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‘Pay close attention’ so your county, our state doesn't repeat a public health emergency
e-Reports, April 20, 2015
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The outbreak of HIV cases in Scott County prompted Executive Order 15-05 declaring a public health emergency. Both Gov. Pence and State Health Commissioner Jerome Adams, MD, MPH, issued a strong caution when they visited the area.

The Indiana State Department of Health encourages health care providers and local health departments to promote testing for HIV and hepatitis C among patients, particularly those who report or show signs of injection drug use or other high risk behaviors. Health care providers are also encouraged to thoroughly screen each patient encountered for such risks and counsel them regarding treatment options and resources for HIV, hepatitis C and drug addiction. Health care providers can also become familiar with certain information ahead of the spread of HIV in their community. ISDH recommends health care providers take the following steps:

 

  • Know hepatitis C and HIV case counts and rates in your county.
  • Detect closed social networks.
  • Determine prevalence of substance abuse, particularly injection drug use.
  • Identify resources including HIV testing/treatment services, substance abuse treatment services and insurance enrollment procedures.

"If we don't pay close attention to what’s going on here, we’re going to be doomed to repeat it throughout all of Indiana and our country," Dr. Adams cautioned.

Scott County Health Officer R. Kevin Rogers, MD, said the epidemic took him by surprise. “We had less than 5 cases per year for several years and all of a sudden, we had 30 cases. It certainly had not been a trend we’d been seeing for several years. Suddenly, when I looked at our monthly statistics, I saw 30 cases of HIV.”

At presstime, that count is at 106, with 95 confirmed and 11 preliminary cases.

Surprises like this are costly in terms of resources and human suffering. They require, as stated in the Executive Order, “all available resources of the state government and of each political subdivision of the state reasonably necessary to cope with the disaster.”

As head of the Indiana State Department of Health, Dr. Adams told reporters, the public and health care providers, “The lessons of the HIV outbreak in southeastern Indiana are still being learned; however, we do know that this HIV outbreak was identified through the cycle of screening/testing, surveillance and contact tracing.

"Health care providers should be vigilant about discussing risk factors for HIV, including intravenous drug use. All health care providers should conduct routine screening, as well as timely reporting of positive lab results and diagnosis. This should be followed by prompt contact tracing to identify other potential exposures and initiative testing."

The Indiana Health Alert Network message below was sent to health care providers statewide on Feb. 24, regarding the outbreak.

More about screening, prevention
Janet Arno, MD, and Diane M. Janowicz, MD, from Indiana University School of Medicine Division of Infectious Diseases are both involved in the HIV clinic being established in Austin, Ind., epicenter of the outbreak.

"As an infectious disease physician, I think it is important for practitioners to know, if they don’t already, that the CDC (Centers for Disease Control and Prevention) and USPSTF (U.S. Preventive Services Task Force) both recommend universal HIV screening for adolescents and adults at least once in all health care settings; more frequent HIV screening or testing should be offered to patients who have identified risk factors for acquisition of HIV," said Dr. Janowicz.

"Additionally, all pregnant women should be screened during pregnancy and those who are at high risk should be offered repeat testing during the third trimester," Dr. Janowicz noted. "HIV screening can be offered in an opt-out manner in which patients have the opportunity to ask questions and the option to decline."

For information on Care Coordination, individuals are encouraged to call the ISDH HIV Services Hotline at (866) 588-4948. The 24/7 Addiction Hotline is (800) 662-HELP (4357).

Do you know who your county health officer is? Find a link to a listing at in.gov.

 Dr. Tharp  Dr. Burke  Dr. Azad
Photos left to right: Three ISMA past presidents, Stephen Tharp, MD, and Kevin Burke, MD, both county health officers, as well as Deepak Azad, MD, who practices in Scottsburg, testified at the Statehouse in support of a measure to allow a needle exchange program for all 92 counties in the state during this health emergency. In his Executive Order 15-05, the governor subsequently allowed a 30-day needle exchange program for Scott County.
Copyright: Information written and displayed on www.ismanet.org is the property of ISMA and may not be reproduced without expressed written permission of the Indiana State Medical Association.

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