Issue 1245: May 11, 2016
Ask the Experts—Question of the Week: We have a 40 lb six-year-old patient who has been taking 15 mg of methotrexate weekly…read more
TOP STORIES
IAC HANDOUTS
VACCINE INFORMATION STATEMENTS
OFFICIAL RELEASES AND ANNOUNCEMENTS
WORLD NEWS
FEATURED RESOURCES
JOURNAL ARTICLES AND NEWSLETTERS
EDUCATION AND TRAINING
TOP STORIES
Download Dr. Gary Marshall's
The Vaccine Handbook: A Practical Guide for Clinicians ("The Purple Book") as an app for iOS devices or purchase as a print book
The Vaccine Handbook: A Practical Guide for Clinicians
(“The Purple Book,” 2015) is a comprehensive source of practical, up-to-date
information for vaccine providers and educators. Its author, Gary S. Marshall,
MD, has drawn together the latest vaccine science and guidance into a concise,
user-friendly, practical resource for the private office, public health clinic,
academic medical center, and hospital. This book is now available as an app for
iOS devices.
Information about the iOS app version of The Vaccine Handbook: A Practical Guide for Clinicians
The Vaccine Handbook App contains the 5th edition of the book, updated
with the latest immunization schedules and recommendations. The app enhances the
utility of an already valuable print resource by including functions like
keyword search, internal links, bookmarking, quick access to schedules and
tables, hyperlinks to external sources, and the ability for real-time updates. A
resources section provides ready access to authoritative immunization-related
websites. Available through a collaboration between the publisher and Sanofi
Pasteur, registration as well as reporting under Open Payments is required.
(Offer void in Minnesota.) Click on the image below to visit the relevant App
Store page to download this resource today.
Information about the print version of The Vaccine Handbook: A Practical Guide for Clinicians
The fifth edition of this valuable guide (560 pages) is available on IAC's website at www.immunize.org/vaccine-handbook. The price of the handbook is $29.95 each, plus shipping charges. Discount pricing is available for more than 10 copies. Order copies for your staff or for distribution at an upcoming conference.
Quantity Discount Pricing
- 1–10 books: no discount + shipping
- 11–50 books: 5% + shipping
- 51–100 books: 10% + shipping
- 101–500 books: 15% + shipping
- 501–1000 books: 20% + shipping
For quotes on larger quantities, email admininfo@immunize.org.
Order your copy today! Click on the image below to visit the "Shop IAC: The Vaccine Handbook" web page.
About the Author
Gary Marshall, MD, is professor of pediatrics at the University of Louisville School of Medicine in Kentucky, where he serves as chief of the division of pediatric infectious diseases and director of the Pediatric Clinical Trials Unit. In addition to being a busy clinician, he is nationally known for his work in the areas of vaccine research, advocacy, and education.
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Institute for Safe Medication Practices reports on hospital in Brazil where 50 employees received a dose of insulin instead of influenza vaccine; same error has been reported many times globally, including in the United States
The Institute of Safe Medication Practices published an article titled Fifty Hospital Employees Given Insulin Instead of Influenza Vaccine in the May 5 issue of its Medication Safety Alert newsletter. The article reports on a hospital in Brazil where 50 employees received a dose of insulin instead of influenza vaccine. Two paragraphs are reprinted below.
The exact same error, administering insulin instead of influenza vaccine, has been reported many times around the world, including several cases in the U.S. Some cases have been fatal. In 1997, the World Health Organization (WHO) reported an incident in which 27 infants died after receiving insulin instead of diphtheria, pertussis, and tetanus (DPT) vaccine (www.ismp.org/sc?id=1720). Errors similar to these mix-ups have also happened with administering influenza vaccine instead of purified protein derivative (PPD) skin tests for tuberculosis, and neuromuscular blockers instead of influenza vaccines, due to nonsegregated storage in emergency department refrigerators (www.ismp.org/sc?id=1715).
Keeping influenza vaccine readily available next to other medications can lead to errors. We strongly advise storing vaccines away from other drugs, in a separate refrigerator. The Centers for Disease Control and Prevention (CDC) recommends keeping vaccines in storage units dedicated only to vaccines (www.ismp.org/sc?id=1721). These incidents show how important regular, thorough drug storage checks in hospitals and ambulatory care areas are to observe and address potentially hazardous storage conditions. Errors involving look-alike vials can also be prevented by using commercially available prefilled syringes of vaccines.
The Institute for Safe Medication Practices (ISMP) is the nation’s only 501(c)(3) nonprofit organization devoted entirely to medication error prevention and safe medication use. The Vaccine Error Reporting Program (VERP) was created to allow healthcare professionals and patients to report vaccine errors confidentially. By collecting and quantifying information about these errors, ISMP will be better able to advocate for changes in vaccine names, labeling, or other appropriate modifications that could reduce the likelihood of vaccine errors in the future. Reporting vaccination administration errors via this link will help improve health care for everyone.
In March 2015, VERP published an excellent guide on avoiding vaccine errors.
Note: If an adverse event occurs following a vaccine administration error, a report should also be sent to Vaccine Adverse Event Reporting System (VAERS). Adverse events should be reported to VAERS regardless of whether a healthcare professional thinks the event is related to the vaccine or not, as long as it follows administering a dose of vaccine.
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Free bulk quantities of pneumococcal and zoster vaccination laminated pocket guides available from IAC for distribution within your organization
IAC is pleased to announce the availability of bulk quantities of two newly updated laminated pocket guides for use by healthcare professionals, yours free for the ordering! The guides address issues related to the administration of (1) pneumococcal conjugate (PCV13) and polysaccharide (PPSV23) vaccines and (2) zoster vaccine.
These concise pocket guides provide front-line healthcare personnel with quick reference information highlighting:
- Indications and contraindications for each vaccine
- Targeted populations to be vaccinated
- Details on how to administer the vaccines
- Talking points for discussions with patients
Each guide is laminated for durability, and the compact size (3¾" x 6¾") is designed to fit in a shirt or lab coat pocket.
The pocket guides are available at no cost to your organization. However, to assist us in controlling our mailing costs, we ask that you order in bulk (with a minimum order of 25) and that you manage the distribution of the guides (e.g., through internal networks, educational forums, member meetings, mass mailings) to your constituents.
To view the pocket guides and place your order, please visit www.immunize.org/pocketguides or click on either image below. These cards are for healthcare professional use only, not for distribution to patients.
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CDC launches Clean Hands Count campaign
On May 5, World Hand Hygiene Day, CDC launched a new hand hygiene campaign for healthcare providers, patients, and their loved ones called Clean Hands Count. Studies show that, on average, healthcare providers clean their hands less than half of the times they should, and that on any given day, about one in 25 hospital patients has at least one healthcare-associated infection.
The campaign aims to:
- Improve healthcare provider adherence to CDC hand hygiene recommendations
- Address the myths and misperceptions about hand hygiene
- Empower patients to play a role in their care by asking or reminding healthcare providers to clean their hands
Visit the Clean Hands Count web section for resources such as posters, factsheets, brochures, infographics, web buttons, a digital press kit, and more.
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IAC Spotlight! Easy-to-access slide deck with speaker notes on meningococcal ACWY disease prevention and how to increase second dose coverage is available for healthcare professionals' use
As announced in a previous issue of IAC Express, IAC has added a valuable new training resource for healthcare professionals (HCPs) to the project website for MCV4: You’re Not Done If You Give Just One; Give 2 Doses to Strengthen Protection. This initiative, which was developed by IAC in collaboration with Sanofi Pasteur, was implemented in response to the low immunization rates found for the recommended second (booster) dose of meningococcal ACWY (MCV4) vaccine administered at age 16 years.
A downloadable slide deck (with accompanying speaker notes) is available for your use when making presentations to HCPs. The presentation was designed to:
- Educate HCPs about the seriousness of meningococcal disease and the risk it poses to adolescents
- Raise awareness of the low immunization rates for the second (booster) dose of MCV4
- Offer tools and resources to help HCPs increase their immunization rates and close the meningococcal booster dose gap
The slide deck, which may be used free of charge, can be easily downloaded (no password is required) from the project website and saved to your computer. It is available in both PDF (without speaker notes) and PowerPoint versions (includes speaker notes.) Be sure to read the “Important Notes” on the download page for assistance in how to view the speaker notes.
This new “ready-to-use” resource has been added to the project’s expanding list of valuable tools for HCPs and their patients. In addition to a wealth of resources available on meningococcal disease prevention, the website includes materials about increasing coverage for all recommended adolescent vaccines. Be sure to take advantage of these great educational tools.
To access the slide deck in either format, go to www.give2mcv4.org/essential-tools/slide-deck.
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Watch a new Medscape module on meningococcal serogroup B vaccination
On April 21, a new continuing education opportunity titled Meningococcal B Disease: Implementing the ACIP Category B Vaccine Recommendations was released on Medscape. [Free, but you must log in to access article.] This activity is intended for pediatricians, primary care physicians, nurses, and obstetricians/gynecologists. The goal of the activity is to provide perspective on implementing the meningococcal serogroup B vaccination recommendations in various settings.
Upon completion of this activity, participants will be able to:
- Identify candidates for vaccination against meningococcal serogroup B disease
- Summarize appropriate meningococcal vaccination strategies for preteens, teens, and young adults
This module is presented by Litjen (LJ) Tan, MS, PhD; Gary S. Marshall, MD; Patricia Stinchfield, RN, MS, CPNP; and Tina Tan, MD. Continuing education credit is available for physicians and nurses.
There is no charge to participate in a Medscape educational activity, but you must register.
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Two healthcare organizations join IAC's Influenza Vaccination Honor Roll for mandatory healthcare worker vaccination
Nearly 600 organizations are now enrolled in IAC's Influenza Vaccination Honor Roll. The honor roll recognizes hospitals, medical practices, professional organizations, health departments, and government entities that have taken a stand for patient safety by implementing mandatory influenza vaccination policies for healthcare personnel.
Since April 6, when IAC Express last reported on the Influenza Vaccination Honor Roll, two additional healthcare organizations have been enrolled.
IAC urges qualifying healthcare organizations to apply.
Newly added healthcare organizations, hospitals, government agencies, and medical practices
- Mercy Medical Center, Cedar Rapids, IA
- Gouverneur Health, New York, NY
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Register now for an IAC “Take a Stand™" workshop on the use of standing orders in Boston, New York, Philadelphia, or Baltimore in June; related workshop to be offered at the Iowa Immunization Conference on June 15
The Immunization Action Coalition (IAC), with support from Pfizer, has implemented Take a Stand™, a national effort designed to improve adult immunization rates by increasing the use of standing orders in medical practices.*
At the core of this project are free workshops led by national experts, including L.J Tan, MS, PhD; William Atkinson, MD, MPH; and Deborah Wexler, MD, from IAC; and Alexandra Stewart, JD, from George Washington University. These workshops already have been conducted in Louisville, KY; Chicago, IL; Portsmouth, VA; Nashville, TN; Little Rock, AR; San Francisco, Sacramento, Los Angeles and San Diego, CA; Fort Worth, San Antonio, and Houston, TX; Seattle, WA; Phoenix and Tucson, AZ; Orlando and Fort Lauderdale, FL; and Atlanta, GA. To illustrate how these have been going, here is a small recent sampling of comments received from attendees:
"Take a Stand Workshop was excellent. It provided my organization with the resources and tools needed for a successful implementation." T.B., registered nurse, SD
"Phenomenal! Helped us learn what next steps to take for our organization and how to obtain buy-in from front line staff!" A.P., BSN, RN, CCP, clinical services coordinator, Sanford Health, SD
"It is interesting to know preventative care of adults is just as important as that of children, so 'take a stand' to get adults immunized. Standing orders are a smart/easy way to capture non-immunized adults. The workshop is very informative and engaging." L.S., clinical manager, GA
"All the speakers are extremely knowledgeable and engaging. It is among the top 3 BEST conference/workshops I've ever attended." S.B., immunization program coordinator, FL
Don’t miss your chance to join these satisfied attendees. The next workshops are scheduled in the following four cities:
In addition, a Take a Stand™ mini-workshop has been added to the Iowa Immunization Conference on June 15. For more information, go to Mini-Session Take A Stand™ Davenport, Iowa. Note: attendees of the mini-workshop will need to register for the conference itself. The non-member registration fee is $100.
Be sure to note that these are one-time-only events in each city.
Who should attend? Clinicians, nurses, and practice managers in medical offices that serve adults, as well as pharmacists and quality improvement managers, will benefit from the workshops.
A sample agenda and online registration information are available on the Take a Stand™ website at www.standingorders.org.
Please “take a stand” with us and spread the word about this unique opportunity for medical practices to improve their adult immunization rates while empowering staff and streamlining facility operations.
* Standing orders are written protocols approved by a physician or other authorized practitioner that allow qualified healthcare professionals (who are eligible to do so under state law, such as registered nurses or pharmacists) to assess the need for vaccination and to vaccinate patients meeting certain criteria.
Workshop Information
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Join Voices for Vaccines on a May 19 conference call with law professor Dr. Dorit
Rubinstein Reiss on parental rights
Join Voices for Vaccines (VFV) on May 19 at 12:00 p.m. (ET) for a conference call with Dr. Dorit Rubinstein Reiss on parental rights related to vaccination. Dr. Reiss is a professor of law at the University of California Hastings College of Law.
To register for this call, you must email info@voicesforvaccines.org.
Voices for Vaccines is a national organization of parents and others who are dedicated to raising the level of the voices of immunization supporters. VFV invites everyone who appreciates vaccines to become a member of their organization. Please spread the word to your friends and colleagues to register for the conference call and to join VFV!
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IAC HANDOUTS
IAC updates "Emergency Response Worksheet," a resource that helps healthcare professionals handle vaccine storage temperature excursions
IAC recently updated Emergency Response Worksheet, a resource that helps healthcare professionals know what to do in case of a power failure or other event that results in vaccine storage outside of the recommended temperature range.
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IAC's Handouts for Patients & Staff web section offers healthcare professionals and the public more than 250 FREE English-language handouts (many also available in translation), which we encourage website users to print out, copy, and distribute widely.
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IAC makes correction to patient handout "You are not alone! Information for young adults who are chronically infected with hepatitis B virus"
Last week, IAC announced the availability of an updated version of "You are not alone! Information for young adults who are chronically infected with hepatitis B virus," written by Karen Y. Wainwright, RN, BS, CCRA, and Sarah Jane Schwarzenberg, MD. Alert reader Cynthia from Missouri pointed out that the advice on page 3 about cleaning up blood spills referred to "a solution of one part household bleach to 100 parts water." This has been corrected to "a solution of one part household bleach to 10 parts water." We apologize for any inconvenience.
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VACCINE INFORMATION STATEMENTS
IAC posts 13 translations of the Meningococcal ACWY VIS
IAC recently posted the following new translations of the Meningococcal ACWY VIS dated March 31, 2016:
IAC thanks the California Department of Public Health for the Farsi, Hmong, Korean, and Tagalog translations. The other translations are provided by IAC through a cooperative agreement with CDC.
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IAC posts 10 translations of the HPV9 VIS
IAC recently posted the following new translations of the HPV9 VIS dated March 31, 2016:
IAC thanks the California Department of Public Health for the Farsi translation. The other translations are provided by IAC through a cooperative agreement with CDC.
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OFFICIAL RELEASES AND ANNOUNCEMENTS
CDC's 2014 viral hepatitis surveillance report is now available
On May 4, CDC released 2014 viral hepatitis surveillance data for the United States. The report highlights the alarming death toll of hepatitis C, the rise in new hepatitis C infections, and the continued public health problem of chronic hepatitis B. The hepatitis B summary is reprinted below.
Acute hepatitis B has been declining in incidence since 1990 mainly due to effective vaccination strategies. The number of reported cases of acute hepatitis B has remained relatively stable since 2009. A total of 2,953 acute cases were reported in 2014. However, chronic HBV infection remains a major public health challenge; CDC investigations report approximately 850,000 HBV-infected persons in the United States, although other studies have estimated as many as 2.2 million persons are living with HBV infection. Surveillance data from enhanced surveillance sites in this report indicate about one-half of chronic HBV infections were among Asians/Pacific Islanders, and 39.7% of chronic HBV infections were among persons born outside of the United States. Other data indicate that approximately 47%–70% of persons with HBV infection living in the United States were born in other countries. Among foreign-born persons with chronic HBV infection, an estimated 58% migrated from Asia. Further, mortality data in this report show that disproportionate numbers of Asians/Pacific Islanders are dying with hepatitis B. Identifying these chronically infected persons and linking them to care is critical. The U.S. Preventive Services Task Force (USPSTF) joined with CDC in 2014 to recommend HBV testing for persons born in countries where HBV infection is endemic. After adjusting for under-ascertainment and under-reporting, the estimated number of new HBV infections was 19,200.
Access Surveillance for Viral Hepatitis—United States, 2014
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WORLD NEWS
CDC and WHO report on laboratory support for global measles and rubella elimination in this week's MMWR and Weekly Epidemiological Report, respectively
CDC published an article titled Global Measles and Rubella Laboratory Network Support for Elimination Goals, 2010–2015 in the May 6 issue of MMWR (pages 438–442). On the same day, WHO's Weekly Epidemiological Record published a similar article titled Global measles and rubella laboratory network support for elimination goals, 2010–2015. A media summary of the MMWR article is reprinted below.
With 703 laboratories supporting surveillance in 191 countries, the WHO Global Measles and Rubella Laboratory Network (GMRLN) provides the laboratory capacity needed to test and confirm suspected measles and rubella cases reported globally. In addition, the network conducts genetic characterization of circulating measles and rubella viruses to track global transmission patterns and document interruption of transmission. During 2010–2015, 742,187 serum specimens from suspected measles and rubella case patients were tested in GMRLN laboratories, and 27,832 viral sequences were reported globally. GMRLN laboratories also provide a platform to conduct surveillance for other vaccine-preventable diseases, including rotavirus diarrhea, yellow fever and Japanese encephalitis, and support detection and response activities during public health emergencies such as those caused by the Ebola, chikungunya, dengue, and Zika viruses.
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Now available! IAC's sturdy laminated versions of the 2016 U.S. child/teen immunization schedule and the 2016 U.S. adult immunization schedule—order a supply for your healthcare setting today!
IAC's laminated versions of the 2016 U.S. child/teen immunization schedule and the 2016 U.S. adult immunization schedule are covered with a tough, washable coating; they will stand up to a year's worth of use in every area of your healthcare setting where immunizations are given. Both schedules are eight pages (i.e., four double-sided pages) and are folded to measure 8.5" x 11".
Laminated schedules are printed in color for easy reading, come complete with essential tables and footnotes, and include contraindications and precautions—a feature that will help you make an on-the-spot determination about the safety of vaccinating patients of any age.
PRICING
1–4 copies: $7.50 each
5–19 copies: $5.50 each
20–99 copies: $4.50 each
100–499 copies: $4.00 each
500–999 copies: $3.50 each
For quotes on customizing or placing orders for 1,000 copies or more, call (651) 647-9009 or email admininfo@immunize.org.
You can access specific information on both schedules, view images of both, order online, or download an order form at the Shop IAC: Laminated Schedules web page.
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JOURNAL ARTICLES AND NEWSLETTERS
Study finds that vaccinating pregnant women against influenza protects their infants
A study titled Influenza in Infants Born to Women Vaccinated During Pregnancy was published in the May issue of Pediatrics. The abstract is reprinted below.
BACKGROUND
Infants <6 months old with influenza are at risk for adverse outcomes. Our objective was to compare influenza outcomes in infants <6 months old born to women who did and did not report influenza vaccine during pregnancy.
METHODS
The study included all women who delivered from 12/2005 to 3/2014 at Intermountain facilities and their infants. Influenza outcomes included infant influenza-like illness (ILI), laboratory-confirmed influenza, and influenza hospitalizations.
RESULTS
The cohort included 245,386 women and 249,387 infants. Overall, 23,383 (10%) pregnant women reported influenza immunization. This number increased from 2.2% before the H1N1 pandemic to 21% postpandemic (P < .001). A total of 866 infants <6 months old had ≥1 ILI encounter: 32 (1.34/1000) infants born to women reporting immunization and 834 (3.70/1000) born to women who did not report immunization (relative risk [RR] 0.36; 95% confidence interval [CI], 0.26–0.52; P < .001). A total of 658 infants had laboratory-confirmed influenza: 20 (0.84/1000) born to women reporting immunization and 638 (2.83/1000) born to unimmunized women (RR 0.30; 95% CI, 0.19–0.46; P < .001). A total of 151 infants with laboratory-confirmed influenza were hospitalized: 3 (0.13/1000) born to women reporting immunization and 148 (0.66/1000) born to unimmunized women (RR 0.19; 95% CI, 0.06–0.60; P = .005).
CONCLUSIONS
Self-reported influenza immunization during pregnancy was low but increased after the H1N1 pandemic. Infants born to women reporting influenza immunization during pregnancy had risk reductions of 64% for ILI, 70% for laboratory-confirmed influenza, and 81% for influenza hospitalizations in their first 6 months. Maternal influenza immunization during pregnancy is a public health priority.
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EDUCATION AND TRAINING
National Partnership on Adolescent Immunization training modules on quality improvement stress HPV vaccination
The National Partnership on Adolescent Immunization Quality Improvement (QI) Modules are a set of 15-minute web videos that explain key introductory concepts in QI. The examples used throughout the series relate to adolescent immunization, with a special focus on HPV vaccination. The modules were created by the Academic Pediatric Association (APA) with funding from CDC, and are freely available for your use. They are now posted on the APA website as QI Education Modules.
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ASK THE EXPERTS
Question of the Week
We have a 40 lb six-year-old patient who has been taking 15 mg of methotrexate weekly for arthritis for 12 months. Can we give the child MMR and varicella vaccine based on this methotrexate dosage?
Based on the weight and dosage provided (40 lbs and 15 mg/week), the child is currently receiving more than 0.4 mg/kg/week of methotrexate. This meets the Infectious Disease Society of America (IDSA) definition of high-level immunosuppression. Administration of both varicella and MMR vaccines are contraindicated until such time as the methotrexate dosage can be reduced.
The IDSA states that administration of varicella vaccine (but not MMR) can be considered for non-varicella-immune patients treated for chronic inflammatory disease who are receiving long-term low-dose immunosuppression. Low-dose immunosuppression for methotrexate is a dosage of less than 0.4 mg/kg/week. See Table 6 (and associated footnotes): cid.oxfordjournals.org/content/early/2013/11/26/cid.cit684.full.pdf.
About IAC's Question of the Week
Each week, IAC Express highlights a new, topical, or important-to-reiterate Q&A. This feature is a cooperative venture between IAC and CDC. William L. Atkinson, MD, MPH, IAC's associate director for immunization education, chooses a new Q&A to feature every week from a set of Q&As prepared by experts at CDC’s National Center for Immunization and Respiratory Diseases.
We hope you enjoy this new feature and find it helpful when dealing with difficult real-life scenarios in your vaccination practice. Please encourage your healthcare professional colleagues to sign up to receive IAC Express at www.immunize.org/subscribe.
If you have a question for the CDC immunization experts, you can email them directly at nipinfo@cdc.gov. There is no charge for this service.
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