Top 10 public health stories in Utah in 2018

It’s time once again for our top 10 public health stories in Utah for 2018.

1. Utah Medical Cannabis Act becomes law
On December 3, 2018, Utah lawmakers passed House Bill 3001: Utah Medical Cannabis Act. This legislation replaces Ballot Proposition 2, which was approved by Utah voters in the November 2018 general election.

The Utah Medical Cannabis Act directs the Utah Department of Health (UDOH) to issue medical cannabis cards to patients, register medical providers who wish to recommend medical cannabis treatment for their patients, and license medical cannabis pharmacies. These activities must be implemented by March 1, 2020. Medical cannabis treatment will be allowed for patients with certain qualifying medical conditions. The UDOH will begin accepting applications for medical cannabis patient cards by March 1, 2020. Prior to January 2021, under Utah law, patients meeting certain criteria outlined in the Medical Cannabis Act may legally possess medical cannabis without a medical cannabis card. Compliance with the Utah Medical Cannabis Act may not protect patients from liability for violations of federal law or the laws of other states.

2. Heroin deaths declined in Utah
For the first time in six years, the state of Utah experienced a decrease in heroin-related overdose deaths (2017). Additionally, data showed that the number of prescription opioid overdose deaths declined for the third consecutive year and the rate of opioid death in the state fell below the U.S. rate – the first time in decades this has happened. Utah was one of only nine states nationwide to observe a decrease in opioid overdose deaths from 2016 to 2017.

“While it’s certainly encouraging to see these numbers headed in the right direction, the number of deaths associated with opioids and deaths of despair in our state is staggering,” said Lt. Governor Spencer Cox. “The sad fact that 360 families are struggling with the loss of a loved one due, at least in part, to opioids is cause for all of us to remain committed to putting a stop to this terrible epidemic.”

To help ensure Utah’s positive momentum is maintained for years to come, Lt. Governor Cox announced he accepted the position as chairperson of the Utah Coalition for Opioid Overdose Prevention (UCO-OP). UCO-OP is a multi-disciplinary collaboration of more than 60 experts in the fields of substance abuse prevention and treatment, law enforcement, environmental quality, healthcare, and public health.

3. Utah voters expand Medicaid
In the November 2018 general election, Utah voters approved the Proposition 3 ballot initiative, Utah Decides Health Care. This new law will expand Medicaid to parents and adults without dependent children earning up to 138% federal poverty level (approximately $16,700 annual income for an individual). Public health officials anticipate approximately 150,000 Utah residents will become newly eligible for Medicaid. Coverage for these individuals is expected to begin on April 1, 2019.

In the November 2018 general election, Utah voters approved the Proposition 3 ballot initiative, Utah Decides Health Care. This new law will expand Medicaid to parents and adults without dependent children earning up to 138% federal poverty level (approximately $16,700 annual income for an individual). Public health officials anticipate approximately 150,000 Utah residents will become newly eligible for Medicaid. Coverage for these individuals is expected to begin on April 1, 2019.

Staff with the Utah Departments of Health and Workforce Services are currently coordinating and preparing to meet this deadline in order to open this benefit to newly eligible members. In addition, the Utah Department of Health is working with the Centers for Medicare and Medicaid Services (CMS) to determine the exact benefits that will be covered for the expansion population; generally, the expansion group will receive the same benefits as other Medicaid members. Staff are also working with the Accountable Care Organizations and local behavioral health authorities to determine the service delivery system for the expansion population. Current Primary Care Network (PCN) members (approximately 15,000) will be auto-enrolled in Medicaid as part of the expansion population, effective April 1, 2019. Individuals currently enrolled in the federal Marketplace, but who now qualify for Medicaid, will be eligible to move over to Medicaid

4. Baby Your Baby celebrates 30 years of helping Utah moms and babies
When Baby Your Baby (BYB) was born in 1987, the Utah Department of Health meant it to be a temporary, two-year prenatal outreach and media campaign. The goal was to educate and encourage all pregnant women to seek early and frequent prenatal care in order to reduce the infant mortality rate in Utah, which was 8.7 deaths per 1,000 births at the time.

Thirty years later, Baby Your Baby is still thriving. Data from 2014 showed the infant mortality rate in Utah is now the lowest in the nation, at 4.9 deaths per 1,000 births.

Baby Your Baby is a partnership with the Utah Department of Health, Intermountain Healthcare, and KUTV. It is the first, longest lasting, and most successful public/private partnership in Utah state government. The Baby Your Baby media component has won more than 50 awards, including The National Association of Governors award for the Best Outreach Program in America and the prestigious Healthy Mothers Healthy Babies National Achievement Award for the Best Sustained Public Information Program in America.

Baby Your Baby has helped more than 100,000 women get financial help so they can get prenatal care early in their pregnancy. The health keepsake book developed by staff at the Utah Department of Health has been given to more than 600,000 expectant Utah mothers and is used by 32 states and other countries worldwide. The Baby Your Baby hotline has answered more than 400,000 phone calls, helping answer questions and providing referrals to women in need.

5. First rabies death in Utah since 1944
In November 2018, the Utah Department of Health (UDOH) was notified of a suspect human rabies case in a Utah resident. In collaboration with several local health departments and the Centers for Disease Control and Prevention (CDC), the UDOH conducted an investigation to verify the diagnosis and determine the source of infection. Laboratory specimens from the Utah Public Health Laboratory and the Office of the Medical Examiner were sent to the CDC which confirmed the patient was infected with a strain of rabies virus associated with the Mexican free-tailed bat. The public health investigation revealed the patient had handled several bats in the weeks prior to symptom onset. The patient was hospitalized and received supportive care, but subsequently died as a result of the rabies infection. Public health ensured that family members received post-exposure prophylaxis (PEP) and worked with them to prevent bats from entering the home.

Exposure assessments were conducted with community members and healthcare workers who were potentially exposed to the patient during the infectious period. A total of 30 community members and 242 healthcare workers were evaluated by public health; of those, 30 community members and 74 healthcare workers were provided PEP for rabies. This case presented an opportunity to educate healthcare providers and the public regarding the risk of rabies and recommendations for rabies prevention.

Rabies is a preventable viral disease of mammals most often transmitted through the bite of a rabid animal. Transmission has been rarely documented through contamination of mucous membranes (i.e., eyes, nose, mouth), aerosol transmission, and corneal and organ transplantations. The rabies virus infects the central nervous system, ultimately causing disease in the brain and death, if PEP is not appropriately administered. In the United States, human fatalities associated with rabies occur in people who fail to seek medical assistance following exposure to rabid animals, usually because they were unaware of their exposure. Because rabies is uniformly fatal once symptoms develop, exposed persons should be promptly evaluated for PEP. Bats are the primary carrier of rabies in Utah–an average of 15-25 bats test positive for rabies in Utah every year. The last recorded case of human rabies in Utah occurred in 1944.

6. Utah becomes first state to screen newborns for spinal muscular atrophy
Utah became the first state to implement population wide newborn screening for Spinal Muscular
Atrophy (SMA) on January 29, 2018. SMA is a progressive neurodegenerative disease that affects the motor nerve cells in the spinal cord which impedes the ability to sit up, walk, swallow, and in the most severe cases, breathe. It is the leading genetic cause of death for infants, affecting approximately one in
11,000 infants nationally.

The initiation of newborn screening for SMA in Utah represents a significant public health advance.
There is clear data that infants with SMA benefit when treated early. Children now have access to groundbreaking therapies that have the potential to improve their quality of life. Infants who are diagnosed before exhibiting symptoms, and who receive treatment have achieved unprecedented milestones such as sitting, standing, and walking.

7. Utah Public Health Laboratory identifies Salmonella contamination in Kratom products
Kratom (Mitragyna speciosa) is a plant native to Southeast Asia that has been used in traditional medicine. The leaves contain psychoactive compounds displaying both stimulant and opioid-like effects. For this reason, kratom leaves are chewed, processed into capsules, brewed, and smoked for self-medication or recreational use.

Between December 2017 and January 2018, two Utah residents were linked to a national Salmonella (serotype I 4,[5]12:b:-) outbreak involving kratom consumption. An epidemiological investigation conducted by the Utah Department of Health and Salt Lake County Health Department lead to the identification of the kratom products the Utah cases consumed. The first case reported the use of kratom capsules, while the other individual purchased kratom powder over the Internet. In March 2018, a third case involving kratom capsules was discovered. For all three cases, leftover kratom powder or capsules, obtained from the stores where they were originally purchased, were submitted to the Utah Public Health Laboratory for testing.

Microbiologists at the Utah Public Health Laboratry were able to isolate Salmonella from all the kratom products tested. Staff made minor but critical modifications to a standard FDA protocol for the isolation of Salmonella from food. In order to do this. These modifications were shared nationwide to help improve isolation of bacteria from these products. Using this new method, epidemiologists were able to link a cluster of illnesses (without a previous known culprit) to kratom across several states. The efforts of staff at the Utah Public Health Laboratroy contributed to an FDA recall of 66 brands of kratom products.

8. HPV vaccination rates increase in Utah

HPV vaccination rates among teens aged 13-17 are improving in Utah, especially among males. According to reports from the Centers for Disease Control and Prevention (CDC), in 2016, only 20% of Utah males aged 13-17 completed the recommended HPV vaccine series. However, in 2017, that number increased by 12%. In addition, the overall HPV vaccination rates in Utah for both males and females increased by 7% from 2016.

The HPV vaccination is a series of two shots and is recommended for preteens, both males and females, at age 11 or 12, so they are protected before ever being exposed to the virus. The HPV vaccine is most effective during the preteen years.

Since 2014, the UDOH has implemented a parent education campaign aimed at increasing the HPV vaccination rates, which may have contributed to the increases seen in the national reports. The campaign encourages parents to talk to their child’s doctor about the HPV vaccine and will begin running again on social media in mid-September 2018.

9. Asthma Home Visiting Program helps Utahns manage their asthma and reduce costly ED visits

Asthma is one of the most common chronic conditions among children and a leading cause of missed school days. There is no cure for asthma; however, those with asthma can learn to manage their asthma and live normal, healthy lives.

The Utah Department of Health Asthma Home Visiting Program is an evidence-based program that provides intensive asthma self-management education in the home in Salt Lake and Utah Counties. Since the program began in January 2016, 250 patients have entered the program and 205 have completed it. As a result of the program, participants have improved asthma control, improved medication adherence, and reduced adverse and costly health events, including 70% reduction in asthma-related ED visits and 82% reduction in asthma-related hospitalizations. For every $1 dollar invested in the program, there is an anticipated $3.31 saved in reduced emergency department visits alone.

One program participant shared, “It used to be a way (of life) for our (daughter) to get sick…but after getting educated on her inhalers and having our home inspected, things changed…we are happier! Plans happen, dates occur, friends play. Life is different.”

10. Utah Department of Health Office of Health Disparities receives national award for the It Takes a Village program

In November 2018, the Association of Maternal & Child Health Program (AMCHP) recognized the Utah Department of Health Office of Health Disparities’ (OHD) It Takes a Village: Giving our babies the best chance (ITAV) program as an AMCHP Promising Practice with the recommendation to pursue the designation of Best Practice. AMCHP awarded the ITAV project as a Promising Practice because of its unique and innovative anthropological approach to addressing birth outcomes disparities.

It Takes a Village (ITAV): Giving our babies the best chance is a community education and engagement series specifically designed for Utah’s Native Hawaiian/Pacific Islander (NHPI) communities who are facing birth outcomes disparities. The ITAV project raises awareness and educates NHPI families and community members about maternal and infant health in the context of Pacific Islander cultural beliefs and practices.