From the Public Health Law Program, Office of the Chief of Public Health Practice, CDC
http://www2a.cdc.gov/phlp/

*** Pandemic Influenza Guidance. The U.S. Department of Health and Human Services seeks public comment on three draft guidance documents: Interim Guidance on the Use and Purchase of Facemasks and Respirators by Individuals and Families for Pandemic Influenza Preparedness; Proposed Guidance on Antiviral Drug Use During an Influenza Pandemic; and Proposed Considerations for Antiviral Drug Stockpiling by Employers In Preparation for an Influenza Pandemic. For more information, visit http://aspe.hhs.gov/panflu/antiviral-n-masks.shtml.

*** Rhode Island Lead Mitigation Database. The Rhode Island Housing Resources Commission has launched an online database of rental units that have been certified free from lead hazards. To access the database, visit http://www.ri.gov/HRC/index.php?property.

*** Shelter Evaluation Tool. CDC and partners have developed an environmental health shelter assessment tool to assist environmental health practitioners in conducting rapid assessment of shelter conditions during emergencies and disasters. To access the tool, visit http://www.emergency.cdc.gov/shelterassessment/.

*** GAO Food Safety Report. The U.S. Government Accountability Office has released Federal Oversight of Food Safety: FDA Has Provided Few Details on the Resources and Strategies Needed to Implements its Food Protection Plan. The report is available at http://www.gao.gov/new.items/d08909t.pdf.

*** Clinical Trials Legal Training (7/24). The American Health Lawyers Association, in collaboration with the Regulatory Affairs Professionals Society, will present “A Day in Court: Critical Implications for Conducting Clinical Trials” on July 24, 2008. The training will be held at the George Washington University Cloyd Heck Marvin Center. For more information, visit http://www.raps.org/personifyebusiness/ConferencesTraining/ADayinCourt/tabid/456/Default.aspx.

Top Story

1. Japan, seeking trim waists, measures millions

States and Localities

2. Illinois: Marriage license tax targets domestic violence
3. Louisiana: La. officials worry about buses for evacuations
4. New York: Some states making schools require dental exams

International

5. Canada: Ottawa knew implants harmful, case alleges
6. Canada: Display of tobacco products banned as of Saturday
7. European Union: Chemical law has global impact

Briefly Noted

California cell phone law · Connecticut bisphenol A suit · Florida dangerous dogs · Louisiana emergency healthcare bill · Massachusetts domestic violence · New York calorie counts · Tobacco tax · National tobacco case · WIC food choice · Hurricane readiness · Food testing · Motorcycle safety · Australia alcopop tax · Canada school nutrition · China food safety · England smoking ban effects · Japan A-bomb ruling · South Korea junk food ads · Uganda DDT ruling

Journal Articles

Mississippi nursing home evacuation lessons · Lead and criminal activity · Nursing home evacuation plans · Mandatory HPV vaccination · Netherlands universal health insurance · United Kingdom pandemic school closure costs

Court Opinions

California smoking · Louisiana Hurricane Katrina · Minnesota warrantless blood draw · New Jersey emotional distress · Virginia alcohol ads regulation · Canada safe-injection sites · South Africa AIDS trial

Quotation of the Month

Residents of Amagasaki, Japan

This Month’s Feature

Law Behind the News. This month, we feature Louisiana House Bill 1379, which will establish the state’s Emergency/Disaster Medicine Review Panel. See below for more.

_____________________________1_____________________________

“Japan, seeking trim waists, measures millions”
New York Times (06/13/08) Norimitsu Onishi
http://www.nytimes.com/2008/06/13/world/asia/13fat.html?_r=1&incamp=article_popular_2&oref=slogin

Two months ago, a new law came into effect in Japan, requiring companies and local governments to measure the waistlines of people between the ages of 40 and 74. The move marks the government’s latest effort to curtail “metabolic syndrome” (or “metabo” as it is colloquially known), a collection of factors including abdominal obesity, high blood pressure, and high blood glucose and cholesterol levels. Metabo has become national shorthand for “overweight.” “Before we had to broach the issue with the word obesity, which definitely has a negative image. But metabo sounds much more inclusive,” said Dr. Yoshikuni Sakamoto, a physician in the employee health insurance union at Matsushita, an electronics manufacturer. The new law mandates limits on waistlines -- 33.5 inches for men and 35.4 inches for women. People exceeding the limit and having a weight-related illness will be given dieting guidance if they do not lose weight within three months of being measured. Companies and local governments that fail to meet specific targets will be fined. The national Ministry of Health says the campaign will help stop diseases like diabetes and stroke, and will slow the country’s rising health care costs. But critics say the guidelines are too strict, and that more than half of all Japanese men will be considered overweight. “I don’t think the campaign will have any positive effect,” said Yoichi Ogushi, a professor at Tokai University School of Medicine. “[T]he Japanese are so slender that they can’t afford to lose weight.”

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“Marriage license tax targets domestic violence”
Chicago Tribune (05/28/08) Joel Hood
http://www.chicagotribune.com/news/local/chi-marriage-29-may29,0,4211569.story

This month, Illinois counties began adding a $5 fee to the cost of marriage licenses to pay for legal counseling and other services for people seeking to escape domestic violence. The new law seeks to help abused women (and in some cases, men) navigate the legal system. “We don’t have as many people today seeking shelters to fix the problem,” said Jacqueline Ferguson, director of operations at the Illinois Coalition Against Domestic Violence. “Instead, they’re seeking counseling and legal advocacy to address some of the bigger issues.” As domestic violence cases in the state have increased over recent years, advocates have seen state and federal funding stripped from domestic programs. As a result, 27 counties in southern Illinois have been forced to cut courthouse advocates who work directly with abused women to help them understand their rights and apply for protective orders. The new Married Families Domestic Violence Fund is expected to generate more than $400,000 a year, which will be doled out by the attorney general’s office. The money will be used for providing legal counseling, restoring the courthouse advocates, and for legal fees in cases where abuse leads to divorce. While some worry that the new fee will impede local government’s ability to increase funds for other needs, advocates and newlyweds-to-be were in favor of the program. “I think it’s wonderful,” said Dolores Brown. “It’s people like me and all the other women out there who have to deal with the threat of violence every day.”

[Editor’s note: To read the text of Illinois Public Act 095-0711, which creates the Married Families Domestic Violence Fund, visit http://www.ilga.gov/legislation/publicacts/fulltext.asp?Name=095-0711.]

_____________________________3_____________________________

“La. officials worry about buses for evacuations”
Associated Press (06/04/08) Mary Foster
http://www.nola.com/newsflash/index.ssf?/base/news-39/1212608960278310.xml&storylist=louisiana

Emergency management officials in Louisiana are making plans to move as many as 39,000 people out of the New Orleans area if a hurricane threatens this summer. Finding the vehicles to accomplish that feat, however, presents a stumbling block. “If a big hurricane begins heading into the Gulf Coast, there could be five states scrambling to get buses,” said Matthew Kallmyer, deputy director of the New Orleans Office of Emergency Preparedness. Under current guidelines, shelters in New Orleans and surrounding parishes will not open if officials declare a mandatory evacuation in anticipation of a Category 3 or greater hurricane. That could leave thousands of elderly people and others with special needs or without transportation to find their own way out of town. Louisiana officials have negotiated to have commercial buses available, and have also looked at using school buses, Regional Transit Authority buses, and even Amtrak trains. But each of those options has its limitations. “[T]he question may be who pulls the trigger on evacuation first. You know, the cone of possibility for a storm to land can sometimes cover Louisiana, Alabama, Mississippi, and Texas. And that means those states will all be looking at the same group of buses,” said John Rahaim Jr., assistant director of the St. Bernard Parish office of Homeland Security and Emergency Preparedness.

_____________________________4_____________________________

“Some states making schools require dental exams”
Associated Press (06/01/08) Michael Gormley
http://www.pressconnects.com/apps/pbcs.dll/article?AID=/20080602/NEWS10/806020360

In September, New York will become the seventh state (along with the District of Columbia) to require schools to help ensure the dental health of students. Methods in the jurisdictions range from requiring students to get a full dental exam before entering school, to a cursory screening by a hygienist. Under a new law, New York schools will ask parents to provide a certificate showing the student has seen a dentist before entering the second, fourth, seventh, and tenth grades. Schools will provide families with a list of dentists that will examine their child for free or at reduced cost if the student arrives for class without the certificate. According to CDC, tooth decay is a common infectious disease among children, and is on the rise. In children, tooth decay is five times more common than asthma, four times more common than obesity, and 20 times more common than diabetes, said Marianthi Bumbaris of the American Academy of Pediatric Dentistry. Tooth decay can result in pain, abnormal chewing, malnutrition, and poor attendance in school, all of which can have a negative impact on students’ concentration, speaking ability, appearance, and self-esteem. “A lot of people think it’s cosmetic,” Bumbaris said. “A lot of parents think, ‘These are baby teeth that will fall out, so what’s the point?’ But imagine the pain [adults] have. And a lot of children up to 3 years old can’t say or explain why they are in pain. Children are falling through the cracks.”

[Editor’s note: To read the text of S. 1239, An act to amend the education law, in relation to requesting that students entering school present a dental health certificate, visit http://assembly.state.ny.us/leg/?bn=S01239&sh=t. To learn more about children’s dental health from CDC, visit http://www.cdc.gov/oralhealth/topics/child.htm.]

_____________________________5_____________________________

“Ottawa knew implants harmful, case alleges”
Toronto Star (05/28/08) Tracey Tyler
http://www.thestar.com/printArticle/432074

In May, the Ontario (Canada) Court of Appeal heard arguments attempting to resurrect a proposed class action lawsuit against the federal government for failing to regulate silicone gel breast implants. According to some estimates, up to 200,000 Canadian women received breast implants between 1969 and 1992, when Dow Corning implants were pulled from the market. Attorneys for Canadian women injured by the implants say Health Canada examined the Dow Corning implants and recommended they be discontinued in 1978 after studies showed they ruptured between 5 and 32 percent of the time. Kirk Baert, an attorney for the plaintiffs, said Health Canada’s failure to ban the implants amounts to negligence. “At the very least, they (federal officials) could have issued a warning,” he said. Last year, a lower court dismissed the case, finding the decision to allow the silicone implants was a government policy decision and therefore immune from suit. The issue of whether the federal government “failed to govern” is the central question of the case. The Court of Appeal has not yet issued a ruling in the case, which is one of a series of lawsuits over alleged breast implant failures filed in countries around the world.

_____________________________6_____________________________

“Display of tobacco products banned as of Saturday”
Niagara Falls Review (05/31/08) Ray Spiteri
http://www.niagarafallsreview.ca/ArticleDisplay.aspx?e=1051893&auth=Ray+Spiteri%2C+Review+Staff+Writer

At the end of May, a provision of the Smoke-Free Ontario Act prohibited the “intentional or unintentional” display of tobacco products in stores. The new rules require that cigarettes must be concealed until they are purchased. Employees must handle and store tobacco products out of view of customers; they can be displayed only briefly when the employee is handing the product to a customer during a transaction. If a customer needs assistance deciding between products, the employee is allowed to show the customer a binder displaying photos of the tobacco products, along with the price. Businesses that fail to comply with the new law could be fined $10,000; employees could be charged $4,000. The mandate has required store owners to buy special shelving or cabinets to hide the products. Some worry about the added inconvenience of the new system, but most shop owners are prepared to comply. “[L]ike most things, there’s a transitional period that takes place and we’ll just have to adjust,” said Louanne Elly, who manages a convenience store in Fort Erie.

[Editor’s note: For a comparison of Ontario’s 1994 Tobacco Control Act and the new Smoke-Free Ontario Act, visit http://www.mhp.gov.on.ca/english/health/smoke_free/chart.asp.]

_____________________________7_____________________________

“Chemical law has global impact”
Washington Post (06/12/08) Lyndsey Layton
http://www.washingtonpost.com/wp-dyn/content/article/2008/06/11/AR2008061103569.html

Earlier this month, new European Union rules requiring companies to demonstrate the safety of a chemical before it enters commerce went into effect. Under the new rules, manufacturers must report the risks posed by specific chemicals. That information will, for the first time, be made available to the public. The rules reflect a philosophy that emphasizes the consumer, and have major implications for the U.S. chemical industry. In the United States, regulators have the burden of proving a chemical is harmful before it can be restricted or removed from the market. In order to access the European market -- 27 countries comprising nearly 500 million consumers -- and compete in global commerce, U.S. companies will be forced to reformulate their products to comply with the E.U. rules. According to Mike Walls, the American Chemistry Council’s managing director of government and regulatory affairs, 90 percent of the Council’s members are affected by the new laws, and some cannot afford the cost of compliance. DuPont, for example, expects to spend “tens of millions” of dollars to register about 500 chemicals with the European Union. But environmental groups are pleased that the new rules will have such an impact on the U.S. chemical industry. “This is going to compel companies to be more responsible for their products than they have ever been,” said Daryl Ditz, senior policy adviser at the Center for International Environmental Law. “They’ll have to know more about the chemicals they make, what their products are and where they go.”

[Editor’s note: To learn more about Registration, Evaluation, Authorization and Restriction of Chemical substances (REACH), the new European Union regulation, visit http://ec.europa.eu/environment/chemicals/reach/reach_intro.htm.]

_____________________BRIEFLY NOTED______________________

California: “Hands free” law aimed at preventing driver distraction, reducing accidents
“New cell phone laws takes effect July 1”
Contra Costa Times (06/02/08) Kelli Phillips
http://www.contracostatimes.com/ci_9457148

Connecticut: Lawsuit alleges baby bottles made with bisphenol A
“Lawsuit filed against baby bottle maker”
Associated Press (05/28/08)
http://www.washingtonpost.com/wp-dyn/content/article/2008/05/28/AR2008052803174.html

Florida: County ordinance updated to include owner education
“Dog owners beware, rules getting tougher in Collier”
Naples Daily News (06/10/08) I.M. Stackel
http://www.naplesnews.com/news/2008/jun/10/dog-owners-beware-rules-getting-tougher-collier/

Louisiana: Bill would establish panel to examine health professionals’ disaster-related decisions
“Panel OKs reviews of doctor acts in disasters”
Times-Picayune (06/11/08) Ed Anderson
http://www.nola.com/news/t-p/capital/index.ssf?/base/news-6/1213161627207940.xml&coll=1

Massachusetts: Governor responds to tripling of domestic violence homicides
“Gov declares domestic violence emergency”
State House News Service (06/06/08)
http://www.bostonherald.com/news/regional/politics/view/2008_06_06_Gov_declares_
domestic_violence_emergency/

New York: City to begin enforcement of calorie counts July 18
“FDA backs NYC in dispute over calories on menus”
Associated Press (06/12/08) Larry Neumeister
http://www.usatoday.com/news/health/2008-06-13-calories-menus_N.htm

New York: State boasts highest tax in the nation resulting in fewer smokers
“NY health official says tax hike has smokers ready to quit”
Associated Press (06/15/08) Valerie Bauman
http://www.wnbc.com/politics/16613040/detail.html?rss=ny&psp=news

National: Supreme Court to determine if state damages award conflicts with prior ruling
“Court will again review $79.5M tobacco award”
Associated Press (06/09/08)
http://news.moneycentral.msn.com/printarticle.aspx?feed=AP&date=20080609&id=8748543

National: Federal food program to expand food choices, offer nutrition education
“Federal WIC program rewriting voucher menu to add fruit, vegetables, more fish”
Press-Enterprise (05/26/08) Douglas Quan
http://www.pe.com/localnews/inland/stories/PE_News_Local_D_voucher27.3546759.html

National: Despite prediction of active hurricane season, many residents without a plan
“Few coast dwellers ready for a hurricane, poll shows”
CNN (05/29/08) John Zarrella
http://www.cnn.com/2008/US/weather/05/29/hurricane.prepare/index.html

National: Food safety concerns spur Congressional investigation
“Lawmakers approve subpoenas over food testing”
Associated Press (06/13/08) Kevin Freking
http://www.boston.com/business/articles/2008/06/13/lawmakers_approve_subpoenas_over_
food_testing/

National: New laws keep motorcyclists legal
“States green-light new red-light laws for motorcycles”
USA TODAY (06/11/08) Ron Barnett
http://www.usatoday.com/news/nation/2008-06-10-red-light-laws_N.htm

Australia: Spirit sales increase, offsetting potential health gains of alcopop tax hike
“Alcopop drinkers ‘turning to spirits’”
Australian (05/29/08) Siobhain Ryan
http://www.theaustralian.news.com.au/story/0,25197,23775465-5013871,00.html

Canada: Food guidelines aimed at schools and daycare and recreational centers
“Nutrition guidelines target obese kids”
Calgary Herald (06/03/08) Renata D’Aliesio and Michelle Magnan
http://www.canada.com/calgaryherald/news/story.html?id=338d86b0-3473-425f-8f20-d293af46e92e

China: Canadian experts contributed to new, more stringent Chinese food safety laws
“China gets help with food industry”
National Post (05/28/08) Tom Blackwell
http://www.nationalpost.com/news/story.html?id=545920

England: Smoking ban related to drop in heart disease rates
“Heart attack admissions fall by up to 40% since smoking ban”
The Times (06/14/08) Will Pavia
http://www.timesonline.co.uk/tol/news/uk/health/article4131177.ece

Japan: Court rules atomic bomb victims currently in need of medical treatment
“High court raps gov’t over appeal against health benefits for A-bomb victims”
Mainichi Daily News (05/29/08)
http://mdn.mainichi.jp/national/news/20080529p2a00m0na008000c.html

South Korea: Korea FDA cracks down on junk food commercials targeting kids
“Junk food ads to be bumped from prime-time TV”
Korea Times (05/27/08) Jane Han
http://www.koreatimes.co.kr/www/news/biz/2008/05/123_24833.html

Uganda: Malaria control at odds with pesticide safety
“Court stops DDT spraying in the north”
New Vision (06/05/08) Anne Mugisa
http://allafrica.com/stories/200806060114.html

___________________JOURNAL ARTICLES____________________

“Providing shelter to nursing home evacuees in disasters: lessons from Hurricane Katrina”
American Journal of Public Health (07/08) Sarah B. Laditka and others
http://www.ajph.org/cgi/content/abstract/98/7/1288?ck=nck (subscription required)

“Association of … childhood blood lead concentrations with criminal arrests in early adulthood”
PLoS Medicine (05/08) John Paul Wright and others
http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371%2
Fjournal.pmed.0050101

“Nursing home evacuation plans”
American Journal of Public Health (07/08) Nicholas G. Castle
http://www.ajph.org/cgi/content/abstract/AJPH.2006.107532v1 (subscription required)

“The HPV vaccine: framing the arguments FOR and AGAINST mandatory vaccination …”
Journal of School Health (06/08) Cheryl A. Vamos and others
http://www.blackwell-synergy.com/doi/abs/10.1111/j.1746-1561.2008.00306.x (subscription required)

“Universal mandatory health insurance in The Netherlands: a model for the United States?”
Health Affairs (06/08) Wynand PMM van de Ven and Frederik T. Schut
http://content.healthaffairs.org/cgi/content/abstract/27/3/771?rss=1 (subscription required)

“Estimating the costs of school closure for mitigating an influenza pandemic”
BMC Public Health (04/24/08) Md Z Sadique and others
http://www.biomedcentral.com/1471-2458/8/135/abstract (subscription required)

___________________COURT OPINIONS____________________

California: Court holds smoking-related diagnoses start running of statute of limitations
Pooshs v. Philip Morris USA, Inc.
U.S. District Court for the Northern District of California
No. C 04-1221 PJH
Decided May 27, 2008
Opinion by Judge Phyllis J. Hamilton
http://www.lawyersusaonline.com/pdfs/POOSHS99310040.pdf

Louisiana: Claims that agencies breached duty to prepare for, respond to Katrina dismissed
In re: Katrina Canal Breaches Consolidated Litigation
U.S. District Court for the Eastern District of Louisiana
Civil Action No. 05-4182 Section “K”(2)
Decided May 27, 2008
Opinion by Judge Stanwood R. Duval Jr.
http://levees.org/Dismissal.pdf

Minnesota: Warrantless blood draw upheld if probable cause in case of vehicular homicide
State v. Shriner
Supreme Court of Minnesota
No. A07-181
Filed May 30, 2008
Opinion by Justice Christopher Dietzen
http://64.233.167.104/search?q=cache:MFJJ1pp1sgIJ:www.mncourts.gov/opinions/sc/current/
OPA070181-0530.pdf+State+v.+Shriner&hl=en&ct=clnk&cd=3&gl=us

New Jersey: Negligent infliction of emotional distress claim for family member death upheld
Jablonowska v. Suther
Supreme Court of New Jersey
No. A-9-07
Decided June 10, 2008
Opinion by Justice Jaynee LaVecchia
http://lawlibrary.rutgers.edu/decisions/supreme/a-9-07.doc.html

Virginia: Court strikes down state reg prohibiting alcohol ads in college publications
Educational Media Company at Virginia Tech v. Swecker
U.S. District Court for the Eastern District of Virginia, Richmond Division
Civil Action No. 3:06CV396
Decided March 31, 2008
Opinion by Magistrate Judge M. Hannah Lauck
http://www.acluva.org/docket/pleadings/techopinion.pdf

Canada: Court holds drug users entitled to health care in form of safe-injection sites
PHS Community Services Society v. Canada
Supreme Court of British Columbia
No. S065547, S065587
Decided May 27, 2008
Opinion by Justice Ian H. Pitfield
http://www.canlii.org/en/bc/bcsc/doc/2008/2008bcsc661/2008bcsc661.html

South Africa: Court finds unapproved clinical trials for AIDS unlawful
Treatment Action Campaign v. Rath
High Court of South Africa
No. 12156/05
Decided June 13, 2008
Opinion by Dumisani Zondi
http://www.tac.org.za/community/files/file/TACAndSAMAVersusRathAndGovernmentJudgment.pdf

__________PHL NEWS QUOTATION OF THE WEEK___________

“Goodbye, metabolic. Let’s get our checkups together. Go! Go! Go!

Goodbye, metabolic. Don’t wait till you get sick. No! No! No!”

-- Residents of Amagasaki, Japan singing the city’s anti-metabo (obesity) song at a local gym. The song warns about trouser buttons popping and flying away. The town’s mayor and six other officials formed a weight-loss group called The Seven Metabo Samurai in support of the national government’s anti-obesity campaign. [See item 1, above.]

__________________LAW BEHIND THE NEWS___________________

A bill working its way through the Louisiana Legislature will establish a three-member Emergency/Disaster Medicine Review Panel to examine disaster-related decisions by healthcare personnel. Findings of the Panel will help prosecutors determine whether to file criminal charges against medical professionals in the event that a person is injured while receiving healthcare services during a state of disaster, medical emergency, or public health emergency. The bill, which has been unanimously approved by the House, recognizes that, during an emergency,

medical personnel are under added duress because of staffing shortages, resource limitations, and damaged infrastructure, and such personnel’s clinical decisions may be affected by nonmedical factors including lack of basic human services, loss of communication, necessity to immediately evacuate, and safety concerns for medical personnel.

Accordingly,

An independent Emergency/Disaster Medicine Review Panel is qualified to gauge the conduct of medical personnel with regard to such clinical judgment during declared disasters and, thereby, provide an independent and objective advisory opinion.

The bill establishes the Panel’s constituents, authorizes the Panel to provide advisory opinions to the prosecuting authority, and establishes the Panel’s review process.

To read the text of H.B. 1379, visit http://www2a.cdc.gov/phlp/docs/streamdocument.pdf.

___________________________________________________________

The CDC Public Health Law News is published the third Wednesday of each month except holidays, plus special issues when warranted. It is distributed only in electronic form and is free of charge. News content is selected solely on the basis of newsworthiness and potential interest to readers. CDC and DHHS assume no responsibility for the factual accuracy of the items presented. The selection, omission, or content of items does not imply any endorsement or other position taken by CDC or DHHS. Opinions expressed by the original authors of items included in the News, or persons quoted therein, are strictly their own and are in no way meant to represent the opinion or views of CDC or DHHS. References to products, trade names, publications, news sources, and non-CDC Websites are provided solely for informational purposes and do not imply endorsement by CDC or DHHS. Legal cases are presented for educational purposes only, and are not meant to represent the current state of the law. The findings and conclusions reported in this document are those of the author(s) and do not necessarily represent the views of CDC. The News is in the public domain and may be freely forwarded and reproduced without permission. The original news sources and the CDC Public Health Law News should be cited as sources. Readers should contact the cited news sources for the full text of the articles.

For past issues or to subscribe to the CDC Public Health Law News, visit http://www2a.cdc.gov/phlp/cphln.asp. For help with subscriptions or to make comments or suggestions, send an email to Rachel Weiss at rweiss@cdc.gov.

The News is published by the Public Health Law Program, Office of Strategy and Innovation, Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services (DHHS). Rachel Weiss, J.D., Editor; Karen M. Leeb, J.D., M.L.S., Editorial Advisor. Thanks to Lisa Thombley, J.D., M.P.H., for her assistance.