Current Trends and Research in Vector-Borne Disease in New York State
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1 New York State Department of Health Bryon Backenson, Melissa Prusinski, and Jennifer White Current Trends and Research in Vector-Borne Disease in New York State
2 Tick-Borne Diseases in NY YES Lyme disease Babesiosis Ehrlichiosis/Anaplasmosis Rocky Mountain Spotted Fever Powassan Encephalitis Borrelia miyamotoi Q-Fever (more commonly transmitted in other ways) Tularemia (tick-bite is one of several modes of transmission) NO (not yet, at least) STARI Heartland virus Bourbon virus MAYBE Meat allergy 2
3 3 Tick - talk: ~30 species of ticks are found in New York State. 10 species commonly bite humans. 4 species can potentially transmit disease (in New York) Deer tick Ixodes scapularis American Dog tick Dermacentor variabilis Lone Star tick Amblyomma americanum Woodchuck tick Ixodes cookei
4 4 American Dog tick: Rocky Mountain spotted fever & Human Monocytic Ehrlichiosis (HME) Lone Star tick: Human Monocytic Ehrlichiosis (HME) Deer tick: Lyme disease, Deer Tick Virus, Babesiosis & Human Granulocytic Anaplasmosis (HGA) Woodchuck tick: Powassan Encephalitis
5 Lyme Disease 5
6 Annual Proportion of Lyme Disease Cases by Region in New York State (Excluding New York City) 100% Elsewhere 6 50% Westchester, Dutchess Putnam & Columbia 0% Nassau & Suffolk & Rockland Year of Report
7 7
8 8 Incidence per 100,000 population
9 9 Incidence per 100,000 population
10 10 Incidence per 100,000 population
11 11 Incidence per 100,000 population
12 12 Incidence per 100,000 population
13 13 Incidence per 100,000 population
14 14 Incidence per 100,000 population
15 15 Incidence per 100,000 population
16 16 Incidence per 100,000 population
17 17 Incidence per 100,000 population
18 18 Incidence per 100,000 population
19 19 Incidence per 100,000 population
20 20 Incidence per 100,000 population
21 21 Incidence per 100,000 population
22 22 Incidence per 100,000 population
23 23 Incidence per 100,000 population
24 24 Incidence per 100,000 population
25 25 Incidence per 100,000 population
26 26 Incidence per 100,000 population
27 27 Incidence per 100,000 population
28 Incidence per 100,000 population Lyme disease in New York State by zip code
29 29 Incidence of Lyme disease per 100,000 population in Adirondack counties, 2002 versus ADK cases 5,476 statewide ADK cases 5,344 statewide
30 30 Incidence of Lyme disease per 100,000 population in Central New York counties, 2002 versus CNY cases 5,476 statewide CNY cases 5,344 statewide
31 Babesiosis 31
32 Babesiosis incidence rate per 100,000 population in New York State* by ZIP code n = 19 Incidence rate per 100,000 <= 10.0 > > > > * exclusive of New York City
33 Babesiosis incidence rate per 100,000 population in New York State* by ZIP code n = 91 Incidence rate per 100,000 <= 10.0 > > > > * exclusive of New York City
34 Babesiosis incidence rate per 100,000 population in New York State* by ZIP code n = 41 Incidence rate per 100,000 <= 10.0 > > > > * exclusive of New York City
35 Babesiosis incidence rate per 100,000 population in New York State* by ZIP code n = 61 Incidence rate per 100,000 <= 10.0 > > > > * exclusive of New York City
36 Babesiosis incidence rate per 100,000 population in New York State* by ZIP code n = 78 Incidence rate per 100,000 <= 10.0 > > > > * exclusive of New York City
37 Babesiosis incidence rate per 100,000 population in New York State* by ZIP code n = 79 Incidence rate per 100,000 <= 10.0 > > > > * exclusive of New York City
38 Babesiosis incidence rate per 100,000 population in New York State* by ZIP code n = 67 Incidence rate per 100,000 <= 10.0 > > > > * exclusive of New York City
39 Babesiosis incidence rate per 100,000 population in New York State* by ZIP code n = 79 Incidence rate per 100,000 <= 10.0 > > > > * exclusive of New York City
40 Babesiosis incidence rate per 100,000 population in New York State* by ZIP code n = 162 Incidence rate per 100,000 <= 10.0 > > > > * exclusive of New York City
41 Babesiosis incidence rate per 100,000 population in New York State* by ZIP code n = 193 Incidence rate per 100,000 <= 10.0 > > > > * exclusive of New York City
42 Babesiosis incidence rate per 100,000 population in New York State* by ZIP code n = 182 Incidence rate per 100,000 <= 10.0 > > > > * exclusive of New York City
43 Babesiosis incidence rate per 100,000 population in New York State* by ZIP code n = 223 Incidence rate per 100,000 <= 10.0 > > > > * exclusive of New York City
44 Babesiosis incidence rate per 100,000 population in New York State* by ZIP code n = 262 Incidence rate per 100,000 <= 10.0 > > > > * exclusive of New York City
45 Babesiosis incidence rate per 100,000 population in New York State* by ZIP code n = 234 Incidence rate per 100,000 <= 10.0 > > > > * exclusive of New York City
46 Babesiosis incidence rate per 100,000 population in New York State* by ZIP code n = 361 Incidence rate per 100,000 <= 10.0 > > > > * exclusive of New York City
47 Babesiosis incidence rate per 100,000 population in New York State* by ZIP code n = 226 Incidence rate per 100,000 <= 10.0 > > > > * exclusive of New York City
48 Babesiosis incidence rate per 100,000 population in New York State* by ZIP code n = 459 Incidence rate per 100,000 <= 10.0 > > > > * exclusive of New York City
49 Anaplasmosis (Human Granulocytic Anaplasmosis) 49
50 Anaplasmosis incidence rate per 100,000 population in New York State* by ZIP code n = 63 Incidence rate per 100,000 <= 10.0 > > > > * exclusive of New York City
51 Anaplasmosis incidence rate per 100,000 population in New York State* by ZIP code n = 102 Incidence rate per 100,000 <= 10.0 > > > > * exclusive of New York City
52 Anaplasmosis incidence rate per 100,000 population in New York State* by ZIP code n = 72 Incidence rate per 100,000 <= 10.0 > > > > * exclusive of New York City
53 Anaplasmosis incidence rate per 100,000 population in New York State* by ZIP code n = 85 Incidence rate per 100,000 <= 10.0 > > > > * exclusive of New York City
54 Anaplasmosis incidence rate per 100,000 population in New York State* by ZIP code n = 72 Incidence rate per 100,000 <= 10.0 > > > > * exclusive of New York City
55 Anaplasmosis incidence rate per 100,000 population in New York State* by ZIP code n = 159 Incidence rate per 100,000 <= 10.0 > > > > * exclusive of New York City
56 Anaplasmosis incidence rate per 100,000 population in New York State* by ZIP code n = 62 Incidence rate per 100,000 <= 10.0 > > > > * exclusive of New York City
57 Anaplasmosis incidence rate per 100,000 population in New York State* by ZIP code n = 78 Incidence rate per 100,000 <= 10.0 > > > > * exclusive of New York City
58 Anaplasmosis incidence rate per 100,000 population in New York State* by ZIP code n = 221 Incidence rate per 100,000 <= 10.0 > > > > * exclusive of New York City
59 Anaplasmosis incidence rate per 100,000 population in New York State* by ZIP code n = 206 Incidence rate per 100,000 <= 10.0 > > > > * exclusive of New York City
60 Anaplasmosis incidence rate per 100,000 population in New York State* by ZIP code n = 205 Incidence rate per 100,000 <= 10.0 > > > > * exclusive of New York City
61 Anaplasmosis incidence rate per 100,000 population in New York State* by ZIP code n = 239 Incidence rate per 100,000 <= 10.0 > > > > * exclusive of New York City
62 Anaplasmosis incidence rate per 100,000 population in New York State* by ZIP code n = 241 Incidence rate per 100,000 <= 10.0 > > > > * exclusive of New York City
63 Anaplasmosis incidence rate per 100,000 population in New York State* by ZIP code n = 220 Incidence rate per 100,000 <= 10.0 > > > > * exclusive of New York City
64 Anaplasmosis incidence rate per 100,000 population in New York State* by ZIP code n = 314 Incidence rate per 100,000 <= 10.0 > > > > * exclusive of New York City
65 Anaplasmosis incidence rate per 100,000 population in New York State* by ZIP code n = 315 Incidence rate per 100,000 <= 10.0 > > > > * exclusive of New York City
66 Anaplasmosis incidence rate per 100,000 population in New York State* by ZIP code n = 454 Incidence rate per 100,000 <= 10.0 > > > > * exclusive of New York City
67 Ehrlichiosis (Human Monocytic Ehrlichiosis) 67
68 Ehrlichiosis incidence rate per 100,000 population in New York State* by ZIP code n = 7 Incidence rate per 100,000 <= 10.0 > > > > * exclusive of New York City
69 Ehrlichiosis incidence rate per 100,000 population in New York State* by ZIP code n = 14 Incidence rate per 100,000 <= 10.0 > > > > * exclusive of New York City
70 Ehrlichiosis incidence rate per 100,000 population in New York State* by ZIP code n = 3 Incidence rate per 100,000 <= 10.0 > 10.0 * exclusive of New York City
71 Ehrlichiosis incidence rate per 100,000 population in New York State* by ZIP code n = 12 Incidence rate per 100,000 <= 10.0 > > > > * exclusive of New York City
72 Ehrlichiosis incidence rate per 100,000 population in New York State* by ZIP code n = 18 Incidence rate per 100,000 <= 10.0 > > 25.0 * exclusive of New York City
73 Ehrlichiosis incidence rate per 100,000 population in New York State* by ZIP code n = 19 Incidence rate per 100,000 <= 10.0 > > > > * exclusive of New York City
74 Ehrlichiosis incidence rate per 100,000 population in New York State* by ZIP code n = 11 Incidence rate per 100,000 <= 10.0 > > > > * exclusive of New York City
75 Ehrlichiosis incidence rate per 100,000 population in New York State* by ZIP code n = 26 Incidence rate per 100,000 <= 10.0 > > > > * exclusive of New York City
76 Ehrlichiosis incidence rate per 100,000 population in New York State* by ZIP code n = 85 Incidence rate per 100,000 <= 10.0 > > > > * exclusive of New York City
77 Ehrlichiosis incidence rate per 100,000 population in New York State* by ZIP code n = 125 Incidence rate per 100,000 <= 10.0 > > > > * exclusive of New York City
78 Ehrlichiosis incidence rate per 100,000 population in New York State* by ZIP code n = 67 Incidence rate per 100,000 <= 10.0 > > > > * exclusive of New York City
79 Ehrlichiosis incidence rate per 100,000 population in New York State* by ZIP code n = 61 Incidence rate per 100,000 <= 10.0 > > > > * exclusive of New York City
80 Ehrlichiosis incidence rate per 100,000 population in New York State* by ZIP code n = 70 Incidence rate per 100,000 <= 10.0 > > > > * exclusive of New York City
81 Ehrlichiosis incidence rate per 100,000 population in New York State* by ZIP code n = 35 Incidence rate per 100,000 <= 10.0 > > > > * exclusive of New York City
82 Ehrlichiosis incidence rate per 100,000 population in New York State* by ZIP code n = 41 Incidence rate per 100,000 <= 10.0 > > > > * exclusive of New York City
83 Ehrlichiosis incidence rate per 100,000 population in New York State* by ZIP code n = 48 Incidence rate per 100,000 <= 10.0 > > > * exclusive of New York City
84 Ehrlichiosis incidence rate per 100,000 population in New York State* by ZIP code n = 92 Incidence rate per 100,000 <= 10.0 > > > > * exclusive of New York City
85 Rocky Mountain Spotted Fever 85
86 Rocky Mountain Spotted Fever incidence rate per 100,000 population in New York State* by ZIP code n = 8 Incidence rate per 100,000 <= 10.0 > > > * exclusive of New York City
87 Rocky Mountain Spotted Fever incidence rate per 100,000 population in New York State* by ZIP code n = 11 Incidence rate per 100,000 <= 10.0 > > > * exclusive of New York City
88 Rocky Mountain Spotted Fever incidence rate per 100,000 population in New York State* by ZIP code n = 14 Incidence rate per 100,000 <= 10.0 > > > * exclusive of New York City
89 Rocky Mountain Spotted Fever incidence rate per 100,000 population in New York State* by ZIP code n = 7 Incidence rate per 100,000 <= 10.0 > * exclusive of New York City
90 Rocky Mountain Spotted Fever incidence rate per 100,000 population in New York State* by ZIP code n = 2 Incidence rate per 100,000 > * exclusive of New York City
91 Rocky Mountain Spotted Fever incidence rate per 100,000 population in New York State* by ZIP code n = 10 Incidence rate per 100,000 <= 10.0 > > > * exclusive of New York City
92 Rocky Mountain Spotted Fever incidence rate per 100,000 population in New York State* by ZIP code n = 6 Incidence rate per 100,000 <= 10.0 > * exclusive of New York City
93 Rocky Mountain Spotted Fever incidence rate per 100,000 population in New York State* by ZIP code n = 1 Incidence rate per 100,000 <= 10.0 * exclusive of New York City
94 Rocky Mountain Spotted Fever incidence rate per 100,000 population in New York State* by ZIP code n = 13 Incidence rate per 100,000 <= 10.0 > > > * exclusive of New York City
95 Rocky Mountain Spotted Fever incidence rate per 100,000 population in New York State* by ZIP code n = 0 * exclusive of New York City
96 Rocky Mountain Spotted Fever incidence rate per 100,000 population in New York State* by ZIP code n = 7 Incidence rate per 100,000 <= 10.0 * exclusive of New York City
97 Rocky Mountain Spotted Fever incidence rate per 100,000 population in New York State* by ZIP code n = 43 Incidence rate per 100,000 <= 10.0 > > > * exclusive of New York City
98 Rocky Mountain Spotted Fever incidence rate per 100,000 population in New York State* by ZIP code n = 16 Incidence rate per 100,000 <= 10.0 > > > * exclusive of New York City
99 Rocky Mountain Spotted Fever incidence rate per 100,000 population in New York State* by ZIP code n = 19 Incidence rate per 100,000 <= 10.0 > > > > * exclusive of New York City
100 Rocky Mountain Spotted Fever incidence rate per 100,000 population in New York State* by ZIP code n = 12 Incidence rate per 100,000 <= 10.0 > > * exclusive of New York City
101 Rocky Mountain Spotted Fever incidence rate per 100,000 population in New York State* by ZIP code n = 28 Incidence rate per 100,000 <= 10.0 > > > * exclusive of New York City
102 Rocky Mountain Spotted Fever incidence rate per 100,000 population in New York State* by ZIP code n = 25 Incidence rate per 100,000 <= 10.0 > > > * exclusive of New York City
103 Powassan Encephalitis 103
104 Powassan virus 104 Lineage I (POWV) Vector: woodchuck tick (Ixodes cookei) Reservoir: small mammals (squirrels, woodchucks, etc.) Woodchuck ticks are relatively difficult to encounter Woodchuck tick Ixodes cookei
105 Powassan virus 105 Lineage II (DTV) Vector: black-legged/deer tick (Ixodes scapularis) Reservoir: rodents (white-footed mice) Encounters with deer ticks are very common Deer tick Ixodes scapularis
106 NYS Powassan cases, Human cases in NYS, case most years Exceptions: 2007=6 cases, 2013=5 cases 19 cases total 14 (73.7%) were residents of the Lower Hudson Valley 15 (78.9%) were male Age range: 4-91 years 15 (78.9%) had no history of travel 5 (26.3%) died Time from onset to death varied greatly
107 Borrelia miyamotoi 107
108 Borrelia miyamotoi 108 Not reportable in NYS Newly described human pathogen Closely related to the bacteria that cause tick-borne relapsing fever Symptoms are more similar to anaplasmosis than Lyme disease Few cases reported in the literature (only 3 to date) Responded well to doxycycline
109 Borrelia miyamotoi 109 Tests are under development and not widely available Wadsworth s TBD lab -- humans Vector Ecology lab -- ticks With development of testing, could identify more cases and/or increased risk in NY
110 110 Tick Sampling and Tick Control
111 Tick population control methods 111 Area-wide acaricides Landscape management Host (deer) reduction Mouse baitboxes Deer four-poster stations Things in the works Biological control with fungal applications Fertilizers Vaccine kibble Others
112 NYSDOH Active Surveillance of Ticks and Tick-Borne Pathogens 112
113 Background: 113 Geographic and Temporal Distribution of Ixodes scapularis in New York State * Through *NYSM and NYSDOH passive surveillance/tick Identification Service data
114 Background: 114 Locally Acquired Deer Ticks (Ixodes scapularis) Mapped by USPS ZIP Code *Unpublished NYSDOH passive surveillance/tick Identification Service data
115 115 NYSDOH I. scapularis Active Surveillance: Tick Collection Sites Saratoga Washington 2002 and and 2006 Albany Rensselaer Greene Columbia Ulster Dutchess Putnam Orange Westchester Rockland
116 116 NYSDOH I. scapularis Active Surveillance: Tick-borne Pathogen Surveillance in the Hudson Valley, New York Greene Columbia Ulster Dutchess Putnam Collection Sites Orange Sites with B. microti Positive ticks Rockland Westchester *Prusinski et al. 2014
117 117 Statewide Tick-borne Pathogen Surveillance Initiative In 2008, the NYSDOH expanded Ixodes scapularis collections across NY Standardized dragging and flagging surveys Some locations sampled annually, some rotationally (every 2-5 years) Nearly every county sampled from Up to 50 ticks per life-stage tested per location Nearly 21,000 individual ticks tested Results shared with LHDs, other State agencies, medical providers, veterinarians, and general public
118 118 NYSDOH Ixodes scapularis Surveillance ( )* I. scapularis not found I. scapularis adults only I. scapularis nymphs only I. scapularis nymphs and adults *New York City region sampled by NYCDOHMH staff
119 119 NYSDOH Tick Surveillance Sites
120 120 Average Prevalence of Borrelia burgdorferi in Host-seeking I. scapularis Nymphs 2014* 0 1 5% 6 10% 11-20% 21 35% 35 50% >50% N = 1,536 *or when last sampled by NYSDOH for pathogen surveillance purposes ( ).
121 Average Prevalence of Anaplasma phagocytophilum in Host-seeking I. scapularis Nymphs 2014* % 6 10% 11-20% 21 35% 35 50% >50% N = 1,536 *or when last sampled by NYSDOH for pathogen surveillance purposes ( ).
122 122 Average Prevalence of Babesia microti in Host-seeking I. scapularis Nymphs 2014* 0 1 5% 6 10% 11-20% 21 35% 35 50% >50% N = 1,536 *or when last sampled by NYSDOH for pathogen surveillance purposes ( ).
123 123 NYSDOH Annual Hunter-killed White-tailed Deer Survey Conducted for decades in CNY Monitor tick species distribution Capital District and WNY added in 2005 Screen ticks for pathogens Started collecting blood samples for arboviral surveillance in 2007
124 124 Annual Hunter-Killed White-tailed Deer Survey Locations NYSDEC Hunter Check Station Deer Processor
125 125 Methods: NYSDOH Annual Hunter-killed White-tailed Deer Survey Conducted during the opening week of rifle season Check head and neck of deer for ticks for 5 min Collect additional ticks for up to 15 min (time permitting) Collect blood from abdominal cavity Record data from NYSDEC permit tag Date harvested, County, Town, WMU, Sex, # Antler Points (bucks) Obtain age data from NYSDEC, if possible
126 126
127 127 Mapping Options: and 2
128 128 Other Pathogens of Interest Low prevalence of Borrelia miyamotoi (2%) in adult I. scapularis from the Hudson Valley, as far north as Washington County. Deer Tick virus detected in pooled I. scapularis nymphs and adults from the Hudson Valley (MIR ~2% at positive sites) Rickettsial agents in Dermacentor variabilis from the New York City region. Plans to screen Amblyomma americanum for Ehrlichia chaffensis and E. ewingi 128
129 Research using Human Surveillance Data Jennifer White, MPH June 29, 2015
130 June 29, Applied Research TickNET
131 June 29, TickNET Established by CDC in 2007 Fosters coordinated surveillance, research, education, and prevention of TBDs Partnerships CDC Division of Vector-borne Disease State and local health departments CDC s Emerging Infections Program currently supports applied research in CT, MD, MN, and NY
132 June 29, Lyme and Other TBDs Prevention Study CT, MD, NY and CDC Prospective, blinded placebo-control trial 2500 households NYS= Dutchess Co. Evaluate the efficacy of a single springtime application of a commercially available, EPA-registered acaricide (bifenthrin) to prevent Lyme and other TBDs in humans Manuscript in progress
133 June 29, Lyme Disease Underreporting MD, MN, NY and CDC Determine degree to which LD is underreported to public health Explore methods to enhance surveillance Various methods employed by partnering states NY: obtain lists of patients diagnosed with LD (ICD9CM code ) from physicians and compare to database Manuscripts in progress
134 June 29, TBD Commercial Laboratory Survey [1] CT, MD, MN, NY and CDC Survey of major commercial laboratories to determine testing methods and volume for 5 TBDs Seven participating labs: ~ 3.4 million LD tests on ~ 2.4 million specimens Estimated cost of $492 million Estimated 240, ,000 infected source patients in 2008 [1] Hinckley A, Connally N, Meek J, Johnson B, Kemperman M, Feldman K, White J, Mead P. Laboratory Testing Practices and the Occurrence of Lyme Disease in the United States, Clin Inf Dis, 2014 Sept 1; 59(5):
135 June 29, Economic Burden of Lyme Disease CT, MD, MN, NY and CDC Prospective, descriptive study among LD cases in 4 states Assessment of total societal and individual level costs of LD Currently enrolling study participants through Fall 2016
136 June 29, Case Series
137 June 29, Lyme Carditis [2] CT, MA, NH, NY 3 cases of sudden cardiac death associated with LD in CT, MA, and NY in [2] Centers for Disease Control and Prevention. Three Sudden Cardiac Deaths Associated with Lyme Carditis United States, November 2012-July MMWR, 2013 Dec 13; 62(49):
138 June 29, Powassan / Deer Tick Virus [3] NY Medical College, NYSDOH, WC 14 cases of POW/DTV encephalitis identified in NYS from Clinical sx, laboratory diagnosis, and outcome 10 (72%) of the cases were from the LHV DTV confirmed in 2 cases by genetic sequencing Majority of others were likely DTV also LD incidence I. scapularis vs. I. cookei [3] El Khoury M, Camargo J, White J, Backenson PB, Dupuis A, Escuyer K, Kramer L, St. George K, Chatterjee D, Prusinski M, Wormser G, Wong S. Potential Role of Deer Tick Virus in Powassan Encephalitis Cases in Lyme Disease-endemic Areas of New York, USA. EID, 2013 Dec; 19(12):
139 June 29, Typhus Fever [4] NYSDOH, WC, CDC Familial cluster of 2 cases in Capital District area in 2009 Epi investigation Consistent sx Confirmatory serologic testing Environmental investigation 11 flying squirrels captured from attic crawl space above enclosed front porch 100% prevalence for R. prowazekii [4] Prusinski M, White J, Wong S, Conlon M, Egan C, Kelly-Cirino C, Laniewicz B, Backenson PB, Nicholson W, Eremeeva M, Karpathy S, Dasch G, White D. Sylvatic Typhus Associated with Flying Squirrels in NYS, USA. VBZD, 2014; 14(4): 1-5.
140 June 29, Environmental Studies
141 June 29, Lyme Disease- Landscape Risk Factors [5] UNC, EPA, NYSDOH Assessed how landcover classification affects associations between landscape characteristics and LD [5] Messier K, Jackson L, White J, Hillborn E. Landscape Risk Factors for Lyme disease in the Eastern Broadleaf Forest Province of the Hudson River valley and the Effect of Explanatory Data Classification Resolution. Spatial and Spatio-temporal Epi\, 2015; 12: 9-17.
142 June 29, Comparison of LD incidence rates versus the coverage of deciduous forest and pasture landcover classes for 2 selected areas. Panels A and B are the same area and are outlined in blue.
143 June 29, Lyme Disease- Seasonal Weather Factors NYSDOH CEH, CCH, CDC Association of weather indicators with LD incidence and documented tick encounters Linked Human case data Data from Tick ID service NYS weather data (severe/mild winter days, PHDI, etc.) Manuscript in progress
144 Lots of Partners Working With NYSDOH On the projects mentioned here: 144 New York State Department of Health Wadsworth Center CDC University at Albany Trudeau Institute American Watershed Institute Paul Smith s College University of Pennsylvania Connecticut Department of Health Maryland Department of Health Minnesota Department of Health Yale University University of North Carolina US Environmental Protection Agency New York Medical College
145 Questions? 145 Contact information: Bureau of Communicable Disease Control (518)
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