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ASTHO Statement on Autism and Vaccines ARLINGTON, VA — ASTHO Chief Medical Officer Susan Kansagra, MD, MBA made the following statement regarding vaccines and autism: “As public health professionals, we unequivocally support the use of vaccines to prevent infectious diseases. The science behind vaccines is robust and well-tested and the overwhelming consensus of scientific evidence is clear that there is no link between vaccines and autism. Vaccines have been rigorously tested and examined for decades. They are one of the most significant public health achievements in human history, having saved countless lives and prevented immeasurable suffering. We all want our kids to be healthy and strong. Please consult your health care provider if you have questions.” ASTHO Press Release Boilerplate website yes

Partnering with Birthing Hospitals to Protect Babies Against RSV Partnering to Protect Babies Against RSV Susan Kansagra, Michelle Fiscus, Kim Martin Learn how immunization programs partnered with birthing hospitals to expand participation in Vaccines for Children and better protect babies against RSV. In 2023, the Advisory Committee on Immunization Practices (ACIP) recommended the use of monoclonal antibodies (mAbs) to prevent respiratory syncytial virus (RSV) in infants, a major milestone in newborn immunization. Unlike vaccines, which stimulate the body’s immune system to produce its own protection over time, mAbs work right away by giving the body ready-made protection against infection. This is especially important for newborns who do not have the protection of maternal RSV vaccination, which causes them to face a higher risk of severe RSV illness and need protection as early as possible. In response to the 2023 ACIP recommendation, state and territorial immunization programs acted quickly to ensure these new protections reached the babies who needed them most. One of the most effective strategies was partnering with birthing hospitals to expand participation in the Vaccines for Children (VFC) program, a federally funded initiative that provides vaccines to children at no cost to their families who might otherwise be unable to afford them. This program enabled the delivery of RSV mAbs — such as nirsevimab and now clesrovimab — to VFC-eligible newborns without any financial burden on their families. High Stakes, Strong Results The stakes were high, as RSV is the leading cause of infant hospitalizations in the United States. It was previously responsible for an estimated 58,000 to 80,000 hospitalizations and up to 300 deaths in children under age five each year. Data on RSV mAbs showed significant results, reducing RSV-related emergency department visits by 63% and hospitalizations by as much as 80%. Administering RSV mAbs in the first few days after birth, during RSV season, ensures that infants are protected before their first exposure — a critical step in reducing illness and health care burden. Strategies for Success Health departments played a leading role in bringing birthing hospitals into the VFC program. Many hospitals were not previously enrolled, often due to limited awareness, logistical barriers, or concerns about administrative burdens. Immunization programs responded by 1) launching targeted outreach, 2) offering tailored technical assistance, 3) simplifying enrollment processes, and 4) providing guidance on proper storage, eligibility screening, and documentation. The Impact of Stronger Partnerships These efforts have generated measurable results: The number of birthing hospitals enrolled in the VFC program increased from 292 in the 2023 season to 1,012 in 2025, boosting coverage from 10% to 36% of all U.S. birthing hospitals. This clearly demonstrates that these partnerships are effective and make a real difference in protecting infants’ health. State data further highlights this success and shows that collaboration across states, hospitals, and public health partners is crucial for achieving measurable impact: Virginia nearly doubled the number of birthing hospitals enrolled in the VFC program, increasing from six to 11 within one year. The state’s immunization program implemented an innovative Replacement Model to simplify requirements and collaborate closely with hospital teams to overcome barriers. Similarly, California provided resources, developed an enrollment checklist, and communicated the benefits of enrollment to birthing hospitals. Finally, across six states, 33 hospitals, and 400 clinics over two RSV seasons, Intermountain Health coordinated a system-wide approach that developed educational tools, enrolled hospitals in VFC, and addressed supply shortages. It also piloted a Replacement Model where mAb product was purchased by the hospital and doses administered to VFC-eligible babies were replaced with VFC-funded stock. These efforts also strengthened relationships between public health programs and birthing institutions. Trust and communication improved, and hospitals became more engaged in broader immunization goals (e.g., access to other birth-dose vaccines like hepatitis B). This expanded partnership not only protected newborns during RSV season but reinforced the capacity of immunization programs to mobilize quickly, implement new recommendations, and ultimately improve health outcomes. Compared to prior seasons, RSV-associated hospitalization rates were 28%-43% lower in 2024-2025, which was the first season with widespread availability of mAbs and maternal RSV vaccine. Future Opportunities Health departments have used a number of strategies to increase VFC enrollment by hospitals and mAbs coverage as a whole, including: Using birth volume data to prioritize outreach to additional hospitals for enrollment in the VFC program. Ensuring linkage to Immunization Information Systems to determine maternal RSV vaccination status and quickly identify eligible infants. Working with health systems on standing orders and protocols to help providers administer mAbs rapidly to eligible infants. Bringing hospitals and payers together to provide financial models that support universal coverage. While bundled payments for labor and delivery stays have been a barrier for private payer coverage, the high ROI for preventing future RSV-related health care utilization may provide additional opportunities for payers to consider alternative coverage models. Sharing promising practices through a Learning Collaborative webinar series developed by the Association of Immunization Managers, in coordination with CDC. The rapid rollout of RSV mAbs through the VFC program is a model of success. It shows that when public health agencies and health care partners work together, we can deliver lifesaving interventions, even in complex, high-volume settings like birthing hospitals. As new immunization tools emerge in the years ahead, the infrastructure, lessons and relationships built through this effort will continue to support the goal of protecting all children from the very start. article yes

Downstream Effects of CDC Adopting ACIP Recommendations for COVID-19 and MMRV Vaccines Downstream Effects of CDC Adopting ACIP Recommendations Susan Kansagra, Andy Baker-White, Meredith Allen, Kimberly Martin, Ericka McGowan Learn about the downstream effects of CDC adopting ACIP recommendations for COVID-19 and MMRV vaccines, as states examine how their policies and laws intersect. On Oct. 6, CDC adopted the recommendations that the Advisory Committee on Immunization Practices (ACIP) made in September — specifically, individual-based decision-making for COVID-19 vaccine and separate measles, mumps, and rubella vaccine, and the varicella vaccine in toddlers. The adoption of these recommendations now sets in motion a cascade of other processes that influence access to vaccines. In addition, several states have begun to examine how their state level policy and laws intersect with ACIP recommendations given the delay in adoption and the uncertainty of the process going forward. COVID-19 Vaccine Recommendation CDC adopted the recommendation for shared clinical decision-making for the COVID-19 vaccine for those six months and older. The adoption of this ACIP recommendation has a ripple effect on coverage and access: It enables states to begin ordering COVID-19 vaccine under the Vaccines for Children program. It allows state Medicaid programs that link coverage to ACIP recommendations to cover the cost of the vaccine. It enables pharmacists to provide the COVID-19 vaccine under the federal PREP act declaration — as opposed to or in addition to state law, which varies by state. Many state health departments issued standing orders and executive orders to enable pharmacists to administer in the meantime. It requires health insurers to cover the cost of the vaccine, as the Affordable Care Act ties insurance coverage requirements to ACIP recommendations. Though, prior to the meeting, health insurers indicated they would do so anyway this year. MMRV Recommendation The CDC also adopted the recommendation for separate varicella (V) and measles, mumps, rubella (MMR) vaccines rather than the MMRV vaccine (combined measles, mumps, rubella, varicella) for children under four years. As background, current guidance allows either MMRV or MMR + V to be administered to children 12-47 months. However, because of a small but higher risk of febrile seizures for dose one, they are recommended to be administered separately (MMR + V), unless families express a preference for MMRV. Only about 15% of children currently receive MMRV for the first dose, and the general consensus is that this decision will result in some changes but not significantly impact access to vaccines: The adoption of this recommendation means that VFC will no longer cover MMRV for children under four, but it continues to cover separate MMR and V vaccines. Since many state Medicaid plans tie vaccine coverage to ACIP recommendations, coverage of MMRV by state Medicaid will vary depending on this language, though separate MMR and V vaccines would continue to be covered. Private insurers can choose to cover MMRV and will likely continue to in the short term but are not required to. They are required to cover separate MMR and V vaccines. How States Are Preparing for the Future As it stands now, ACIP recommendations, particularly for respiratory viral season, are not that different than prior years – with influenza, RSV, and the COVID-19 vaccine recommended (the latter with shared clinical decision making). However, the delayed and unpredictable process has led many states to examine how closely they are tied to ACIP in law, regulation, or practice. Over 600 statutes across U.S. states and territories reference ACIP — whether for pharmacist vaccine authority, school entry, health care worker or other requirements. States have considered a variety of actions to ensure they maintain access to vaccinations for their jurisdictions including: Passing or introducing legislation that allows the state health department to use ACIP guidance from previous years or recommendations from other bodies (e.g., medical provider organizations) in state law, as it relates to school entry, pharmacist authority, and others. Issuing standing orders and executive orders to enable pharmacists to administer vaccines in the absence of ACIP recommendations. Examining Medicaid state plan language to determine how to interpret requirements when ACIP is referenced and considering updates to that language (e.g., North Carolina). Issuing state requirements for insurers on vaccine coverage (e.g., Oregon, California, Hawaii). Examining use of state funds to purchase vaccines. Supplemental Resources Tracking State Actions on Vaccine Policy and Access by KFF Vaccine Resources by the Common Health Coalition States Take Action to “Immunize” Vaccine Access by Mandy Cohen, Julian Polaris, and Liz Dervan Vaccine Integrity Project — Fall Immunization Information by the Center for Infectious Disease Research and Policy Special Thanks - Blog - Downstream Effects of CDC Adopting ACIP Recommendations Padding Block - Large Related Content - Blog - Downstream Effects of CDC Adopting ACIP Recommendations article yes

Federal, State, and Stakeholder Perspectives on the Rural Health Transformation Fund Perspectives on the Rural Health Transformation Fund Catherine Jones Explore federal, state, and stakeholder perspectives on the Rural Health Transformation Fund, shared at a discussion hosted by ASTHO and Cornerstore Government Affairs teams. In early July, ahead of final votes on the One Big Beautiful Bill Act (full text H.R.1), Senate Majority Leader John Thune (R-SD), joined by Senators Susan Collins (R-ME) and Lisa Murkowski (R-AK), secured a $50 billion funding line for a new Rural Health Transformation Program (RHTP). This five-year mandatory fund is designed with two primary goals: To stabilize vulnerable rural hospitals, health centers, clinics, and their workforces. To improve access, affordability, modernization, and health outcomes for rural residents, who on average experience higher rates of chronic disease, shorter lifespans, and lower earning power compared to urban populations. To help states better understand how to apply and utilize RHTP dollars, ASTHO partnered with Cornerstone Government Affairs to host a discussion on Sept. 4 featuring two expert panels. Participants included representatives from Centers for Medicare & Medicaid Services (CMS) and HRSA, congressional staff, state health departments, and experts from the National Rural Health Association and National Association of Medicaid Directors. Lively discussions provided valuable insights into the application process, how states might deploy funds to build and sustain rural health programs, and the realities of delivering care on the ground. Panel One: Federal Perspectives Application Tips The first order of business was to provide potential applicants with essential information they need to apply. CMS is working quickly to release the Notice of Funding Opportunity in early September. Applications will be due in November, with funding decisions finalized by Dec. 31. This is a one-time application for the five-year mandatory fund, with dollars allocated evenly across FY26 to FY30 ($10 billion per year). Importantly, the RHTP fund is separate from — and unaffected by — FY26 Labor Health and Human Services, and Education discretionary appropriations outlined by the Senate and House, and any continuing resolutions. The $50 billion program will be divided into two parts. $25 billion will be distributed evenly among states that apply and have successful applications. The remaining $25 billion will be allocated at CMS’s discretion based on factors such as a state’s rural population, the number of rural health care facilities, and state policies and policy commitments. States will not be required to provide matching funds. In anticipation of the application deadline, many state health departments have been mobilizing over the past weeks. Health officials are convening task forces, launching working groups and public hearings, and issuing Requests for Information and surveys to shape projects and spending plans. These efforts are focused on aligning with CMS’s strategic goals, including making rural America healthy again, providing sustainable access to care, workforce development, innovative care delivery, and technology modernization. Program Insights Panelists also highlighted how RHTP differs from existing rural health programs. The Federal Office of Rural Health Policy, for example, funds initiatives focused on quality improvement, hospital technical assistance programs for operational challenges, and targeted pilot programs to test the feasibility of ideas related to community needs. By contrast, RHTP will provide states with a large, flexible infusion of funds to augment existing and novel rural health care efforts. States will also be permitted to use RHTP dollars for one-time investments (e.g., electronic health record systems, diagnostic equipment, and network-building initiatives). Panelists emphasized the importance of tailoring approaches to state and community needs, noting that Tribal communities face especially severe challenges, requiring intentional engagement. The first session concluded with a focus on Alaska, where 73.7% of hospitals are in rural areas — a key driver of Senator Murkowski’s strong advocacy for the fund. Her legislative director noted the state’s persistent struggles with connectivity, limited primary care access, workforce shortages, and low patient volume. Previous funding formulas, which relied heavily on hospital bed counts or numbers of health care facilities, often disadvantaged Alaska and similar states. RHTP, structured as a cooperative agreement, gives states both predictability and flexibility: dollars they can count on, combined with broad authority to design solutions in partnership with CMS protocols and assistance. CMS has existing protocols for grant management, and Congress will likely ask for clear reporting requirements as they monitor the successful implementation of the fund. Panel Two: State and Stakeholder Perspectives Rural Health Challenges To align visions with on-the-ground realities, health department leaders from Pennsylvania and Mississippi described their extensive efforts underway to gather input and identify priorities that are both sustainable and impactful, underscoring the importance of community engagement in shaping state strategies. Panelists noted that states are working through a broad list of rural health challenges, including: Maternal and child health. Behavioral health. Substance use disorder. Emergency medical services. Transportation barriers. Aging populations. Specialist shortages. Data modernization (including cybersecurity, AI, broadband, training, and administrative support). Telehealth. Workforce shortages. Hospital, clinic and federally qualified health care center closures. Payment models (public and private). Improving health information exchanges and electronic heath records were also mentioned as universal goals. RHTP is designed with flexibility to tackle these issues and to craft solutions (some of them can be shelf-ready, such as technology or prevention kits) to respond to the diverse needs of rural communities. Aligning Programs Panelists were asked how they are working with partners to achieve alignment for their programs. All concurred that strategic planning is essential, with an emphasis on local partnerships and regional collaborations. It was stressed that rural health care should ideally be delivered as close to the community level as possible, supported by a robust ecosystem. Speakers agreed that the financial health of rural areas is inseparable from the health of their hospitals and clinics. It was underscored that local residents are deeply invested in their communities and want to see them thrive. Transforming rural health care systems will require large-scale collaborations at a local level, which are built on trust, a shared vision, and a clear understanding of the long-term goals. The challenges of chronic disease, which occurs and leads to death at significantly higher rates in rural areas, surfaced. Panelists agreed that tackling this issue requires major investments in ancillary professions — such as nutritionists, physical therapists, and community health workers — alongside a renewed emphasis on primary care services and alleviating the acute shortage of primary care physicians. According to the American Medical Association, roughly 65% of rural areas face a shortage of primary care providers, and only 4%-5% of incoming medical students now come from rural backgrounds. Some solutions noted by the panelists were extending medical student rotations in rural settings from a few weeks to 12 or more, coupled with financial and professional incentives. Encouragingly, research shows that students from rural areas are far more likely to return home as practicing physicians. Final Words Panelists overwhelmingly agreed that RHTP represents an unprecedented opportunity for states — though, notably, not for U.S. territories or Washington, D.C. — to expand access, raise the quality of rural health care, and ultimately improve both quality of life and life expectancy for their rural residents. The $50 billion fund is not only a lifeline but also a testing ground, and if implemented successfully, it could serve as a model to pave the way for future federal investments of this magnitude in rural health. For more information on RHTP, please email MAHARural@cms.hhs.gov. Participants Part One: Federal Senator Lisa Murkowski and Angela Ramponi, MPH, Legislative Director Emily Chen, MBA, Senior Advisor, Office of the Administrator, Centers for Medicare and Medicaid Services, U.S. Department of Health and Human Services Tom Morris, MPA, Associate Administrator for Rural Health Policy, Health Resources and Services Administration, U.S. Department of Health and Human Services Moderated by Carlos Jackson, Principal, Cornerstone Government Affairs Part Two: State and Stakeholder Daniel Edney, MD, FACP, FASAM, State Health Officer, Mississippi State Department of Health Debra Bogen, MD, FAAP, Secretary of Health, Pennsylvania Department of Health Zil Joyce Dixon Romero, State Government Affairs Manager, National Rural Health Association Lindsey Browning, Deputy Executive Director of Programs, National Association of Medicaid Directors Moderated by Susan Kansagra, MD, MBA, Chief Medical Officer, ASTHO article yes

Learn about public health strategies for preventing chronic disease that intersect with themes in MAHA report including nutrition and physical activity.

Discover how leadership coaching sessions reinforced partnerships between public health and community-based organizations.

This video highlights specific administrative strategies, partnerships, and metrics used by the North Carolina Division of Public Health to support efficient and effective spending of federal funding.

Don't Panic! A Panel on How to be an Effective Crisis Communicator This ASTHO webinar explored strategies for strengthening jurisdictional capacity for public health risk communication. The panel discussion featured insights from the subject matter experts, state health department representatives, and public health leaders listed below. The session showcased best practices for communicating about trending public health threats, innovative resources for applying the latest risk communications research, and an overview of practical tools to help public health communicators effectively address crises and emergencies across diverse jurisdictions. Speakers Amanda Kwong, MPH: Director, Public Health Communications Collaborative Kelley Richardson, MPH, CHES: Communications Supervisor, Division of Public Health, North Carolina Department of Health and Human Services Ann Rowe: Executive Board President and Member-at-Large, National Public Health Information Coalition Kasisomayajula Viswanath, PhD: Lee Kum Kee Professor of Health Communication, Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health Moderator Susan Kansagra, MD, MBA (Alum-NC): Chief Medical Officer, ASTHO article yes

People with chronic diseases have suffered the most during the pandemic both in rates of COVID-19 mortality and morbidity, and the health disparities that exist in those with chronic disease and poor social determinants of health are stark. On today’s episode, we speak to chronic disease and health equity experts on how to address this growing divide.

This collection highlights pieces from the Office of the Chief Medical Officer that best exemplify Marcus Plescia's contributions and expertise in his role as a leader at ASTHO and in public health.

Find funding criteria/distribution details for the Rural Health Transformation Grant, and explore collaboration and tactical considerations for your application.

New World Screwworm Insights and Action Steps Shalini Nair Learn about the recently confirmed human case of New World screwworm in the United States, plus action steps to stay prepared for this evolving threat. CDC, in coordination with the Maryland Department of Health, recently confirmed a human case of New World screwworm (NWS) in the United States associated with the ongoing outbreak in Central America. Prior to late 2023, NWS was present in South America and certain countries of the Caribbean, and a biological barrier in eastern Panama prevented the pest from spreading through Central America. Although the United States has experienced travel-associated cases from countries where NWS is endemic in the past, this is the first travel-associated case from a country affected in this outbreak. The parasite, most often seen in animals (especially livestock), was confirmed on Aug. 4 in a Maryland resident with recent travel to El Salvador — a country affected by the current outbreak. While the risk to public health in the United States remains low at this time, it is important for state and territorial health officials to stay informed and prepared for this evolving threat. What Is New World Screwworm? New World screwworm, or Cochliomyia hominivorax, is a parasitic fly whose larvae (maggots) feed on healthy tissue. NWS flies are attracted to and lay eggs on and inside of open wounds, which leads to myiasis, or a parasitic infestation in which fly larvae burrow into the flesh of the affected host. While NWS can affect various warm-blooded animals, most commonly livestock and wildlife, it does not spread between humans and animals. Further, the fly is not a carrier of vector-borne disease. Risk factors for contracting NWS myiasis include: An open wound (even wounds as small as a tick bite may attract the flies). A weakened immune system. A medical condition that contributes to bleeding or open sores. Spending extended amounts of time outdoors or near livestock in areas where NWS flies are present. NWS infestation can be very painful. In humans, symptoms may include unexplained skin wounds or lesions that worsen over a few days, bleeding from an open sore, the presence or feeling of maggots around or in open wounds, and a foul-smelling odor at the infestation site. Larvae can also be present in the nose, eyes, mouth, or ears. In animals, signs may include irritated behavior, head shaking, presence of larvae in wounds, and the smell of decay; animals may also stop eating and self-isolate. There is currently no drug-only cure for NWS but effective treatment consists of quick and thorough removal of larvae. The USDA also maintains a list of EPA-registered pesticides to use against NWS on pastures, agricultural buildings, livestock, and other animals. Framework for Outbreak Prevention NWS was formerly eradicated from the United States in the 1960s, following a large-scale, coordinated effort and the creation of a “barrier” zone between NWS-endemic South America and NWS-free Central and North America. While subsequent outbreaks have occurred since then, the last confirmed (and later eradicated) U.S. outbreak of NWS was in the Florida Keys in 2016, affecting wild Key deer. However, NWS has slowly migrated northward towards the southern U.S. border since the emergence of a new outbreak in Panama in 2023. In the 1950s, USDA developed a successful method for eradicating NWS, referred to as sterile insect technique (SIT). This method involves the mass-rearing and release of sterilized male flies into infested areas to mate with wild females, resulting in nonviable eggs and a vast reduction in the target fly population. It has been used in the United States and across North and Central Mexico and was successful in maintaining eradication until the outbreak in recent years. Addressing the Current Outbreak USDA and HHS have initiated proactive measures to address the current threat to the United States. This includes CDC collaborating with health care professionals, state and local health departments, and tribal organizations to prepare for the potential arrival of NWS in the United States and developing clinical guidance and other resources for health care and public health partners on how to identify and respond to NWS myiasis cases in humans. Additionally, USDA is taking comprehensive action in coordination with U.S. Government partners to protect the United States and prevent the further spread of NWS. In May, USDA suspended imports of cattle, horses, and bison from Mexico, following recent detections of NWS as close as 370 miles from the border. In June, USDA announced the construction of an $8.5 million sterile NWS fly production facility in South Texas, aimed at bolstering their ability to control and eliminate this pest. Also, the new NWS Domestic Readiness and Response Policy Initiative outlines a five-pronged plan to mitigate the threat of NWS. In response to the travel-associated human case, USDA has initiated targeted surveillance for NWS in nearby areas of Washington, D.C., Maryland, and Virginia. As of September 5, no trap results have come back positive for NWS flies. Need-to-Know Information for Health Officials Veterinary Considerations Currently, the potential threat of NWS looms largest for livestock such as cattle, horses, and pigs — although no infestations in animals have been identified in the United States since the outbreak in Key Deer was eradicated in 2017. Coordination between public health agencies and the agricultural and animal health sectors is strongly encouraged as part of a One Health approach to strengthening disease surveillance. Veterinarians should report any suspicious cases in any animal species immediately to their state animal health official and to USDA-APHIS. HHS recently authorized FDA to issue emergency use authorizations for drugs to treat infestations in animals, should they be necessary. While no FDA-approved drugs currently exist for treating NWS infestation in animals in the United States, this may expedite the use of drugs approved for other purposes or those available in other countries to treat NWS-infested animals. Food Safety NWS is not transmitted through consuming appropriately cooked meat or poultry products. In addition, all livestock used for food production in the United States must pass inspection both before and after slaughter, and the presence of infestations or treatment residues that deem meat unsafe for human consumption will prevent the affected product from entering the food supply. Current Human Epidemiologic Situation Over the years, the United States has experienced occasional travel-associated cases of NWS in people traveling from endemic countries; however, the confirmation of a travel-associated case of NWS in Maryland marks the first human case of this parasitic infestation in the United States from the outbreak area. The patient has since recovered, and officials confirmed that there is no indication that the infestation spread to other humans or animals. At this time, there are no active human cases in the United States. The risk to public and traveler health in the United States remains low, and cases of NWS in humans remain much lower than animal cases in countries affected by the current outbreak in Mexico and Central America. Public health officials are encouraged to promote clinician awareness of NWS and consider developing coordinated public communications resources as necessary. Diagnosing and Reporting Suspected Human NWS Infestations Health care providers should remain aware of the risks in patients who have traveled to areas affected by the current outbreak, in addition to those where NWS is endemic. If a human case is suspected, providers should report it immediately to their local or state health department for further investigation. Any maggots found in suspected cases should be placed into a leak-proof container filled with 70% ethanol for proper disposal, and providers should contact CDC’s DPDx team for further specimen submission instructions. Proper disposal of suspected NWS larvae is critical to preventing the parasite from spreading to the environment. If a suspect case is identified, contact CDC (newworldscrewworm@cdc.gov) to obtain the case report form and case investigation guide. ASTHO will continue to monitor developments on this emerging public health issue. Supplemental Resources Overview of NWS – CDC About New World Screwworm Clinical Overview of New World Screwworm Acerca de la miasis por el gusano barrenador del Nuevo Mundo Información clínica sobre la miasis por el gusano barrenador del Nuevo Mundo Lab Identification of New World Screwworm (PDF) Local/State Public Health Departments Epi On Call by CSTE Clinical or Diagnostic Assistance – CDC Clinical inquiries and patient management related questions: parasites@cdc.gov or 404-718-4745. Direct after-hours inquiries to CDC’s Emergency Operations Center at 770-488-7100. Diagnostic assistance for suspected human cases: dpdx@cdc.gov. USDA New World Screwworm New World Screwworm: What You Need to Know PDF (English and Spanish) New World Screwworm Story Map Screwworm: An International Threat to Human and Animal Health (PDF) Veterinarians Report any suspicious cases immediately to your state animal health official and APHIS office. Insect Bite Prevention – CDC Preventing Mosquito Bites Preventing Mosquito Bites While Traveling About Permethrin-Treated Clothing and Gear How to Prevent Mosquito and Tick Bites Insect Repellents Repellents: Protection Against Mosquitoes, Ticks and Other Arthropods Reviewed by - Susan Kansagra article yes

Outcomes and Implications of ACIP’s Vote on the Hepatitis B Vaccine for Newborns Implications of ACIP Vote on Hepatitis B Vaccine for Newborns Susan Kansagra, Andy Baker-White, Kim Martin, Jessica Baggett Learn about the outcomes and implications of the December 2025 ACIP vote on the hepatitis B vaccine for newborns. On Dec. 4 and 5, the Advisory Committee on Immunization Practices (ACIP) held a long-anticipated meeting featuring two major topics of discussion: the hepatitis B birth dose and the pediatric vaccine schedule. The committee voted on two questions related to the pediatric hepatitis B vaccine schedule, both of which passed. To briefly summarize the outcome of the meeting, ACIP shifted from recommending a universal birth dose of the hepatitis B vaccine for all newborns to individualized decision-making for newborns born to HBsAg-negative mothers. There was no change to the recommendation for infants born to HBsAg-positive mothers or whose HBsAg status is unknown. CDC has not yet adopted these changes. In the meantime, many states are taking actions to provide clarity to providers and promote public confidence in the vaccine. How States Are Taking Action In response to (and in some cases before) the new ACIP recommendations, several states issued recommendations, guidelines, standing orders, executive directives, and health alerts for providers to provide clarity. States Recommending or Encouraging the Full Vaccine Series Some states are issuing their own guidance and recommendations for the hepatitis B vaccine series or encouraging providers to adhere to the series as is it was before the new ACIP recommendations: The Northeast Public Health Collaborative released a consensus statement before the ACIP meeting recommending the hepatitis B vaccine birth dose and a schedule that aligns with clinical recommendations. Collaborative members also issued statements reaffirming their adherence to established hepatitis B vaccine recommendations, including Connecticut, Maine, Maryland, Massachusetts, New Jersey, New York, Pennsylvania, and Rhode Island. Maryland also released guidance for parents and caregivers about its childhood immunization recommendations. States in the West Coast Health Alliance issued statements supporting the universal birth dose of the hepatitis B vaccine. These states include California, Hawaii, Oregon, and Washington. Many individual states also issued statements affirming the recommendation for the continued use of the hepatitis B vaccine birth dose, including Arizona, Colorado, Illinois, Michigan, New Mexico, and Vermont. States Issuing Standing Orders and Executive Directives At least two states issued a standing order or executive directive related to the hepatitis B vaccine: The Maryland Department of Health issued a standing order to ensure hepatitis B vaccine access for infants and children in the state. The standing order authorizes qualified health care providers to administer the hepatitis B vaccine and outlines the policies and procedures for administering the vaccine. In New Jersey, the acting health commissioner issued an executive directive recommending the hepatitis B vaccine birth dose and full series. States Issuing Public Health Alerts and Advisories Well before the recent ACIP meeting, the Maine CDC issued a health advisory to providers recommending the hepatitis B vaccine birth dose and full series. Since the ACIP meeting, at least two other states have released provider advisories. Maryland issued a letter to providers laying out the state’s hepatitis B vaccine recommendations, and New Hampshire issued a health alert with a continued recommendation for the full hepatitis B vaccine series and birth dose. In addition, Vermont sent a guidance letter to the providers in the state’s vaccine program. States Reexamine State Statutes and Agency Rules Linking to ACIP Recommendations Over the last several months, many states have proposed and enacted legislation to move away from sole reliance on ACIP recommendations. More recently, Massachusetts adopted H 4761, authorizing the health commissioner — in consultation with a newly established committee on immunization recommendations — to review and issue alternative standards to ACIP recommendations. States are also proposing changes to agency rules related to school and childcare immunization requirements. For example, Colorado’s health department has issued a proposed rule to modify the state’s standards for school and childcare immunization requirements and to align its rules with recent changes to state statute. Additional Considerations for States If CDC adopts the proposed ACIP recommendations, states can consider the following actions. Hepatitis B Screening States should continue to work with health care providers to close gaps in hepatitis B screening and follow-up for infants of HBsAg-positive mothers. Data show the most common cause of perinatal infection occurs when a mother with hepatitis B gives birth and the infant does not receive follow-up postexposure prophylaxis. Insurance Coverage While public and private insurance, including the Vaccines for Children program, are still required to cover the hepatitis B vaccine, such as any birth doses given to infants of HBsAg-negative mothers under shared clinical decision-making, states can consider creating additional coverage requirements. Some states have passed policies on insurance coverage, and other states have proposed legislation related to other vaccine coverage. Implementation of Shared Clinical Decision-Making While health care providers and parents have the flexibility to determine their approach for infants of HBsAg-negative mothers (i.e., continuing to recommend/give a birth dose), ACIP recommendations that rely on shared clinical decision-making have increased provider questions on how to have and document these conversations. States can work with medical associations, provider boards, and health care partners to ensure clinicians understand how to apply shared clinical decision-making recommendations. This includes educating staff in birthing hospitals, community clinics, and pediatric practices on how to counsel parents and document informed discussions. Jurisdictions can also develop or adapt educational materials and decision aids that clearly outline benefits, risks, timing, and follow-up options to support both providers and parents. More information on shared clinical decision-making is available from CDC and Common Health Coalition. States can also encourage providers and birthing institutions to examine workflows, Immunization Information System documentation, and follow-up to ensure scheduling of future doses. Implications for Vaccine Supply States can examine vaccine supply through the Vaccines for Children program to understand how the new recommendations impact supply of single antigen hepatitis B vaccines. If a significant percentage of the population receives vaccines on a different timetable, it could impact supply and timing for other vaccinations, given the reliance on combination vaccines for hepatitis B dose two and three, which can include DTaP, polio, and Hib vaccines. Supplemental Resources Common Health Coalition: Vaccine Resources December 2025 ACIP Meeting: Hepatitis B Updates for Health Leaders (PDF) Vaccine Integrity Project – Hepatitis B by Centers for Infectious Disease Research and Policy Understanding the Benefits of Vaccines: Common Questions by HealthyChildren.org Childhood Vaccinations (PDF) by Your Local Epidemiologist Hep B Birth Dose Media Toolkit by Hepatitis B Foundation Reframing the Conversation About Child and Adolescent Vaccinations by Frameworks Institute CDC: ACIP Shared Clinical Decision-Making Recommendations ACIP Meeting Materials for Public Posting: Hepatitis B Birth Dose Briefing Document (PDF) Hepatitis B Birth Dose Vaccination (PDF) article yes

A Difficult Week for Public Health: The Cost of Incomplete Efforts The Cost of Incomplete Public Health Efforts Due to Funding Cuts Susan Kansagra Hear from ASTHO's chief medical officer who discusses the implications of funding cuts on public health. Last week state, territory, and local public health departments received abrupt notices terminating several CDC funding streams that covered a range of public health activities. While the rationale given was that these funds supported COVID-19 (no longer a declared public health emergency), the reality is that the funds supported public health response infrastructure as a whole — both for COVID-19 and for other health threats. While some jurisdictions may be able to absorb or reprioritize activities, most are reporting detrimental impacts on their ability to deliver public health services. Here are just a few of the impacts we’re hearing from states/territories, locals, and partners. A House Without a Roof First, the funding cuts will halt technology improvements and data systems modernization that would have made sharing information with health care facilities and the public timelier and more efficient. In addition to impacting future work, cutting funding early for these public health technology improvements results in waste of past work. Why? It’s like building four walls of a house and then abruptly stopping construction before the roof is in place. The usefulness of the whole house goes to waste. This is the quandary that many health departments are facing as funding terminates for updates already underway to immunization, surveillance, and case reporting systems as well as laboratories themselves. The First Line of Defense Against Health Threats When you walk into an emergency room you expect a health care provider to treat you. Likewise, when an outbreak occurs, public health expects it will step in to contain disease spread and protect the community. For some states, these funding cuts disrupt the very core duties of what health departments do to detect and respond to health threats like measles, H5N1, and mpox. And that’s to say nothing of diseases we don’t know about yet. For example, these funds were allocated by Congress to support lab capacity including specialized lab personnel and equipment. So, if there is a suspected or known measles or foodborne outbreak, many health departments will have less capacity to quickly test and use that knowledge to prevent people from getting sick. They will also have limited capacity to deliver treatments and vaccinations directly to people. For some communities, that will mean fewer clinic hours, longer waits, and delays in accessing care. Timing and Communication Matter In addition to the impact of the cuts themselves, public health departments report struggling with how abruptly they learned about them. Many public health workers found out about funding termination the same day the funding ended. The suddenness felt akin to shutting off the lights to the operating room while the surgeon is still in the middle of a procedure. In short, while the cuts themselves had a health impact, so did the lack of notice. For some funding streams, health departments were already preparing to close out the funds, but for many it created unnecessary disruption for people still depending on the services from these funds today. Overall, most jurisdictions report that the loss of these activities leaves an immediate hole in public health infrastructure that will impact their ability to respond to health threats both now and into the future. article yes

Meet ASTHO's new Chief Medical Officer, Susan Kansagra, and learn about her public health priorities in this blog post.

The Public Health Response to Hantavirus: Key Actions, Perspectives, and Takeaways Public Health Response to Hantavirus: Key Takeaways Ericka McGowan, Sidnie Christian, Margaret Nilz Learn about the hantavirus outbreak from the MV Hondius and the ongoing public health response — including the important work of state and local health departments. On May 2, the World Health Organization (WHO) received notification of an international hantavirus cluster linked to passengers aboard the MV Hondius cruise ship, following reports of severe acute respiratory illness. Subsequent laboratory testing confirmed infection with the Andes strain of hantavirus, a rare zoonotic virus associated with hantavirus pulmonary syndrome. The event drew international public health attention because of the distinct challenges posed by the cruise ship setting, the need for multi-country coordination as exposed passengers returned home, and the involvement of the Andes virus — which can be transmitted person to person unlike other strains of hantavirus. In response, WHO and U.S. health authorities initiated contact tracing and surveillance to monitor for additional cases. Despite international attention, the risk to the public is low at this time. However, it remains crucial for state and territorial health officials to stay up to date on this developing threat, which serves as an important reminder that public health preparedness is more critical than ever. What Is Hantavirus? Hantaviruses belong to the family Hantaviridae within the order Bunyavirales and are primarily spread through contact with infected rodents (i.e., via exposure to their urine, droppings, saliva, or contaminated surfaces). Various strains exist globally, including the Sin Nombre virus, predominant in North America, and the Andes virus, predominant in South America. In humans, clinical signs are non-specific, including fever, fatigue, muscle aches, headache, and gastrointestinal symptoms. In severe cases, infection may progress to hantavirus pulmonary syndrome, with rapid onset of cough, shortness of breath, and fluid accumulation in the lungs. The recent cases raised concerns as the cruise ship setting likely facilitated exposure among passengers and crew. Additionally, the expedition's international nature meant potential exposure across multiple countries, with passengers disembarking before confirmation that illnesses on board were due to Andes virus — thus requiring coordinated surveillance, contact tracing, and risk communication among national health agencies. The particularly long incubation period of the Andes virus, 4-42 days after exposure, further complicates monitoring. MV Hondius Hantavirus Outbreak: Key Insights Timeline In early April, the MV Hondius ship departed Argentina. On April 11, the first case died on board, and a close contact died shortly after. On April 28, a passenger experienced onset of symptoms, later presenting with pneumonia, and died on May 2. On May 2, the United Kingdom reported a cluster of passengers with severe respiratory illness to WHO. At the time of reporting, 147 passengers and crew were on board while 34 passengers had disembarked. On May 2, PCR testing confirmed hantavirus infection of a probable case. On May 10, the MV Hondius was permitted to dock and let passengers disembark in the Canary Islands off the coast of Spain. Passengers were then transported to their home countries via non-commercial means. On May 11, U.S. passengers arrived at the National Quarantine Unit (NQU) in Nebraska for evaluation and monitoring. WHO and CDC continue to provide updates as the situation evolves. Risk to the Public While the risk to the public remains low, it is important for public health authorities to assess and monitor contacts closely during the 42-day period for symptoms, as deterioration can occur quickly. Monitoring and assessment are collaborative efforts supported by CDC and led by state and local health departments. CDC released interim risk assessment guidance to support health departments in managing people with potential exposure related to the MV Hondius. It provides definitions of high- and low-risk contacts, recommended care, monitoring, and guidance to reduce the risk of transmission and exposure. A Coordinated Public Health Response This outbreak punctuates the importance of international and federal agencies, state and local health departments, laboratories, health care systems, and specialized treatment centers working together to manage emerging threats. Shared guidance and regulations were necessary to help standardize monitoring and response efforts. WHO coordinated with 10 countries to ensure timely information sharing, response, repatriation, and contact tracing. Domestically, the U.S. Department of State, Health and Human Services Administration of Strategic Preparedness and Response (ASPR), and CDC coordinated to form the domestic hantavirus taskforce. Together, the agencies have managed: U.S. passenger transport and repatriation. International coordination and communications. Access to health care and treatment structure. Quarantine and preparedness assets. Disease surveillance. Epidemiologic support. Risk assessment. Public communication. Coordination with state and local public health departments. This response highlights the expertise, logistics, and coordination required to manage high-consequence public health threats. Specialized Response Systems Responses to high-consequence infectious diseases (HCID) often require specialized infrastructure beyond routine health care. During events like this Hantavirus cluster, quarantine facilities, treatment centers, and coordinated health care networks help safely manage potentially exposed travelers while supporting health care system readiness. Together, these specialized preparedness systems help ensure that patients can be safely evaluated and treated while minimizing disruption to broader health care operations during HCID emergencies: The NQU at the University of Nebraska Medical Center and the Global Center for Health Security is a key component of this infrastructure. This unit is specifically designed to support quarantine and individuals exposed to HCIDs. U.S. passengers returning from the cruise ship were transported to Nebraska for assessment and monitoring, including one asymptomatic passenger who was admitted to the Medical Center’s Biocontainment Unit for further evaluation but has since been cleared to return back to the NQU. Regional Emerging Special Pathogen Treatment Centers (RESPTCs) serve as specialized hubs within the National Special Pathogen System. ASPR funds 13 RESPTCs in the United States to support management of care related to high consequence pathogens. The system is designed to distribute specialized care, offset operational burden, and maintain national surge capacity during complex infectious disease responses. ASPR’s Hospital Preparedness Program provided additional preparedness aid. This program supports health care coalitions and strengthens coordination among hospitals, emergency management agencies, public health departments, and health care partners. By advancing planning, training, exercises, and regional coordination, it helps health care systems maintain surge capacity and preparedness for complex emergencies. The Laboratory Response Network, which supports responses to biological threats, emerging infectious diseases, and other public health emergencies, plays a role in public health responses by supporting epidemiologic investigations and providing timely laboratory information to guide monitoring and response activities. In response to this Hantavirus cluster, the Association of Public Health Laboratories activated its Incident Command System to help support a coordinated laboratory response to the Andes virus. The Role of State and Local Health Departments State, territorial, and local public health agencies play a central role in infectious disease responses, especially when exposed travelers cross jurisdictional boundaries. For this response, agencies coordinated contact tracing, symptom monitoring, health care communication and preparation, laboratory coordination, and public risk communication. State and Territorial State and territorial health agencies serve as the primary lead for investigating and managing public health emergencies within their jurisdictions. In addition to coordinating with federal partners, health care systems, and laboratories, state and territorial health agencies may exercise legal authorities (i.e., isolation and quarantine) when necessary to help contain infectious disease threats. Their role helps translate national guidance into coordinated, jurisdiction-specific response activities. Local Local health departments also play a multifaceted role in outbreak response through community-level coordination, health care access, communication, and follow-up for potentially exposed individuals. In some states, local health departments also have the authority related to quarantine and isolation to prevent spread of public health threats. Local health departments help connect public health agencies, health care, emergency management partners, and community organizations to facilitate operational coordination and timely information sharing. Support from the Public Health Emergency Preparedness Cooperative Agreement Many of these preparedness and response capabilities are supported by the Public Health Emergency Preparedness cooperative agreement, which has helped health departments across the country strengthen their ability to respond to infectious disease outbreaks, natural disasters, and other public health emergencies since 2002. It supports surveillance capacity, emergency coordination, epidemiology staffing, and risk communication capabilities while helping jurisdictions build flexible and adaptable preparedness systems before emergencies occur. Events like this recent Hantavirus

Understanding Current U.S. Measles Outbreaks and Elimination Status Current U.S. Measles Outbreaks and Elimination Status Jessica Baggett, Susan Kansagra, Meredith Allen, Kimberly Martin Understand current U.S. measles outbreaks and the country's elimination status, following recent outbreaks and the highest case counts in decades. In 2016, the Pan American Health Organization (PAHO) declared the elimination of measles in the Region of the Americas, marking a monumental public health achievement. But in 2025, that progress came under threat and remains at risk at the top of 2026 — as recent measles outbreaks have driven the highest case counts in decades, prompting health agencies to reassess elimination status. Current Outbreaks Jan. 21 marks one year since the first U.S. measles outbreak of 2025 was reported. The United States went on to experience its worst year for measles in over three decades, with 2,144 confirmed cases. According to CDC, there were 49 outbreaks in 2025 and 88% of confirmed cases (1,884 of 2,144) were outbreak-associated. For comparison, 16 outbreaks were reported during 2024 and 69% of cases (198 of 285) were outbreak-associated. Most 2025 cases occurred in unvaccinated (93%) or under-vaccinated (3%) individuals, and three deaths were confirmed. Measles Elimination These outbreaks put the United States at risk of losing elimination status if transmission of the same strain continues for 12 months uninterrupted. In public health terms, “elimination” means that a disease’s continuous (endemic) spread within a region has ceased for at least 12 months. While it doesn’t necessarily mean zero cases, it does mean that local chains of transmission have been interrupted. The United States achieved elimination status in 2000 due to high coverage with the measles, mumps, and rubella (MMR) vaccine, strong disease surveillance, and public health response to isolated cases. Other countries in the Americas followed similar paths. As a result, PAHO verified the region as measles-free for years. Why Elimination Status Matters Elimination is more than a label. It reflects protective immunity within a population and the capacity of the public health system to prevent sustained outbreaks. When elimination status holds: Transmission is less likely, preventing widespread illness and death. Health care systems avoid unnecessary strain from preventable care utilization. Public health systems circumvent the toll of managing large outbreaks. Vulnerable groups (i.e., infants too young for vaccination, immunocompromised people) are better protected. Public confidence in immunization programs remains strong. What Happens if Elimination Is Lost? In November 2025, PAHO announced that the Region of the Americas — including the United States and Canada — lost measles elimination status after endemic transmission persisted, especially in Canada, for more than 12 months. This means that measles is once again circulating continuously within the region rather than only in isolated imported cases and quickly contained outbreaks. CDC is currently working with state and local health officials to analyze data and determine individual U.S. status, assessing if the various outbreaks are linked, which would signify ongoing transmission rather than individual introductions of disease. In November 2025, Canada officially declared their lost elimination status following prolonged transmission in 2024-2025. Ongoing outbreaks in Mexico and other parts of the Americas further contributed to the rise in regional case counts. Finally, PAHO invited both the United States and Mexico to a virtual meeting on April 13 to review their current measles elimination status. Endemic transmission makes outbreaks larger and more frequent, and increases the number of people who become ill, particularly those not protected by vaccination. Ongoing measles transmission also requires additional public health resources including expanded surveillance, outbreak response, and efforts to raise vaccination coverage, especially in communities with low immunization rates. This adds strain to health departments which often have fixed resources, with one study estimating the average cost per measles case at nearly $60k when including the public health perspective. Measles transmission in the United States has disproportionately impacted communities with lower vaccination rates. Therefore, the loss of elimination status could necessitate greater attention to vaccination recommendations for international travelers coming to the United States, particularly for infants. For example, similar to U.S. recommendations for those traveling internationally, Australia suggests that infants 6-11 months traveling to areas where measles is endemic or having an outbreak can get assessed for an earlier dose of the measles vaccine. Response Strategies for Public Health Departments While the United States works to determine its official status, there are many activities state and territorial public health departments continue to implement to prevent the spread of measles: Vaccination Campaigns The MMR vaccine is highly effective in preventing measles, with CDC reporting 93% protection after one dose and 97% after two doses. Herd immunity is a critical preventive measure that interrupts transmission and requires approximately 95% of the population to be vaccinated. Despite this strong science, falling vaccination rates driven by hesitancy, misinformation, and gaps in access have left pockets of the population vulnerable. Boosting vaccination is the most effective way to stop outbreaks, protect children and adults (particularly those who can’t get vaccinated), and prevent hospitalizations and deaths. Examples of vaccination campaigns include New York’s “Immunization Is Protection” and Minnesota’s reminders about immunization importance. Analyzing Local Data to Identify High Risk Sub-Populations Public health departments are evaluating local Immunization Information System data to identify sub-populations with lower measles vaccination rates, areas with high exemption rates, and settings with persistent under-immunization. Examples include Illinois’ Vaccination Coverage Dashboards, Washington’s Immunization Measures by County Dashboard, and American Immunization Registry Association’s Small Area Analysis. Understanding which populations are at higher risk can inform education and outreach activities. Establishing Relationships with Trusted Community Messengers Identifying under-vaccinated sub-populations is only beneficial when health departments build trust and authentic engagement within communities. They must work with trusted messengers such as faith leaders, community health workers, and local organizations to co-develop and amplify messages about measles risks and the importance of MMR vaccination. In addition, it is important to tailor communication materials to reflect community languages, values, and concerns. Communities are more likely to accept and act on respectful, relevant messaging. Examples of successful community partnerships include the Palmetto Community Action Partnership, the Enrichment Services Program, and the Community Action Program for Central Arkansas. Read ASTHO’s “Championing Change” Toolkit for more information and examples. Supporting Health Care Systems and Providers Clinicians remain highly trusted voices within communities. Health departments equip providers with up-to-date information and resources to ensure they are prepared to recognize, test, report, and manage measles cases effectively. Examples of these resources include CDC’s Be Ready for Measles Toolkit, Arizona’s Measles Surveillance Toolkit, South Carolina’s Measles Clinical Assessment Guide, and North Carolina’s Measles (Rubeola) Resources for Health Care Providers. article yes

On March 3, 2025, ASTHO announced that Susan Kansagra would be joining the organization as Chief Medical Officer.

Recording Available: State Health Leaders Convene During ASTHO Deskside Briefing to Rally Behind Chronic Disease Prevention in U.S. ARLINGTON, VA — On June 24, the Association of State and Territorial Health Officials (ASTHO), convened state health officials for a deskside media briefing focused on the impact of nutrition on chronic disease prevention in the United States. The event highlighted how strategic public health investments can help reduce chronic disease nationwide and help Americans lead healthier lives. “We know chronic disease is a leading cause of death in the United States. It’s something that state health departments have particularly been working on for a long time," says ASTHO Chief Medical Officer Susan Kansagra, MD, MBA, who moderated the discussion. “Obesity makes every chronic disease harder, it just makes life harder. I’m thrilled that this is a national priority. I welcome it,” says James McDonald, MD, MPH, commissioner of health, New York State Department of Health. “I think if we can get our handle on obesity as a nation then this is just one of the ways you can make us all healthier again.” “I am ecstatic that we as a nation and here in the state of Indiana with our Make Indiana Healthy Again plan are talking about nutrition and physical activity,” says Lindsay Weaver, MD, state health commissioner, Indiana Department of Health. “Frankly, it’s going back to the basics. It’s educating new moms and families. It’s working closely with our schools and education.” “Our legislators see the problem in their communities and we are working with them to be a part of the solution. Here in Tennessee, the General Assembly recently passed a law to expand the amount of time children have to be physically active at school,” says Ralph Alvarado, MD, commissioner, Tennessee Department of Health. Dr. Alvarado also discussed valued partnerships with faith-based communities, volunteer Health Councils which exist in every county in Tennessee, and the growing interest in ‘Blue Zone’ concepts -including in many rural parts of the state.” View the recording of ASTHO’s deskside media briefing. ASTHO Press Release Boilerplate website yes