Antibiotic Awareness Week

November 13-19 is U.S. Antibiotic Awareness Week. This annual event serves to raise awareness about safe antibiotic prescribing and use. It is important for us to know when we need antibiotics, when we do not, how best to take antibiotics, and what side effects may be caused by antibiotics.

Inappropriate use of antibiotics is a leading cause of antibiotic resistance around the world. Antibiotics are some of the most prescribed drugs, but up to half of prescriptions are not necessary or effective.  Every year in the United States, at least 2 million people get infected with bacteria that are resistant to antibiotics. And at least 23,000 people die because of these infections. When bacteria become resistant, antibiotics cannot fight them and the bacteria multiply. Some resistant bacteria can be harder to treat and can spread to other people.  By working together to appropriately use antibiotics only when they are necessary, we can decrease the number of infections caused by bacteria resistant to antibiotics.

I encourage you to do these things to stay antibiotics aware:

  • Get the facts about antibiotics. Antibiotics do not work on viruses such as colds and flu, or runny noses, even if the mucus is thick, yellow or green. When antibiotics aren’t needed, they won’t help you and the side effects could still hurt you.
  • Ask your healthcare provider about the best way to feel better while your body fights off a virus. Pain relievers, fever reducers, saline nasal spray or drops, warm compresses, liquids and rest may help.
  • If you need antibiotics, take them exactly as prescribed. Talk with your healthcare provider if you have any questions about your antibiotics or if you develop any side effects. Be sure to talk with them if you have diarrhea, since that could be a Clostridium difficile ( C. difficile) infection, which should be treated.
  • Stay healthy and keep others healthy by washing your hands, covering your coughs and staying home when you are sick. Be sure to get recommended vaccines for infections like the flu.
  1. C. difficile is the infection most often associated with healthcare exposure and recent antibiotic use. In Virginia’s Plan for Well-Being, we track progress towards the prevention of C. difficile infections. In 2016, Virginia acute care hospitals reported more than 2,300 C. difficile infections. To meet the national prevention goal, hospitals would need to prevent more than 600 C. difficile infections per year.

Learn more by visiting:

State Health Commissioner Comments on Opioid Addiction Declaration

These remarks were delivered on November 21, 2016 at 10am

Good morning.  This is Dr. Marissa Levine, Virginia State Health Commissioner here with key state agency colleagues for an important announcement about the opioid addiction crisis in Virginia.  Thank you for joining us this morning.

We are here today in the shadow of the Surgeon General’s report on Addiction in America released just last week which highlights the addiction crisis facing Americans and emphasizes the need for:

  • effective public health steps to prevent and treat substance use disorders
  • a shift in attitudes toward addiction
  • and a coordinated effort among multiple sectors at community and jurisdictional levels to implement proven approaches

We are also here on the Monday before Thanksgiving when families, friends and loved ones will be gathering

So it is no coincidence that I am here with you today because the facts clearly tell us that the consequences of opioid addiction in Virginia have risen to unprecedented levels and can now be classified as epidemic.  Some of the statistics include:

  • On average, three Virginians die of a drug overdose and over two dozen are treated in emergency departments for drug overdose each day.
  • Number of emergency department visits due to heroin overdose has increased 89% for the first 9 months of the year compared to 2015
  • During the first half of this year fatal drug overdoses increased 35% when compared to the same period in 2015
  • By the end of 2016, the number of fatal opioid overdoses is expected to increase by 77% compared to five years ago.
  • In addition, our Department of Forensic Sciences just this month identified the presence of Carfentanil in Virginia. This synthetic opioid is 10,000 times more potent than morphine and 100 times more potent than fentanyl and, given its presence in Virginia, could significantly increase the death rate trends from opioid overdoses.
  • And we have the continuing prescription opioid crisis most prominent in the far southwest region of the Commonwealth where we are additionally concerned about the growing prevalence of hepatitis C and HIV resulting from injection drug use.

 With all these facts (which are the story of the people of Virginia) facing us, today I am declaring a Public Health Emergency for Virginia as a result of the opioid addiction epidemic.

This declaration is an effort to raise continued awareness among all Virginians about this worsening problem and emphasize that we must treat it as a public health issue as we have done for other health emergencies.  Our law enforcement partners have repeatedly claimed that we cannot arrest our way out of this problem.  I have heard them loud and clear:

  • This declaration has no force of law and is not a Governor’s emergency declaration. It is also not an attempt to keep opioid medications from those with chronic pain such as those with cancer pain, who legitimately need those medications.
  • In my 14 years of public health experience in Virginia, I have seen time and again Virginians rising to the emergency, coming together to work collaboratively to solve challenging, complex issues. That is my hope with this declaration- that we come together to build upon the great work that has already started as a result of the Governor’s Opioid Task Force, General Assembly actions, the AG efforts, the work of the medical and pharmacy professionals and community coalitions around the Commonwealth. We are all working to support families and communities as they help their family members, friends, neighbors and loved ones get the help they need to fight addiction.

So with all of the above in mind I am taking one more specific step in an effort to lower the death rate and prevent deaths from opioid addiction:

  • I have signed a statewide standing order for Naloxone – the rescue medicine for opioid overdose. This could only have been accomplished in close collaboration and consultation with the Virginia Department of Health Professions, its Board of Pharmacy and the Virginia Department of Behavioral Health and Developmental Services.
  • This will allow anyone in Virginia who believes they or their loved ones are at risk of an opioid overdose to buy naloxone at any of our approximately 2000 pharmacies in the Commonwealth without first having to get a prescription.
  • As we speak we have begun distributing this order to the pharmacies. The pharmacy community has been a great partner in this effort and I know they will work diligently to implement this order as soon as possible.  Realize that it may take time before every pharmacy has the order in place so please check with your pharmacy first.
  • Unfortunately the statewide standing order does not cover the cost of the Naloxone but I am confident that our collective efforts will continue to work to make Naloxone available to everyone who could benefit regardless of whether they can afford it.

I realize that this declaration and the statewide standing order cannot in anyway minimize the loss already experienced by so many families as a result of the opioid addiction epidemic.  However if the declaration and statewide standing order save even one life from here on it will have been worth it.

This Thanksgiving, as we gather around the dinner table, let us be sure we are familiar with the signs of addiction and substance use. Visit the Commonwealth’s new website VAAware ( which offers resources on how best to discuss addiction with someone you love.  As we take inventory of one another also take inventory of the medications in our household, let us also be sure to dispose of unused, expired or unwanted medications in a safe manner. Thanks to the AG office, local health departments and other community resources have drug disposal bags.  You can find a location near you on the AG website. Authorized pharmacies and some local law enforcement agencies also collect and destroy unwanted drugs.  As you take inventory this week, if you identify that someone in your life is struggling with an opioid addiction obtain Naloxone to have on hand just in case. And you can learn more about Naloxone as a result of work by our colleagues at the DBHDS through their Revive! program.  That information is also available on the website mentioned.

I realize that this is not the cheerful Thanksgiving message you may have hoped to hear, but when we live in times of epidemic and emergencies it’s important to take every opportunity as an opportunity to be prepared and informed. As we have found in every emergency the better prepared and informed we are, the more likely that we will minimize the risk of the emergency and prevent death and suffering. And in the process we build stronger connections with each other and build healthier and resilient Virginians in healthier and resilient communities.  That is what I wish this Thanksgiving and holiday season and I do so hope that you have a safe and healthy Thanksgiving.

Listen to the November 21, 2016 Telebriefing

Learn more about Opioid Addiction in Virginia.

National Infant Immunization Week

National Infant Immunization Week. Immuzation. Power to Protect.First word and steps are some of the many childhood milestones. Parents and caregivers do a lot to keep their babies safe and healthy. Vaccination is one of the best ways parents can protect infants from diseases. National Infant Immunization Week celebrates the role vaccinations play in protecting our children, communities and public health.

Immunizations are recommended for all children starting at birth. Routine vaccination can protect a child from 14 diseases by age 2. Before the measles vaccine in 1963, almost every child had the disease. Now with vaccinations, many current doctors have never seen a case of measles. Today, vaccinations have prevented nearly 20 million people from disease.

Everyone has a role when it comes to improving health in Virginia.  If you are a parent or caregiver:

  • Talk with your child’s healthcare provider to have your questions about vaccination answered.
  • Keep your child up to date on their vaccines.
  • Keep all appointments for vaccines to ensure your child is fully protected. Some vaccines are given as part of a series over time.
  • While you are at it, make sure you are up to date with vaccines recommended for you.
  • Vaccines are safe, effective and proven to be one of the most effective ways to keep from getting sick. Give your kids a strong start for a healthy future.


  • About vaccines, the diseases they prevent and when you should get them.
  • If you do not have insurance or cannot afford the cost of vaccines, there are programs that can help. The Vaccines for Children program provides vaccines to uninsured and other qualified children. Call 800-CDC-INFO (800-232-4636) to find a Vaccines for Children program near you.


World TB Day – March 24, 2017

For many decades, death was likely for people with tuberculosis (TB). World TB Day celebrates the day in 1882 when Dr. Robert Koch discovered the cause of tuberculosis. Tuberculosis is a small rod-shaped bacteria.   At the time of Koch’s announcement, TB was raging through both Europe and the Americas. It caused the death of one out of every seven people.  Dr. Koch’s discovery was an important step toward the control and elimination of this deadly disease.Tuberculosis in Virginia. Only the Tip of the Iceberg. There are two types of tuberculosis (TB) conditions: active tb disease and latent (inactive) TB Infection. People with active TB are sick from active TB germs. People with latent TV infection do not feel sick and do not have symptoms. For every person in Virginia with TB disease, there are another 2,000 people living in Virginia with latent TB infection. Thousands of people in Virginia have latent TB infection. Without treatment, they are at risk for developing TB disease. VDH. Virginia Department of Health. Healthy People in Health Communities.

Scientists later learned that there are two types of TB Conditions:

  • TB Disease and
  • Latent (or inactive) TB infection.

People with TB Disease are sick from active TB bacteria.  They usually have symptoms such as cough, fever, tiredness, or weight loss.  They may spread the bacteria to others.

People with latent TB infection:

  • Do not feel sick,
  • Do not have symptoms, and
  • Cannot spread TB bacteria to others.

If left untreated, the inactive, non-contagious form of TB can become an infectious form of the disease.

For every person in Virginia with TB Disease, there are another 2,000 people living in Virginia with latent TB infection.

TB in Virginia

TB was the first disease that the Virginia Department of Health (VDH) addressed when it was formed in 1908.  At that time, VDH had a staff of four and a budget of $40,000. At least half of the budget was used to help the 12,100 Virginians living with TB at that time.  Today, TB remains an important preventable disease in Virginia.  Treating cases of infectious TB disease is important, but it’s only the tip of the iceberg.  We will never end TB without screening people for latent TB infection and treating it to prevent its progression.   Treatment for LTBI can be as short as one dose of medicine a week for 12 weeks!

Should you be screened for latent (or inactive) TB Infection?  You may want to contact your health provider or local health department if you:

  • Have close contact (in your home or workplace) with a person with infectious TB disease;
  • Have lived or visited for 3 months or more in a country where tuberculosis is common;
  • Have been homeless and lived in a shelter or other setting where many people live together;
  • Have a medical condition that makes it hard for your body to fight infections, such as diabetes mellitus, severe kidney disease or HIV infection;
  • Take medical treatments such as steroids on a regular basis or take special medicines for rheumatoid arthritis or Crohn’s Disease.

Want more information about Latent Tuberculosis Infections?  Please visit:


It’s Not Too Late To Get Your Flu Shot!

miss the fluBy now, you probably know that it is recommended that everyone 6 months of age or older receive a flu vaccination each year. While it’s best to get your flu shot as soon as it is available (sometimes as early as August), it’s still not too late to get your flu shot! Flu season usually peaks in January or February and continues through May. Getting a flu shot is not only the single best way to protect yourself from getting sick, it’s also the best way to prevent the spread of flu to others.

Help us make Virginia the healthiest state in the nation by getting a flu shot and encouraging your friends and family to get one as well. One of the goals of Virginia’s Plan for Well-Being is to increase the percent of adults in Virginia who receive an annual influenza vaccine from 48.2% to 70% by 2020.

It is important to get a flu shot even if you had one last year. Your immune protection from vaccination declines over time, so an annual vaccination is needed to get the best protection against the flu.

The flu is a serious disease, especially for certain age groups and people with certain chronic health conditions, such as:

  • Children younger than five, but especially younger than two years old
  • Adults 65 years of age or older
  • Women who are pregnant or just had a baby
  • People with chronic health conditions

Remember, a flu shot cannot cause illness.

To find out where to get a flu shot in your area, contact your local health department or use the vaccine finder. And visit our Miss The Flu page for more information on how to miss the flu, not your life!

February Is American Heart Month

february heart monthHeart disease is a leading cause of death for both men and women in Virginia. The most common type of heart disease is coronary artery disease (CAD). A key part of Virginia’s Plan for Well-Being focuses on preventive actions that keep Virginians active and healthy, and the good news is that most heart disease and its complications are completely preventable by making healthy choices and knowing your risk factors.

High blood pressure is a major risk factor for heart disease. If you have high blood pressure, manage it by going to your health care provider for regular visits, taking your prescribed medication, and monitoring your blood pressure at home.

One of the greatest concerns with heart disease, especially CAD, is having a heart attack. A heart attack occurs when a part of the heart muscle dies or gets damaged due to reduced blood supply. If you know the signs and symptoms of a heart attack you are more likely to survive.

The four major symptoms of a heart attack are:

  • Pain or discomfort in the jaw, neck, back, arm, or shoulders
  • Feeling weak, light-headed, or faint
  • General chest pain or discomfort
  • Shortness of breath

If you or a loved one have any of these symptoms call 9-1-1 immediately and get to the hospital quickly. Making healthy lifestyle choices after a heart attack can reduce the risk of future heart attacks.

If you make healthy lifestyle choices, you can prevent heart disease and its complications. Make a promise to yourself to:

  • Choose heart healthy meals
  • Limit salt and sodium intake
  • Maintain a healthy weight and learn your body mass index (BMI)
  • Exercise regularly
  • Breathe clean air (don’t smoke) and limit alcohol use

It is easy to keep your heart healthy, so this Valentine’s Day give your loved ones the gift of a healthy and happy heart!

January is Cervical Cancer Awareness Month

january is cervical cancer awareness monthJanuary is Cervical Cancer Awareness Month. Cervical cancer is a highly preventable and treatable cancer, thanks to improved screening and vaccination.

According to the US Preventive Services Task Force, cervical cancer screening should start at age 21.  Screening can identify changes in the cells of the cervix that could lead to cancer.  Screening might include a Pap test and, for some women, testing for human papillomavirus (HPV).

About one in four Americans are currently infected with HPV virus. HPV is the main cause of cervical cancer in women. The HPV vaccine is successful in protecting people from HPV related cancers.  It is extremely important for boys and girls to receive the vaccine at age 11 or 12. The vaccine is the most effective when preteens receive the vaccine before exposure to HPV infection. The HPV vaccine is given in a series of two shots. For more information, refer to the Centers for Disease Control and Prevention (CDC)’s guide to HPV vaccines for preteens and teens.

Who should get screened for cervical cancer?

  • Women aged 21-29 years should have a Pap test every 3 years
  • Women aged 30-65 year should have a Pap test and an HPV test (known as “co-testing”) every 5 years (preferred).  Although preferred, it is acceptable to have a Pap test every 3 years alone.
  • Immunocompromised women, women who have a history of cervical cancer and women aged 65 and older should consult with their physician for screening management.

Learn more about Cervical Cancer Screening

Looking Ahead To 2017

road to 2017As we head into the New Year, I wanted to take a moment to discuss our journey toward becoming the healthiest state in the nation, the challenges we faced this past year and how VDH will keep working for you in 2017.

A critical challenge that faced us before and during 2016, and we’ll continue to face in 2017, is one that affects all Virginians. In November 2016, I declared Virginia’s opioid addiction crisis a public health emergency.  There’s still much we don’t know about this issue but there are steps everyone can take to protect themselves and their loved ones:  Know the signs of addiction and where to get help.  If you believe someone in your life is struggling with addiction, talk to them, consider obtaining the rescue medicine, naloxone, which is now available under a standing order I wrote and sent to all pharmacies in Virginia.  In addition, take the REVIVE! course on how to recognize and respond to an opioid overdose emergency. Visit for more information on all aspects of this emergent problem.  This is an issue that our entire nation will continue to face in the New Year.  Please know that no matter the challenge, VDH will be here promoting well-being and protecting health.

Also in 2016, a new public health challenge came our way in the form of the Zika virus. Our early attention to the virus and the efforts of many different parts of our agency helped to ensure Virginia did not see a locally transmitted case of Zika in 2016. But like many health challenges we face, Zika will be an ongoing one.  As we head into the colder months, be aware of the precautions to take before and after traveling to areas with Zika, especially if you are pregnant or are considering becoming pregnant.  Stay tuned to our VDH webpage for more information as we approach mosquito season in 2017.

January is traditionally a time where we set goals for the New Year and focus on how to improve ourselves. I encourage you to take a look at Virginia’s Plan for Well-Being.  The plan is a call to action for all of us to create and sustain conditions that support health and well-being. There are many simple things you can do to help Virginia become the healthiest state in the nation.

  1. Make sure you and your families are up to date on vaccinations. Had your flu shot yet? It’s not too late ; )
  2. Read to your children
  3. Start that new exercise plan
  4. Try out healthy recipes you’ve had your eye on
  5. Quit tobacco

Here at VDH, we deliver 41 different services to Virginians every day, everything from vaccination clinics, outbreak investigations and family health services to emergency preparedness, HIV/STI testing, assuring clean drinking water in municipal waterworks and safe food in food service facilities. Throughout 2017, we’ll provide an inside look at some of the services that may not be as visible, but play an important role in keeping Virginia safe and healthy. Check back here often….

Finally, because we each have a role in protecting health and promoting well-being, I thank you for everything that YOU do to promote well-being and protect the health of all Virginians. On behalf of the VDH family, have a healthy and happy New Year.