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Issue 1229: February 10, 2016

Ask the Experts
Ask the Experts—Question of the Week: If someone is older than 55 years and had their spleen removed…read more










CDC publishes two articles about the release of the 2016 childhood and adult immunization schedules; both previously published as MMWR Early Releases

CDC published the following articles about the 2016 U.S. immunization schedules in the February 5 issue of MMWR. These articles were previously published as MMWR Early Releases on February 2, and covered in IAC Express on February 3.

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CDC reports on surveillance of vaccination coverage among adults in 2014

CDC published Surveillance of Vaccination Coverage Among Adult Populations—United States, 2014 in a February 5 MMWR Surveillance Summary. This report is based on data from CDC's National Health Interview Survey (NHIS). NHIS is a continuous, cross-sectional national household survey of the noninstitutionalized U.S. civilian population. In-person interviews are conducted throughout the year in a probability sample of households, and NHIS data are compiled and released annually. The "Results" section of this report is reprinted below.
Compared with data from the 2013 NHIS, increases in vaccination coverage occurred for Tdap vaccine among adults aged ≥19 years (a 2.9 percentage point increase to 20.1%) and herpes zoster vaccine among adults aged ≥60 years (a 3.6 percentage point increase to 27.9%). Aside from these modest improvements, vaccination coverage among adults in 2014 was similar to estimates from 2013 (for influenza coverage, similar to the 2012–13 season). Influenza vaccination coverage among adults aged ≥19 years was 43.2%. Pneumococcal vaccination coverage among high-risk persons aged 19–64 years was 20.3% and among adults aged ≥65 years was 61.3%. Td vaccination coverage among adults aged ≥19 years was 62.2%. Hepatitis A vaccination coverage among adults aged ≥19 years was 9.0%. Hepatitis B vaccination coverage among adults aged ≥19 years was 24.5%. HPV vaccination coverage among adults aged 19–26 years was 40.2% for females and 8.2% for males. Racial/ethnic differences in coverage persisted for all seven vaccines, with higher coverage generally for whites compared with most other groups. Adults without health insurance were significantly less likely than those with health insurance to report receipt of influenza vaccine (aged ≥19 years), pneumococcal vaccine (aged 19–64 years with high-risk conditions and aged ≥65 years), Td vaccine (aged ≥19 years), Tdap vaccine (aged ≥19 years and 19–64 years), hepatitis A vaccine (aged ≥19 years overall and among travelers), hepatitis B vaccine (aged ≥19 years, 19–49 years, and 19–59 years with diabetes), herpes zoster vaccine (aged ≥60 years and 60–64 years), and HPV vaccine (females aged 19–26 years and males aged 19–26 years). Adults who reported having a usual place for health care generally were more likely to receive recommended vaccinations than those who did not have a usual place for health care, regardless of whether they had health insurance. Vaccination coverage was significantly higher among those reporting one or more physician contacts in the past year compared with those who had not visited a physician in the past year, regardless of whether they had health insurance. Even among adults who had health insurance and ≥10 physician contacts within the past year, 23.8%–88.8% reported not having received vaccinations that were recommended either for all persons or for those with some specific indication. Overall, vaccination coverage among U.S.-born respondents was significantly higher than that of foreign-born respondents with few exceptions (influenza vaccination [adults aged 19–49 years], hepatitis A vaccination [adults aged ≥19 years], hepatitis B vaccination [adults with diabetes aged ≥60 years], and HPV vaccination [males aged 19–26 years]).

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National Vaccine Program Office releases National Adult Immunization Plan

The National Vaccine Program Office (NVPO), part of the U.S. Department of Health and Human Services (HHS), recently released a National Adult Immunization Plan. The plan provides an overview of actions needed to be undertaken by federal and nonfederal partners to protect public health and achieve optimal prevention of infectious diseases and their consequences through vaccination of adults. Studies show little change in adult immunization rates since 2010, with rates remaining below national targets. Significant racial and ethnic disparities also exist. 

The new plan, developed by NVPO with input from a wide range of experts from a variety of organizations, lays out the following four goals to increase adult immunization rates in the U.S.:

  1. Strengthen the public health and healthcare systems involved in adult immunization.
  2. Improve access to adult vaccines.
  3. Increase awareness of adult vaccine recommendations and use of recommended vaccines.
  4. Foster innovations in adult vaccines, including new vaccines and new ways to provide them.

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"Ask the Experts" web section about Hib vaccination updated 

The Haemophilus influenzae type b (Hib) web section of "Ask the Experts" was recently updated.

IAC’s Ask the Experts web section is a compilation of common as well as challenging questions and answers (Q&As) about vaccines and their administration. The experts are Andrew T. Kroger, MD, MPH, medical officer, and Donna L. Weaver, RN, MN, nurse educator. Both are at CDC's National Center for Immunization and Respiratory Diseases. The Q&As have been featured in previous issues of IAC ExpressNeedle Tips, and Vaccinate Adults.

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Subscribe to IAC Express and receive a new "Ask the Experts" Q&A every week, as well as several special editions of "Ask the Experts" throughout the year.

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IAC’s “Take a Stand™” workshops proving highly successful around the country: Register NOW for the next sessions in Texas (February 16–19)

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, PhDWilliam 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, and San Francisco, Sacramento, Los Angeles and San Diego, CA. To illustrate how these have been going, here is a small sampling of comments received from attendees:
“Not only does this workshop provide great education, but it provides you with the tools and resources you need to implement this within your practice.” J.M., APN, MPH (Chicago, IL)
“This workshop gave us great ideas and information. Can’t wait to go back and start this process to get our Standing Orders going.” 
T.S., clinical manager (Fredericksburg, VA)
“Fantastic—great expertise, resources, tools and advice.” 
D.S. (Nashville, TN)
“This workshop is excellent for nursing directors/managers in the ambulatory setting. Excellent resources for preventive services.” 
L.R., primary care service line nursing director (Little Rock, AR)
Don’t miss your chance to join these satisfied attendees. The next workshops are scheduled in three Texas cities.

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.
In addition to the Texas sessions, other workshop locations and schedules, a sample agenda, and online registration are available on the Take a Stand™ website at

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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February is Heart Month; patients with heart disease are at high risk of influenza complications

February is designated Heart Month, and CDC is taking the opportunity to remind healthcare professionals that patients with heart disease are at high risk of influenza complications. Some information from CDC's Flu and Heart Disease & Stroke web page is reprinted below.

People with heart disease and those who have had a stroke are at high risk for developing serious complications from the flu. Among adults hospitalized with the flu during the 2014–2015 influenza season, heart disease was among the most commonly occurring chronic conditions; 50% of adults hospitalized with the flu during the 2014–2015 flu season had heart disease. Studies have shown that influenza is associated with an increase of heart attacks and stroke.

Heart disease includes but is not limited to coronary artery disease [heart attack or myocardial infarction, acute coronary syndrome and angina (chest pain related to heart disease)]. It also includes the following common conditions:

  • Heart failure
  • Hypertensive heart disease
  • Pulmonary heart disease
  • Heart valve disorders
  • Arrhythmias including atrial fibrillation
  • Congenital heart defects

Healthcare professionals should make sure their patients with heart disease are appropriately vaccinated against influenza and pneumococcal disease. In addition, CDC urges rapid antiviral treatment of very ill and high-risk suspect influenza patients without waiting for testing.

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U.S. cancer centers call for improved HPV vaccination rates to help prevent HPV-associated cancers 

At the end of January, all 69 National Cancer Institute-designated cancer centers joined together to call for improved HPV vaccination rates. A portion of the Call to Action letter from this group is reprinted below.

Approximately 79 million people in the United States are currently infected with a human papillomavirus (HPV) according to the Centers for Disease Control and Prevention (CDC), and 14 million new infections occur each year. Several types of high-risk HPV are responsible for the vast majority of cervical, anal, oropharyngeal (middle throat) and other genital cancers. The CDC also reports that each year in the U.S., 27,000 men and women are diagnosed with an HPV-related cancer, which amounts to a new case every 20 minutes. Even though many of these HPV-related cancers are preventable with a safe and effective vaccine, HPV vaccination rates across the U.S. remain low...

The low vaccination rates are alarming given our current ability to safely and effectively save lives by preventing HPV infection and its associated cancers. Therefore, we urge parents and health care providers to protect the health of our children through a number of actions:

  • We encourage all parents and guardians to have their sons and daughters complete the 3-dose HPV vaccine series before the 13th birthday, and complete the series as soon as possible in children aged 13 to 17. Parents and guardians should talk to their health care provider to learn more about HPV vaccines and their benefits.
  • We encourage young men (up to age 21) and young women (up to age 26), who were not vaccinated as preteens or teens, to complete the 3-dose HPV vaccine series to protect themselves against HPV.
  • We encourage all health care providers to be advocates for cancer prevention by making strong recommendations for childhood HPV vaccination. We ask providers to join forces to educate parents/guardians and colleagues about the importance and benefits of HPV vaccination.

HPV vaccination is our best defense in stopping HPV infection in our youth and preventing HPV-related cancers in our communities. The HPV vaccine is CANCER PREVENTION. More information is available from the CDC.

Access the Call to Action letter: NCI-designated Cancer Centers Urge HPV Vaccination for the Prevention of Cancer

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Reminder: Nominations are now open for the National Adult and Influenza Immunization Summit Excellence Awards; submission deadline is February 15

The National Adult and Influenza Immunization Summit (NAIIS) is now soliciting nominations for the 2016 Immunization Excellence Awards. These prestigious awards recognize individuals and organizations that have made extraordinary contributions towards improving vaccination rates within their communities during 2015. The national winner in each category will be invited to present their program at the 2016 NAIIS meeting in Atlanta, Georgia. The deadline for receipt of nominations is February 15, 2016.

Award nominations will be accepted for:

  • Laura Scott NAIIS Immunization Excellence Award for Outstanding Influenza Season Activities
  • “Immunization Neighborhood” Champion
  • Adult Immunization Champion
  • Corporate Campaign
  • Adult Immunization Publication

Additional award to be presented (no nomination):

  • Influencer Award—selected by the NAIIS Organizing Committee to recognize an individual or organization in the media, legislature, or community whose activities, contributions, and/or willingness to go above and beyond have advanced adult and/or influenza immunization implementation

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UNITY Consortium invites practices to apply for participation in a new study about adolescent vaccination

The UNITY Consortium is inviting practices to apply for participation in a new study, the “Pursuit of the Three Cs: Confident, Concise, and Consistent Health Care Provider Recommendations for Adolescent Vaccines." This study will evaluate the impact of a simple intervention designed to improve adolescent vaccination rates that can be readily adopted by healthcare professionals (HCPs) regardless of HCP type, geography, or location. 

The inclusion and exclusion practice criteria are listed below.

Inclusion criteria

  • Single specialty pediatrics practice with moderate to high volume of adolescent visits
  • Practice has at least five providers, which may include nurse practitioners and/or physician assistants
  • At least 90 percent of the providers in the practice must agree to participate
  • Participating providers should work at least 60 percent FTE, spend at least 70 percent of time in direct patient care, and have been practicing for at least 2 years and less than 25 years
  • Practice equipped with electronic health records that allow for generating blinded vaccination data/rates by provider

Exclusion criteria

  • Practice based in hospital/academic center
  • Practice cannot be based in Illinois, North Carolina, Rhode Island, or Utah as new adolescent vaccination mandates for these states started in the 2015–2016 school year 

The Unity Consortium welcomes an opportunity to discuss this study with interested practices. There is no fee to participate, and practices will be provided a modest honorarium. Please email Denise Lewis at for additional information. 

The mission of the Unity Consortium is improving adolescent health through a focus on prevention and immunization. Visit their website for more information.

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Join Voices for Vaccines on February 17 for a conference call featuring Dr. David Gorski, author of the Respectful Insolence blog

One of the longest-running and most popular blogs to cover immunization is Respectful Insolence. This blog, written by David Gorski, MD, under the "nom de blog" Orac, has been a great source for debunking anti-vaccine misinformation since 2004. Dr. Gorski is professor of surgery at Wayne State University School of Medicine and a surgical oncologist specializing in breast cancer surgery. According to the site: "Respectful Insolence™ is a repository for the ramblings of the aforementioned surgeon/scientist concerning medicine and quackery, science and pseudoscience, history and pseudohistory, politics, and anything else that interests him..."

Join Voices for Vaccines( VFV) on a call with Dr. Gorski at 12:00 p.m. (ET) on February 17. To register for this call, you must email

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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National Vaccine Program Office solicits proposals for conducting research related to vaccine confidence and hesitancy 

HHS's National Vaccine Program Office (NVPO) is currently soliciting proposals for a competitive cooperative agreement on the topic of "Understanding and Addressing Vaccine Confidence and Hesitancy to Foster Informed Vaccine Decision Making." The closing date for submissions is March 1, 2016, and a non-binding letter of intent is due by February 23, 2016.

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IAC updates three parent-friendly vaccine schedules for children and adolescents to include meningococcal B vaccine 

IAC recently revised three handouts for parents of children and adolescents to include current ACIP recommendations for use of meningococcal serogroup B vaccine. Other minor edits were made. The three updated parent-friendly vaccine schedules are:

Visit IAC's Patient Schedules web page to access these handouts and more, as well as available translations.

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 updates "Healthcare Personnel Vaccination Recommendations" to include meningococcal B vaccination for microbiologists who are routinely exposed to isolates of Neisseria meningitidis

IAC has updated Healthcare Personnel Vaccination Recommendations to include the meningococcal serogroup B vaccination recommendation for microbiologists who are routinely exposed to isolates of Neisseria meningitidis.

Visit IAC's Vaccine Recommendations web page to access this resource and more summaries of ACIP recommendations.

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AAP publishes 2016 recommended childhood and adolescent immunization schedule online 

The American Academy of Pediatrics (AAP) has published Recommended Childhood and Adolescent Immunization Schedule—United States, 2016 as an AAP Policy Statement online. The first paragraph is reprinted below.

The 2016 recommended childhood and adolescent immunization schedule has been approved by the American Academy of Pediatrics, the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention, the American Academy of Family Physicians, and the American College of Obstetricians and Gynecologists. The 2016 format is similar to the 2015 schedule, with a single schedule for people from birth through 18 years of age. The yellow bars indicate the recommended age range for all children and contain a notation indicating the recommended dose number by age. The green bars indicate the ages for recommended catch-up. The purple bars designate the recommended ages for immunization for certain groups at high risk. A blue bar has been added for the first time and indicates the range of recommended ages for people in non-high-risk groups who may receive a vaccine, subject to individual decision-making. The combined green and purple bar indicates the recommended age when vaccine catch-up is encouraged for certain high-risk groups. The white boxes show the ages when a vaccine is not recommended routinely. The catch-up schedule offers recommendations for children and adolescents 4 months through 18 years of age who start vaccinations late or are >1 month behind.

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Influenza is spreading and serious; CDC releases guidance on antiviral treatment

According to this week's FluView report from CDC, seasonal influenza activity continues to increase slightly in the United States. Flu activity most often peaks in February and can last into May. The vast majority of circulating influenza viruses analyzed this season remain similar to the vaccine virus components for this season's influenza vaccines.

Influenza vaccination is recommended for everyone six months of age and older. If you don't provide influenza vaccination in your clinic, please recommend vaccination to your patients and refer them to a clinic or pharmacy that provides vaccines or to the HealthMap Vaccine Finder to locate sites near their workplaces or homes that offer influenza vaccination services. 

Influenza antiviral drugs can treat influenza illness. Early antiviral treatment works best. On February 1, the CDC Health Alert Network (HAN) issued a CDC Health Advisory titled Flu Season Begins: Severe Influenza Illness Reported. In this advisory, CDC urges rapid antiviral treatment of very ill and high-risk suspect influenza patients without waiting for testing.

Following is a list of resources related to influenza disease and vaccination for healthcare professionals and the public:

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The Vaccine Handbook: A Practical Guide for Clinicians, a.k.a. "The Purple Book," by Dr. Gary Marshall available for purchase from IAC 

The Vaccine Handbook: A Practical Guide for Clinicians (“The Purple Book,” 2015, 560 pages) is a uniquely 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.
Order your copy of The Vaccine Handbook today!
IAC Executive Director Deborah Wexler, MD, is enthusiastic about helping get this book circulated as widely as possible. “During more than 20 years in the field of immunization education, I have not seen a book that is so brimming with state-of-the-science vaccine information,” she states. "This book belongs in the hands of every medical student, physician-in-training, doctor, nursing student, and nurse who provides vaccines to patients.”
The Vaccine Handbook provides:

  • Information on every licensed vaccine in the United States
  • Rationale behind authoritative vaccine recommendations
  • Contingencies encountered in everyday practice
  • A chapter dedicated to addressing vaccine concerns
  • Background on how vaccine policy is made
  • Standards and regulations
  • Office logistics, including billing procedures, and much more

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.

The newly released fifth edition of this invaluable guide is now available on IAC’s website at

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

Order your copy today!

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January issue of CDC's Immunization Works newsletter now available

CDC recently released the January issue of its monthly newsletter, Immunization Works, and posted it on the website of the National Center for Immunization and Respiratory Diseases (NCIRD). The newsletter offers the immunization community information about current topics. The information is in the public domain and can be reproduced and circulated widely.

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CDC updates its "You Call the Shots" module on meningococcal vaccine; free CE credit available

CDC recently updated the meningococcal module of its web-based training course, You Call the Shots. The nurse education training program has 11 modules on a variety of immunization topics (e.g., DTaP, Hepatitis A, Influenza, Vaccine Storage and Handling, Vaccines For Children). Continuing education credit is available for viewing a module and completing an evaluation. The training course is supported by CDC through a cooperative agreement with the Association for Prevention Teaching and Research.

Participants can access information about obtaining CE credit from the You Call the Shots main page.

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Reminder: Early bird registration deadline is February 12 for National Conference on Immunization Coalitions and Partnerships; poster deadline is February 29 

The 12th National Conference for Immunization Coalitions and Partnerships, Ready. Set. Vaccinate!, will be held in Indianapolis on May 25–27. The early bird registration rate for the conference is only available until February 12, so plan to register this week.

The conference planners are currently soliciting posters to be displayed in an exhibit hall at the conference. The Indiana Immunization Coalition will print all posters—presenters will NOT need to travel with their poster. The deadline for poster submission is February 29.

For more information, go to the conference website, and click on the "Submit a Poster Presentation" link. You will then be given the opportunity to download instructions and a template.

Note: This conference was formerly known as the National Conference on Immunization and Health Coalitions. The goal of the National Conference for Immunization Coalitions and Partnerships is to improve community health by enhancing the effectiveness of coalitions and partners through training in relevant coalition management and health promotion topics, as well as to provide networking and professional development opportunities.

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Question of the Week

If someone is older than 55 years and had their spleen removed, are they recommended for meningococcal polysaccharide vaccine or meningococcal conjugate vaccine?   

Meningococcal conjugate vaccines (MCV4) are licensed for persons through age 55 years. For persons older than 55 years with a high-risk medical condition (such as asplenia), the Advisory Committee on Immunization Practices (ACIP) recommends off-label use of MCV4. Asplenic persons should receive a primary series of two doses of MCV4 separated by eight weeks, followed by a dose every five years thereafter. These recommendations are available at, page 15.

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 health care professional colleagues to sign up to receive IAC Express at

If you have a question for the CDC immunization experts, you can email them directly at There is no charge for this service.

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About IZ Express

IZ Express is supported in part by Grant No. 1NH23IP922654 from CDC’s National Center for Immunization and Respiratory Diseases. Its contents are solely the responsibility of and do not necessarily represent the official views of CDC.

IZ Express Disclaimer
ISSN 2771-8085

Editorial Information

  • Editor-in-Chief
    Kelly L. Moore, MD, MPH
  • Managing Editor
    John D. Grabenstein, RPh, PhD
  • Associate Editor
    Sharon G. Humiston, MD, MPH
  • Writer/Publication Coordinator
    Taryn Chapman, MS
    Courtnay Londo, MA
  • Style and Copy Editor
    Marian Deegan, JD
  • Web Edition Managers
    Arkady Shakhnovich
    Jermaine Royes
  • Contributing Writer
    Laurel H. Wood, MPA
  • Technical Reviewer
    Kayla Ohlde

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