Monthly Highlights 

HEALTH NEWS

Native American Heritage Month

(Image Source: Institute for Public Relations)

“I'll go and do more.”

- Annie Dodge Wauneka

In November, we lift up stories of pivotal Native Americans and their contributions to their tribes and to public health.

In the late 1910s, when the Spanish influenza swept through the Navajo Tribe, a young Annie Dodge Wauneka witnessed firsthand the devastating impact of the epidemic. This harrowing experience inspired her to dedicate her life to public health and improve the well-being of her community. Wauneka became a leader in the fight against tuberculosis and took significant steps to bridge the gap between her culture and Western medicine by publishing a translation of medical English terms into Navajo. Read more about her and other tribal public health heroes here. 

Despite making up just 1.3% of the U.S. population in 2022, American Indian and Alaska Native (AI/AN) individuals face outsize challenges, including the lowest life expectancy among racial and ethnic groups. Most of the community, 87%, lives in urban areas—including roughly 30,000 people here in San Antonio. The effects of historical trauma and structural racism on housing, education, wealth, and employment continue to complicate health outcomes. To stay informed and offer culturally and linguistically appropriate healthcare, read basics about AI/AN history and languages here, myths and facts here, and resources for healthcare professionals here.

Antibiotic Awareness Week (Nov. 18–24)

Did you know that according to the CDC, 28% of antibiotics prescribed are unnecessary? Or that antibiotics are the most common cause of children’s ED visits for adverse drug events? Overuse and misuse of antibiotics continues to contribute to antimicrobial and antifungal resistance, serious health problems and deaths worldwide. This year’s theme is Fighting Antimicrobial Resistance Takes All of Us – focusing on the interconnectedness of antibiotic use on human health, animal health and environmental health. 

You can advance antibiotic stewardship with CDC’s Antibiotic Prescribing and Use Toolkit, which includes downloadable English/Spanish prescription pads for watchful waiting, symptomatic relief for viruses and colds, and delayed prescribing. Delayed prescribing is for conditions that typically resolve without treatment but may benefit from antibiotics if unimproved (i.e., acute uncomplicated sinusitis, mild acute otitis media). It is a strategy that can be used even during virtual visits. For children older than 5 years with mild acute otitis media, the American Academy of Pediatrics supports an abbreviated 5-day course. Additionally:

• Download free patient education materials here and infographics explaining antimicrobial resistance here.
• Join the Texas Epidemic Public Health Insitute on Nov. 13 at 3 PM as they highlight cutting-edge innovations in science, policy, and community health initiatives aimed at curbing the spread of resistant pathogens. Webinar registration

Learn more about U.S. Antibiotic Awareness Week here.

HEALTH NEWS

Your Recommendation Matters for RSV Vaccines

One of the most common reasons for newborn hospitalizations, respiratory syncytial virus (RSV), is now preventable. A recent CDC study found that among pregnant women eligible for RSV vaccination when it launched during the 2023-24 season, only 33% reported receiving it. Obstetric providers experienced supply and reimbursement challenges the first year. Patients, meanwhile, reported that they did not get vaccinated because of a lack of a recommendation from healthcare providers, including nurses, doctors, or other medical professionals. Vaccination rates were higher among people with private or military insurance, those with higher levels of education and those with higher incomes. Read the full article here. 

Marburg Virus Emerges in Rwanda

The CDC issued a Health Advisory about Rwanda's first Marburg virus disease (MVD) outbreak, reporting 65 confirmed cases and 15 deaths as of Oct. 28. Healthcare workers make up the majority of cases. There are no confirmed cases related to this outbreak in the United States or other countries outside the Republic of Rwanda to date. Recommendations for clinicians include:

• Assess patients with travel history for exposure risk and compatible symptoms for viral hemorrhagic fevers, including MVD.
• Include MVD in your differential diagnosis while also considering more common diagnoses such as malaria.

Symptoms may include fever, headache, muscle and joint pain, fatigue, loss of appetite, gastrointestinal symptoms, or unexplained bleeding. Transmission is through direct contact once the patient is symptomatic. Read the alert here and clinician resources here. MVD is a rare but often fatal viral hemorrhagic fever and notifiable condition that must be reported immediately.  Report cases to Metro Health here. Consult with the 24/7 Epidemiology line at (210) 207-8876.

Pertussis Cases Up, Vaccinations Down

As of October, CDC reports nearly five times as many cases of whooping cough, compared to the same time last year. This is higher than the pre-pandemic level in 2019. In Texas, we are seeing almost triple the number of cases we saw by October 2023. Increased precautions during the COVID-19 pandemic helped lower pertussis rates, so some rebound was expected. At the same time, fewer children are obtaining routine vaccines in the second year of life, when a fourth DTap dose is recommended. The estimated percentage of 2-year-olds with four or more DTap doses was 81.8% for children born in 2018-2019, versus 79.3% for children born in 2020-21 (and even lower, 76.9%, in Bexar County children born in 2020-21). Coverage rates were lowest in AI/AN and low-income children, and highest in Asian children.

CDC expects pertussis rates to grow in both unvaccinated and vaccinated populations. Pertussis occurs in vaccinated people because protection from vaccination fades over time. Find routine and catch-up pertussis vaccine schedules here, including quick guides for ages 4 months through 6 years and 7-18 years of age.

Medicare Part B Adds HIV PrEP

The Centers for Medicaid and Medicare Services (CMS) moved HIV Pre-Exposure Prophylaxis (PrEP) into Medicare Part B, meaning patients no longer face out-of-pocket costs for PrEP or related services. While fewer than 1% of new HIV infections occur in people 65 and older, seniors are more likely than any other age group to be diagnosed at an advanced stage of disease. With rates of syphilis nearly doubling in this age group between 2019 and 2022, it’s worth asking seniors about sexual activity and offering PrEP as appropriate.

HIV PrEP is a safe and effective way to prevent HIV acquisition, and is even more effective when combined with other measures including condoms. PrEP comes as a daily oral medication or an injection every 8 weeks. It is recommended by the US Preventive Services Task Force (Grade A) for people who are HIV negative and

• Have been sexually active (vaginal or anal sex) in the last 6 months and
• Have/had a partner with HIV, or whose HIV status is not known, or
• Inconsistent condom use (seniors have low rates of condom use), or
• Have had an STI in the last 6 months

Also eligible are people who inject drugs and have an injection partner with HIV or who share injection equipment.  Download the CMS fact sheet here. Learn more about PrEP and related preventative services, including billing and coding, here.

RESOURCE(S) OF THE MONTH

Healthy Beats

Did you know that Metro Health offers a pregnancy case management program focused on preventing congenital syphilis in Bexar County? The Healthy Beats program offers prenatal care education, sexual health screenings including syphilis testing, linkage to Medicaid and WIC enrollment and more. Find out more or refer a client by calling 210-207-8077.

Texas Medicaid Collaborative Care Model

Texas Medicaid covers integrated behavioral healthcare for enrollees of all ages who have a mental health or substance use condition, including preexisting or suspected conditions, when overseen by a primary care provider (MD, PA or NP). Click links for basics and additional tools including links to billing case studies. Note that existing and new providers needed to attest to their eligibility in the Provider Enrollment and Management System (PEMS) as of Aug. 1.

EDUCATIONAL OPPORTUNITIES

Syphilis 201: Case Study Analyses (1.00 hour CME/CNE)

Metro Health’s Clinician Ambassadors invite you to join us Nov. 6 from 12 p.m. to 1 p.m. for an interactive training. Apply your knowledge of syphilis testing, staging, treatment and follow-up using a set of diverse patient case scenarios. Register here.

San Antonio Congenital Syphilis Reviews (3.00 hours CME/CNE)

San Antonio Metro Health’s Congenital Syphilis Team invites you to the Fetal Infant Morbidity Review on Congenital Syphilis (FIMR-S), in-person on Nov. 12, 1 p.m. to 4:30 p.m., at the Phil Hardberger Park Urban Ecology Center, 8400 NW Military Hwy, 78231. Participants will review 3 cases focusing on congenital syphilis and identify community action items. Register here. (Registration required for confidentiality purposes.)

Getting In Sync with Sexual Health ECHO (1 hour CME)

Project Echo hosts “STIs – Testing, Treatment and Prevention” every other Tuesday from 11 a.m. – noon, until the end of the year. Register now for one of the sessions below.

Nov. 12 – HIV (PrEP and non-occupational PEP)

Nov. 26 – Hepatitis B and C

Dec. 10 – HPV, Mpox, Mycoplasma/Ureaplasma

2024 HIV & SUD Virtual Symposium

UT Health San Antonio and South Central AIDS Education Training Center hosts the 4^th Annual HIV and SUD Symposium Nov. 13, from 9 a.m. – 4 p.m.  Learn more about the intersection of HIV and Substance Use Disorders and how we, as healthcare providers, can better serve our communities. Register here for this virtual event.

TxRx ECHO: Medications for Substance Use Disorder (1 hour CME)

Attention prescribers and allied care team members! Join UT Health San Antonio, and C-Stat by Be Well Texas every 2^nd and 4^th Thursday of the month from noon – 1 p.m. for this engaging educational opportunity. Participants will receive telementoring from experts in the use of medications to treat substance use disorders including alcohol, opioids, and stimulants. Register here. This program meets DEA training requirements.

Texas PeriPAN Grand Rounds (1 hour CME)

The Perinatal Psychiatry Access Network (PeriPAN) hosts evidence-based practice discussions with Texas Tech University Health Sciences Center monthly from noon – 1 p.m. Register now for the final session of the year, Nov. 19, on NICU Parent Supports and Considerations.

Injectable PrEP: Implementation in Health Centers (1 hour CME)

Join the National LGBTQIA+ Health Education Center on December 12 from 11:00 a.m. – noon for a webinar that explores eligibility and assessment of candidates, administering long-acting injectable PrEP and common challenges. Register here.

SAVE THE DATE

Texas HIV/STI Conference

The 2024 Texas HIV/STI Conference will allow advocates, health educators and clinicians to share information and efforts around health disparities that negatively impact Texas communities at risk of and affected by HIV. The two-day conference starts Dec. 2 at 1 p.m. in Austin; register here.

ON-DEMAND EDUCATION

Updates on Diagnostic Testing and Outpatient Treatment for COVID-19 and Influenza (1 hour CME/CNE/CE through Nov. 11) 

Resurgence of New World Screwworm in the Americas: What Healthcare Providers Need to Know (1 hour CME/CNE/CE through Nov. 18) 

CIDRAP Antimicrobial Stewardship Webinars

CDC Antibiotic Stewardship Courses (CME/CNE/CE). Fulfills Improvement Activities (IA) Patient Safety and Practice Assessment (PSPA)_23 and PSPA_24 under CMS Merit-Based Incentive Programs.