D ISEASE C ONTROL N EWSLETTER

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1 MINNESOTA DEPARTMENT OF HEALTH D ISEASE C ONTROL N EWSLETTER Volume 34, Number 1 (pages 1-8) January/February 2006 Hmong Resettlement, June 2004-June 2005 Starting in June 2004, Minnesota experienced the largest volume of refugee arrivals since state resettlement efforts began in Increased refugee numbers reflect continuing strong migration from Africa and a one-time, large group resettlement of ethnic Hmong from Wat Tham Krabok, a refugee camp near Bangkok, Thailand. Refugees have a unique immigration status in that they are forced to leave their homeland because of civil strife, war, famine, or natural disaster. The U.S. Department of Homeland Security defines refugees as foreign-born persons fleeing their country of origin because of persecution or a wellfounded fear of persecution due to race, religion, nationality, political Number of Arrivals opinion, or membership in a particular social group. This report covers the resettlement period from June 2004 through June During this timeframe, 7,859 primary refugees (ones who arrived directly from overseas) came to Minnesota; more than half of these, or 3,999 (51%), were Hmong arrivals from Wat Tham Krabok (Figure 1). Historical Context of Hmong-U.S. Relations An estimated 12 million ethnic Hmong live throughout Southeast Asia. The Hmong population is also growing in the United States. 1 From , the U.S. military recruited Hmong living in the highlands of Laos as soldiers to fight Communist expansion of the Ho Chi Minh Trail. With the fall of Saigon, Figure 1. Hmong Refugees Arriving in Minnesota, June 2004-June ,500 1,200 1,424 Migration Halted * Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun Month of Arrival *Migration halted January 21, 2005, due to detection of multidrug-resistant tuberculosis among refugees thousands of Hmong fled from Laos into Thailand, where refugee camps were established. In recognition of its wartime alliance with the Hmong, the United States opened its borders to Hmong refugees beginning in late The last U.S. resettlement from these camps occurred in The Hmong who chose to remain in Thailand did so knowing that U.S. humanitarian aid would no longer be available to them. A benevolent monk invited those Hmong remaining in Thailand to live on the grounds of Wat Tham Krabok, a Buddhist temple. By the end of 2003, more than 15,000 Hmong were living there. At that point, the Thai government approached the United States about accepting this population as refugees, and the U. S. Department of State agreed. In December 2003, the Minnesota Department of Health (MDH) Refugee Health Program (RHP) was notified of this anticipated resettlement. One third of the refugees at Wat Tham Krabok were expected to join families in Minnesota. continued... Inside: Early- and Late-Onset Neontal Group B Streptococcal Disease; Neonatal Sepsis Now Reportable... 4 Proposed Revisions to Newborn Screening Rules...6 New Report Describes Burden of Asthma in Minnesota...6 Subject Index for the Disease Control Newsletter, MDH s Interactive Asthma Action Plan (IAAP) An Update...8

2 In June 2004, the Wat Tham Krabok resettlement began. Twenty-two states have been involved, with California, Minnesota, and Wisconsin receiving the majority of the refugees approximately 38%, 34%, and 21%, respectively. These states are also those with the largest existing Hmong populations, according to the 2000 U.S. Census. 4 Of U.S. cities, St. Paul, Minnesota, has received the highest number of Wat Tham Krabok refugees approximately 2,387 individuals from June 2004 through June Background on Refugee Health Screening The RHP, which is federally funded, offers refugees a comprehensive physical exam within 90 days of their arrival in the United States. The exam focuses on the detection and treatment of infectious disease as well as on the assessment of preventive health needs among the new refugees. These exams are completed by county public health clinics in the Twin Cities metropolitan area and in Rochester, and by private clinics in other parts of the state. In the Minneapolis-St. Paul area, the RHP trained and partnered with more than 18 private clinics to meet the increased need for health screening created by the high volume of arrivals from Wat Tham Krabok. In St. Paul, five of the recruited clinics are the private practices of Hmong physicians, who share linguistic and cultural similarities with the incoming 28% 4% 2% refugee population. These partnerships have been critical in enabling the state to maintain a high overall screening rate and to respond effectively to the special disease outbreak situations reported below. Fifty-four percent of the refugees were children under 15 years of age. Due to established Hmong communities in St. Paul and environs, 2,537 (64%) of the refugees initially resettled in Ramsey County. Another 1,126 (28%) moved to Hennepin County (Figure 2). Almost all of the refugees who resettled in Minnesota, 3,973 (99%), were eligible for refugee health screening and assessment. The remaining 26 individuals either moved out of state or died prior to screening. Among those who were eligible, 3,896 (98%) received a complete or partial health screening. A complete exam includes testing for tuberculosis (TB), hepatitis B, pathogenic intestinal parasites, sexually transmitted infections, anemia, and lead level (in children younger than 6 years). Most refugees were assessed for and vaccinated with age-appropriate immunizations. They were also assessed for other chronic conditions and referred for follow-up care. Health Screening Results Tuberculosis Although TB is a major health concern in Southeast Asia, the infection rate was lower than expected among the 3,318 Hmong who arrived in Minnesota Figure 2. Initial County/Area of Resettlement of Hmong Refugess, Arriving in Minnesota, June 2004-June % N=3,999 64% Ramsey Hennepin Anoka Suburban Metro Greater MN between June 21, 2004, and January 21, Of the 3,201 refugees who received a tuberculin skin test (TST) during this period, 413 (13%) had an induration of 10 mm or more; adults aged 25 to 44 years had the highest rate of TB infection (Table 1). Among this initial cohort of screened refugees, six TB disease cases (three children [< 10 years of age] and three adults) were identified in Minnesota. Isolates from all six cases were drug susceptible. However, multidrugresistant (MDR) TB was detected at Wat Tham Krabok and among refugees newly arrived to California. 5 Because these cases of active disease were missed in the overseas screening process, the migration of Hmong refugees was suspended on January 21 to allow for the implementation of an enhanced screening protocol at Wat Tham Krabok. All refugees started on TB treatment were prohibited from traveling until full treatment was completed. The enhanced screening included a TST for children <10 years of age and multiple chest x-rays for all refugees (>6 months of age). In addition, sputum smears, mycobacterial cultures, and drug susceptibility tests were required if persons presented with suspect TB disease. Some children who were contacts of active TB cases were started on latent tuberculosis infection (LTBI) treatment. Minnesota health officials responded to the suspension of refugee arrivals and the identification of cases of active disease among new arrivals by holding educational forums for resettlement agencies, the Hmong community, and healthcare providers serving the Hmong community. Migration resumed on March 3, Families without any indication of TB were allowed to travel to the United States. Subsequently, contacts of TB cases and people with positive TST results but without evidence of TB disease were permitted to resettle as well. Between March 3, and June 30, 2005, a second cohort of 681 Wat Tham Krabok refugees arrived in Minnesota. This group had a higher rate of TB infection than the previous one. Of the 639 persons screened for TB in this second cohort, 143 (22%) had a positive TST with >10 mm induration. 2 DCN 34;1 January/February 2006

3 One person (> 65 years of age) was diagnosed with TB disease during this time frame and started on treatment. Hepatitis B Of the 3,896 Hmong refugees who received a health assessment in Minnesota, 3,741 (96%) were tested for hepatitis B surface antigen, and 402 (11%) were positive. Among the individuals with acute or chronic infection, 53% were adults. All refugees with positive results were referred to primary care for follow up. Intestinal Parasites During the time period covered in this report, Hmong refugees had the highest rate of parasitosis compared to refugees who came from other world regions; the infection rate among sub- Saharan Africans, for example, was 12%. Parasites were identified either by a stool ova and parasite exam or by antigen testing. Of the 3,642 (93%) Hmong refugees who were screened, 860 (24%) had at least one type of intestinal parasite. The most commonly identified parasite was Giardia intestinalis; it was found in 715 (83%) of the cases. Other parasites identified included Hymenolepis nana (90 cases), Strongyloides stercoralis (37 cases), Entamoeba histolytica (26 cases), Dientamoeba fragilis (15 cases), and hookworm (11 cases). Multiple parasites were found in 48 (6%) of the refugees (43 had two types and five had three types of parasites). Parasitosis was most prevalent among children younger than 14 years, and was particularly common among children younger than 5 years. Hepatitis A Hepatitis A screening becomes part of the domestic health screening protocol for refugees only when a known outbreak of the disease occurs in a specific camp. In late August 2004, an acute hepatitis A case (IgM+ and ALT >100 U/L) in a recently arrived Hmong refugee was reported. Within 3 weeks of this first report, MDH was notified of three additional cases. In collaboration with the Centers for Disease Control and Prevention (CDC), an investigation was conducted at Wat Tham Krabok. An outbreak of hepatitis A was recognized in the camp, and an immunization campaign targeting children aged 1 to 12 years was quickly implemented. In Minnesota, recent arrivals and clinics conducting screenings were notified; 10 additional acute cases were subsequently identified between October 2004 and December Of the 14 acute cases, 11 (79%) were in children aged 5 years and younger. The remaining three cases were in children aged 9, 10, and 14 years. Two cases of transmission from new arrivals to host family members were also reported. Immunizations Due to their precarious living circumstances, most refugees do not arrive in the United States with health records (if such records exist); thus, the Hmong refugee s immunization status was unknown prior to their domestic health assessment. Under a unique immunization campaign, the International Office of Migration (IOM) and CDC began immunizing Hmong refugees at Wat Tham Krabok in May Of the refugees arriving in Minnesota, 3,985 (~100%) had received at least one type of vaccination. Most adults were given tetanus and varicella vaccinations. Children (<19 years) were given ageappropriate vaccinations against MMR (measles, mumps, and rubella), varicella, polio, tetanus/diphtheria, hepatitis B, and hepatitis A. During their health assessments in Minnesota, 3,624 (93%) of all those who were screened started their age-appropriate vaccines or continued with the series that were initiated in the camp. All vaccinations given at Wat Tham Krabok were entered into the Minnesota immunization registry, the Minnesota Immunization Information Connection (MIIC). Lead Between June 2004 and June 2005, 1,067 Hmong children younger than 6 years received a health assessment. Of these children, 870 (85%) were tested for lead, and 24 (3%) were found to have an elevated blood lead level greater than 10 ug/dl. These children were referred for follow-up care. Table 1. Tuberculosis, Hepatitis B, and Parastic Infection Rates by Age Distribution Among Hmong Refugees Arriving in Minnesota, June 2004-June 2005 Age Group (years) Tuberculosis Hepatitis B Intestinal Parasites Jun 2004-Jan 2005 Mar 2005-Jun 2005 No. with >1 No.TST+* /Total No. No. TST+* /Total No. No. HBsAg+ /Total No. Type of Parasite/Total Screened (%) Screened (%) Screened (%) No. Screened (%) <5 20/703 (3) 13/136 (10) 37/766 (5) 311/795 (39) /1,037 (10) 34/196 (17) 126/1,200 (11) 377/1,154 (33) /609 (15) 44/137 (32) 104/746 (14) 103/716 (14) /505 (24) 36/107 (34) 90/614 (15) 46/588 (8) /231 (23) 10/42 (24) 27/274 (10) 19/260 (7) /116 (18) 6/21 (29) 18/141 (13) 4/129 (3) Total 413/3,201 (13) 143/639 (22) 402/3,741 (11) 860/3,642 (24) *TST indicates tuberculin skin test HBsAg, hepatitis B surface antigen DCN 34;1 January/February

4 Conclusion As of December 2005, approximately 800 Hmong refugees remain with their families at Wat Tham Krabok, completing treatment for TB. Once their treatment is completed, those individuals and their families will depart, and resettlement of the refugee camp will be finished. During the time period covered in this report, 3,860 non-hmong refugees also resettled in Minnesota, for a total of 7,859 refugees. More than 2,000 of the non-hmong arrivals were from Somalia. Other large numbers of refugees arrived from Ethiopia, Liberia, and Burma. For more information about the RHP or the Hmong resettlement call or visit refugee. References 1. United Hmong International, Inc., and Lao Human Rights Council, Inc. Hmong population in the world, Year Available at: Accessed December Txong PL, Pfeifer ME. Building bridges: Learning about the Hmong. Hmong Cultural and Resource Center online presentation. Available at: presentation/hmong101_files/ frame.htm. Accessed December U.S. Office of Refugee Resettlement. Cumulative Hmong Arrivals by Voluntary Agency (VOLAG). Arlington, VA: Refugee Processing Center, Pfeifer, ME. U.S. Census 2000: Trends in Hmong Population Across the Regions and Metropolitan Areas of the United States. Research Report. St. Paul, Minn: Hmong Resource Centre of the Hmong Cultural Center; Centers for Disease Control and Prevention. Multidrug-resistant tuberculosis in Hmong refugees resettling from Thailand into the United States, MMWR Morb Mortal Wkly Rep. 2005;54: Early- and Late-Onset Neonatal Group B Streptococcal Disease; Neonatal Sepsis Now Reportable On December 2, 2005, the Centers for Disease Control and Prevention (CDC) published an article in the MMWR concerning early- and late-onset neonatal group B streptococcal disease (GBS) in the United States. 1 As a participant in the Emerging Infections Program (EIP) Active Bacterial Core surveillance (ABCs) system, the Minnesota Department of Health (MDH) was one of 10 ABCs sites participating in this study. ABCs conducts active, population-based surveillance for invasive group B Streptococcus, defined as isolation of GBS from a normally sterile site. ABCs collects data from standardized casereport forms that capture demographic, obstetric, and neonatal data from medical records. Below is a summary of the results of that study with data specific to Minnesota included. The complete article as it appears in the MMWR can be found at mmwrhtml/mm5447a2.htm?s_c Introduction GBS disease emerged as the leading cause of invasive bacterial infections in newborns in the United States in the 1970s. In the mid-1980s, clinical trials demonstrated that administering antimicrobials intrapartum to GBS carriers protected their newborns from disease. In 1996, CDC published consensus guidelines recommending two methods of perinatal GBS disease prevention. The screening-based approach recommends obtaining vaginal and rectal cultures at weeks gestation. Women with GBSpositive cultures are offered intrapartum antimicrobial prophylaxis (IAP) during labor. The risk-based approach recommends administering IAP to women who present with GBS risk factors during labor. A large, population-based cohort study of deliveries during demonstrated that routine screening and IAP for carriers prevented more cases of early-onset disease than the risk-based method. In 2002, CDC, the American College of Obstetricians and Gynecologists, and the American Academy of Pediatrics issued revised guidelines for prevention of perinatal GBS disease. 2 These guidelines recommend universal screening of pregnant women for rectovaginal GBS colonization at weeks gestation and administering IAP to carriers. Multistate ABCs data indicated a 65% decline in the incidence of early-onset disease (0-6 days of age) from 1993 to 1998, coinciding with increased use of IAP, followed by a plateau during Adoption of the 2002 guidelines was expected to result in further reductions in early-onset disease, and a subsequent decline was observed during To assess the impact of these new guidelines on the incidence of neonatal GBS disease, CDC analyzed data from the ABCs sites from Results From (the period immediately before universal screening was implemented) to 2004 (the period after universal screening was implemented), the incidence of earlyonset GBS disease decreased by 31% (10% decrease in Minnesota). From , the incidence of earlyonset disease remained stable, averaging 0.47 (0.39 in Minnesota) cases per 1,000 live births. Incidence declined to 0.32 (0.29 in Minnesota) in 2003 and remained stable at 0.34 (0.37 in Minnesota) in Incidence of GBS disease in infants aged 7-89 days (late-onset disease) has remained unchanged. During , late-onset disease incidence varied little, averaging 0.35 per 1,000 live births, with annual rates ranging from cases per 1,000 live births. In 2003, in most sites except Minnesota, the rate of late-onset disease surpassed that of early-onset disease for the first time, a trend that continued in Continued monitoring is needed to assess the impact of the 2002 guidelines on early-onset disease and the long-term effect of widespread intrapartum use of antimicrobial agents on neonatal GBS disease. 4 DCN 34;1 January/February 2006

5 Information regarding GBS is available from MDH at divs/idepc/diseases/gbs/index.html Evaluation of Adherence to the 2002 Revised Guidelines for the Prevention of Perinatal GBS Disease Despite great progress in perinatal disease prevention, vertically-transmitted infections remain a leading cause of preventable morbidity and mortality among newborns in the United States. This winter, MDH will be involved in a multi-site survey to evaluate prenatal screening practices for group B Streptococcus, hepatitis B virus, human immunodeficiency virus, rubella, syphilis, Chlamydia trachomatis, gonococcus, and bacterial vaginosis. We will examine adherence to recommendations for treatment or prophylaxis against the diseases caused by these pathogens. Such detailed knowledge of actual prevention practices will help to identify barriers to adherence and detect missed opportunities for prevention, which will in turn help to formulate strategies for increasing uptake of the guidelines. All 20, seven-county Minneapolis-St. Paul metropolitan area hospitals that delivered an infant during will be surveyed. Data for the survey will be collected through chart review by staff from MDH. Data will be abstracted exclusively from labor and delivery records. For the subset of women who present to the delivery hospital for premature labor (not progressing to delivery), additional data will be collected from the hospital record. If you would like further information regarding this survey, please contact Craig Morin at craig.morin@health.state.mn.us or call (651) Neonatal Sepsis is Now Reportable Increase in the use of IAP associated with GBS prevention strategies has raised concern that other pathogens with reduced susceptibility to penicillin or ampicillin may become more common causes of disease among neonates. Recent reports from some hospital-based studies have shown increasing rates of early-onset non- GBS sepsis due to antibiotic-resistant organisms among very-low-birthweight and pre-term infants, heightening interest in this area. Although overall trends have been reassuring, continued surveillance in large populations and additional information on antimicrobial resistance is needed in order to assess whether increases in the incidence of disease or deaths caused by organisms other than GBS exceeds the decreases in illness and death attributable to IAP. As a result, MDH added neonatal sepsis to the Minnesota Communicable Disease Reporting Rules in September 2005 ( newsletters/dcn/2005/mayjune05.pdf). Reporting of all bacteria, excluding coagulase-negative Staphylococcus, isolated from a sterile site in infants less than 7 days of age is now required. Sites considered sterile include blood, CSF, joint fluid, etc. Submission of clinical materials to the MDH Public Health Laboratory is also required as part of the disease reporting rule. Please indicate either Neonatal Sepsis or Study 789 (project identification code for this study) when submitting clinical materials. Please call the MDH Public Health Laboratory at (651) if you have questions about submitting clinical materials, or call (651) if you have questions about disease reporting. To download copies of our neonatal sepsis poster or for more information on neonatal sepsis surveillance activities in Minnesota please visit: dtopics/neosep/ References 1. Centers for Disease Control and Prevention. Early-Onset and Late- Onset Neonatal Group B Streptococcal Disease United States, MMWR Morb Mortal Wkly Rep 2005;54(47); Centers for Disease Control and Prevention. Prevention of Perinatal Group B Streptococcal Disease. MMWR Morb Mortal Wkly Rep 2002;51(No. RR-11). DCN 34;1 January/February

6 Proposed Revisions to Newborn Screening Rules The Minnesota Department of Health (MDH) is proposing revisions to the state s Newborn Screening (NBS) Rules, Minn. Rules, Chapter Newborn screening is the practice of testing every newborn for certain harmful or potentially fatal metabolic disorders that are not otherwise apparent at birth. Since 1965, the MDH Newborn Screening Program has screened all infants born in Minnesota. This program provides quality, costeffective screening and follow-up in order to prevent or minimize the longterm effects of disorders that can lead to death, developmental disability, or other serious medical conditions in newborns. Currently, the Program screens infants for disorders in the following categories: amino acid disorders, organic acid disorders, fatty acid oxidation disorders, endocrinopathies, and hemoglobinopathies. While the disorders included in the newborn screening panel are individually rare, approximately 70 Minnesota babies are born every year with a condition detected by newborn blood spot screening. All Minnesota newborns are required to receive newborn screening as per Minnesota Statute unless their parent or guardian denies such testing and indicates their intentions on a form. Blood is collected on a specimen card available from MDH. Collection from all infants should be completed between hours of age by the birthing facility or the clinician attending the birth. The newborn screening specimen cards should be submitted daily to the MDH Laboratory in St. Paul. A portion of the specimen is sent to the Mayo Clinic where tandem mass spectrometry (MS/MS) is performed to detect a number of metabolic diseases. The rest of the specimen is retained by MDH to conduct the remaining tests in the panel. All results are released together in a final MDH report. Testing is typically completed within 2 days from receipt of specimen. For infants with a normal newborn screen, results are mailed to the submitter (birthing hospital or clinic) who then forwards them to the practitioner listed on the newborn screening card as the physician for follow-up. Infants who require repeat screening will be identified and brought to the attention of the submitting birth hospital or clinic and/or the practitioner. Repeat screening is necessary if the original specimen was collected improperly or if the infant was less than 24 hours old at the time of collection. The practitioner may be asked to help obtain the repeat specimens. When an infant s newborn screen is abnormal, MDH will immediately contact the primary care physician for follow-up as well as the relevant medical specialists by phone and fax to ensure appropriate diagnosis and prompt care of the child. Program staff will assist in establishing a connection between the primary care practitioner and the appropriate metabolic, endocrine, or hematology specialists. These specialists can provide expert guidance for diagnostic testing and follow-up evaluations. This rulemaking process will update the NBS rules to reflect 2003 statutory changes and new technological advances, as well as to clarify the roles of MDH, hospitals, and health care providers. In general, the department is considering the following changes: updating references to include all tests, strengthening roles of participants, deleting obsolete information, describing how parents will receive information required by statute, and describing how the opt out provision in the new statute will be implemented. All interested persons or groups may submit comments or information on these possible changes in writing. MDH encourages you to submit your comments by February 13, 2006 to ensure that they are considered for the next draft. For more information and a copy of the draft revisions, visit the MDH rulemaking Web site at newborn/rulechange.html, NBSrule@health.state.mn.us, or call (651) , New Report Describes Burden of Asthma in Minnesota The Minnesota Department of Health recently released a new report on the burden of asthma in Minnesota. Among other things, the report describes asthma prevalence, asthmarelated hospitalizations, quality of life for people with asthma, and asthma mortality. Asthma affects an estimated 255,000 adult Minnesotans and more than 98,000 Minnesota children ages Overall, Minnesota s asthma rates are lower than national rates; however, disparities affect certain segments of the population. Most significantly, there are large disparities in asthma hospitalization rates between those who live in the Minneapolis-St. Paul metropolitan area and the rest of the state. The Asthma in Minnesota 2005 Epidemiology Report can be found at hpcd/cdee/asthma/documents/ epi2005.pdf. For more information, call the Minnesota Department of Health Asthma Program at or visit their Web site at for fact sheets, educational materials, blank Asthma Action Plans, and local resources. Information on the Minnesota Asthma Coalition can be found at 6 DCN 34;1 January/February 2006

7 Subject Index for the Disease Control Newsletter, 2005 ANNUAL SUMMARY Annual Summary of Communicable Diseases Reported to the Minnesota Department of Health, July/August ANTIMICROBIAL RESISTANCE Antimicrobial Susceptibilities of Selected Pathogens, May/June CANCER Minnesota Cervical Cancer Update...May/June DISEASE REPORTING Revisions to the Communicable Disease Reporting Rules...May/June Notice of Intent to Adopt Amendments to Rules Governing Communicable Disease Reporting, Minnesota Rules, Chapter January/February MISCELLANEOUS Delusional Parasitosis...September/October Disease Control Newsletter-20 Years Ago...May/June Emerging Infections Conference...March/April,May/June,July/August,September/October Health of Refugees in Minnesota, January/February Recent Infectious Disease Publications by MDH Staff...September/October Revised Recommendations for Screening and Treating Latent Tuberculosis (TB) Infection in Children and Adolescents...January/February Subject Index for the Disease Control Newsletter, January/February NEW BUILDINGS Health Department Moves to New Quarters in St. Paul...November/December We Are Moving at the End of October to St. Paul...September/October SEXUALLY TRANSMITTED DISEASES HIV Drug Resistance and Subtype Surveillance...September/October VACCINES/VACCINE-PREVENTABLE DISEASES Decline in Pneumococcal Disease in Adults Following Introduction of Pediatric Vaccine...November/December Meningococcal Vaccine...September/October Minnesota Influenza Vaccination Plan, November/December Pertussis and the Healthcare Setting...November/December Pertussis Vaccines for Adolescents and Adults and Updated Treatment and Prophylaxis Recommendations...November/December Recommended Childhood and Adolesecent Immunization Schedule, Minnesota, January/February Shortage of Pneumococcal Conjugate Vaccine, 7-valent (PCV7) is Resolved...January/February VECTOR-BORNE DISEASES Dramatic Increase in Lyme Disease and Other Tick-borne Diseases, May/June ZOONOTIC DISEASES Enteric Disease Associated with Animal Contact, Minnesota, March/April DCN 34;1 January/February

8 MDH s Interactive Asthma Action Plan (IAAP) An Update Health care providers who treat their patient. The program pulls the software, you should now download the patients with asthma are encouraged provided information into a user update by going to to use a downloadable, interactive tool friendly IAAP that can be printed in If you have developed by the Minnesota Depart- both English and Spanish. A prescrip- questions, please contact ment of Health (MDH) Asthma Pro- tion of selected medications can also susan.ross@health.state.mn.us or 651 gram. Available in desktop or online be printed. Formulary information for For fact sheets, patient formats, this tool assists the provider in seven key Minnesota health plans has education materials and other informadetermining the correct asthma been updated to include the latest tion on asthma, please visit severity level and selecting an appro- medication listings for each plan. If priate treatment plan especially for you have previously downloaded this Dianne Mandernach, Commissioner of Health Division of Infectious Disease Epidemiology, Prevention and Control Harry F. Hull, M.D...State Epidemiologist Richard N. Danila, Ph.D., M.P.H...Assistant State Epidemiologist Susan Perry...Editor Valerie Solovjovs...Production Editor CHANGING YOUR ADDRESS? Mail changes to: MDH/Disease Control Newsletter PO Box St. Paul, MN or Phone: or Outstate: or dcn@health.state.mn.us The Disease Control Newsletter is available on the MDH web site ( If you require this document in another format such as large print, Braille, or cassette tape, call or, in Greater Minnesota, call Minnesota Deparmtnet of Health 625 Robert Street North PO Box St Paul, MN Presort Standard U.S. Postage PAID Permit No. 171 St. Paul, MN