Alabama Department of Public Health
Alabama Emergency Response Technology
Health Alert Network (HAN)
June 7, 2023
Consider bacterial, viral, parasitic, or intestinal worm infections in patients with exposure to raw sewage and presenting with certain symptoms
The United States Department of Justice and Health and Human Services conducted a civil rights investigation of the sanitation programs of the Alabama Department of Public Health (ADPH) related to Lowndes County, Alabama.  On May 4, 2023, ADPH entered into a legal agreement with the United States to take immediate actions on the raw sewage exposure issues in Lowndes County (News Release: https://www.alabamapublichealth.gov/blog/2023/06/nr-06.html). Part of this agreement includes disseminating information and education to healthcare providers.

Although efforts are primarily focused in Lowndes County, ADPH is asking that all providers in the state of Alabama be aware of medical issues and diseases associated with exposure to raw sewage. Consider viral infections such as Hepatitis A, bacterial infections including campylobacteriosis, salmonellosis, or shigellosis, parasite infections such as cryptosporidiosis or giardiasis, or intestinal worms such as hookworms or roundworms in patients with exposure to raw sewage.  ADPH encourages including, in your assessment and interview, questions about exposure to raw sewage which may occur due to lack of proper sewage systems or septic tank failures.

Although ADPH is encouraging this effort statewide, this may be particularly useful in patients originating from the Black Belt region of Alabama (which includes Lowndes County) who present with gastrointestinal symptoms including diarrhea, bloody stools, fever, abdominal pain and cramping, nausea, vomiting, or loose stools.

The ADPH Bureau of Environmental Services has set up a web page (https://www.alabamapublichealth.gov/environmental/septic-system-program.html) for residents of Lowndes County to request assistance with repairing or replacing failing septic systems, eliminating straight pipes, and installing conventional or engineered systems.  Residents can also call 334-206-5373 for more information.  Please share this information with patients from Lowndes County.

The University of Alabama at Birmingham (UAB) has several projects with community partners regarding failing sanitation and community education in the Black Belt Region.  ADPH is collaborating with UAB regarding updated medical education.  UAB’s current free CME course, UAB Sanitation Health Study, is active until August 31, 2023. (see link below.)  Over the next few months, ADPH will work with UAB to distribute additional educational links for healthcare providers.  Continuing education will be available.
https://sites.uab.edu/sanitationhealthstudy/providers/
https://prostudies.uab.edu/corporate/search/publicCourseSearchDetails.do;jsessionid=D72E6FA9F28A415233CBF3AEC52799EB?method=load&courseId=34584069&corporateGroupId=34583611