Tuesday, September 24th, 2013
The New York Health Department is now “requiring thousands of medical staff and other personnel statewide to get vaccinated” against influenza “or else wear masks when in close contact with patients.” The new “rules apply to more than 4,000 hospitals, clinics, diagnostic centers, nursing homes, hospices and home care agencies statewide.” The rules were adopted two months ago, but will go into effect when officials deem influenza to be rampant. Documentation of compliance, as well as employee vaccination status, must be maintained by all health facilities.
Effect of Rule:
Any facility defined as a hospital pursuant to Article 28, a home services agency by PHL Article 36, or a hospice by PHL Article 40 will be required to comply. In New York State there are 228 general hospitals, 1198 hospital extension clinics, 1239 diagnostic and treatment centers, and 635 nursing homes. There are also 139 certified home health agencies (CHHAs), 97 long term home health care programs (LTHHCP), 19 hospices and 1164 licensed home care services agencies (LHCSAs).
Of those, it is known that 3 general hospitals, approximately 237 diagnostic and treatment centers, 40 nursing homes, 69 CHHAs, 36 hospices and 860 LHCSAs are small businesses (defined as 100 employees or less), independently owned and operated, affected by this rule.
Local governments operate 18 hospitals, 40 nursing homes, 42 CHHAs, at least 7 LHCSAs, and a number of diagnostic and treatment centers and hospices.
All facilities and agencies must document the vaccination status of each personnel member as defined in this regulation for influenza virus, in their personnel or other appropriate record. Each facility must develop a policy and procedure which requires all personnel who have not been vaccinated for influenza during the current influenza season to wear a surgical or procedure mask.
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Tuesday, September 24th, 2013
For dates of service on or after August 1, 2013, the following influenza vaccine codes will be available for billing for certain age groups:
*90672 INFLUENZA VIRUS VACCINE, QUADRIVALENT, LIVE, FOR INTRANASAL USE
For beneficiaries 2 years of age to 49 years of age
90685 INFLUENZA VIRUS VACCINE, QUADRIVALENT, SPLIT VIRUS, PRESERVATIVE FREE, WHEN ADMINISTERED TO CHILDREN 6-35 MONTHS OF AGE, FOR INTRAMUSCULAR USE
For beneficiaries 6 months to 35 months only.
*90686 INFLUENZA VIRUS VACCINE, QUADRIVALENT, SPLIT VIRUS, PRESERVATIVE FREE, WHEN ADMINISTERED TO INDIVIDUALS 3 YEARS OF AGE AND OLDER, FOR INTRAMUSCULAR USE
*The administration of these vaccines to adults 18 years of age and older is also available through Medicaid enrolled pharmacies with pharmacists qualified to administer immunizations.
Questions may be referred to the Office of Health Insurance Programs Operations at (800) 342-3005.
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Tuesday, July 16th, 2013
Monday, July 1st, 2013
June 28, 2013
To: Providers, Hosptials, Emergency and Primary Care Departments
From: Nassau County Department of Health, Bureau of Communicable Disease Control
|HEALTH ADVISORY: IMPORTED MEASLES IN AN INTERNATIONAL TRAVELER
Please distribute to: Chief Medical Officer, Infection Control Department, Infectious Disease Department, Director of Nursing, Emergency Department Director, Primary Care Clinic Directors, Director of Risk Management/ Quality Improvement, Director of Pharmacy, and all patient care areas.
Nassau County has reported a laboratory confirmed case of measles disease in a 13 year old adolescent international traveler. This individual traveled from Turkey to New York on June 17, 2013. Onset of fever 103F, cough, corysa and conjunctivitis were noted on 6/21/13. The index case was hospitalized on 6/24/13. This individual traveled to New York City on 6/19/13 and to Woodbury Commons Outlet Mall in Orange County, NY on 6/22/13. The index case was associated with a large group of fellow travelers. The travelers were lodged at Hofstra University in isolated dormitory buildings that were separate and apart from other campus lodging.
• Providers and hospital personnel should increase their index of suspicion for measles in patients with rash and fever illness. Any suspected case of measles should be promptly triaged, placed on airborne precautions and reported immediately to the local health department (LHD) where the patient resides. LHDs should notify the NYSDOH regional office or Bureau of Immunization to arrange for appropriate testing for confirmation.
• All contacts of cases that are not immune should be fully vaccinated according to age as recommended by the Advisory Committee on Immunization Practices (ACIP).
• The increased numbers of outbreaks and measles importations into the U. S. underscore the ongoing risk for measles among unvaccinated persons and the importance of vaccination against measles. These exposures put non-immune individuals at risk for becoming infected, particularly young children and the immunocompromised that are at highest risk for severe disease.
On June 25, 2013, Nassau County was notified of a clinically compatible case of measles in an 13 year old who had traveled from Turkey to New York on June 17, 2013 The individual was hospitalized on June 24, 2013 and the diagnosis of measles was laboratory confirmed. The window of communicability has now ended. The Centers for Disease Control and Prevention (CDC) Quarantine office has been notified of the case. Flight manifests will be reviewed and contacts notified. The NYSDOH and Nassau County are completing contact investigations in the community and the admitting hospital.
Measles can be severe and is highly infectious; following exposure, up to 90% of susceptible persons develop measles. It is spread by airborne contact with an infected person through coughing and sneezing. Measles virus can remain active and contagious for up to 2-3 hours in the air. From exposure to rash onset averages 14 days with a range of 7 to 21 days. Persons with measles are infectious from 4 days before to 4 days after rash onset.
Measles is characterized by a prodrome of fever (101–105 degrees F) followed by cough, coryza, and/or conjunctivitis. An erythematous, maculopapular rash presents 2-4 days later and lasts ≥3 days. It usually starts on the face and proceeds down the body to involve the extremities last, including the palms and soles. The rash is usually discrete but may become confluent on the upper body; it resolves in the same order that it appeared. Koplik’s spots (punctate blue-white spots on the bright red background of the buccal mucosa) may be present but are often not seen and are not required for the diagnosis of measles.
Health care providers should increase their index of suspicion for measles in clinically compatible cases. The LHD should be notified of any suspect case immediately. Reports should be made at the time of initial clinical suspicion. If the diagnosis of measles is being considered and diagnostic testing for measles is ordered, then the case should be reported at that time. LHDs should also be notified of discharge plans from the health care setting. This is especially important if the case lives in a multifamily dwelling, dormitory, group home or has young children at home.
Measles is spread via airborne transmission and direct contact with infectious droplets. Cases of fever and rash illness should immediately be placed in airborne isolation. If an airborne infection isolation room is not available, then the exam room used to isolate a suspect measles case should not be used for 2 hours after the case leaves the room and the number of people entering and leaving should be minimized. When transporting a patient through the hospital, the patient should be masked. If possible, elevators and corridors should not be used for two hours after the patient has passed through them. If possible, any procedures required for the patient should be performed in the patient’s room or delayed until the patient is no longer infectious.
Serology and viral specimens (urine or nasal-pharyngeal swab) should be obtained for diagnostic testing and confirmation. Use of commercial laboratories for measles testing may take up to a week to obtain results. Reporting suspected cases of measles enables access to rapid testing through the NYS Wadsworth Center Laboratory. Viral specimens that result in a positive PCR or culture will be forwarded to CDC for confirmation and genotyping.
MEASLES POST-EXPOSURE PROPHYLAXIS (PEP)
The successful initiation of measles PEP requires rapid intervention. LHDs can assist with the proper PEP recommendations and infection control measures. Measles vaccination should be administered to susceptible contacts of a measles patient within 72 hours of exposure and may offer protection. Immune globulin is indicated for susceptible household or other close contacts of patients with measles, particularly those contacts younger than 1 year of age, pregnant women and/or immunocompromised persons, for whom risk of complications is highest. Immune globulin should be given within 6 days of exposure to prevent or lessen the severity of measles.
MEASLES VACCINATION RECOMMENDATIONS
Children 6–11 months of age who are traveling outside the United States should receive a dose of MMR vaccine prior to international travel.
MMR vaccine given before 12 months of age should not be counted as part of the routine series. Children who receive MMR vaccine before age 12 months will need two more doses for a total of three doses, the first of which should be administered at 12–15 months of age and the second at least 28 days later (typically at age 4–6 years or before beginning kindergarten).
Children ≥ 12 months, adolescents, and adults
All children should receive an MMR vaccine at 12–15 months of age. The second dose of MMR is routinely administered at age 4–6 years, but may be administered as soon as 28 days after the first dose. Children over one year of age who have received one dose of MMR vaccine and who have recently been exposed to measles infection or are planning travel outside the United States should receive a second dose as soon as possible, as long as 28 days have passed since the first dose. Second doses of MMR are valid so long as they are administered after 12 months of age and at least 28 days after the first dose was administered.
Anyone who has received two valid doses of MMR, or other live measles-containing vaccine, is considered immune to measles.
Documentation of laboratory evidence of immunity, or having been born before 1957 are also accepted as proof of immunity to measles.
The NYSDOH Measles Fact Sheet is available at: http://www.nyhealth.gov/diseases/communicable/measles/fact_sheet.htm Destination specific travel immunization information is available on the Centers for Disease Control and Prevention’s Travelers’ Health website at: www.cdc.gov/travel/destinations/list.aspx. For further information, please contact your local health department, the New York State Department of Health, Bureau of Immunization at 518-473-4437, or the New York City Department of Health and Mental Hygiene at 347-396-2400.
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Monday, July 1st, 2013
From: Dr. Constantine Ioannou, Vice Chairman of Psychiatry and Addiction Services, NUMC:
Starting Monday, July 1, NUMC’s often wait-listed inpatient detox unit is moving to a telephone appointment system. The patient calls 516-572-6740; is screened (not asked about insurance), and are given an appointment when staff knows a bed will be open.
Previously there has been a mass rush every morning to the Emergency Room for admittance, often to be told no beds are available – come back another day.
This way, the day of you appointment, a bed is ready.
If beds open up unexpectedly, staff will call people to come in earlier.
Currently, there’s a 4-day wait for a detox bed at NUMC. But staff can change the length of stay, by a day, to address this.
Detox runs between 3 and 5 ½ days, depending on the need.
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Thursday, February 3rd, 2011
Feb. 2, 2011: Nassau County Department of Health today announced that a case of measles has been confirmed in the county. The individual recently traveled internationally to areas with widespread measles. Residents may have been exposed to the case if they visited:
Macy’s at Roosevelt Field Mall
630 Old Country Rd
Garden City, NY 11530
January 20 (Thursday) from 3pm to 10:30pm
1) Report all suspect measles cases immediately (DO NOT WAIT FOR LABORATORY CONFIRMATION) to the Bureau of Communicable Disease Control at 516.227.9496 during business hours or 516.742.6154 evenings, weekends and holidays.
2) Patients with febrile rash illness should notify staff before arriving so that they may be placed in isolation immediately.
3) Offer measles vaccine or immune globulin to susceptible exposed contacts.
4) Assure that all those eligible for MMR vaccine receive appropriate and timely
5) Please contact Bureau of Communicable Disease Control at 516.227.9496 during business hours or 516.742.6154 evenings, weekends and holidays. As always, your cooperation is greatly appreciated.
Thursday, January 6th, 2011
Nassau County Department of Health (NCDOH) has identified a case of acute hepatitis A in an individual associated with Our Lady of Lourdes Church, located at 855 Carmans Road in Massapequa Park. In consultation with the New York State Department of Health and the Centers for Disease Control and Prevention, Nassau County Department of Health recommends that individuals that received Holy Communion at any of the masses receive post exposure prophylaxis (PEP) against hepatitis A.
• Christmas Day, December 25, 2010 at the 10:30am, 12 Noon and 1:30 pm
• Sunday, December 26, 2010 at 7:30 am, 9:00 am, 10:30 am, 12 pm and 1:30 pm
Persons who have been vaccinated for hepatitis A or have had the illness in the past are protected from hepatitis A infection, and there is no need for further action, despite the potential exposure. NCDOH will be holding a PEP clinic on Friday, January 7, from 7:00 am to 12:00 pm at
Our Lady of Lourdes Church School Auditorium 855 Carmans Road in Massapequa Park. PEP will also be available that day by appointment only at NCDOH, 106 Charles Lindbergh Boulevard in Uniondale. Individuals interested in making an appointment can
Providers are encouraged to consider and test for hepatitis A in patients with jaundice, abdominal pain, fever, nausea, and diarrhea with a history of exposure at these masses. Providers should report suspected and confirmed cases of hepatitis A promptly to NCDOH at 516.227.9496. Suspected cases of hepatitis A in a food worker should bereported immediately.
Hepatitis A is caused by the hepatitis A virus. Hepatitis A virus may be spread by consuming food or drink that has been handled by an infected person. It may also be spread from person to person by putting something in the mouth that has been contaminated with the stool of a person with hepatitis A. Casual contact, as in sitting in church during mass, office or school setting, does not spread the virus.
The symptoms of hepatitis A may range from mild to severe and include an abrupt onset of fever, fatigue, poor appetite, nausea, stomach pain, dark-colored urine and jaundice (a yellowing of the skin and whites of the eyes). The disease is rarely fatal and most people recover in a few weeks without any complications. The symptoms commonly appear within 28 days of exposure, with a range of 15-50 days. There are no special medicines or antibiotics that can be used to treat a person once symptoms appear. Generally bed rest is all that is needed. Thorough hand washing after bathroom use and before, during and after food preparation is the most important means to prevent the spread of this and other intestinal illnesses. Sharing of food and utensils should be discouraged especially whenever anyone is ill.
RECOMMENDATIONS FOR PROPHYLAXIS OF EXPOSED PERSONS
The Centers for Disease Control and Prevention (CDC) recommends that persons who are not protected and are within 14 days of exposure receive a dose of single antigen hepatitis A vaccine or immune globulin (IG).
• For healthy persons age ≥ 12 months to 40 years, hepatitis A vaccine at the age
appropriate dose is preferred to IG because of vaccine’s advantages, including long term
protection and ease of administration.
• For persons > 40 years of age, IG plus vaccine is preferred because of the absence of
information regarding vaccine performance and the more severe manifestations of
hepatitis A in this age group.
• IG should be used for immunocompromised persons, persons who have been diagnosed
with chronic liver disease, and persons for whom vaccine is contraindicated.
A clinic has been scheduled to provide post-exposure prophylaxis (PEP) for exposed persons on Friday, January 7, from 7:00 am to 12:00 pm at Our Lady of Lourdes Church School Auditorium 855 Carmans Road in Massapequa Park. PEP will also be available that day by appointment only at NCDOH, 106 Charles Lindbergh Boulevard in Uniondale. Individuals interested in making an appointment can call 516.227.9496. PEP had previously been offered at NCDOH clinics on January 4 and January 5. Persons who have been vaccinated for hepatitis A or have had the illness in the past are protected from hepatitis A infection, and there is no need for further action. Those persons eligible for vaccination or immune globulin (IG) at the NCDOH clinic must meet EACH of the following requirements:
1. Received Holy Communion at Our Lady of Lourdes Church on at any of the following
• Christmas Day, December 25, 2010 at the 10:30am, 12 Noon and 1:30 pm
• Sunday, December 26, 2010 at 7:30 am, 9:00 am, 10:30 am, 12 pm and 1:30 pm
2. Have no prior history of immunization against hepatitis A or diagnosis of hepatitis A
NCDOH is asking providers to consider hepatitis A infection when evaluating any patient with jaundice with or without abdominal pain, fever, nausea, and/or diarrhea. Hepatitis A infection should also be considered for persons without jaundice who present with abdominal pain, fever, nausea, and/or diarrhea and have a history of receiving Holy Communion at Our Lady of Lourdes Church at the above referenced dates and times. For symptomatic persons, physicians should order serologic tests for hepatitis A virus (HAV) (total and IgM anti-HAVantibody, available commercially). Due to the possibility of false positive results, serologic tests for HAV should not be used to identify infection
in those exposed who received Holy Communion but have no symptoms. However, for exposed patients under the age of 6 with milder symptoms, especially those in daycare or school settings, testing should be considered. Positive total anti-HAV and negative IgM anti-HAV indicates past infection or vaccination and immunity.
Providers should report suspected and confirmed cases of hepatitis A promptly to NCDOH at 516.227.9496. Suspected cases of hepatitis A in a food worker should be reported immediately by phone.
For additional information on the potential hepatitis A exposure at Our Lady of Lourdes Church, please call the Nassau County Department of Health at 516.227.9496 between the hours of 9:00 am and 4:45 pm. Additional information on hepatitis A is available on the Nassau County Department of Health web site at http://www.nassaucountyny.gov/agencies/Health/index.html
Thursday, July 29th, 2010
I’m writing to inform you and your membership of the increasingly alarming statistics concerning OxyContin (Oxycodone) prescription usage in Nassau County over the past 24 months.
While we have seen a 21% increase in Nassau County Medicaid enrollment for the years 2008-2010, during that time we have also seen a corresponding 580% increase in OxyContin Prescriptions filled during the same period of time, and an 800% increase specifically for 80 mg OxyContin tablets.
Nassau County Medicaid expenditures for OxyContin has doubled each year since 2007, with $1.4 million to date and projected expenditures of over $2 million in 2010.
Nassau County Department of Social Services has initiated a number of efforts to stem the tide of this rising prescription drug usage. Our Medicaid Investigative Unit’s collaborative efforts with the NYS Office of the Medicaid Inspector General (OMIG) and the Nassau County District Attorney’s office have resulted in multiple consumer and provider arrests over the last 3 years for forging or selling OxyContin and other Medicaid narcotics drugs.
We have initiated a Prescription Drug Fraud Outreach to every pharmacy in Nassau County including establishment of a tip hotline (516-227-7813) for suspicious prescriptions.
We also recommend certain recipients to the OMIG’s “Restricted Recipient Program” which limits a recipient to one doctor, one pharmacist and one hospital, so that their prescription drug usage can be more closely monitored. The OMIG receives and approves the recommendations and then sends them back to the county to implement the restrictions. Each recipient is typically restricted for 24 month periods and will result in $150k in cost avoidance for Nassau County.
Consumer and medical education are also vital in stemming the tide of prescription drug misuse, especially OxyContin. The Nassau County Department of Mental Health, Chemical Dependency and Developmental Disability Services does provide speakers for public education forums, as does the Long Island Council on Alcoholism and Drug Dependency (LICADD).
We appreciate that your membership will continue to support our efforts to closely monitor the inappropriate usage of prescription drugs.
If there is any further information we may provide, please feel free to contact me at 516 227 7403, ext. 5
John E. Imhof, PhD
Friday, July 23rd, 2010
Distributed via Health Alert Network
July 22, 2010, 18:35 EST (6:35 PM EST)
Increased Potential for Dengue Infection in Travelers Returning from International and Selected Domestic Areas
Summary: Dengue virus transmission has been increasing to epidemic levels in many parts of the tropics and subtropics. Travelers to these areas are at risk of acquiring dengue virus and developing dengue fever (DF) or the severe form of the disease, dengue hemorrhagic fever (DHF). The Centers for Disease Control and Prevention (CDC) strongly advises that health care providers in the United States should: 1) consider DF and DHF when evaluating patients returning from dengue-affected areas–both domestic and abroad–who present with an acute febrile illness within two weeks of their return, 2) submit serum specimens for appropriate laboratory testing, and 3) report all presumptive and confirmed cases of DF and DHF to their local or state health department.
Dengue transmission has been increasing to epidemic levels in many parts of the tropics and subtropics where it had previously been absent or mild. Dengue-affected areas are widely distributed throughout Africa, Asia, Pacific, the Americas and the Caribbean. This calendar year, more than 50 countries have reported evidence of dengue transmission; including 17 countries in Asia, 17 in the Americas, 10 in Africa, seven in the Caribbean, and one in the Pacific. With an extensive dengue outbreak occurring in Puerto Rico and evidence of continued transmission in Key West, Florida, travel to certain domestic locations may also pose a risk for the traveler. The mosquitoes known to transmit dengue virus, Aedes aegypti and Aedes albopictus, are present throughout much of the southeastern United States and infected returning travelers may pose a risk for initiating local transmission.
Dengue virus infections can manifest as a subclinical infection or DF, and may develop into potentially fatal DHF. DF is a self-limited febrile illness that is characterized by high fever plus two or more of the following: headache, retro-orbital pain, joint pain, muscle or bone pain, rash, mild hemorrhagic manifestations (e.g., bleeding of nose or gums, petechiae, or easy bruising), and leukopenia. Because the incubation period for dengue infection ranges from 3 to 14 days, the patient may not present with illness until after returning from travel. Clinical management of DF consists of symptomatic treatment (avoid aspirin, NSAIDS and corticosteroids, as they can promote hemorrhage) and monitoring for the development of severe disease at or around the time of defervescence. A small proportion of patients develop DHF, which is characterized by presence of resolving fever or a recent history of fever, lasting 2–7 days, any hemorrhagic manifestation, thrombocytopenia (platelet count ≤100,000/mm3), and increased vascular permeability, evidenced by hemoconcentration, hypoalbuminemia or hypoproteinemia, ascites, or pleural effusion. DHF can result in circulatory instability or shock. Adequate management requires timely recognition and hospitalization, close monitoring of hemodynamic status, and judicious administration of intravascular fluids. There is no antiviral drug or vaccine against the dengue virus. Updated guidelines for the management of dengue can be found at http://whqlibdoc.who.int/publications/2009/9789241547871_eng.pdf
· Health care providers seeing patients with dengue-like illness who have recently traveled to Puerto Rico, Key West, Florida or international dengue-affected areas (See world distribution of dengue maps at http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-5/dengue-fever-dengue-hemorrhagic-fever.aspx) should report cases to the local or state health department and send specimens for laboratory testing. DF and DHF are now nationally notifiable conditions in the United States. Please remember that apart from individuals traveling for tourism, individuals responding to international disasters (e.g., Haiti earthquake), participating in medical or religious missionary work, and visiting friends and relatives are often returning from dengue-affected areas and should be evaluated for dengue infection if they present with dengue-like illness during or after their travel.
· Reporting to local public health officials and consideration of hospitalization to initiate supportive care should not be delayed pending test results. Reporting suspected dengue cases will trigger a public health investigation and the implementation of prevention measures.
· Specimens from patients with acute febrile illness, who returned from dengue-affected areas within the past 14 days, should be submitted to their local or state health department, if the health department laboratory offers dengue testing. State health departments with the capacity to test for dengue include: AZ, CA, CT, FL, NY, PR, and TX.
· If the local or state health department does not perform dengue testing, submit specimens directly to CDC laboratories in San Juan, Puerto Rico (address below). CDC offers free diagnostic testing for health care providers and confirmatory dengue testing for health department and private laboratories. A completed CDC Dengue Case Investigation Form (http://www.cdc.gov/Dengue/resources/DCIF_English_ColorSept1508_FINAL_.pdf) must accompany the specimens for the appropriate testing to be performed.
Whenever possible, submit paired acute and convalescent specimens (2 ml of centrifuged serum.) Accuracy is increased when both acute and convalescent specimens are available for testing. But providers should not wait and should submit acute specimens as soon as available; a convalescent specimen can be submitted when available.
Type of specimen Interval since onset of symptoms Type of Analysis
Acute until day 5 RT-PCR for dengue virus
Convalescent 6 to 30 days ELISA for dengue IgM
Centers for Disease Control & Prevention
1324 Cañada Street
San Juan, Puerto Rico 00920
Tel: (787) 706-2399; Fax (787) 706-2496
For More Information
· Instructions for the preparing and delivering specimens for dengue testing to the CDC Dengue Branch is available at: www.cdc.gov/Dengue/resources/TestpolEng_2.pdf.
· Additional information about dengue is available at: www.cdc.gov/dengue
· Call CDC’s toll-free information line, 800-CDC-INFO (800-232-4636 ) TTY: (888) 232-6348, which is available 24 hours a day, every day.
Monday, June 14th, 2010
The ILINet Surveillance Program works in collaboration with the New York State Department of Health (NYSDOH) and the Centers for Disease Control (CDC) to provide a state and nationwide report on the spread of the influenza virus and its current activity. The ILINet data, in combination with other influenza surveillance data, can be used to guide prevention and control activities, vaccine strain selection, and patient care. ILINet Providers help fight the disease by collecting and reporting their total number of patient visits and their total numbers of patient visits for Influenza-Like-Illness (ILI) to the CDC on a weekly basis. Free of charge, ILINet Providers are permitted to submit a designated number of patient specimens to the NYSDOH Wadsworth Center for virus testing and sub-typing.
Additionally, all ILINet Providers receive a free subscription to the CDC’s Morbidity and Mortality Weekly Report and Emerging Infectious Diseases Journal.
Further information may be obtained from the MSSNY website or by contacting:
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Nassau Academy of Medicine
serving Long Island and the surrounding area.
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