90% reduc-
tion in new HIV infections in ten years. Living-in-
fected-and-undiagnosed forms the basis of one
of the major focus of ongoing HIV prevention ef-
forts by both the CDC and HRSA. At the moment
ADH efforts are to integrate with and support
ongoing HIV prevention initiatives to target this
cohort. Another aspect of the initiative is to offer
high-risk individuals who may develop HIV with
Pre Exposure Prophylaxis (PrEP). ADH is explor-
ing options to identify these high-risk individuals
who may benefit from PrEP and at the same time
encourage community providers to offer PrEP to
high-risk groups. ADH has the expertise to train
community providers who may be interested in
offering PrEP services in their practices. ADH cur-
rently has an Integrated HIV Prevention & Care
Plan for the State of Arkansas as well as an End-
ing the Epidemic plan under development. All
In 2019, ADH investigated 79 possible Legio-
nella cases, of which 11 were determined not to
be cases. Legionella naturally occurs in the envi-
ronment but exposures occur through the built
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