Publication of the Division of Public Health Services

January/February 2004, Vol. 18, No. 1

Inf luenza Strains Providers, Public Health System
by Karen Lewis, MD

Bacterial pathogens such as
information on influenza activity in
Streptococcus pneumoniae,
Arizona or nationally, please visit the
Haemophilus influenzae, or group A
website for ADHS at www.hs.state.
beta-hemolytic streptoccus can cause
az.us/phs/oids/epi/flu/ or for CDC at
pneumonia even without influenza.
www.cdc.gov/flu/weekly/index.htm
However, the incidence of S. aureus
As of this writing, several hunas a cause for pneumodred cases of influenza
nia is three times more
from 12 counties had
So, when a patient
common when associbeen laboratory-conwith influenza-like
ated with influenza (1).
firmed by either rapid
symptoms has
Physicians are seetesting or viral culture.
worsening respiratory ing more patients with
The percentage of visits
distress, consider a community-acquired
for influenza-like illnessbacterial pneumonia, MRSA infections.
es at sentinel providers
around the state
order cultures, and Therefore, it is not
increased steadily from
start broad-spectrum surprising to find MRSA
complicating influenza.
the week ending
antibiotics pending
Since S. aureus pneuNovember 15 through
culture results.
monia can have a fulthe week ending
minant course, the
December 19. At least
choice of empiric antibiotics is very
three influenza-associated deaths
important. So, when a patient with
among children had also been
influenza-like symptoms has worsenconfirmed.
ing respiratory distress, consider a
bacterial pneumonia, order cultures,
Bacterial infections
and start broad-spectrum antibiotics
complicating influenza
pending culture results.
Several deaths have occurred this
Empiric antibiotics that would
year in the United States due to
cover MRSA, S. pneumoniae, H.
pneumonia from the combination of
influenzae, and group A betainfluenza and methicillin-resistant
hemolytic streptococcus would be
Staphylococcus aureus (MRSA).
Vancomycin and a third generation
Respiratory morbidity and mortality
cephalosporin (like ceftriaxone/
from influenza can be due to either
Rocephin® or cefotaxime/Claforan®).
viral pneumonia, or a secondary bacterial pneumonia.

Influenza came in with a bang
this winter. However, if we are fortunate, the influenza outbreak in
Arizona will have started to wane by
the time you read this article. This
season may or may not turn out to be
much worse than usual, but there are
a few things healthcare providers
should be aware of this year.
The first laboratory-confirmed
influenza case of the season in
Arizona was identified in midOctober, much earlier than during
four of the previous five seasons.
Influenza was reported as “widespread” in Arizona for the week ending December 6, 2003. Nationally,
the influenza season also had an
early start, with 24 states reporting
widespread activity by the end of the
first week in December.
The predominant influenza strain
nationally is A/Fujian (H3N2), a drift
variant of the A/Panama (H3N2)
strain included in this year’s vaccine.
Both A/Fujian and A/Panama strains
have been identified from Arizona
isolates. All influenza specimens
subtyped by the Arizona State Health
Laboratory as of December 10 were
influenza A(H3N2).
Data change quickly during an
influenza season, so the statewide
picture may look very different by the
time of publication. For current

continued on page 2

Visit the ADHS Web site at www.hs.state.az.us
New CDC
Guidelines on
SARS
Page 2
January/February 2004

Earn CME
Credits for
Public Health
Lectures Page 3

Substance
Abuse
Treatment
Page 4

Communicable
Disease
Summary
Page 6

HIV and AIDS
in the State of
Arizona
Page 7

New Comm.
Disease Rules
Published
Page 8
Prevention Bulletin

1

Inf luenza

continued from page 1

Oral antibiotics that often cover MRSA include
trimethoprim-sulfamethoxazole (although it gives poor
S. pneumoniae coverage), clindamycin, or
linezolid/Zyvox®. (Note: Linezolid should only be
used in extraordinary cases, where the infection is
known to be due to a multiply resistant organism
such as MRSA, and effective antibiotics such as TMPSMZ and clindamycin are contraindicated.)
Some physicians in Arizona have been seeing
many patients who test positive for both influenza
and group A beta-hemolytic streptococcus. Please
remember to consider the possibility of secondary
bacterial infections in patients with influenza.

Influenza vaccine supply
Manufacturers produced 85.5 million doses of
inactivated influenza vaccine for the U.S. for the
2003-2004 influenza season. This was expected to
be adequate for the demand. For example, 79 million doses of vaccine were sold in the U.S. for the
2002-2003 influenza season (2). However, demand
increased due to widely publicized illnesses and
pediatric deaths. The Arizona supply of inactivated
influenza vaccine was mostly gone by the middle of
December; however, Federal resources were mobilized to send more vaccine into the states for highrisk groups.

Plan for next year
Influenza vaccination not only protects high-risk
individuals. It also decreases influenza in
health care workers (who spread influenza
to their patients) (3), decreases morbidity
associated with day care spread of influenza (4), and decreases work absenteeism in
health adults by 43% (5). Start planning
now to get ready for next year’s influenza
outbreak!
Karen Lewis, MD, is an infectious disease specialist
with the Arizona Department of Health Services. She
can be reached at 602.364.3289 or
klewis@hs.state.az.us.
References:
1. Treanor JJ. “Influenza Virus.” Principles and Practice of
Infectious Diseases. Mandell GL, Bennett JE, Dolin R.
Churchill Livingston, Philadelphia; 2000,1823-1849.
2. http://www.naccho.org/general825.cfm
3. Carman WF, Elder AG, Wallace LA et al. Effects of
influenza vaccination of health-care workers on mortality of
elderly people in long-term care: a randomized controlled
trial. Lancet 2000; 355: 93-97.
4. Hurwitz ES, Haber M, Chang A, et al. JAMA 2000; 284:
1677-1682.
5.Nichol KL, Lind A, Margolis KL, et al. The effectiveness of
vaccination against influenza in healthy, working adults.
NEJM 1995; 333: 889-893.

2

Prevention Bulletin

New CDC
Guidelines on SARS
By Bob England, MD

The CDC has published guidelines to quickly detect and
contain SARS, even in the absence of known SARS anywhere
in the world, at www.cdc.gov/ncidod/sars/
updatedguidance.htm. The major points for health care
providers and institutions are:
Promote “respiratory hygiene.” This is a bigger deal than
one might think. It means providing masks in every waiting
room and encouraging those with a cough to use them. It
means providing alcohol-based hand sanitizer in convenient
locations in waiting rooms, so that patients can use it after
handling tissues and so forth. It means teaching patients to use
these and teaching front desk staff to encourage their use.
During colds and flu season, we should see a large fraction of
those in the waiting room and elsewhere wearing masks.
Ask three questions of every patient hospitalized with
pneumonia without a known underlying etiology. Have they,
within 10 days of symptom onset:
• Had a history of recent travel to mainland China, Hong
Kong, or Taiwan, or had close contact with ill persons with
a history of recent travel to such areas? or;
• Been employed in an occupation at particular risk for
SARS-CoV exposure? (This includes any healthcare worker with direct patient contact or a worker in a laboratory
that contains live SARS-CoV.) or;
• Been part of a cluster of cases of atypical pneumonia without an alternative diagnosis? (i.e., ask whether they’ve
been around anyone
else with pneumonia.)
If you get a yes
answer to any of the
above, REPORT the
case to your local
health department.
(Also, let us know as
soon as an alternative
etiology is discovered).
If SARS does
return, guidelines still
in draft form may
ratchet this up to
include the same
questions and reporting of any patient with
a fever or respiratory
symptoms. That’s
potentially a lot of
patients.
continued on page 3

January/February 2004

Noteworthy
Earn CME Credits for
Public Health Lectures
Are you interested in learning
more about
SARS?
Influenza?
Smallpox?
Other emerging
infections? The
Arizona
Department
of Health
Services’
Office of Emergency Preparedness
and Response offers one hour lectures through the Public Health
Emergency Preparedness and
Response Lecture series.
The lectures include the
following subjects: SARS; Influenza;
West Nile Virus; Category A agents
of Bioterrorism; Smallpox; and
Respiratory Illness: Is It Viral,
Bacterial, or Bioterrorism?
Each lecture is designated to
provide up to one hour of category
one credit of CME. Lectures will be
given by Dr. Peter Kelly and Dr.
Karen Lewis. The lecturers will
bring the lectures to you, and are
available to groups of doctors
throughout the state.
Call 602.364.3289 for more
information and to schedule lectures.

Providers Urged to
Report Varicella Cases
As the use of varicella vaccine
causes further decline in chickenpox
cases, there will be greater opportunity for real control of this once
common disease. In addition, we
need an accurate baseline count of
adult cases of varicella in order to
monitor the effect of the vaccine on
the vaccinated population as it ages.
To do this, the public health system
needs good surveillance.
The Arizona Department of
Health Services encourages the
reporting of all varicella cases,
especially those among adults. All
varicella should be reported to the
local health department by the
January/February 2004

health care provider as per the
Arizona Administrative Code (A.A.C.
R9-6-301). This year, the
Department is also implementing
the Arizona School-based
Chickenpox Surveillance System for
reporting of chickenpox by select
schools and child care centers.
Reports from providers and information gathered through sentinel surveillance will be important for monitoring changes in the epidemiology
of this disease in Arizona.
Please contact your local health
department or the Arizona
Department of Health Services
Infectious Disease Epidemiology
Section at 602.364.3676 if you have
any questions about
reporting varicella or
need additional
Communicable
Disease Report
forms.

2003 West Nile Wrap-Up
In 2003, the State Health Lab
tested approximately 2,100 mosquito
samples, 1,200 chicken bloods and
200 human specimens. In addition,
the University of Arizona Veterinary
Diagnostic Lab tested more than 230
horses and 870 dead birds. As of
Dec. 22, 2003, the following turned
up positive for West Nile: 12
humans; 98 mosquito pools; 54
birds; 26 sentinel chickens; and
111 horses.
A tremendous amount of teamwork occurred between the state,
tribal and county health departments,
as well as the University of Arizona
Diagnostic Lab, State Health
Laboratory, Arizona Dept of
Agriculture, Arizona Game and Fish,
Yuma County Pest Abatement
District, Navajo Veterinary Service,
Indian Health Services, many large
animal veterinarians, and others for
the bounty of surveillance data gathered this year.
To bolster the state’s West Nile
virus surveillance efforts, the Arizona
Department of Health Services issued
an emergency order in August

making West Nile virus a reportable
disease. Under the order, a physician
or an administrator of a health care
facility is required to submit a
communicable disease report of a
case or a suspect case of West Nile
within 24 hours of diagnosis to the
local health agency. Additionally,
clinical laboratories are required to
report to the Department.
For more information, contact
your local health department or
ADHS at 602.364.3851.

SARS continued from page 2
On our end, that’s also a lot of
reports that we will have to
investigate, looking for clusters,
particularly suspicious cases, and
determining whether SARS testing
may be appropriate. SARS testing is
available at the State Lab, but there
is a high false positive rate in a
setting of little or no known disease.
SARS testing will therefore be limited to patients with certain epidemiologic factors as determined
case-by-case by the local health
department. We have developed
a SARS Reference Guide for local
health departments, will have
reporting rules in place, and we’re
gearing up for a LOT of ruling-out.
Does this make sense?
Absolutely. SARS exploded within
health care facilities that missed
that first case, so high suspicion is
warranted, within reason. We are
of course unlikely to find the first
case of a new outbreak before
cases are found in Asia, so ask the
right questions but keep your
differential diagnosis in perspective.
More importantly, perhaps, is that
the emphasis on respiratory hygiene
will go a long way to prevent the
spread of all sorts of respiratory
infections, and that should make
life better for all of us.
Bob England, MD, is the State
Epidemiologist and can be reached at
602.364.3582 or benglan@hs.state.az.us.
Prevention Bulletin

3

Medical Professionals: A Key Component
of Substance Abuse Treatment
As a chronic, life-threatening
condition, substance abuse has
extraordinarily negative effects on
the health, behavior, and development of human beings. Substance
abuse contributes to 100,000 deaths
in the United States per year and
costs society billions of dollars each
year.
Medical professionals are in a
unique position to identify substance
abuse problems in patients and initiate treatment early. Doctors, nurses,
and physicians assistants are encouraged to screen patients for substance
abuse as a part of inquiring about
other lifestyle issues. If substance
abuse is suspected, medical professionals should refer the patient to a
licensed behavioral health provider
for a thorough assessment and treatment. Because substance abuse
exacerbates other medical conditions, medical professionals should
screen for substance abuse whenever unusual symptoms are observed
that may indicate substance abuse.
Affordable treatment is available
throughout Arizona for addiction
treatment. Federal and State appropriations are passed down from the
Division of Behavioral Health
through Regional Behavioral Health
Authorities (RBHAs) to providers for
individuals enrolled in AHCCCS and
other groups depending on funding
availability.

progress. Individuals
addicted to alcohol
• More Arizona teens smoke marijuana than tobacco. or other drugs often
have co-occurring
• 20% of Arizona high school students go to school
physical health
intoxicated.
problems and
• 10% of Arizona residents have a drug or alcohol
injuries such as:
problem.
fractures, chronic
• Senior citizens exhibit a high rate of alcohol abuse. pain, depression,
• Illicit drug use in Arizona is increasing.
anxiety, gastritis,
high blood pressure,
• Arizona’s rate of illicit drug use ranks among the
sprains, strains,
ten highest in the Nation.
burns, headaches,
• Most people addicted to substances cannot stop
and arthritis.
using them without help.
Medical profession• Only 1/4 of the people who need treatment for
als can instruct
substance abuse receive it.
patients in alternative
methods to relieve
pain, anxiety, and
Providers strive to enhance supinsomnia
such
as:
physical therapy,
port systems through integration of
relaxation
methods,
ice, heat,
substance abuse treatment with
massage, deep breathing, and/or
community and family systems. As
meditation. Medications a physician
part of a new initiative, behavioral
might normally prescribe for pain,
health providers are developing
or insomnia (such as narcotics) can
treatment teams for each person in
trigger relapse in patients with
the behavioral health system.
substance abuse disorders. This is
Treatment teams are composed of
why coordination of care between
the client, persons the client identithe Primary Care Provider and the
fies as family, and persons who have
Substance Abuse Treatment Provider
knowledge of or influence on the
is essential.
individual’s recovery.
Regional Behavioral Health
As a part of the team, medical
Authorities (RBHAs) can recommend
professionals treat medical condia substance abuse treatment facility
tions, encourage continuing particiin your community.
pation in behavioral health services,
conduct follow up visits after treatment termination, and monitor
continued on page 5

Facts About Substance Abuse in Arizona

RBHA
The EXCEL Group
Community Partnership of Southern Arizona

Phone Number
1.800.880.8901
1.800.771.9889

Pinal Gila Behavioral Health Authority

Counties Served
Yuma and La Paz
Pima, Graham, Greenlee, Cochise,
and Santa Cruz
Maricopa
Mohave, Coconino, Apache,
Navajo, and Yavapai
Pinal and Gila

TRBHA
Gila River Health Care Corporation
Navajo Nation
Pasqua Yaqui

Tribe Served
Gila River Indian Community
Navajo Nation
Pasqua Yacqui

Phone Number
602.528.1343
928.871.6239
520.879.6060

Value Options
Northern Arizona Regional Behavioral Health Authority

4

By Lisa Shumaker

Prevention Bulletin

1.800.564.5465
1.800.640.2123
1.800.982.1317

January/February 2004

Substance Abuse continued from page 4
References
Bureau of Substance Abuse and General Mental Health (1998). Substance Use in Arizona: Final Report of
the 1996 Telephone Household Survey. Arizona Department of Health Services.
Wright, Douglas (2003). State Estimates of Substance Use from the 2001 National Household Survey on
Drug Abuse: Volume 1. Findings (DHHS Publication No. SMA 03-3775, NHSDA Series H-19) Rockville,
MD: Substance Abuse and Mental Health Services Administration, Office of Applied Studies.

Lisa Shumaker is a Community Program Representative in the ADHS Division of Behavioral
Health Services. She can be reached at 602.364.4600 or lshumak@hs.state.az.us.

Some Indicators of
Substance Use
• Consumes more than 4 alcoholic
drinks at one time (men) at least
once per month.
• Consumes more than 3 alcoholic
drinks at one time (women) at
least once per month.
• History of a problem with alcohol
or other substances.

National Alcohol Screening Day
National Alcohol Screening Day (NASD) is a free annual event to raise
awareness about alcohol’s effect on health and to screen for at-risk
drinking. NASD is a ready-to-use education and screening program
that explores alcohol effects on health and connects people in need
with treatment. In-person trainings & web-based training are available
to sites wishing to participate in NASD. NASD will take place on April
8, 2004. If you are an agency that would like to participate in NASD or
for additional information, please contact Cora Bagley at 602.364.4612.

• Neglects responsibilities due to
binge drinking or drug use.
• Prior hospitalization for drugs or
alcohol.
• History of taking prescription
medications in inappropriate
doses or combinations.
• Spouse or significant other is
concerned about the patients’
substance abuse.

New State Health Laboratory Expected to Open in June 2004
The Arizona Department of Health Services new State
Laboratory facility is under construction with expected completion
and occupancy by June 2004. Much of the external construction
has been completed. The remaining work involves completion of
the installation of the chemical fume hoods, biological safety
cabinets, autoclaves and laboratory casework.
The state-of-the-art laboratory will contain approximately
75,000 gross square feet. The first floor will be administrative
offices, training facilities, storage, mechanical systems and the
loading dock for receipt of supplies and delivery of specimens.
The second floor will house all of Microbiology; the third floor
will be Chemistry.
The laboratory will contain advanced security systems,
communications and conferencing networks. A seminar/conference center will accommodate up to 100 people. This space can
also be subdivided to host smaller presentations. A training
laboratory has been included to host sessions of 16 students in
laboratory procedures training ranging from Biological Safety
Level III to less complex standard methodologies.
The Design-Build Team of Gilbane Construction, CUH2A
Architects, the Arizona Department of Administration and the
Arizona Department of Health Services have collaborated to
develop an extremely successful project.

January/February 2004

Prevention Bulletin

5

SUMMARY OF SELECTED REPORTABLE DISEASES
Year to Date (January - November, 2003)1, 2
Jan - Nov
2003

Jan - Nov
2002

5 Year Median
Jan - Nov

7 (3)
1
0
79 (50)
0 (0)

6 (4)
0
1
221 (103)
0 (0)

6 (4)
1
2
213 (103)
0 (0)

791
39
10
737
531

671
36
16
711
564

584
36
16
725
553

271
286
935
7
8,533 (3,232)

286
226
1,040
6
9,460 (4,776)

432
169
960
11
5,671 (2,085)

504
146
21
14

709
281
24
31

708
188
38
31

12,121
3,352
170 (18)

13,569
3,385
172 (14)

11,624
3,800
175 (26)

6 (1)
713

9 (0)
944

9 (1)
879

0
0
70

1
0
137

3
0
95

2,430
199
493
431
273 (246)

2,724
204
449
388
223 (200)

1,773
197
449
455
259 (200)

VACCINE PREVENTABLE DISEASES:
Haemophilus influenzae, serotype b invasive disease (<5 years of age)
Measles
Mumps
Pertussis (<12 years of age)
Rubella (Congenital Rubella Syndrome)
FOODBORNE DISEASES:
Campylobacteriosis
E.coli O157:H7
Listeriosis
Salmonellosis
Shigellosis
VIRAL HEPATITIDES:
Hepatitis A
Hepatitis B: acute
Hepatitis B: non-acute3
Hepatitis C: acute
Hepatitis C: non-acute3 (confirmed to date)
INVASIVE DISEASES:
Streptococcus pneumoniae
Streptococcus Group A
Streptococcus Group B in infants <30 days of age
Meningococcal Infection
SEXUALLY TRANSMITTED DISEASES:
Chlamydia
Gonorrhea
P/S Syphilis (Congenital Syphilis)
DRUG-RESISTANT BACTERIA:
TB isolates resistant to at least INH (resistant to at least INH & Rifampin)
Vancomycin resistant Enterococci isolates
VECTOR-BORNE & ZOONOTIC DISEASES:
Hantavirus Pulmonary Syndrome
Plague
Animals with Rabies4
ALSO OF INTEREST IN ARIZONA:
Coccidioidomycosis
Tuberculosis
HIV
AIDS
Lead Poisoning (<16 years of age)
1
2
3
4

6

Data are provisional and reflect case reports during this period except Lead Poisoning which is by date of diagnosis.
These counts reflect the year reported or tested and not the date infected.
Case counts for non-acute Hepatitis B and C are not available before 1998.
Based on animals submitted for rabies testing.

Prevention Bulletin

January/February 2004

HIV and AIDS in the State of Arizona
Since 1981, the first
year of HIV/AIDS reporting
in Arizona, a total of 8,785
AIDS cases and 5,545
cases of HIV(non-AIDS)
were reported to the
Arizona Department of
Health Services. Of these,
53 percent of the AIDS
cases and 9 percent of the
HIV cases are deceased
(See Figure 1).
Cases of HIV and AIDS
are distributed disproportionately in state metropolitan centers. Maricopa
County, the state’s largest
urban area, comprises 60
percent of Arizona’s population and 70 percent of
the AIDS cases and 72
percent of the HIV cases.
Pima County, the next most
populous urban county
with 16 percent of the
state’s population, has 20
percent of the state’s AIDS
cases and 19 percent of its
HIV cases. The remaining
cases, less than one-fourth
of the total, are scattered
across the rest of Arizona.
Despite increases over
the past ten years in
heterosexual transmission,
the primary risk factor in
Arizona for HIV continues
to be among men who
have sex with men (MSM),
followed by intravenous
drug use (See Figure 2.).
Overall reports of HIV
infection have fallen during
the decade between these
time periods, from 1,902
during 1990-1992 to 1,405
during 2000-2002.
For more information
on HIV/AIDS, contact
ADHS at 602.364.3610
or visit the web at
www.hs.state.az.us.

Figure 1

Figure 2

1990-1992
Modes of Exposure for
Ten-Year Span of HIV
Cases in Arizona

2000-2002
n=1,902

n=1,405
January/February 2004

Prevention Bulletin

7

❍ Change of Address/Name
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Arizona Department of Health Services
Public Information Office
150 North 18th Avenue
Phoenix, AZ 85007

Please include your mailing label with all
requests for changes. Fax changes to
602.542.1265 or call 602.364.2401

PRSRT STD
US Postage
PAID
Phoenix, AZ
Permit No. 957

Janet Napolitano, Governor
Catherine R. Eden, Ph.D., Director ADHS
Rose Conner, Assistant Director, Public Health Services
Editorial Board
Bob England, M.D., M.P.H., State Epidemiologist
Victorio Vaz, D.V.M., Ph.D.
Tim Flood, M.D.
Kathy Fredrickson, M.P.H.
Will Humble, M.P.H.
Karen Lewis, M.D.
Ken Komatsu, M.P.H.
Cheryl McRill, M.D.
Wesley Press, M.S.
Lisa Shumaker, M.A.
Emma N. Viera, M.P.H.
Managing Editor: Courtney Casillas
e-mail: ccasill@hs.state.az.us
Contributors: Bob England, Laura Erhart,
Mersija Hadzihasanovic, Sarah Harpring,
Karen Lewis, Lisa Shumaker
This publication is supported by the Preventive Health and Health Services Block
Grant from the Centers for Disease Control and Prevention (CDC).
Its contents do not necessarily represent the views of the CDC.
If you need this publication in alternative format, please contact the ADHS Public
Information Office at 602.364.1201 or 1.800.367.8939 (State TDD/TTY Relay).

New Communicable Disease Rules Published
Proposed revisions to the communicable disease rules in 9 A.A.C.
6, Articles 1, 2, 3, 5, and 6 will be
published in the Arizona
Administrative Register on January 9,
2004. The Notice of Proposed
Rulemaking is the result of a lengthy
rule drafting process during which
the Bureau of Epidemiology and
Disease Control Services (BEDCS)
solicited and obtained input from
interested persons starting in March
2003.
In preparing the proposed rules,
BEDCS seriously considered each of
the comments received and made
numerous changes in response to
those comments. BEDCS believes
that the proposed rules reflect the
best means to improve Arizona’s system for detecting, reporting, controlling, and preventing communicable
diseases and thereby to protect and
improve the public health.
8

Prevention Bulletin

BEDCS will be holding three
oral proceedings (in Phoenix,
Flagstaff, and Tucson) to obtain public comment on the proposed rules:
February 9, 2004; 1:00 p.m.
1740 W. Adams,
Room 411
Phoenix, AZ 85007
February 10, 2004; 1:00 p.m
1500 E. Cedar Ave.,
Suite 22
Flagstaff, AZ 86004
February 11, 2004; 1:00 p.m
400 W. Congress
Room 5
Tucson, AZ 85701
Written comments may also be
submitted, until 5:00 p.m. on
February 13, 2004, to the individuals identified in the Notice of
Proposed Rulemaking.
On January 9, 2004, the Notice
of Proposed Rulemaking will be

available for review on the ADHS
website by going to www.hs.state.
az.us/diro/admin_rules/proposed.htm
and selecting the link for
“Communicable Diseases and
Infestations” under Division of
Public Health Services. If you do
not have access to the ADHS website and would like a copy of the
proposed rules, please call
602.364.0781 to request a copy.
January/February 2004