July 5, 2018
On July 19, North Carolina Attorney General Josh Stein will present the keynote address at a daylong conference in Asheville on the ethical issues healthcare professionals face when treating patients who are struggling with opioid use disorders (OUDs) and substance misuse. The Attorney General will provide an update and discuss the ethics of North Carolina’s formal response to the opioid crisis.
June 22, 2018
The purpose of National Hernia Awareness Month is to raise the public knowledge of the warning signs and latest treatment options available regarding hernias. It is estimated that more than 5 million persons have some type of hernia, but only 750,000 people per year actually seek medical attention.
May 23, 2018
This month, and especially in the past week, we have seen an increase in confirmed cases of pertussis throughout Buncombe County, mainly in school-aged children. Our Communicable Disease Control staff are working with school nurses and school administration to inform parents of exposed students, identify additional symptomatic individuals, and provide prophylaxis for high-risk contacts. Letters have been sent to parents of students who may have been exposed to pertussis. The letter asks them to contact their child’s doctor to prescribe prophylactic antibiotics against pertussis to their child if the child:
- has a weakened immune system or a pre-existing health condition that may be worsened by a pertussis infection; or
- lives with or has close contact with any of the following people:
- A woman who is in her third trimester of pregnancy,
- An infant younger than 12 months old, or
- Anyone with a weakened immune system or other pre-existing health condition that may be worsened by a pertussis infection.
The letter also instructs parents that if their child has recently started coughing, they should keep them out of school & group activities and inform their child’s health care provider of their symptoms and that they might have been exposed to pertussis. They have also been given a “Dear Colleague” letter (attached) to share with their provider that outlines clinical recommendations for testing, treatment and exclusion.
Please consider pertussis in your differential when seeing anyone who has the symptoms listed below. Test, treat, exclude & report whenever you suspect a case of pertussis. (More details below.) It is critical that you notify our Communicable Disease Control nurses immediately whenever you suspect a patient of having pertussis – this enables us to stop the spread of infection in our schools and community. For Buncombe County Communicable Disease staff, call 250-5109 (available 24/7/365).
Please promote pertussis immunization for everyone, but especially for those who are in their 3rd trimester of pregnancy or in contact with infants.
- BCHHS Immunization Clinic (53 S. French Broad Ave., ground floor) is open Monday-Friday, 8am-5pm, no appointment necessary. We will be closed Memorial Day. We are able to provide low- or no-cost Tdap to clients who are under- or uninsured.
Symptoms of pertussis: In the absence of a more likely diagnosis, persons with the following symptoms should be suspected of having pertussis:
· Cough lasting for > 2 weeks PLUS 1 of the following
o paroxysms (violent fits) of coughing
o inspiratory whoop
o post-tussive vomiting
o apnea (with or without cyanosis) in an infant < 1 year old
· Keep in mind that infants < 6 months of age, partially vaccinated children, adolescents and adults frequently do not have the characteristic whoop and may have other atypical features.
If you suspect someone of having pertussis based on their signs/symptoms, please DO ALL 4 of the following steps:
- Collect both a PCR and culture of nasopharyngeal secretions for Bordetella pertussis.
o For the PCR test, consider ordering a PCR Respiratory Panel that offers same-day results for common respiratory pathogens, including Bordetella pertussis. Clearly, use your clinical judgment to balance the costs of any tests you order with the utility it can offer in the diagnosis & management of your patient. PCR tests can be falsely negative or falsely positive if not ordered appropriately, so make sure to order only in patients who have the signs & symptoms of pertussis.
- Please note that we do NOT perform testing for pertussis at Buncombe County Health and Human Services.
- If you have to send a patient suspected of having pertussis elsewhere for lab work, please be sure to provide them a mask to wear.
- Macrolides are first-line treatment. For adults, the easiest option is Azithromycin 500 mg PO x 1 day, then 250 mg PO daily on days 2-5.
- If allergic to macrolides, prescribe TMP/SMX (160 mg/800 mg) PO BID x 14 days.
- See Table 4 at this link for dosing regimens for children as well as other macrolide dosing https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5414a1.htm#tab4
- Persons suspected of having pertussis should refrain from all public activities, staying home from school, childcare, extracurricular activities, places of worship, and work until they have completed the first 5 days of appropriate antibiotics.
o They especially should avoid contact with infants & young children and pregnant women.
- Persons suspected of having pertussis who choose not to take antimicrobial treatment should stay isolated at home for 21 days from their onset of cough or until their cough resolves, whichever occurs first.
- Per NC law, medical providers must report all suspected and confirmed cases of pertussis to your local health department within 24 hours.
o For Buncombe County, call our Communicable Disease Control nurses at 250-5109 (available 24/7/365).
o It is very helpful to our investigation if you can tell us if the person suspected of having pertussis has any high-risk contacts (infants, pregnant women, or persons with an underlying medical condition that may be worsened by pertussis).
§ Be aware that when BCHHS Communicable Disease nurses conduct pertussis investigations and find symptomatic contacts to suspected or known cases, we ask these persons to see their primary care provider for testing and evaluation.
For more details on pertussis, see https://www.cdc.gov/pertussis/clinical/
Our Communicable Disease nurses are also available for consultation if you are uncertain of how to proceed or want to talk through a scenario. Please call them at 828-250-5109 anytime you have questions.
May 11, 2018
Dear fellow WNC providers,
I am proud to announce that UNC Gillings School of Global Public Health will be starting a Masters in Public Health Program this fall in Asheville. Applications for this program will open later this month and classes will begin August 21.
December 21, 2017
As of yesterday, Henderson County’s pertussis outbreak had increased to 52 cases, mainly in school-aged children. So far, in Buncombe County, we have had 1 probable case (lab negative, but symptoms consistent with pertussis).
Please remain vigilant and continue to promote pertussis immunization for everyone, but especially those in their 3rd trimester of pregnancy or in contact with infants.
December 6, 2017
As you are likely aware, an outbreak of pertussis is currently happening in Henderson County – as of last night, 10 cases have been identified, affecting numerous schools. Investigation and contact tracing by Henderson County Department of Public Health is ongoing. Additionally, other surrounding counties have confirmed cases.
November 22, 2017
CMS updates Medicare Advantage Value-Based Insurance Design (VBID) Model for 2019
Expansion of model to 25 total states to provide Medicare beneficiaries with more choices and lower costs
The Centers for Medicare & Medicaid Services (CMS) today announced several updates to the Medicare Advantage Value-Based Insurance Design (VBID) Model for 2019 that encourages customized benefit designs and flexibilities that meet the health needs of beneficiaries in a total of 25 states.
“This Administration is committed to making sure that our seniors have more choices and lower premiums in their Medicare Advantage plans,” said CMS Administrator Seema Verma. “CMS expects that this demonstration will provide insights into future innovations for the Medicare Advantage program.”
CMS recently announced in the Medicare Advantage and Part D proposed rule that it is providing new flexibility for customized benefit designs that address the specific health needs of certain beneficiaries under Medicare Advantage. This allows additional plan variety and options, reduced cost sharing for customized benefits and different cost-sharing for beneficiaries that meet specific medical criteria
November 21, 2017
MAHEC hosts RWJF-funded workshop on December 7 to support shared decision making for patients
On December 7, the National Patient Advocate Foundation (NPAF) and the Mountain Area Health Education Center (MAHEC) will host the first of two national skilled communications workshops to support shared decision making in healthcare.
"Person-centered care requires that patients and providers have the communications skills to talk about what matters at critical points in the treatment process,” shares Gwen Darien, NPAF executive vice president for patient advocacy. “This workshop brings patients, providers and community advocates together to identify and develop those skills.”
November 14, 2017
Buncombe County Commissioners will hold a press conference at 4 p.m. on Tuesday, November 14 to announce the filing of a lawsuit in the fight against the distribution of opioids.
November 13, 2017
The Mountain Area Health Education Center (MAHEC) is offering Basic Life Support in Obstetrics (BLSOSM) trainings on November 30 and December 11 at its Biltmore campus to help healthcare providers, first responders and emergency personnel effectively manage normal deliveries and obstetrical emergencies.
November 6, 2017
On Monday, November 13, Mountain Area Health Education Center (MAHEC) will welcome
Dr. Hendrée Jones from UNC Chapel Hill to discuss strategies for improving health outcomes for women with opioid use disorder during pregnancy.
October 25, 2017
CDC issued the attached Health Advisory on 10/24/17 to remind clinicians assessing patients currently in or recently returned from hurricane-affected areas to be vigilant in looking for certain infectious diseases, including leptospirosis, dengue, hepatitis A, typhoid fever, vibriosis, and influenza.
October 25, 2017
In 2005 this patient went in for surgery to correct a deviated septum. The surgery was successful and he was discharged home with a prescription for 30 Percocet tablets. His recovery was uneventful and when he went back for a re-check and reported that he had not needed to take any of the pain pills he was given the surgeon informed him that this was pretty much a “painless surgery.” When he asked why he been given the 30 pills he was told it was “expected.”
October 2, 2017
The BCHHS Communicable Disease phone and fax lines are back in service. If you tried to call or fax a communicable disease report to us on 9/30 or 10/1, please resend that information at this time to ensure we have all the information we need.
In general, BCHHS Communicable Disease staff are available 24/7 by calling 828-250-5109 or fax at 828-250-6169.
- If you ever try to contact them at these numbers and are unable to leave a message or your fax fails to go through, please contact me at 828-989-6145 or Ellis Vaughan, our Clinical Services Coordinator, at 828-545-6740.
As a reminder, physicians in NC are required by state law (NC General Statute § 130A-135) to report suspected or confirmed communicable diseases to the local health department. The Communicable Disease report form for Buncombe County is located at https://www.buncombecounty.org/common/health/Morb_Card.pdf. Please review the list of reportable diseases and conditions on the form, as well as the time frame for reporting them to public health.
Finally, we have had situations where health care providers have been hesitant to share protected health information with our Communicable Disease nurses during their investigations. Please understand that release of this information is allowable under HIPAA. See the attached memo from the NC DHHS for specifics.
Thanks for working with us to identify, contain and manage communicable diseases in our community.
September 15, 2017
This memo is intended to provide updated guidance on Zika virus testing and caring for pregnant women with possible Zika virus exposure.