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Dr. Brian Amy

hen the Mississippi Legislature convened Jan. 2, and despite a just-past chaotic year of unheralded public scrutiny and Senate Committee's "no confidence vote" for the state's top medical officer, nobody had filed any proposal to remedy numerous problems within public health. The Board and the Department of Health management teams in place at the end of 2006 remained but faced an uncertain future.

At the same time, public health advocates expressed serious concerns about rapidly rising infectious disease numbers — new cases of communicable disease reported by the state department itself via its Web-based Mississippi Morbidity Reports, November 2006.

Public health advocates, workers, and dependents wonder whether lawmakers will institute Mississippi Code § 41-3-20, thereby repealing Sections 41-3-1 through 41-3-19 to end both Board and Department.

The "sunset" provision would repeal — effective June 30, 2007 — those sections which created and prescribe the powers and duties of the State Board of Health and the State Department of Health.

The board met Dec. 13, 2006, a meeting "called" at the routine quarterly gathering in October to hear the state health officer's "plan for corrective action" and determine whether to keep Dr. Brian Amy at the state department's helm.

Amy presented what he dubbed State Health Officer's Plan for 2007 & Beyond via slides and a full script in three-ring binders for board members. He complained that political pressure and interference in regulatory matters, Hurricane Katrina, and a decrease in state general funding hampered success in 2005. He promised "organizational enhancements and operational deployments" that would "prioritize communicable disease and epidemiology."

After the December meeting, at least one board member said that counsel from the attorney general's office advised them not to fire Amy on threat of suit based on violation of due process. Just five of the 12 board members present reportedly voted to oust Amy.

Public health proponents expressed dismay, and advocates underscored the need for change, even if based only on rising disease rates.



Reportable Infectious Diseases

In November's report, the latest report available at press time, comparison of state year-to-date totals (YTD) for infectious diseases reported in November 2005 and November 2006 revealed dramatic increases in primary and secondary syphilis, total early syphilis, HIV disease, pulmonary tuberculosis, and West Nile Virus.



Tuberculosis

In Mississippi, tuberculosis cases soared from 70 to 93 — almost 33 percent more new cases in 2006 compared to just a year before. Biostatisticians suggest that could be Mississippi's first increase in tuberculosis (TB) case rates in 15 years and a solid predictor of long-term disease control problems.

For the nation, the 14,097 TB cases reported to the Centers for Disease Control and Prevention (CDC) for 2005 represented a 2.9 percent decrease from 2004 and a 47 percent decrease from 1992, when the number of cases and the case rate peaked during resurgence in the United States.

Bacteria called Mycobacterium tuberculosis cause TB. The bacteria usually attack the lungs but can attack any part of the body such as the kidney, spine, and brain. If not treated properly, TB disease can kill; TB disease once led causes of death in the United States.

TB spreads through the air from one person to another, for example, when a person with active TB disease of the lungs or throat coughs or sneezes. People nearby may breathe in these bacteria and become infected. Not everyone infected with TB bacteria becomes sick. People who are not sick have latent TB infection; they do not feel sick, do not have any symptoms, and cannot spread TB to others. But some people with latent TB infection go on to get TB disease. People with active TB disease can be treated and cured if they seek medical help. Even better, people with latent TB infection can take medicine so that they will not develop active TB disease.

Historically, Mississippi has struggled with curbing the disease to prevent huge surges of multi-drug resistant TB in years to come.



Primary & Secondary Syphilis

Primary and secondary syphilis cases jumped year-to-date (YTD) from 46 to 69 — a 50 percent swell. Despite the increases, the department's Web site still proclaims, "In 1995, Mississippi was ranked number one in primary and secondary syphilis nationally, with a case rate of 78 per 100,000. By Dec. 31, 2002, this was reduced to 1.7 cases per 100,000."

The Mississippi expansion shadows national reports. According to the CDC, the rate of primary and secondary (P&S) syphilis — the most infectious stages of the disease — decreased throughout the 1990s and in 2000 reached an all-time low. For the next five years, though, the syphilis rate in the United States increased; between 2004 and 2005, the national P&S syphilis rate increased 11.1 percent, from 2.7 to 3.0 cases per 100,000 population.

CDC describes syphilis, a genital ulcerative disease, as highly infectious but easily curable in its early (P&S) stages. If untreated, syphilis can lead to serious long-term complications, including neurologic, cardiovascular, and organ damage, and even death. Congenital syphilis can cause stillbirth, death soon after birth, and physical deformity and neurological complications in children who survive. Syphilis, like many other STDs, facilitates the spread of HIV, increasing transmission of the virus at least two to five-fold.



HIV

Mississippi HIV cases were up for the year, too: 587 against 532 YTD, a 10 percent increase. Unpublished reports indicate the end-of-year total for new HIV cases could top 660.

CDC's Web site sheds more light on HIV infection, which "produces a spectrum of disease that progresses from a clinically latent or asymptomatic state to AIDS as a late manifestation. The pace of disease progression varies. In untreated patients, the time between infection with HIV and the development of AIDS ranges from a few months to as long as 17 years (median: 10 years). The majority of adults and adolescents infected with HIV remain symptom-free for extended periods, but viral replication is active during all stages of infection and increases substantially as the immune system deteriorates. In the absence of treatment, AIDS will develop eventually in nearly all HIV-infected persons."

Advice from CDC relates specifically to reporting HIV infection: "Data on HIV infection (not AIDS) should be interpreted with caution. HIV surveillance reports may not be representative of all persons infected with HIV because not all infected persons have been tested." Commentary on cases of HIV infection and AIDS in the United States, 2004, can be found online at http://www.cdc.gov/hiv/topics/surveillance/resources/reports/2004report/commentary.htm.



Other Notable Mississippi Increases

· West Nile Virus more than doubled, with YTD cases 185 compared to 85 in 2005.

· Invasive H. influenzae disease more than doubled YTD, from six to 13 cases.

· New cases of E. coli 0157:H7/HUS increased from 7 to 12.

Despite criticism from the medical community, elected officials, the mass media, and individual citizens, the state department has posted no news release to warn the consumer public of these disease increases, except in relation to influenza and West Nile Virus. That opposes the CDC position and practice (posted on www.cdc.gov) that "effective communication is essential to fulfilling the core public health functions of assessment, policy development, and assurance. The public health system relies extensively on the accurate and timely flow of information to and from public health agencies. Poor communication processes can undo otherwise effective public health efforts."



February 2007

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