Putnam County

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News

"Healthstyles" - Putnam County Health Department News & Information:  oct2008.pdf

Food, Car Seat, & Other Product Recalls, Alerts, & Safety:  Recalls

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It’s Flu Vaccination Season Again!

fluclinics2008.pdf

Epidemics of influenza typically occur in winter months and have been responsible for an average of approximately 36,000 deaths per year in the United States.  Influenza viruses cause disease among all age groups, but rates are typically higher among children.  Rates of serious illness and death are higher among those 65 years and older, children less than 2 years old, and those of any age that have medical conditions which place them at higher risk for complications.  Getting the influenza vaccine is the best way to prevent influenza and it’s severe complications.

The Putnam County Health Department has planned clinics to administer the influenza vaccine to residents in various locations throughout the county.  This year, there are two flu vaccines offered.  There are 3 strains of influenza that are covered by both vaccines.  Those three strains include A/Brisbane/59/2007 (H1N1)-like; A/Brisbane/10/2007 (H3N2)-like; and B/Florida/4/2006-like antigens.  FluMist is a weakened live vaccine given as a nasal spray and can be given to any healthy individuals that are 2 – 49 years old excluding women who are pregnant.  FluMist will cost $10 for those 18 years and younger and $25 if you are older than 18 years.  This vaccine may offer better and longer lasting protection for influenza when the vaccine strains do not exactly match the virus that is going around that year.  The inactivated vaccine given by a shot is indicated for anyone 6 months and older and will cost $10 for those 18 years and younger and $20 for 19 years and above.  This vaccine is indicated for those with chronic illnesses, the very young, and the older population.  With proof of Medicaid or Medicare, the vaccine is free, and we bill those insurances.  All clinics are on a walk-in basis; no appointments are necessary.

The influenza vaccination clinics open to the public include:

Please call the health department at 419-523-5608 with any questions and/or to schedule an appointment for your flu vaccination today.  

Why Should I Get the Flu Vaccine?

Many people feel like they don’t need the flu vaccine for various reasons.  But it’s important to make this decision based on the facts.  Influenza viruses are spread from person to person primarily through contact with someone’s infected cough or sneeze.  Adults can be infectious from the day before symptoms begin through approximately 5 days after the onset of illness.  Children can be infectious for 10 days or more and young children can transmit the virus for several days before they show symptoms.  For immunocompromised persons, the virus can be shed for weeks or months.  So you can get the virus or give it to others without yet knowing you are sick.

Uncomplicated influenza symptoms include fever, body aches, headache, cough, sore throat, and runny nose.  Children can also have earaches, nausea, and vomiting.  Illnesses from influenza are often difficult to differentiate from illnesses caused by other respiratory diseases.  Influenza illness typically lasts 3-7 days for the majority of persons, but the cough and body aches can last 2 weeks or longer.  For certain persons, influenza can make their underlying medical conditions even worse which can lead to pneumonia, blood and brain infections, and viruses in and around the heart.  These complications often mean going to the hospital and sometimes death.

The best way to prevent influenza is to get the influenza vaccine.  The Advisory Committee on Immunization Practices (ACIP) recommends vaccination for:

If you have any questions as to where you fit into the vaccination picture, please consult your doctor, health care provider, or the health department.

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Food Safety During Power Outages:  PowerOutageFoodSafetyInfo9-16-08.pdf

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Flood Information:  FLOOD

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When the Ohio Tobacco Prevention Foundation recently ceased operations, many Ohioans incorrectly thought the Ohio Tobacco Quit Line – 1-800-QUIT-NOW – had ceased operations with it. Rest assured, the quit line has not quit on you.

The Ohio Tobacco Quit Line is now housed at the Ohio Department of Health and continues to provide invaluable assistance to smokers who want to kick the tobacco habit. Tobacco counselors are available to help you from 9 a.m. to 11 p.m. Monday-Friday and from 10 a.m. to 6:30 p.m. Saturday and Sunday. Soon-to-be-former smokers can also leave a message 24 hours a day and request a call-back time that is convenient for them.

Service is available in 150 languages and TTY service is available for the deaf and hard of hearing at 1-888-229-2182.

Smokers who want to quit are much more successful when they take advantage of services such as the Ohio Tobacco Quit Line. Indeed, only 5 percent of those who try to quit smoking cold turkey are successful, compared to 22 percent who use the quit line.

You have nothing to lose – except for a nasty habit that is the leading cause of preventable death – and everything to gain. Call the Ohio Tobacco Quit Line today at 1-800-QUIT-NOW (784-8669) or 1-888-229-2182 for TTY service. You and your loved ones will be glad you did.

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Council of Social Services 2008 Scholarship Recipients

The Putnam County Council of Social Services has recently announced the scholarship recipients for 2008.  The scholarship was open to all individuals who are pursuing a degree in the social services field.  This year’s recipients are Kayla Hanneman and Julie Mason.  Ms. Hanneman is planning to attend Wright State University this fall with a major in Social Work.  Her ultimate goal is to help children and families that have been victims of abuse and neglect.  She would like to return to Putnam County to work after receiving her degree.  Ms. Mason is currently attending The Ohio State University, Lima Campus and is pursuing a Master’s of Social Work.  She currently works for Putnam County HomeCare and Hospice and is working towards the master’s degree due to a requirement for accreditation at the agency.  Mason plans to continue working with the terminally ill patients of Putnam County.  Scholarship recipients will receive $400 to help toward the cost of their higher education.  The Putnam County Council of Social Services plans to continue to offer scholarships each year to those who are interested in entering the field of social services.

Left to right:  Joan Kline, Lois Holder, Julie Mason, Kayla Hanneman, Lynn Bryan

 Joan Kline (left), Lois Holder and Lynn Bryan (right) of the Putnam County Council of Social Services present scholarship awards to Julie Mason and Kayla Hanneman.

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Family Fun Night Held

The Action for a Healthy Putnam County Coalition recently sponsored  “Family Fun Night:  Get the Skinny on Fun Foods”, a fun evening event for families of young children.  The program allowed young families and their children to learn more about healthy foods that are easy and fun to prepare such as fruit kabobs, fruit and yogurt parfaits, and mini-pizzas.  Children also made a healthy trail mix, tried whole grain cereals, and could vote for their favorite fruit or vegetable from the tasting table.  A physical activity area provided the young children and their families with an opportunity to try fun activities. 

The idea for this event was suggested due to the concern regarding childhood obesity and nutrition of young children.  According to a Body Mass Index (BMI) study of third-graders completed by the Ohio Department of Health in 2004-2005, 37% of Putnam County third-graders were overweight or at-risk of being overweight.  This is slightly above the state percentage of 35.6%. 

The Action for a Healthy Putnam County Coalition, a group of schools, agencies and businesses in Putnam County, is working to provide awareness and educational opportunities for children and families regarding the importance of nutrition and physical activity.  Efforts will continue to address the issue of childhood obesity and overweight.  For more information, or if you would like to become a member of the coalition, please call the Putnam County Health Department at 419-523-5608.

Allison and Kamryn Wurth learn how to make healthy mini-pizzas at the “Family Fun Night: Get the Skinny on Fun Foods” recently sponsored by the Action for a Healthy Putnam County Coalition.

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Meningitis Vaccine Recommended

Meningococcal disease is a serious illness, caused by a bacteria.  It is the leading cause of bacterial meningitis in children 2-18 years old in the United States.  Meningitis is an infection of fluid surrounding the brain and the spinal cord.  Bacterial meningitis can be treated with antibiotics.  Still, about 1 out of every ten people who get the disease dies from it, and of those who live, another 11-19% lose their arms or legs, become deaf, have problems with their nervous systems, become mentally retarded, or suffer seizures or strokes.  This is why preventing the disease through use of vaccine is important.

The Putnam County Health Department is offering the meningitis vaccine called Menactra®.  It is recommended for all children at their routine preadolescent visit (11-12 years of age).  For those who never received the vaccine before, a dose is recommended at high school entry.  Meningitis vaccine is also recommended for others at increased risk for disease such as college freshmen living in dormitories and those persons with certain  medical conditions.

Currently, the Putnam County Health Department is able to offer the meningitis vaccine for anyone 11–18 years old and those 2-10 years of age with certain medical conditions for a $7.00 donation unless proof of Medicaid is shown. Once a person turns 19 years of age or older, the cost of the vaccine increases to $100.00.

Call the health department for more information and to schedule an appointment. 

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May 29, 2008

COLUMBUS – More Ohio teenagers are engaging in healthy behaviors today, compared to 1999 and 2003, according to the 2007 Ohio Youth Risk Behavior Survey (YRBS). While the results of the survey are encouraging, there are still areas for improvement.

Not using a seat belt, physical fighting in schools, suicide attempts and alcohol, tobacco and illegal drug use have all decreased significantly since 1999, the YRBS shows. However, fruit consumption and daily milk drinking have also declined significantly since 2003, according to the survey.

“Ohio teenagers are on the right track,” said Ohio Department of Health (ODH) Director Alvin D. Jackson, M.D. “While the overall results are encouraging, we must continue our efforts to instill healthy habits in our young people.”

The 2007 YRBS follows similar surveys conducted in 1993, 1995, 1997, 1999, 2003 and 2005 and measures behaviors that contribute to the leading causes of death, disease and injury among youth. It focuses on 11 categories: youth development; injury; violence; mental health; tobacco; alcohol; illegal drugs and prescription drug abuse; sexual behaviors; nutrition; physical activity; and preventive health care.

In 2007, 2,527 students in 101 high schools were surveyed. Key findings of the 2007 YRBS include:

• Ninety percent of teens report they did not drink and drive in the past month.

• Seventy-eight percent report they did not smoke cigarettes in the past month.

• Sixty-eight percent report seeing a doctor for a checkup in the past year.

• Thirty-four percent report using marijuana at least once during their lives.

• Twenty-nine percent report binge drinking.

• Fifty-nine percent report spending at least one hour a month doing volunteer work.

“Healthy youth are likely to become healthy adults and unhealthy youth are likely to be unhealthy adults,” Jackson said. “ODH remains committed to work to protect and improve the health of all Ohioans – and that includes young Ohioans.”

ODH conducts the biennial survey under the direction of the Centers for Disease Control and Prevention. To view the entire report, go to the ODH Web site at: http://www.odh.ohio.gov.

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Kalida Elementary Receives Physical Activity Grant

Kalida Elementary School has recently been awarded a $500 Ohio Action for Healthy Kids Physical Activity Grant.  This grant, sponsored by Zone 2 of the Ohio Action for Healthy Kids Initiative, will be used to initiate a walking program at Kalida Elementary using pedometers to track student progress.   Sherry Luebrecht, Kalida Elementary Physical Education teacher wrote the grant after attending a physical education workshop in Lima in November.  Ohio Action for Healthy Kids is part of a nationwide initiative dedicated to improving the health and educational performance of children through better nutrition and physical activity in schools.  This is in response to the growing concern of childhood overweight in our country today.  Ohio Action for Healthy Kids Zone 2 consists of Allen, Hancock, Putnam, Van Wert, Mercer, Auglaize, Logan, and Hardin counties.  Joan Kline of the Putnam County Health Department represents Putnam County on the Zone 2 committee.

Joan Kline of the Putnam County Health Department

and Ohio Action for Healthy Kids Zone 2

presents a $500 grant award to

Sherry Luebrecht, Physical Education Teacher at Kalida Elementary

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COLUMBUS – Ohio’s immunization registry, Impact Statewide Immunization Information System (ImpactSIIS), recently logged its 30 millionth unique immunization history.

The record was filed by the Lakewood City Health Department and marks a milestone for the 6-year-old ImpactSIIS immunization registry, Ohio’s secure, Web-based immunization information system housed at the Ohio Department of Health (ODH).

“This is good news for Ohio’s children, their parents and their physicians,” said ODH Director Alvin D. Jackson, M.D. “Providers who use the registry have immunization rates 15 to 20 percent higher than other providers.”

Each of the approximately 150,000 babies born in Ohio every year requires nearly 30 doses of vaccine by age 6 to protect them from 14 serious, but preventable, diseases. Having a centralized immunization information system allows providers to ensure timely vaccinations and cuts down on unnecessary shots. This is especially important as one in five U.S children receives at least one unneeded vaccination.

And because 22 percent of all U.S. children have seen at least two health care providers by age 2, the registry makes it easier for parents to keep current on their children’s immunization status. When an Ohioan needs an immunization record for day care, school entry, college or work, participating physicians can quickly print a copy of the necessary record.

The registry also captures important information on the federal Vaccines for Children program, helps manage vaccine inventory and allows providers to give reminders and recalls to patients.

“I encourage all providers to participate in ImpactSIIS,” Jackson said. “It is another important tool to use as we work to protect and improve the health of all Ohioans.”

ImpactSIIS is on the Web at: http://www.impactsiis.org.

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Voluntary Recall of Certain Lots of Haemophilus influenza type b (Hib) Vaccine Produced by Merck & Co., Inc.:  Information for Public Health Agencies and Healthcare Providers

Last month, Merck & Co., Inc. reported that their PedvaxHIB vaccine would be unavailable for shipment pending the results of production quality tests.  At that time, Merck expected PedvaxHIB to be available some time in the first quarter of 2008, but reported that the exact timing would be dependent on resolution of a manufacturing issue.  On December 13, Merck & Co. will announce that it has initiated a voluntary recall in the United States for certain lots of PedvaxHIB® [Haemophilus b Conjugate Vaccine (Meningococcal Protein Conjugate)] and COMVAX® [Haemophilus b Conjugate (Meningococcal Protein Conjugate) and Hepatitis B (Recombinant) Vaccine].

CDC understands that this recall will present several challenges to our public health and provider partners.  We are working rapidly to gather and assess information which will allow us to develop guidance for immunization providers and their patients.  We will continue to release information as it becomes available.     

1. What vaccine is being recalled?

Merck & Co. has initiated a voluntary recall in the United States for ten lots of PedvaxHIB® [Haemophilus b Conjugate Vaccine (Meningococcal Protein Conjugate)] and two lots of COMVAX® [Haemophilus b Conjugate (Meningococcal Protein Conjugate) and Hepatitis B (Recombinant) Vaccine].  The affected doses were distributed in the U.S. starting in April 2007.

The lots that are being recalled are:

No other lots of PedvaxHIB® or COMVAX® and no other Merck products are affected by this recall.

2. Why are these lots being recalled?

Merck is taking this step as a precautionary measure.  The company cannot assure sterility for these specific vaccine lots. The potential contamination in these specific lots was identified as part of Merck’s standard evaluation of their manufacturing processes.  In routine testing of the vaccine manufacturing equipment used to produce PedvaxHIB® and COMVAX®, Merck identified the presence of a certain bacteria called Bacillus cereus.  Sterility tests of the vaccine lots themselves have not found any contamination. 

The potential for contamination of any individual vaccine is low, and, if present, the level of contamination would be low.  However, because they cannot guarantee the sterility of these specific lots of vaccine, Merck is conducting this recall.

3. What is the extent of the recall?

About 1 million doses of vaccine are being recalled, including ten lots of PedvaxHIB® and two lots of COMVAX® that were distributed in the U.S. as well as vaccine lots within the CDC stockpile.

4. Will children who received vaccine from affected lots need to be revaccinated?

No.  Children who received Hib vaccine from affected lots do not need to be revaccinated.  No potency concerns have been identified for these vaccine lots.

5.  What are the risks to children who received vaccine from affected lots?    

Sterility tests of the vaccine lots themselves have not found any contamination.  Merck has not received any reports of abscesses or disseminated B. cereus infection in children who received vaccines from affected lots.  In addition, no problems have been detected by the Vaccine Adverse Event Reporting System (VAERS) related to the Hib vaccine affected by this recall.  However, since sterility of the vaccine cannot be assured, if a child was vaccinated with a vial of PedvaxHIB® or COMVAX® that contained B. cereus or other microorganisms, there may be a risk of developing localized or disseminated infections.   Immunocompromised children may be at the greater risk for these infections.  These infections are most likely to occur within one week after vaccination.

VAERS will continue to monitor adverse events following vaccination as they are reported.  Any potentially vaccine-related adverse events should be reported to the Vaccine Adverse Event Reporting System (VAERS) at 1-800-822-7967 (or at www.vaers.hhs.gov), and to Merck at 1-800-672-6372.    

6.  What should providers do if they have recalled lots in their office?

Providers should immediately discontinue use of any of the affected lots and follow Merck’s instructions for returning recalled vaccine (both VFC and non-VFC vaccine).

7.  How does this impact the nation’s Hib vaccine supply?  Are there other Hib vaccine manufacturers?

As a result of this recall, providers who only use Merck Hib vaccines may have none, some or all of their vaccine recalled, and about half of the Hib vaccine in CDC’s stockpile is being recalled.  CDC realizes that some providers will be faced with the prospect of having children to vaccinate with no vaccine available.  There are two U.S. Hib vaccine manufacturers – Merck & Co., Inc. and sanofi pasteur.  In the past, each manufacturer has produced about half of the nation’s Hib vaccine supply.      

8.  What is CDC doing in response to the shortage of Hib vaccine?

CDC is in contact with the two U.S. Hib vaccine manufacturers – Merck and sanofi pasteur.  CDC is assessing availability of Hib vaccine and timing of future supply, and will make appropriate recommendations soon.  Key considerations being addressed by CDC, along with partners such as the American Academy of Pediatrics, the American Academy of Family Physicians, and a representative of CDC’s Advisory Committee on Immunization Practices, include whether to change recommendations for Hib vaccine temporarily and how to allocate the smaller CDC stockpile of Merck’s Hib vaccines.   

9.  Will the shortage of Hib vaccine result in an increase in disease occurrence of Haemophilus influenza type b?    

Fortunately, current immunization rates in the U.S. for Hib vaccine are high.  In 2006, about 94% of U.S. children 19-35 months of age were vaccinated against Hib.  This has resulted in a dramatic decline in transmission of this bacteria; however, it has not gone away completely.  Experience has shown that we cannot let down our guard against vaccine-preventable diseases such as Hib.  When immunization rates fall we are susceptible to increases in disease occurrence, so we are taking the current situation very seriously.  

10.  What should providers tell their patients?

For the time being, providers should continue to use Hib vaccine not affected by this recall according to current ACIP recommendations.  If concerned parents contact their providers, they should be informed that children who were vaccinated with vaccine affected by this recall do not need to be revaccinated.  Although there have been no reports of any adverse reactions among children who have been vaccinated, parents of children recently vaccinated with recalled vaccine should watch for any signs of infection (such as redness and swelling at the injection site) and contact their providers if such reactions occur.  It should be emphasized that sterility tests of samples from the recalled lots have not found any contamination and the potential of contamination of any individual dose of Hib vaccine is very low.

11.  What should providers do if they have no vaccine or little vaccine in their office? 

Providers with shortages of vaccine may defer the booster (12-15 month-old) dose of Hib-containing vaccine in fully immunized children who are not otherwise at increased risk of invasive Hib disease (see question 13).  Providers who are completely out of Hib vaccine, can contact sanofi pasteur regarding the availability of Hib vaccine to meet immediate short term needs.

12.  What should providers do if they have no or little vaccine in their office and they are a VFC provider?

VFC providers should contact their health department.  CDC anticipates additional guidance will be available soon.

13.  Are some children at high risk for Hib?

Yes.  Children at increased risk for Hib include: children with sickle cell disease, leukemia and malignant neoplasms, HIV and certain other immunocompromising conditions, asplenia, as well as American Indian and Alaska Native children. Vaccinating these children according to the recommended schedule is a high priority.  

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Toys and Childhood Lead Exposure

Lead is a well known hazard. Children may be exposed to lead from toys that have been made in other countries and then imported into the country, or from antique toys and collectibles passed down through generations. The U.S. Consumer Product Safety Commission (CPSC) issues recalls of toys that could potentially expose children to lead.

Lead may be used in two aspects of toy manufacturing.

1. Paint: Lead may be found in the paint on toys. Lead paint was banned for use in house paint, on products marketed to children, and dishes or cookware in the United States in 1978; however, it is still widely used in other countries and therefore the reason it can be found in imported toys. It may also be found on older toys made in the United States before the ban in 1978.

2. Plastic: Lead may also be used in plastic toys to stabilize the plastic molecules from heat. It makes the plastic more flexible and softens the plastic so that it can go back to its original shape. The use of lead in plastics has not been banned. When the plastic is exposed to substances such as sunlight, air, and detergents the chemical bond between the lead and plastics breaks down and forms a dust.

How your child may be exposed.

Lead is invisible to the naked eye and has no smell. Children may be exposed to lead from consumer products through normal hand-to-mouth activity. As part of normal development, young children often place their toys, fingers, and other objects in their mouth, which puts them in contact with the lead paint or dust.

How to test a toy for lead.

The only accurate way to test a toy for lead is by a certified laboratory. Do-it-yourself kits are available. However these kits do not indicate how much lead is present and their reliability at detecting low levels of lead has not been determined.

What to do if you are concerned about your child’s exposure.

If you have any reason to suspect that your child has been exposed to lead remove the toy from your child. Your child’s health care provider can help you decide whether to perform a blood test to see if your child has an elevated blood lead level. A blood lead test is the only way you can tell if your child has an elevated lead level. Most children with elevated blood lead levels have no symptoms. The health care provider can recommend treatment if your child has been exposed to lead.

How to obtain more information about recalls

The CPSC asks that parents search their children’s toys for items that have been recalled and take them away from children immediately. Photos and descriptions of recalled toys can be found by visiting the CPSC (www.cpsc.gov) website or 1-800-638-2772.

Federal action

A working group of nine federal agencies has been convened to develop a comprehensive strategy to control sources of lead in food and consumer products through interagency collaboration and cooperation.

Lead in Toy Jewelry

If you have concerns about Lead in Toy Jewelry see http://www.cdc.gov/nceh/lead/faq/jewelry.htm for information from the US Centers for Disease Control and Prevention.

NCHH is a national 501c3 non-profit organization dedicated to protecting children from hazards in their homes while preserving affordable housing. NCHH was founded to provide the scientific underpinnings for the lead poisoning prevention movement.  Since that time, the number of homes with lead-based paint has dropped from 64 million to 38 million and the number of children with lead poisoning has dropped from 890,000 to 310,000. Today, NCHH conducts research on a broad array of housing-related health issues, including mold, radon, asthma triggers, and the promotion of green and healthy building. Additionally, NCHH engages in policy and training activities to promote decent, safe, and affordable housing in the United States.

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Methicillin-resistant staph aureus (MRSA) caused more than 94,000 life-threatening infections and nearly 19,000 deaths in the United States in 2005, most of them associated with health care settings, according to the most thorough study of life-threatening infections caused by these bacteria, experts with the Centers for Disease Control and Prevention (CDC) report.

The study in the Oct. 17 edition of the Journal of American Medical Association (JAMA) establishes the first national baseline by which to assess future trends in invasive MRSA infections. MRSA infections can range from mild skin infections to more severe infections of the bloodstream, lungs and at surgical sites.

The study found about 85 percent of all invasive MRSA infections were associated with health care settings, of which two-thirds surfaced in the community among people who were hospitalized, underwent a medical procedure or resided in a long-term care facility within the previous year. In contrast, about 15 percent of reported infections were considered to be community-associated, which means that the infection occurred in people without documented health care risk factors.

The 2005 rates of invasive infection were highest among people 65 years of age or older. Black people were affected at twice the rate of whites, which could be due to higher rates of chronic illness among blacks.

"These numbers show that many families are being affected by these drug-resistant infections," said Denise Cardo, M.D., director of CDC’s Division of Healthcare Quality Promotion. "Healthcare facilities need to make MRSA prevention a greater priority. The closer we get to 100 percent compliance with CDC recommendations, the greater the impact on patient health and safety."

Experts arrived at the new national estimate by projecting from the number of invasive MRSA cases from nine U.S. sites. The sites included the state of Connecticut; the Atlanta metropolitan area; the San Francisco Bay area; the Denver metropolitan area; the Portland, Ore., metropolitan area; Monroe County, N.Y.; Baltimore City, Md.; Davidson County, Tenn.; and Ramsey County, Minn. All the sites were part of CDC’s Active Bacterial Core surveillance program, which actively tracks a number of pathogens in the United States representing a population of 38 million Americans.

In health care settings, MRSA occurs most frequently among patients who undergo invasive medical procedures or who have weakened immune systems and are being treated in hospitals and health care facilities such as nursing homes and dialysis centers.

For more information on MRSA, please visit http://www.cdc.gov/ncidod/diseases/submenus/sub_mrsa.htm . For more information on CDC's guidelines for the prevention of MRSA in health care settings, visit http://www.cdc.gov/ncidod/dhqp/ar_mrsa_prevention.html.

MRSA Informational Flyers:  mrsa.pdf & Guidelines_for_schools.pdf

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20% of Ohio Third Graders are Overweight:  BMIsurvey.pdf

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Burden of Stroke:  BurdenOfStrokeReport.pdf

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Disaster Supply Checklist:  disasterchecklist.pdf

Family Preparedness Guide:  family preparedness.pdf

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Last modified: 12/03/2008