Publication of the Division of Public Health Services

May/June 2005, Vol. 19, No. 3

New Pertussis Vaccine for Adolescents
Karen Lewis, M.D.

An acellular pertussis vaccine is
now approved for adolescents by the
Food and Drug Administration (FDA).
Boostrix™ is a GlaxoSmithKline vaccine which contains acellular components of Bordetella pertussis, diphtheria toxoid, and tetanus toxoid.
Boostrix™ is indicated as a single
booster dose for ages 10-18 years old.
Another acellular pertussis vaccine
(ADACEL™) has been recommended for
licensure by an FDA Advisory Panel. It
is expected to be approved soon for
ages 11-64 years old. ADACEL™ is
manufactured by sanofi pasteur.
Despite high rates of pertussis vaccination, pertussis has increased from
1,248 cases in 1981 to an annual
average of 9,431 during 1996-2003.(1)
In 2003, there were 11,647 cases of
pertussis, the highest number reported
since 1964. (2)
One reason is that pertussis vaccine immunity wears off. Adolescents
and adults can be infected, even if
they were vaccinated as a child.
Physicians often do not consider pertussis as a cause of afebrile coughing
in adolescents and adults.
During 1996-2004, most of the
cases in the U.S. were in children too
young to be fully immunized, or in
people too old to be vaccinated. For
example, 35.1% of cases were < 6
months old, and 60.7% were > 7
years old. (1).

Adolescents contribute to the pertussis burden in Arizona. In 2004,
adolescents comprised 21.9% of all
pertussis cases. Vaccinating this age
group would decrease the spread of
pertussis in schools and throughout
the community.
Arizona is currently seeing a prolonged increase in pertussis cases.
From January through mid May, both
Pima and Maricopa Counties have
reported well over 100 cases of pertussis each. Approximately 40% of
the cases have been in high school
and middle school students.
Boostrix™ (and when approved,
ADACEL™) can be used in adolescents
in place of tetanus and diphtheria toxoids (Td). This is timely in light of

recent increases in pertussis cases in
Arizona.
In people who have previously
been fully vaccinated against tetanus
and diphtheria, tetanus and diphtheria
vaccines are not indicated more frequently than every 5 years, due to an
increased incidence and severity of
local adverse reactions. (3)
Therefore, adolescents ages 10-18
years old who have previously been
fully vaccinated can be given
Boostrix™ as long as it has been > 5
years since their most recent dose of
tetanus and diphtheria toxoid-containing vaccine.
The Arizona State Immunization
Information System (ASIIS) can help
physicians to find when past doses
were given. For ASIIS questions, contact the Arizona Immunization
Program Office at 602.364.3899, or
1.877.491.5741.
References:
1. CDC. Outbreaks of Pertussis Associated with
Hospitals—Kentucky, Pennsylvania, and Oregon,
2003. MMWR. 52 (3), 67-72.
2. CDC. Summary of Notifiable Diseases—United
States, 2003. MMWR. 52 (54), 1-85.
3. CDC. Epidemiology and Prevention of VaccinePreventable Diseases. Atkinson W, Hamborsky J,
Wolfe S, eds. 8th ed. Washington DC: Public Health
Foundation, 2004, p.71.

Karen Lewis, MD, is Medical Director for
Bureau of Epidemiology and Disease Control.
She can be reached at 602.364.4562 or
lewisk@azdhs.gov

Visit the ADHS Web site at www.azdhs.gov
Flu Vaccine Went
To High-Risk
Patients
Page 2
May/June 2005

Influenza
Surveillance
Summary,
2004-2005
Page 3

Meningococcal
Conjugate Vaccine
Licensed
Page 4

Toxic Shock
Syndrome in
Coconino County
Page 5

Communicable
Disease Summary
Page 7

Prevention Bulletin

1

Most Of 2004-2005 Flu Vaccine
Went To High Risk Patients

Some Ways To
Use Up Extra
Influenza Vaccine

by Karen Lewis, M.D.

In spite of severe influenza vaccine shortages this winter in the
United States, the Centers for Disease
Control and Prevention (CDC) reports
that most of vaccine went to the people at greatest risk for serious complications from influenza: 6 to 23
months old children, people 65 years
of age and older, and people with
chronic health conditions. Influenza
vaccination coverage levels among
adults in priority
groups were close
to levels similar to
previous years.
Adults not in
priority groups
received about
half of historic
levels.
About 40
million doses of
the 61 million
doses of influenza
vaccine distributed
this last influenza
season went to
persons in the priority groups. Among
adults, influenza vaccination coverage
this season (through January 2005)
was highest among persons aged 65
years old and older (62.7%), followed
by health-care workers with direct
patient contact (35.7%), and people
aged 18-64 years with high-risk conditions (25.5%).
In contrast, during the 2003-04
influenza season, vaccine coverage
was 65.6% in persons aged 65 years
and older, 40.1% in health-care workers, and 34.2% in adults aged 18-64
years with high-risk conditions.
Healthy persons aged 18-64 years
old were much less likely to have
received an influenza shot during the
2004-05 influenza season. Excluding
health care workers and contacts of
children under 6 months of age, only
8.8 percent of healthy persons aged
18-64 years old reported receiving an
2

Prevention Bulletin

influenza vaccination compared to an
estimated 17.8 percent in 2003. This
resulted in about 17.5 million additional doses of vaccine available this
year for priority groups.
This influenza season was the first
one in which influenza vaccination
was recommended for children aged
6 - 23 months. For children aged 623 months, vaccine coverage was esti-

mated at 48.4 percent. In contrast,
during the 2002- 2003 influenza season, coverage among children aged 6
to 23 months was only 7.4 percent.
For children aged 2-17 years with
high-risk conditions, vaccine coverage
during the 2004-05 season was estimated at 34.8 percent. Coverage
among children not in priority groups
was estimated at 12.3 percent.
Karen Lewis, MD, is Medical Director for
Bureau of Epidemiology and Disease Control.
She can be reached at 602.364.4562 or
lewisk@azdhs.gov
Reference:
1. Morbidity and Mortality Weekly Report
April 1, 2005/54(12); 304-307.
2. Estimated Influenza Vaccination Coverage
Among Adults and Children --- United States,
September 1, 2004--January 31, 2005
http://www.cdc.gov/mmwr/preview/mmwrhtml/
mm5412a3.htm

by Karen Lewis, M.D.

Do you have unused influenza
vaccine in your office? Although
influenza season has gone, there
are still ways to use vaccine before
it expires June 30, 2005.
Consider influenza vaccine
for:
•

Travelers to the Southern
Hemisphere during our summer (which is their winter so it
is when they have influenza
outbreaks).

•

People going on cruises anywhere. Influenza outbreaks
occur on cruise ships, even
during the summer.

•

Children > 6 months to < 9
years old who have never
received influenza vaccine.

Infants and children from 6
months to 9 years old would be
the largest potential group to
whom vaccine could be offered at
this point. This is because children from 6 months to 9 years old
receiving influenza vaccine for the
first time should receive two doses
at least a month apart for optimal
protection during influenza season. However, if they have
received even just one dose of
influenza vaccine in the past, they
only need one dose in subsequent
seasons.
Therefore, if you have patients
who are now over 6 months old,
and who will be under 9 years of
age by next influenza season, and
who will need influenza vaccine
next fall, you can get a head start
by giving them a dose of influenza
vaccine now. Normally, these
children would require two doses
of influenza vaccine next fall.
However, if they receive a dose
now (before June 30, 2005), they
will only need one dose of
influenza vaccine next fall and in
subsequent influenza seasons.
May/June 2005

Influenza Surveillance Summary, 2004-2005
Laura Erhart, MPH

00

5

05

/2

4/

23

9/

4/

00

3/

26

/2

/2

12

20

5

5

00

5

3/

26

2/

/2

/2

00

00

5

5

12

2/

29

1/

/2

15

/2

00

00

5

05

20

1/

1/

1/

/1

12

/4

12

8/

/2

20

00

04

4

04

0/

/2

11

/6

/2

20

00

04

20

3/

/2

10

11

4

00

/2

/9

10

4

Number of positive tests

Coming on the heels of extensive efforts by providers
revealed that this strain circulated in the state this season.
and health departments to distribute a limited supply of
The 2004-2005 season was the first for which influeninfluenza vaccine, influenza activity during the 2004za was reportable by laboratories, representing an
2005 season was mild. Influenza activity peaked in
additional component of Arizona’s influenza surveillance.
Arizona in February after an initial increase of cases in
While no data were available for comparison from previJanuary. This temporal pattern mirrors the typical flu seaous years, the timing and length of the season can be
son in Arizona, despite the very early peak in 2003-2004.
observed from the reported laboratory-confirmed cases by
As of the beginning of April, new influenza cases continweek of report (see figure 1 below).
ue to be identified and reported. No pediatric flu-associEven as the season comes to a close, limited influenza
ated deaths were reported in Arizona during the season.
surveillance must continue in order to identify any unusuInfluenza A and B viruses co-circulated throughout
al events or detect novel strains imported from other
the Arizona flu season. The Mountain region (which
sources.
includes Arizona) reported the highest proportion of
Laura Erhart, MPH, is an Epidemiologist, for ADHS Infectious Disease
influenza B isolates out of all ten CDC-designated
Epidemiology Section. She can be reached at 602.364.3674 or
regions, though influenza A accounted for the majority of
erhartl@azdhs.gov
cases regionally and nationwide. A variant of the
A/Fujian strain [the
Figure 1
A(H3N2)] vaccine
component for
Laboratory-confirmed influenza, Arizona, 2004-2005
2003-2004) was
identified in
California at the
end of 2004. In
the following
weeks, this
A/California strain
increased in prevalence nationally.
This strain will be
included in the
2005-2006
vaccine. Antigenic
subtyping of
Arizona specimens
Date reported to ADHS, by week
performed by CDC

FluMist®: Start Thinking Now about the 2005-06 Influenza Season
• Begin thinking now about Health Care Worker (HCW)
influenza vaccination
• FluMist® is appropriate for most HCWs
• Freezer storage requirements have been eased
• FluMist® does not contain thimerosal
CDC recommends that we begin thinking now about
potential influenza vaccine availability for the 2005-06
season. Recent ACIP language more strongly emphasized
the use of the live attenuated influenza vaccine (LAIV,
manufactured as FluMist®) for healthy people aged 5-49
years, and also clarified that tiering of vaccine priority
groups applies to inactivated (injectable) influenza vaccine only. In addition, CDC has also clarified its recom-

mendation that most HCWs who are healthy, less than 50
years of age, and are not pregnant can get LAIV. There is
one exception for use of LAIV in a HCW, a HCW who
cares for severely immunocompromised patients in protected environments, such as patients who have received
bone marrow transplants, or patients that have Severe
Combined Immunodeficiency Disease (SCID) should not
receive LAIV. For these HCWs, the injectable influenza
vaccine is preferred due to a theoretical risk of transmission of the weakened live virus in LAIV to severely
immunocompromised patients. If these HCW receive
LAIV, they must avoid contact with severely immunocompromised patients for 7 days after receiving LAIV. To date,
there have been no reports of transmission of LAIV from a
HCW to any patient.
continued on page 5

May/June 2005

Prevention Bulletin

3

Meningococcal Conjugate Vaccine Licensed
by Karen Lewis, M.D.

At the February 10-11, 2005
meeting, the Advisory Committee for
Immunization Practices (ACIP) working group recommended routine vaccination with meningococcal conjugate vaccine quadrivalent (MCV4) for
protection against meningococcal disease in adolescents and adults aged
11-55 years. Meningococcal disease
is caused by bacteria that infect the
bloodstream, lining of the brain and
spinal cord, often causing serious illness. Every year in the U.S., 1,400 to
2,800 people contract meningococcal
disease. Ten to 14 per cent die and
11-19 percent have permanent disabilities such as mental retardation,
hearing loss and loss of limbs.
ACIP recommended the vaccine
at pre-adolescent visits (11-12 year
olds) or high school entry (15 year
olds); college freshmen living in
dorms, and other groups at highest
risk (military recruits, travelers to or
residents of countries experiencing
epidemic disease, microbiologists at
risk). A catch-up campaign was not
recommended. MCV4 will be preferred for all persons aged 11 – 55
years old, although MPSV4 (meningococcal polysaccharide vaccine
quadrivalent) is acceptable.
Recommendations for control of
outbreaks are unchanged from prior
recommendations. Persons vaccinated with MPSV4 should be re-vaccinated after 3-5 years if they remain at
risk. No recommendation was made
Figure 2

Figure 1

on re-vaccination of recipients of
MCV4, pending observations over the
next 5 years. These recommendations
were unanimously accepted by the
full ACIP.
The vaccine was licensed by the
U.S. Food and Drug Administration
(FDA) on January 14, 2005, is manufactured by Sanofi Pasteur and will be
marketed as Menactra™. The vaccine
is highly effective. However, it does
not protect people against meningococcal disease caused by “type B”
bacteria. This type of bacteria causes
one-third of meningococcal cases.
More than half of the cases among
infants aged <1 year are caused by
“type B,” for which no vaccine is

licensed or available in the United
States.
The vaccine is recommended for
these groups:
Adolescents aged 11-18 years
traveling to countries in which
meningococcus is hyperendemic or
epidemic, particularly if contact with
the local population will be prolonged.
• Adolescents aged 11-18 years with
terminal complement deficiencies
and those with anatomic or functional asplenia.
• Adolescents aged 11-18 years who
are infected with HIV
• Adolescents 11-12 years old at their
preadolescent assessment visit.
• Adolescents at high school entry
(aged 15 years) who were not vaccinated at the preadolescent visit.
• College freshmen living in dormitories.
MCV4 should be administered
0.5mL intramuscularly (IM). There is
no recommendation for revaccination
but this may change pending observations over the next 5 years.
Arizona specific data on
meningococcal disease is illustrated
in the charts shown in Figures 1 & 2.
Karen Lewis, MD, is Medical Director for
Bureau of Epidemiology and Disease Control.
She can be reached at 602.364.4562 or
lewisk@azdhs.gov

4

Prevention Bulletin

May/June 2005

Healthcare Associated Streptococcal
Toxic Shock Syndrome in Coconino County
by Clare Kioski, MPH

Two cases of Streptococcal Toxic
Shock Syndrome were reported in a
Coconino County healthcare facility
in February, 2005. Pulsed Field Gel
Electrophoresis (PFGE) of the isolates
at the Arizona Public Health
Laboratory (APHL) indicated that
these isolates were genetically related. Subsequently, the isolates were
sent to the Centers for Disease
Control and Prevention (CDC) for M
protein gene (emm) typing. The
CDC uses a sequence-based system
to determine the emm gene which
encodes the cell surface M virulence
protein. Both case isolates belong to
the emm type group 1.0, a relatively
common emm type among invasive
streptococcal strains. These isolates
were further subtyped at CDC and
were identified as emm1.6, a rare
subtype in the United States.
The initial case was hospitalized
at a healthcare facility with necrotizing fasciitis of the leg and streptococcal toxic shock syndrome (STSS).
Her leg was amputated at the hip
due to the infection. The second
case was a respiratory therapist
employed by the health care facility
who was admitted to the same facility eight days after the initial case was
admitted. He was diagnosed with
pneumonia and streptococcal toxic
shock syndrome. He had cared for
the initial case several days after the
patient was removed from contact
precautions. Both cases survived.
Given the potential transmission
in the healthcare facility and upon
consultation with the CDC and the
Arizona Department of Health

Services (ADHS), the healthcare
facility obtained throat swab specimens and questionnaires on all contacts of these cases. Those with
Group A Streptococcus (GAS) isolates were given prophylactic antibiArizona averages 248 cases of
invasive GAS infections every year.
In 2004, there were 262 cases of
invasive GAS infection in Arizona.
otics (azithromycin) to prevent invasive disease. Contacts of any GAS
positive contacts also had throat
swabs obtained. All GAS isolates
were analyzed by PFGE and compared to the STSS case strain.
Isolates were also sent to CDC for
emm typing.
Throat swabs were obtained from
704 individuals who may have had
contact with these two recent cases.
Twenty-one of these “contacts”
(2.9%) were positive for GAS. None
of these contacts were symptomatic
for pharyngitis. Only one of the 21
matched the STSS case strain and
emm type. This individual does not
provide patient care and actually did
not have contact with either case
and was sampled inadvertently. The
period of increased risk for secondary cases of invasive GAS disease is
in the first 30 days after exposure.
No further cases of invasive GAS
occurred during this time period.
Two isolates from previous cases
of invasive GAS from Coconino
County, one each from 2000 and
2002, were tested to determine if

they were related to the 2005 STSS
case strain. There was not a match
between the 2000 and 2005 isolates.
However, the 2002 isolate matched
the 2005 STSS strain by PFGE and
was further identified to be emm
type 1.0. The person with the 2002
isolate died of Streptococcal Toxic
Shock Syndrome.
It is of interest, that the 2005
invasive GAS isolates were indistinguishable from the asymptomatic
individual, who did not have apparent contact with either case, as well
as being indistinguishable by PFGE
from the 2002 fatal case. This suggests that this subtype of GAS circulates in the community and has been
circulating over the last few years,
and may only rarely manifests itself
as invasive disease.
Arizona averages 248 cases of
invasive GAS infections every year.
In Arizona in 2004, there were 262
case of invasive GAS infection.
The APHL has now developed
the capability to perform emm typing
of invasive GAS isolates. This laboratory technique will allow for
improved investigation of unusual
GAS infections.
Reference:
Prevention of Invasive Group A Streptococcal
Disease among Household Contacts of Case
Patients and among Postpartum and Post-surgical Patients: Recommendations from the
Centers for Disease Control and Prevention.
CID. 2002:35 (15 October) 950-959.
Clare Kioski, MPH is an Infection Control
Epidemiologist and can be reached at
602.364.3675 or kioskic@@azdhs.gov.

FluMist® continued from page 3
Storage requirements for FluMist® have been changed. In November 2004 the requirement for the hard plastic freezer storage box supplied by the manufacturer was eased, and storage of FluMist® in a freezer at –15º Celsius or colder is
now required. Storage of FluMist® in a frost-free freezer is also allowed, as of November 2004.
Given the injectable influenza vaccine shortage during the 2004-05 season, consideration of FluMist® for HCW
who meet eligibility criteria may be a decision point to ponder early in the planning process. For more information go
to this website: http://www.cdc.gov/flu/professionals/flugallery/images04_05/FluMistQA.pdf.
May/June 2005

Prevention Bulletin

5

Noteworthy
Varicella Vaccination
Requirement Coming
This Fall
ADHS anticipates
approval of a varicella
vaccination requirement this June by the
Secretary of State’s
Office. Children
attending childcare,
Kindergarten, 1st and 7th grades will
be required to show proof of immunization or parental history of disease. This requirement will be effective in Fall 2005. Providers should
make sure these patients receive a
varicella vaccination or have documented history of varicella (chickenpox) disease.

Contracts Awarded
The Arizona Department of
Health Services has awarded $360
million in three contracts for the provision of mental health services outside of Maricopa County.
The winners of the contracts are:
Northern Arizona Regional Behavioral
Health Authority (NARBHA) ,
Community Partnership of Southern
Arizona (CPSA), and Cenpatico
Behavioral Health. NARBHA and
CPSA are current holders of contracts,
which cover geographic service areas
(GSA) 1 (Apache, Coconino, Mohave,
Navajo, and Yavapai Counties), 3
(Cochise, Graham, Greenlee, and
Santa Cruz Counties) and 5 (Pima
County). Cenpatico Behavioral
Health is a new contractor and will
assume the administration of services
provided in GSAs 2 (La Paz and Yuma
Counties) and 4 (Gila and Pinal
Counties). All services under the new
contracts, must meet the needs of
people with mental illness, including
easy access to services; consumer
and family involvement; collaboration
with the greater community; effective
innovation; and cultural competency.
As of January 2005, there were
58,301 adults and children receiving
behavioral health services outside of
Maricopa County. For more informa6

Prevention Bulletin

tion on mental health services in
Arizona, please visit the ADHS
website at http://www.azdhs.gov.

Physician Signature
on Electronic Death
Certificates
You Have Heard the Rumors . . .
Over the last six or seven years,
you have heard rumors that the
Office of Vital Records is going electronic. You have heard that physicians will be able to digitally sign
death certificates. You have heard
that funeral directors will no longer
be chasing you down in hospitals and
interrupting your practice to get your
signature on a death certificate. Like
the boy who called wolf, you have
heard it for so long, and so often, you
don’t believe it any more. Well,
believe it.
For several weeks, the Office of
Vital Records has had a consultant
developing the requirements for this
new electronic system. In fact, birth
certificates, fetal death certificates
and death certificates will all be electronic records in a matter of months.
The requirements will become
part of an RFP (Request For Proposal)
that we expect to issue by June to
select a vendor for the system design
and development. We should have a
contract awarded by September, and
we will have the system built, tested
and in place, and begin rolling it out
to all of our partners (you included)
some time in 2006.
As certifying physicians, you will
find this very convenient. In addition
to the advantages listed above, you
will be able to log into the system
from any computer with a secure
Internet connection. When you log
in, you will see a screen that will tell
you if you have a death certificate in
your queue, go to that record, enter
the causes and manner of death and
digitally sign the certificate. You’re
done! You will be able to do this at a
time and place convenient to you.
We anticipate many hospitals, clinics,

hospices, etc., will have computers
set up in convenient locations that
you can use for this purpose.
Watch for more information as
we move closer to making this a
reality.

Confirmed Hantavirus
Pulmonary Syndrome
(HPS) Case
The Department announced the
first confirmed hantavirus pulmonary
syndrome (HPS)
case in the state
in April. The
patient appears
to have been
exposed in the northern part of the
state, although it is likely that the risk
of exposure to hantavirus is higher
this year throughout the state.
Physicians are reminded to consider
hantavirus as a potential etiology for
patients experiencing severe respiratory distress and who have reported
exposure to rodents, rodent droppings
or their nests.
Clinical findings may include a
prodromal history of fever, myalgias,
malaise, and nausea. Prodrome (avg.
4-5 days) is typically followed by
onset of respiratory symptoms,
including dry cough and dyspnea,
which may progress into pulmonary
edema and hypoxemia within a few
hours. Initial chest X-rays may reveal
signs of interstitial edema. As HPS
progresses, alveolar flooding occurs
in the basilar or perihilar areas rather
than the peripheral pattern typically
seen with ARDS. Pleural effusions
are also seen as the disease progresses. Laboratory findings commonly
include an elevated hematocrit,
thrombocytopenia, and leukocytosis
with a left shift. At least 10% of lymphocytes are either immunoblasts or
plasma cells.
Serologic testing for HPS is available at the Arizona State Health
Laboratory (ASHL). See previous
Prevention Bulletin or contact Craig
Levy at 602.364.4562 for consultation or more information on HPS.
May/June 2005

SUMMARY OF SELECTED REPORTABLE DISEASES
Year to Date (January - March, 2005)1, 2
Jan - Mar
2005

Jan - Mar
2004

5 Year Median
Jan - Mar

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

0 (0)
1
0
55 (23)
0 (0)

0 (0)
0
0
26 (13)
0 (0)

2 (1)
0
0
24 (13)
0 (0)

172
5
3
149
63

142
4
2
163
96

116
4
4
131
87

69
81
277
0
2,317 (720)

80
53
256
0
2,853 (975)

104
54
308
1
2,272 (979)

221
86
13
280
11

253
85
11
N/A
4

324
68
8
N/A
13

5,369
1,130
35 (4)

4,414
1,279
41 (2)

3,343
1,082
41 (7)

2 (0)
434

1 (0)
357

1 (0)
256

0
0
0
50

0
0
0
15

N/A
0
0
15

645
24
167
124

870
42
117
112

651
29
127
118

VIRAL HEPATITIDES:
Hepatitis A
Hepatitis B: acute
Hepatitis B: non-acute
Hepatitis C: acute
Hepatitis C: non-acute (confirmed to date)
INVASIVE DISEASES:
Streptococcus pneumoniae
Streptococcus Group A
Streptococcus Group B in infants <90 days of age
Methicillin-resistant Staphylococcus aureus3
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:
West Nile virus Infection
Hantavirus Pulmonary Syndrome
Plague
Animals with Rabies4
ALSO OF INTEREST IN ARIZONA:
Coccidioidomycosis
Tuberculosis
HIV
AIDS
1
2
3
4

Data are provisional and reflect case reports during this period.
These counts reflect the year reported or tested and not the date infected.
MRSA was not reportable before October 2004.
Based on animals submitted for rabies testing.
Data compiled by Offices of Infectious Disease and Office of HIV/AIDS Services

May/June 2005

Prevention Bulletin

7

❍ Change of Address/Name
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Please include your mailing label with all
requests for changes. Fax changes to
602.364.3266 or call 602.364.3860

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Permit No. 957

Arizona Department of Health Services
Public Information Office
150 North 18th Avenue
Phoenix, AZ 85007
Janet Napolitano, Governor
Susan Gerard, Director ADHS
Rose Conner, Assistant Director, Public Health Services
Contributors
Laura Erhart, Karen Lewis, the Office of Infectious Disease
Services, the Arizona Immunization Program Office
and the Office of HIV/AIDS Services
Managing Editor: Mary Ehlert, M.S., ABC
e-mail: ehlertm@azdhs.gov

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).

Clinical Lab Rulemaking Notice
The Arizona Department of
Health Services has filed a
Notice of Proposed
Exempt Rulemaking and
Notice of Public
Information for Title 9,
Chapter 14, Article 1 of
the Arizona
Administrative Code.
Arizona Revised
Statutes (A.R.S.) § 36466, as added by Laws 2004,
Chapter 49, § 1 (HB 2046), established the Advisory Committee on
Clinical Laboratories (ACCL). At public meetings on January 10, 2005,
and February 2, 2005, the ACCL
approved a list of direct access tests
and standards for the use of laboratory standing orders.
Arizona Revised Statutes § 36466(D) requires the ADHS to make
rules based on the ACCL's recommendations. According to Laws
2004, Chapter 49, § 3, the ADHS is
8

Prevention Bulletin

exempt from the rulemaking
requirements of A.R.S. Title
41, Chapter 6, until
August 25, 2005.
The ADHS filed
with the Secretary of
State a Notice of
Proposed Exempt
Rulemaking and a
Notice of Public
Information. These notices
are published in the Arizona
Administrative Register for April 22,
2005. The notices are available at
the Secretary of State's website at
www.azsos.gov/aar/2005/17/
contents.shtm or by link from the
ADHS Office of Administrative Rules
website at www.azdhs.gov/diro/
admin_rules/exempt.htm under
Division of Public Health Services,
Laboratories - Direct Access Tests and
Laboratory Standing Orders.
The Notice of Proposed Exempt
Rulemaking contains the proposed

rules on direct access tests and laboratory standing orders and schedules
a May 31, 2005 public hearing on
the proposed rules. The Notice of
Public Information also informs the
public about the public hearing at
10:00 a.m., May 31, 2005, at 1740
W. Adams, Phoenix, AZ 85007,
Room 411.
You can submit written comments on the proposed rules until
5:00 p.m., May 31, 2005 to:
Lynn Golder, Rules Analyst
Arizona Dept. of Health Services
1740 W. Adams, Suite 202
Phoenix, AZ 85007
Telephone: (602) 364-3958
Fax: (602) 364-1150
E-Mail: golderl@azdhs.gov
The ADHS looks forward to your
comments on the proposed rules for
direct access tests and laboratory
standing orders.
May/June 2005