Issue
Number 605
June 19, 2006
CONTENTS OF THIS ISSUE
- New: JCAHO establishes infection control standards that
address influenza vaccination for healthcare staff
- VIS translations: Current VIS for hepatitis A vaccine
translated into Spanish and 10 other languages
- Updated: IAC revises many immunization and hepatitis
information pieces for parents, patients, and professionals
- Time magazine selects CDC's Dr. Nancy Cox as one of the
Time 100: The People Who Shape Our World
- July 7 NIP net conference will cover human
papillomavirus (HPV), cervical cancer, and HPV vaccine and recommendations
- July 20 NIP net conference to focus on vaccine
preparation and delivery and on 2006 influenza recommendations
- August 10 broadcast to cover influenza, pertussis,
rotavirus and zoster vaccines and hepatitis A recommendations
- CDC issues an update on U.S. and worldwide influenza
activity in 2005-06 and on composition of 2006-07 influenza vaccine
- CDC issues "Summary of Notifiable Diseases—United
States, 2004"
- HHS announces final rule for smallpox vaccine injury
compensation
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ABBREVIATIONS: AAFP, American Academy of Family Physicians; AAP, American
Academy of Pediatrics; ACIP, Advisory Committee on Immunization Practices;
CDC, Centers for Disease Control and Prevention; FDA, Food and Drug
Administration; IAC, Immunization Action Coalition; MMWR, Morbidity and
Mortality Weekly Report; NIP, National Immunization Program; VIS, Vaccine
Information Statement; VPD, vaccine-preventable disease; WHO, World Health
Organization.
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June 19, 2006
NEW: JCAHO ESTABLISHES INFECTION CONTROL STANDARDS THAT ADDRESS INFLUENZA
VACCINATION FOR HEALTHCARE STAFF
On June 13, the Joint Commission on Accreditation of Healthcare
Organizations (JCAHO) issued a press release announcing that it has approved
a standard requiring accredited healthcare organizations to offer influenza
vaccinations to staff, volunteers, and independent practitioners, effective
January 1, 2007. The press release is reprinted below in its entirety.
*********************
June 13, 2006
JOINT COMMISSION ESTABLISHES INFECTION CONTROL STANDARD TO ADDRESS INFLUENZA
VACCINES FOR STAFF
The Joint Commission on Accreditation of Healthcare Organizations today
announced the approval of an infection control standard that requires
accredited organizations to offer influenza vaccinations to staff, which
includes volunteers and licensed independent practitioners with close
patient contact. The standard will become an accreditation requirement
beginning January 1, 2007, for the Critical Access Hospital, Hospital and
Long-Term—Care accreditation programs.
"Preventing the spread of the flu protects patients and saves lives.
Encouraging healthcare workers to be vaccinated can play a vital role in
stopping the transmission of this potentially fatal infection," says Robert
Wise, MD, vice president, Division of Standards and Survey Methods, Joint
Commission.
The Joint Commission developed the standard in response to recommendations
by the Centers for Disease Control and Prevention (CDC) making the reduction
of influenza transmission from healthcare professionals to patients a top
priority in the United States. While the CDC has urged annual influenza
vaccination for healthcare workers since 1981, the CDC's Morbidity and
Mortality Weekly Report published earlier this year calls for stronger steps
to increase influenza vaccination of healthcare workers. Despite the
recommendations, the vaccination rates as measured by the CDC remain low.
Studies show that influenza causes 36,000 deaths and [more than] 200,000
hospitalizations on average in the United States annually. Furthermore,
healthcare-associated transmission of influenza has been documented among
many patient populations in a variety of clinical settings, and infections
have been linked epidemiologically to unvaccinated healthcare workers.
Typically, fewer than 40 percent of healthcare workers are immunized each
year.
The new Joint Commission standard requires organizations to
-
Establish an annual influenza vaccination program that includes at least
staff and licensed independent practitioners;
-
Provide access to influenza vaccinations on site;
-
Educate staff and licensed independent practitioners about flu
vaccination; non-vaccine control measures (such as the use of appropriate
precautions); and diagnosis, transmission, and potential impact of
influenza;
-
Annually evaluate vaccination rates and reasons for non-participation in
the organization's immunization program; and
-
Implement enhancements to the program to increase participation.
*********************
To access the press release from the JCAHO website, go to:
http://www.jointcommission.org/newsroom/newsreleases/nr_06_13_06.htm
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June 19, 2006
VIS TRANSLATIONS: CURRENT VIS FOR HEPATITIS A VACCINE TRANSLATED INTO
SPANISH AND 10 OTHER LANGUAGES
Dated 3/21/06, the current version of the hepatitis A vaccine VIS is now
available on the IAC website in Spanish and 10 additional languages:
Arabic, Armenian, Cambodian, Chinese, Farsi, Hmong, Korean, Russian,
Tagalog, and Vietnamese. IAC gratefully acknowledges the California
Department of Health Services for the translations.
To obtain a ready-to-copy (PDF) version of the current VIS hepatitis A
vaccine in Spanish, go to:
http://www.immunize.org/vis/sp_hpa06.pdf
To obtain it in Arabic, go to:
http://www.immunize.org/vis/ab_hpa06.pdf
To obtain it in Armenian, go to:
http://www.immunize.org/vis/ar_hpa06.pdf
To obtain it in Cambodian, go to:
http://www.immunize.org/vis/ca_hpa06.pdf
To obtain it in Chinese, go to:
http://www.immunize.org/vis/ch_hpa06.pdf
To obtain it in Farsi, go to:
http://www.immunize.org/vis/fa_hpa06.pdf
To obtain it in Hmong, go to:
http://www.immunize.org/vis/hm_hpa06.pdf
To obtain it in Korean, go to:
http://www.immunize.org/vis/ko_hpa06.pdf
To obtain it in Russian, go to:
http://www.immunize.org/vis/ru_hpa06.pdf
To obtain it in Tagalog, go to:
http://www.immunize.org/vis/ta_hpa06.pdf
To obtain it in Vietnamese, go to:
http://www.immunize.org/vis/vn_hpa06.pdf
To obtain it in English, go to:
http://www.immunize.org/vis/v-hepa.pdf
For information about the use of VISs, and for VISs in more than 30
languages, visit IAC's VIS web section at
http://www.immunize.org/vis
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June 19, 2006
UPDATED: IAC REVISES MANY IMMUNIZATION AND HEPATITIS INFORMATION PIECES
FOR PARENTS, PATIENTS, AND PROFESSIONALS
IAC recently revised many of its immunization and hepatitis education
materials for parents, patients, and healthcare professionals. Following
is a list of the updated materials; it explains the changes made to each
and provides links to each.
IMMUNIZATION EDUCATIONAL MATERIALS
For parents and patients:
1. The two-page brochure "Questions parents ask about baby shots" now
includes rotavirus vaccine.
To access a ready-to-print (PDF) version of it, go to:
http://www.immunize.org/catg.d/p4025.pdf
To access a web-text (HTML) version, go to:
http://www.immunize.org/nslt.d/n18/p4025.htm
2. The Spanish-language version of the one-page chart "When do children
and teens need vaccinations?" was changed to add rotavirus vaccine and
update the recommended age for influenza vaccination from 6–23 months to
6–59 months. IAC gratefully acknowledges the California Department of
Health Services for the translation.
To access a ready-to-print (PDF) version of it, go to:
http://www.immunize.org/catg.d/p4050-01.pdf
To access a web-text (HTML) version, go to:
http://www.immunize.org/catg.d/p4050-01.htm
To access a ready-to-print (PDF) version of it in English, go
to:
http://www.immunize.org/catg.d/when1.pdf
To access a web-text (HTML) version in English, go to: To access a
web-text (HTML) version in English, go to:
http://www.immunize.org/nslt.d/n17/when1.htm
3. The English- and Spanish-language versions of the one-page chart
"Immunizations for babies . . . a guide for parents: These are the
vaccinations your baby needs!" were changed to add rotavirus vaccine and
update the recommended age for influenza vaccination from 6–23 months to
6–59 months. IAC gratefully acknowledges the California Department of
Health Services for the Spanish translation.
To access a ready-to-print (PDF) version of it in English, go to:
http://www.immunize.org/catg.d/p4010imm.pdf
To access a web-text (HTML) version in English, go to:
http://www.immunize.org/catg.d/p4010.htm
To access a ready-to-print (PDF) version of it in Spanish, go
to:
http://www.immunize.org/catg.d/p4010-01imm.pdf
To access a web-text (HTML) version in Spanish, go to:
http://www.immunize.org/catg.d/p4010-01.htm
For healthcare professionals:
1. The one-page document "Brief sex history questionnaire" was recently
reviewed and minor changes were made.
To access a ready-to-print (PDF) version of it, go to:
http://www.immunize.org/catg.d/p4401.pdf
HEPATITIS EDUCATIONAL MATERIALS
For patients:
1. The two-page brochure "Every day, teens are infected with hepatitis B
virus: Be sure you're vaccinated against this disease" was recently
reviewed and minor changes were made.
To access a ready-to-print (PDF) version of it, go to:
http://www.immunize.org/catg.d/p4100tee.pdf
To access a web-text (HTML) version, go to:
http://www.immunize.org/catg.d/p4100tee.htm
2. The two-page brochure "Every week hundreds of sexually active people
get hepatitis B: Get protected! Get vaccinated!" was recently reviewed and
minor changes were made.
To access a ready-to-print (PDF) version of it, go to:
http://www.immunize.org/catg.d/4112std.pdf
To access a web-text (HTML) version, go to:
http://www.immunize.org/catg.d/4112std.htm
3. The two-page brochure "If you, your parents, or your children were born
in any of these places . . . give this brochure to your healthcare
provider and ask to find out your hepatitis B status" was recently
translated into Spanish. IAC gratefully acknowledges the California
Department of Health Services for the translation.
To access a ready-to-print (PDF) version of it, go to:
http://www.immunize.org/catg.d/p4170sp.pdf
To access a ready-to-print (PDF) version of it in English, go to:
http://www.immunize.org/catg.d/p4170ref.pdf
4. Dated 9/03, the four-page document "Questions frequently asked about
hepatitis B" was recently translated into Spanish. IAC gratefully
acknowledges the Perinatal Hepatitis B Prevention Program of the
Montgomery County (Maryland) Department of Health and Human Services for
the translation.
To access a ready-to-print (PDF) version of it, go to:
http://www.immunize.org/catg.d/4090-01q.pdf
To access a ready-to-print (PDF) version of it in English, go to:
http://www.immunize.org/catg.d/p4090.pdf
For healthcare professionals:
1. The one-page document "Give the birth dose . . . hepatitis B vaccine at
birth saves lives" was modified to be consistent with the new birth dose
recommendations made by CDC, AAP, AAFP, and American College of
Obstetricians/Gynecologists (ACOG).
To access a ready-to-print (PDF) version of it, go to:
http://www.immunize.org/catg.d/p2125.pdf
To access a web-text (HTML) version, go to:
http://www.immunize.org/catg.d/p2125.htm
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June 19, 2006
TIME MAGAZINE SELECTS CDC'S DR. NANCY COX AS ONE OF THE TIME 100: THE
PEOPLE WHO SHAPE OUR WORLD
CDC recently announced that scientist Nancy Cox, PhD, has been selected to
be included in the Time 100: The People Who Shape Our World. Dr. Cox,
director of CDC's Influenza Division, is widely respected for her
knowledge of and understanding of influenza viruses, as well as her
insights into important influenza prevention and control strategies.
To read the CDC announcement, go to:
http://www.cdc.gov/flu/nancycox_article.htm
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June 19, 2006
JULY 7 NIP NET CONFERENCE WILL COVER HUMAN PAPILLOMAVIRUS (HPV), CERVICAL
CANCER, AND HPV VACCINE AND RECOMMENDATIONS
A supplemental Current Issues in Immunization net conference is scheduled
for July 7, from noon to 1PM ET. It will focus on the newly emerging
immunization topic of HPV disease, vaccine, and recommendations.
PLEASE NOTE: Based on decisions made at the June 29–30 ACIP meeting this
supplemental session on HPV may be rescheduled. If so, the net
conference's new dates and times will be posted at
http://www.cdc.gov/nip/ed/ciinc/hpv.htm
The net conference will cover three primary topics:
-
Epidemiology of human papillomavirus, presented by Eileen Dunne, MD, MPH
-
Cervical cancer in the United States, presented by Herschel Lawson, MD
-
HPV vaccine efficacy and recommendations, presented by Lauri Markowitz,
MD
The conference requires pre-registration, as space is limited. Registration
will close when the course is full or on July 5 (midnight ET). To register
for the conference, go to:
http://www2a.cdc.gov/nip/isd/ciinc_hpv
The program will combine a telephone audio conference and simultaneous
online visual content. Participants can join the Q&A session by telephone or
Internet. For instructions and system requirements, go to:
http://www.cdc.gov/nip/ed/ciinc/instructions.htm
For additional information, go to:
http://www.cdc.gov/nip/ed/ciinc/hpv.htm or call (800) 232-4636.
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June 19, 2006
JULY 20 NIP NET CONFERENCE TO FOCUS ON VACCINE PREPARATION AND DELIVERY
AND ON 2006 INFLUENZA RECOMMENDATIONS
Scheduled for July 20, from noon to 1PM ET, the Current Issues in
Immunization net conference is designed to provide clinicians with
up-to-date information on immunization. The program has two primary
topics: (1) vaccine administration and current recommendations
(presented by Donna Weaver, RN, MN) and (2) the 2006 influenza
recommendations (presented by David Shay, MD, MPH).
The conference requires pre-registration, as space is limited.
Registration will close when the course is full or on July 17 (midnight
ET). To register for the conference, go to:
http://www2a.cdc.gov/nip/isd/ciinc
The program will combine a telephone audio conference and simultaneous
online visual content. Participants can join the Q&A session by
telephone or Internet. For instructions and system requirements, go to:
http://www.cdc.gov/nip/ed/ciinc/instructions.htm
For additional information, go to:
http://www.cdc.gov/nip/ed/ciinc or email
nipinfo@cdc.org or call (800)
232-4636.
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June 19, 2006
AUGUST 10 BROADCAST TO COVER INFLUENZA, PERTUSSIS, ROTAVIRUS, AND ZOSTER
VACCINES AND HEPATITIS A RECOMMENDATIONS
The live satellite broadcast and webcast Immunization Update 2006 will
provide up-to-date information on the rapidly changing field of
immunization. Sponsored by CDC, the live broadcast is scheduled for
August 10, from 9AM to 11:30AM ET. It will be rebroadcast later in the
day from noon to 2:30PM ET. Both broadcasts will feature a live Q&A
session in which participants nationwide can interact with the course
instructors by toll-free telephone lines.
Following is the anticipated course content: influenza vaccine,
pertussis vaccine for adolescents and adults, revised recommendations
for childhood hepatitis A vaccination, the new vaccines for rotavirus
and herpes zoster, and possibly information about human papillomavirus (HPV)
vaccine.
The course instructors are William L. Atkinson, MD, MPH; Donna Weaver,
RN, MN; and Andrew Kroger, MD, MPH. All are with the CDC's National
Immunization Program.
Site registration begins on June 22; individual registration, on July
13. Registration is not required for the webcast. For further
registration information, email ce@cdc.gov
or call (800) 418-7246.
For comprehensive program information, go to:
http://www.phppo.cdc.gov/PHTN/immup-2006 or email
nipinfo@cdc.gov
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June 19, 2006
CDC ISSUES AN UPDATE ON U.S. AND WORLDWIDE INFLUENZA ACTIVITY IN 2005–06
AND ON COMPOSITION OF 2006-07 INFLUENZA VACCINE
CDC published "Update: Influenza activity—United States and worldwide,
2005–06 season, and composition of the 2006–07 influenza vaccine" in the
June 16 issue of MMWR. Portions of the article and editorial note are
reprinted below.
***********************
During the 2005-06 influenza season, influenza A (H1N1), A (H3N2), and B
viruses co-circulated worldwide. In the United States, influenza A
(H3N2) viruses predominated overall, but influenza B viruses were
isolated more frequently than influenza A viruses late in the season.
Influenza activity in the United States peaked in early March, and the
number of pneumonia and influenza deaths did not exceed the epidemic
threshold. Worldwide, influenza B viruses were the most commonly
reported influenza type in Europe; influenza A (H1N1) and influenza B
viruses predominated in Asia. Through June 13, 2006, outbreaks of
influenza A (H5N1) viruses (avian influenza) among migratory birds and
poultry flocks were associated with severe human illness or death in 10
countries (Azerbaijan, Cambodia, China, Djibouti, Egypt, Indonesia,
Iraq, Thailand, Turkey, and Vietnam). This report summarizes influenza
activity in the United States and worldwide during the 2005-06 influenza
season and describes composition of the 2006-07 influenza vaccine.
UNITED STATES
The national percentage of respiratory specimens testing positive for
influenza and the proportion of outpatient visits to sentinel providers
for influenza-like illness (ILI) peaked in early March 2006. Influenza A
(H3N2) viruses were most commonly isolated overall, but influenza B
viruses were more frequently identified than influenza A viruses during
late April and May. A small number of influenza A (H1N1) viruses also
were identified. . . .
COMPOSITION OF THE INFLUENZA VACCINE FOR THE 2006-07 SEASON
The Food and Drug Administration's Vaccines and Related Biological
Products Advisory Committee has recommended that the 2006-07 trivalent
influenza vaccine for the United States contain A/New
Caledonia/20/99-like (H1N1), A/Wisconsin/67/2005-like (H3N2), and
B/Malaysia/2506/2004-like viruses. This represents a change in the
influenza A (H3N2) and influenza B components. For the
A/Wisconsin/67/2005-like (H3N2) virus, U.S. vaccine manufacturers can
use A/Wisconsin/67/2005 or the antigenically equivalent
A/Hiroshima/52/2005 strain. For the influenza B component, either the
B/Malaysia/2506/2004 or B/Ohio/1/2005 strain can be used. This
recommendation is based on antigenic analyses of recently isolated
influenza viruses, epidemiologic data, and postvaccination serologic
studies in humans. . . .
PNEUMONIA- AND INFLUENZA-RELATED MORTALITY
During the 2005-06 influenza season, the percentage of deaths attributed
to pneumonia and influenza (P&I) as reported by the 122 Cities Mortality
Reporting System did not exceed the epidemic threshold. The percentage
of P&I deaths peaked twice at 7.8%, once during the week ending January
14, 2006 (week 2), and again during the week ending March 18, 2006 (week
11). During the preceding five influenza seasons, the peak percentage of
P&I deaths ranged from 8.1% to 10.4%, and the total number of weeks
above the epidemic threshold ranged from 4 to 16 (CDC, unpublished data,
2006). . . .
HUMAN INFECTIONS WITH AVIAN INFLUENZA A (H5N1) VIRUSES
During December 1, 2003-June 13, 2006, a total of 225 human cases of
avian influenza A (H5N1) infection were reported to WHO from 10
countries. Of these, 128 (57%) were fatal. All cases were reported from
Asia (Azerbaijan, Cambodia, China, Indonesia, Iraq, Thailand, Turkey,
and Vietnam) or Africa (Djibouti and Egypt). To date, no human case of
avian influenza A (H5N1) virus infection has been identified in the
United States. . . .
EDITORIAL NOTE:
During the 2005-06 influenza season, influenza activity in the United
States peaked in early March and excess mortality was not detected. In
the United States, influenza A (H3N2) viruses predominated during most
of the season, but influenza B viruses were more frequently identified
than influenza A viruses during late April through May. Worldwide,
influenza B viruses were reported most commonly in many European
countries, and influenza A (H1N1) and influenza B viruses predominated
in Asia. . . .
As a supplement to influenza vaccination, antiviral drugs have aided in
the control and prevention of influenza. However, the 2005-06 influenza
season was notable because of the emergence of a high level of
resistance among circulating influenza A (H3N2) viruses to the antiviral
adamantanes (i.e., amantadine and rimantadine). Of 209 influenza A
(H3N2) virus isolates collected from 26 states and sent to CDC during
October 1-December 31, 2005, a total of 193 (92.3%) were resistant to
adamantanes. On the basis of these findings, in January 2006, CDC
recommended against use of the adamantane class of antivirals for the
treatment and prophylaxis of influenza in the United States until
susceptibility to adamantanes has been reestablished among circulating
influenza A isolates. A high level of resistance to adamantanes
([greater than] 90%) by influenza A (H3N2) viruses continued to be
observed among specimens tested through May 2006.
As of June 13, 2006, influenza A (H5N1) had been reported in migratory
birds or poultry flocks in Africa (Burkina Faso, Cameroon, Cote
d'Ivoire, Djibouti, Egypt, Niger, Nigeria, and Sudan), Asia
(Afghanistan, Azerbaijan, Cambodia, China, Georgia, Hong Kong,
Kazakhstan, India, Indonesia, Iraq, Iran, Israel, Jordan, Malaysia,
Mongolia, Myanmar, Palestinian Autonomous Territories, Pakistan,
Thailand, Turkey, and Vietnam), and Europe (Albania, Austria,
Bosnia-Herzegovina, Bulgaria, Croatia, Czech Republic, Denmark, France,
Germany, Greece, Hungary, Italy, Poland, Romania, Russia,
Serbia-Montenegro, Slovakia, Slovenia, Sweden, Switzerland, Ukraine, and
the United Kingdom). The spread of the virus can be associated, in part,
with the movement of wild migratory birds from Asia, suggesting that
apparently healthy birds can carry the virus over long distances. No
evidence of sustained person-to-person transmission of influenza A
(H5N1) viruses has been reported to date, but rare cases of
person-to-person transmission likely have occurred.
In collaboration with local and state health departments, CDC continues
to recommend enhanced surveillance for possible influenza A (H5N1)
infection among travelers with severe unexplained respiratory illness
returning from influenza A (H5N1)-affected countries. Additional
information on influenza, including avian influenza, is available at
http://www.cdc.gov/flu Updates on
the worldwide avian influenza situation are available from WHO at
http://www.who.int/csr/disease/avian_influenza/en
***********************
To access a web-text (HTML) version of the complete article, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5523a2.htm
To access a ready-to-print (PDF) version of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5523.pdf
To receive a FREE electronic subscription to MMWR (which includes new
ACIP statements), go to:
http://www.cdc.gov/mmwr/mmwrsubscribe.html
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June 19, 2006
CDC ISSUES "SUMMARY OF NOTIFIABLE DISEASES—UNITED STATES, 2004"
CDC published "Summary of Notifiable Diseases—United States, 2004" in
the June 16 issue of MMWR Summary of Notifiable Diseases.
The summary has two primary sections. They are Part 1: Summaries of
Notifiable Diseases in the United States, 2004; and Part 2: Graphs and
Maps for Selected Notifiable Diseases in the United States, 2004. The
opening paragraph of the preface is reprinted below.
***********************
The "Summary of Notifiable Diseases—United States, 2004" contains the
official statistics, in tabular and graphic form, for the reported
occurrence of nationally notifiable infectious diseases in the United
States for 2004. Unless otherwise noted, the data are final totals for
2004 reported as of December 2, 2005. These statistics are collected and
compiled from reports sent by state health departments to the National
Notifiable Diseases Surveillance System (NNDSS), which is operated by
CDC in collaboration with the Council of State and Territorial
Epidemiologists (CSTE). The summary is available at
http://www.cdc.gov/mmwr/summary.html This site also includes
publications from past years.
***********************
To access a web-text (HTML) version of the summary online, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5353a1.htm
Because the summary is a large file (1.7 MB), printing problems may
occur because of printer memory size. One solution is to print a few
pages at a time. To access more tips on downloading and printing large
PDF files, go to:
http://www.immunize.org/nslt.d/tips.htm
To access a ready-to-print (PDF) version, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5353.pdf
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June 19, 2006
HHS ANNOUNCES FINAL RULE FOR SMALLPOX VACCINATION INJURY COMPENSATION
On June 16, HHS issued a press release announcing the final rules for
the Smallpox Vaccine Injury Compensation Program. Portions of the press
release are reprinted below
************************
For immediate release
Friday, June 16, 2006
HHS ISSUES FINAL RULE FOR SMALLPOX VACCINE INJURY COMPENSATION PROGRAM
HHS Secretary Mike Leavitt today announced final rules for the Smallpox
Vaccine Injury Compensation Program. The rules strengthen the smallpox
vaccination compensation program, which provides benefits to public
health and medical response team members and others who are injured as a
result of receiving the smallpox vaccine.
The final rules supersede and update the Smallpox Vaccine Injury Table
and the Administrative Implementation interim final rules that were
published in the Dec. 16, 2003, Federal Register. . . .
************************
To access the complete press release, go to:
http://www.hhs.gov/news/press/2006pres/20060616.html |
