American Diabetes Month

November marks American Diabetes Month and, this year, it’s happening along with an early onset of the flu season.

In Virginia, more than 740,000 people are at a higher risk of severe complications from the flu that can lead to hospitalization or sometimes death, says the Centers for Disease Control and Prevention. In recent flu seasons, about 30 percent of adults with flu in hospitals had diabetes.

People who have diabetes have a higher risk of heart disease, stroke or other problems such as kidney failure, blindness, and amputation of a toe, foot, or leg.

Diabetes Month also is an opportunity to learn more about the disease and the challenges of managing diabetes.

Virginia’s plan to help fight diabetes includes federal money to take part in the National Diabetes Prevention Program. It’s a partnership of public and private organizations working to prevent or delay type 2 diabetes. The program helps make it easier for people at risk for type 2 diabetes to participate in programs that help them reduce their risk through healthy habits.

Those diagnosed with diabetes can get help through Diabetes Self Management Education and Support programs. The DSMES services help diabetics learn about taking medicines, planning healthy meals, and being active. Diabetes care and education specialists work with diabetics on a plan that works for them. To learn about the types of diabetes, visit the American Diabetes Association’s website.

One in three Virginians has prediabetes, and most do not know it. To learn whether you are at risk for prediabetes, take the Prediabetes Risk Test. Prediabetes can be reversed before it becomes Type 2 Diabetes. The Diabetes Prevention Program is a year-long program, funded by private and public institutions (and free to you), that focuses on lifestyle change. For help finding a program, visit the Virginia Diabetes Council’s website. 

October is National Pharmacists Month! Learn a little more about the Pharmacists within VDH who serve the Commonwealth of Virginia.

The Division of Pharmacy Services supports the Department of Health in its public health mission by providing vaccines, pharmaceuticals, pharmaceutical services, and biologicals to other divisions within the Department of Health and to the local health departments.

What does the VDH Division of Pharmacy Services (DPS) do?

  • DPS supports the local health departments by providing vaccines, medications, medical supplies, drug information services, and biologics for programs that include: 
    • Providing treatments for sexually transmitted or communicable diseases including tuberculosis and HIV
    • Providing vaccines for influenza, foreign travel, and for patients who are not eligible for the Vaccines for Children Program
    • Providing pharmaceuticals to support metabolic disorders and hemophilia
  • DPS provides naloxone and drug disposal bags to First Responders, Comprehensive Harm Reduction Sites, Community Services Boards, local health departments, the Department of Corrections, and public schools.
  • DPS also collaborates with the Department of Education to provide epinephrine, albuterol, and supplies to public and private schools across Virginia. 
  • They also respond to public health emergencies including pandemics, bioterrorism, and natural disasters.
  • They provide clinical support to healthcare providers and manage inventory of medications to treat communicable diseases and chronic diseases. 

To support all of these programs, the Pharmacy Shipper ships an average of 150 boxes of medications and supplies per day and receives at least 20 boxes a day!

What other roles do Pharmacists play in VDH?

  • Pharmacists can assist patients in learning to take care of their health, from managing their medications and implementing lifestyle changes.
  • Pharmacists often also counsel patients on how to take medications correctly.
  • Another role of the pharmacist is ensuring medications don’t interact with other medications the patient is taking.
  • They may also process bulk orders, manage inventory and supply, and provide training to other providers. 
  • Pharmacists provide important perspective, input and leadership for public health programs and response efforts such as monkeypox and COVID-19. 

The pharmacy services team includes pharmacists, pharmacy technicians, pharmacy interns, and other support services. VDH thanks the Division of Pharmacy Services and all of the Pharmacists throughout VDH for their dedication, effort, and work for all people of the Commonwealth of Virginia. 

Bird flu found across Virginia expected to increase, but poses low risk to humans

A bird flu virus – a Eurasian strain of H5N1 – that has been spreading across the country has a low risk of infecting people. The virus, also called avian flu, was first found in wild birds, commercial poultry and backyard flocks in January 2022. It has infected several million wild and domestic birds across the country (and the continent) and is still being found. The number of infections is expected to grow during the winter..   

Bird owners should review their biosecurity steps and stay aware to protect poultry and pet birds from this disease. Get more information from the USDA’s Defend the Flock Program.

Usually, the virus causes illness and death in birds, but doesn’t cause wildlife to get sick. In this outbreak, large wild birds such as vultures and Canada geese have died off across the country. Some mammals such as foxes and otters have been infected, but that hasn’t been seen often. 

People who need to dispose of dead birds should wear appropriate clothing and protective equipment (PPE), including eye protection, a well-fitting mask, gloves, and protective outer clothing (gown or coveralls). The level of PPE needed may depend on the situation. Workers who deal with a large number of sick or dead birds should wear PPE and follow instructions from their agency. A situation with a large number of dead wild birds can be reported to the Department of Wildlife Resources through their wildlife helpline: 1-855-571-9003. This helpline is staffed Monday-Friday during normal business hours.

People who have direct contact with infected animals that are dead or may be sick, including sick animals that might have eaten birds infected with avian flu, should watch for symptoms that include fever or feeling feverish/chills, cough, sore throat, difficulty breathing/shortness of breath, conjunctivitis (eye tearing, redness, irritation, or discharge from eyes), headaches, runny or stuffy nose, muscle or body aches, and diarrhea. You may not have a fever. Anyone who is sick  within 10 days of exposure to an animal that may be infected should call their local health department and get tested if needed.

So far, this virus has been detected in millions of birds. With close monitoring of people who have been in contact with infected birds, only one person has tested positive for this virus. This person had direct exposure to infected poultry, was mildly sick and has recovered. The U.S. Department of Agriculture (USDA) continues to test for and watch this virus and other similar viruses. Right now, officials haven’t found any evidence that this virus could cause a pandemic.

More avian flu information and resources are available at the links below.

You can avoid a fright this Halloween by making sure your trick-or-treaters are safe.

We’ve rounded up some tips to help, from choosing costumes and checking candy to hosting a party at home.

Trick-or-Treating 

  • Stay home if you’re sick and stay away from those who are ill. 
  • Children shouldn’t snack on treats from their goody bags while they’re out trick-or-treating. Give them a light meal or snack before they head out – don’t send them out on an empty stomach. Urge them to wait until they get home and let you inspect their loot before they eat any of it.  
  • Prepare your trick or treater with trick or treat safety items: a flashlight, reflective tape or strips applied to costumes and candy bags, and an emergency contact information card in case they get lost or separated from the group.
  • Trick or treat as part of a large group with a responsible adult.
  • Walk on sidewalks whenever possible, or on the far edge of the road facing traffic to stay safe.
  • Look both ways before crossing the street at a crosswalk or intersection.
  • Walk, don’t run between houses to avoid trips and falls.
  • Keep your hands clean by using hand sanitizer. If you’re giving out candy, wash your hands frequently.
  • Never take candy from strangers. Parents should only allow kids to go to homes in which they know the residents. 

Check Your Treats

  • Homemade is not preferred. Parents are advised to only allow children to eat candy that has been pre-packaged by a reputable manufacturer. Check wrapped treats for signs of tampering. Throw away anything that is discolored, has tiny pinholes or that has a torn wrapper.
  • Illegal drugs may be made look like popular candy brands; these are known as “look-alikes.” If you suspect your child’s candy contains illicit or illegal substances, call your local police department.
  • Pets like candy, too. Many candy items, including chocolate, are poisonous to pets. Use this as a chance to teach children about pet safety and the need to properly store candy. 
  • Lock your stock. Locked medicine cabinets keep look-alike prescription and over-the-counter medications away from children who can easily mistake them for candy. 
  • If your child has a food allergy, check the label to ensure the allergen isn’t present. Do not allow the child to eat any home-baked goods he or she may have received.
  • If you have very young children, be sure to remove any choking hazards such as gum, peanuts, hard candies, or small toys.
  • Call the Poison Control Hotline (1-800-222-1222) to report any incidents and receive trained medical advice. Officials also recommend putting the number in all family cell phones as well as programming it as a speed dial number on landlines, and posting the number near house phones. Medical professionals including physicians, registered nurses and pharmacists offer confidential advice on poison emergencies, poison prevention, drug information, food poisoning, animal bites and more. They are available 24 hours a day, 7 days a week. 

Costumes

  • Do not wear decorative contact lenses without a prescription. Decorative lenses purchased without a prescription may not fit properly, leaving the eye more susceptible to scratches on the outer layer of the eye, or getting an ulcer (an open sore) on the cornea—the clear covering over the front of the eye.
  • Painting your face can be a fun alternative to wearing a mask. Test novelty makeups in a small area on the arm to test for an allergic reaction before applying it to your face. Remove all makeup according to the manufacturers’ instructions before bedtime to prevent possible skin and eye irritation.
  • Make sure costumes fit well to avoid blocked vision and help prevent trips and falls.
  • Choose costume accessories that are short, soft and flexible. Choose items that are made of materials such as plastic or foam.

Parties 

  • Skip the Halloween party if you aren’t feeling well.
  • Bobbing for apples is a favorite Halloween game, but make sure the apples are rinsed well under cool running water or use a produce brush to remove surface dirt before playing. 
  • Check your cider. Unpasteurized juice or cider can contain harmful bacteria such as Salmonella. To stay safe, always serve pasteurized products at your parties.
  • Don’t taste raw cookie dough or cake batter that contains uncooked eggs.
  • If you’re serving hot foods, cook everything to a safe minimum internal temperature to get rid of any foodborne illness bacteria.
  • Keep finger sandwiches, cheese platters, fruit or tossed salads, cold pasta dishes with meat, poultry, or seafood, and cream pies or cakes with whipped-cream and cream-cheese frostings chilled until serving time.
  • Don’t let those types of foods sit out too long after taking them out of the refrigerator. They should not sit out for more than two hours. 

 

Hurricane Preparedness and Your Pet

When you are making a plan and building your kit, be sure to include your pets and plan for their safety during an emergency.

Make a plan for your pet.

  • Find out ahead of time if public shelters and hotels in your area accept pets. Most American Red Cross shelters cannot accept pets, but service animals that assist people with disabilities are allowed.
  • Assign a family member to be responsible for your pet’s needs in an emergency. Talk with your neighbors, family and friends about taking care of your pets or getting them to safety if your family is not able to.
  • Get your pet microchipped and have copies of vaccine records with your current address and phone number. Include an emergency contact such as a relative of friend outside your local area. Include a copy of your pet’s registration information.
  •  Take a photo of yourself with your pet to help you prove ownership and identify your pet in case you are separated. Keep contact information of your local animal control office and shelters in case they find your pet.
  • Include your pets in family evacuation drills to make sure they get used to calmly getting into a crate or carrier.

Build a kit for your pet that includes the following:

  • Food and water: Include food and water for several days in your kit. Make sure the food container is airtight and waterproof. Don’t forget bowls.
  • Medicine: Keep extra medicine that your pet takes regularly. Keep it in an airtight container.
  • First aid supplies: Have items on hand that are specific to your pet’s needs. 
  • Collar, ID tag, leash or harness: Keep a backup collar and leash in your kit along with an ID tag that has current contact information.
  • Crate or carrier: Have a separate carrier for each pet, if possible.
  • Grooming items: Put shampoo and other items you use to clean your pet into your kit.
  • Sanitation items: Pet waste bags, litter and a litter box are items to include in your kit.
  • Comfort items: Toys, treats and bedding that help your pet feel more comfortable and help reduce stress are a good idea to include in your kit.

Large animals and livestock:

  • Large animals: Consider evacuating large animals and move them sooner rather than later.
  • If possible, move livestock to higher ground. If you use a horse trailer, move the animals as soon as possible.  
  • Make sure you have a second route mapped out in case your original route is blocked or backed up.
  • Make sure the place you plan to take your animals has food, water, veterinary care and equipment to handle the animals.
  • If you cannot evacuate the animals, you must decide whether to move them to a barn or turn them loose outside.

For additional information on how to care for pets and other animals during and after a storm, visit the following sites:
American Humane
ASPCA
American Red Cross 

 

VDH Urges Caution In Advance of Severe Weather

RICHMOND, VA — The remnants of Tropical Storm Ian are expected to impact areas of the state beginning Friday, September 30 through the weekend. This storm could create dangerous conditions in creeks, rivers, and low lying areas along the coast. The Virginia Department of Health (VDH) reminds people to take precautions to be prepared for severe weather and once the sun comes out, be aware of potential health risks before you participate in recreational water activities.

“I encourage everyone, especially those with travel plans, to pay close attention to storm updates, plan appropriately, and take proper precautions as the storm arrives,” said State Health Commissioner Colin M. Greene, MD, MPH. “Be safe; stay safe.”

Heavy rains can increase the risk of animal waste and the potential release of inadequately treated wastewater from sewage treatment plants. Bacteria, debris, and other pollutants in rainwater runoff end up in rivers, lakes and streams, which can pose risks to human health and safety. Rain events also cause flooding and fast-moving waters, especially in low-lying areas.

The most common illnesses from contaminated water are gastrointestinal illnesses. These illnesses may cause vomiting, diarrhea, nausea, abdominal pain or fever and are a result from swallowing water contaminated by disease-causing microbiological organisms. Additionally, contact with contaminated water has the potential to cause upper respiratory (ear, nose, throat) and skin infections.

VDH recommends avoiding swimming in fast-moving water as there is a drowning risk. Boaters, kayakers, canoeists, etc. face an elevated risk in high waters and should not try to navigate in fast-moving waters.

VDH recommends the following safety tips for people planning to swim, wade, kayak, canoe or go rafting in Virginia natural waters after heavy rains:

  • Everyone should wear a life vest at all times on the water.
  • Avoid getting water in your mouth. Never swallow water from an untreated water source.
  • Don’t swim if you have broken skin. Bacteria, viruses and other organisms can infect wounds causing more serious illness.
  • Shower with soap and water after recreating in natural waters.
  • Don’t swim when you are ill.
  • Avoid swimming if dead fish are present.
  • Use extreme caution and avoid unnecessary risks if you encounter covered roads or fast-moving waters. The water may be deeper and moving faster than you think.

Residents or facilities that provide water to the public including campgrounds, restaurants, or daycares with private wells or septic systems submerged by flood waters should also take extra precautions.

For more information and safety tips regarding private wells and septic systems visit http://www.vdh.virginia.gov/environmental-health/responding-to-an-emergency-affecting-your-private-well/.

To contact your local health department, visit http://www.vdh.virginia.gov/local-health-districts/ or call 877-ASK-VDH3 (1-877-275-8343).

To contact your local health department, visit http://www.vdh.virginia.gov/local-health-districts/.

For more information regarding recreation water safety tips, including the Virginia Department of Health’s “Safely Enjoy Virginia’s Natural Waters” brochure, visit: www.SwimHealthyVA.com.

World Rabies Day, September 28, 2022

Rabies is a virus that is commonly found in Virginia’s wildlife, especially in certain wild animals such as raccoons, skunks and foxes.  It’s important to remember though that any mammal can get rabies and so it’s important to take some basic precautions to help protect you and your pets from being infected.  Remember to protect yourself and your pets from rabies exposures by following these simple steps:

  • Have your veterinarian vaccinate your dogs, cats, ferrets, and selected livestock. Remember to keep their vaccinations up-to-date.
  • Contact your local health department or animal control authorities if your pet is attacked or bitten by a wild animal.  Depending on the situation, keep in mind that your pet may need a rabies booster vaccination and be restricted to your property for a period of time after the wildlife exposure. 
  • Wash animal bite wounds thoroughly and report the bite to your local health department.  
  • Limit the possibility of exposure to rabies by keeping your animals on your property. Don’t let pets roam free.
  • Keep garbage or pet food inside. Leaving garbage or food outside may attract wild or stray animals.
  • Enjoy all wild animals from a distance, even if they seem friendly, and NEVER keep wild animals as pets. A rabid animal sometimes acts tame. If you see an animal acting strangely, especially if rabies exposures may have occurred, report it to your local animal control department and do not approach it.
  • Contact the Virginia Department of Wildlife Resources to find a licensed wildlife rehabilitator for guidance if you think a wild animal needs help. DO NOT take matters into your own hands. 
  • Bring stray domestic animals, especially if they appear ill or injured, to the attention of local animal control authorities. If you think a stray animal needs help, contact your local animal control office for guidance.

VDH Further Expands Eligibility for Those Seeking Monkeypox Vaccination

Today, the Virginia Department of Health (VDH) announced a further expansion of eligibility for JYNNEOS, the monkeypox vaccine. Newly eligible for vaccination in Virginia are persons of any gender or sexual orientation living with HIV/AIDS or who have been diagnosed with a sexually transmitted infection in the past three months.

“VDH is taking this step to expand eligibility for the JYNNEOS monkeypox vaccine to ensure as many people at high risk of contracting this disease who want to get vaccinated can do so if they choose,” said State Health Commissioner Colin M. Greene, MD, MPH. “Maximizing effectiveness of prevention and treatment against monkeypox now is our best chance to keep it from becoming entrenched in the United States.”

In Virginia, as of Monday, September 26, there were 464 cases of monkeypox, 249 of those Northern Health Region consisting of the Alexandria, Arlington, Fairfax, Loudoun and Prince William Health Districts. Across the state, 21 cases have required hospitalization.

The newly expanded eligibility criteria for vaccination now include additional populations in Virginia. Those who meet one or more of the following are eligible to receive the monkeypox vaccine:

  • Any person, of any sexual orientation or gender, who have had anonymous or multiple (more than one) sexual partners in the past two weeks; or
  • Sex workers of any sexual orientation or gender; or
  • Staff, of any sexual orientation or gender, at establishments or events where sexual activity occurs; or
  • Any person, of any sexual orientation or gender, who is living with HIV/AIDS; or
  • Any person, of any sexual orientation or gender, diagnosed with any sexually transmitted infection in the past three months.

Virginia has received a limited supply of JYNNEOS vaccine. If you are eligible, visit your local health district website to learn about how you can access the vaccine. You may use this locator tool to determine which local health district you reside in.

As of September 26, VDH has overseen administration of 9,860 first doses of the two-dose JYNNEOS series and 4,948 second doses.

Monkeypox is a contagious rash illness caused by the monkeypox virus. In most cases, it resolves without treatment. It is spread by close contact with an infected person. Close contact includes touching skin lesions, bodily fluids, or clothing or linens that have been in contact with an infected person. Spread can also occur during prolonged, face-to-face contact.

While anyone, regardless of gender identity or sexual orientation, can catch monkeypox if they have close contact with someone with monkeypox, many of those affected in the current global outbreak are gay, bisexual, or men who have sex with men. While this level of monkeypox activity is unexpected, the risk to the general population is low. People with monkeypox in the current outbreak generally report having close, sustained contact with other people who have monkeypox.

The highest risk activity currently is having sex with multiple or anonymous partners; avoiding these activities greatly reduces one’s risk of catching or spreading monkeypox. Monkeypox does not spread from person to person from walking past someone who is infected or through casual conversation with someone who is infected. Because we are still learning about the vaccine’s effectiveness in the current outbreak, vaccinated individuals should continue to take steps to protect themselves from infection.

Initial symptoms of the disease often include flu-like symptoms, such as fever, headache, muscle aches, and swollen lymph nodes, followed by skin lesions. However, some people have a rash without other symptoms. Although the majority of cases don’t require hospitalization, the rash can be painful. If you have a rash that resembles monkeypox, talk to your healthcare provider about whether you need to get tested. Treatment is available for those at risk of severe illness.

For the latest information about monkeypox from VDH, visit our monkeypox information webpage: www.vdh.virginia.gov/monkeypox/.

Prescriptions: Prepare Your Medicine Cabinet for an Emergency

Many people depend on daily medications. Nearly half of Americans take at least one prescription medication; 1 in 4 take three or more. A large-scale natural disaster, such as a hurricane, or other emergency could make it difficult to find an open pharmacy let alone get a prescription filled. You and your family may need to rely on a prepared emergency supply. If, for example, you or a loved one rely on daily medication to treat or manage a chronic disease, it is in your best interest to prepare your medicine cabinet for an emergency. Here’s how:

  • Keep at least a 7 to 10-day supply of prescription medications. Keep your medications in labeled, childproof containers.
  • Keep an up-to-date list of all prescription medications, including dosage amounts and the names of their generic equivalents, your medical supply needs, and known allergies.
  • Create a supply of nonprescription medications, including pain and fever relievers, diuretics, antihistamines, and antidiarrheal medications.
  • Don’t let the medications in your emergency supply kit expire. Remove, use, and replace any food and water, medications, and supplies before they expire.

Safe storage

In the wrong hands, medicines are dangerous. Too often, the wrong hands belong to kids. About 60,000 children are taken to emergency rooms each year because they got into medicines.The threat of medication poisoning in kids and adults is also there in an emergency evacuation when families are forced from their homes and into a shelter, a hotel, or the home of a friend or family. Under stressful circumstances and in unfamiliar surroundings, people can forget to practice safe medication use and storage. Here are three ways you can prepare for and prevent medication poisoning after a disaster.

  • Keep all prescription medications and over-the-counter medicines and vitamins, including your emergency supply, Up and Away and out of the reach and sight of children and pets—this includes medicines in suitcases, purses, and “grab and go” bags.
  • Create an Emergency Action Plan that includes important contact information, such as phone numbers for your physician, pediatrician, pharmacist, veterinarian, and the Poison Control Center: 800-222-1222.
  • Properly dispose of unused, expired, or contaminated medicines in your medicine cabinet and emergency supply. Discard medications that touched floodwater or have changed in appearance or smell. Contact a pharmacist or healthcare provider if you are unsure about a drug’s safety.

Quick Tips

  • Find out if laws in your state permit pharmacists to dispense a 30-day refill of medications in an emergency.
  • Stay current on your immunizations and vaccinations for infections and illnesses such as tetanus and seasonal flu. Know the date of your last tetanus shot in case of injury in an emergency.
  • Learn more about the Emergency Prescription Assistance Program (EPAP)
  • The EPAP helps people who live in a federally-declared disaster area and do not have health insurance. Eligible people can receive a free 30-day supply of their medications for as long as EPAP is active. People can also use the program to receive vaccinations or to replace specific medical supplies or some forms of medical equipment that were lost or damaged because of an emergency or while evacuating.

For more Prepare Your Health information, tips, and checklists, visit cdc.gov/prepyourhealth.

Source
Prescriptions: Prepare Your Medicine Cabinet for an Emergency
Ready.gov/September

Additional Resources
Podcast   Preparing for Hurricanes – Prescription Medications 
Complete Care Plan for Loved Ones
Asthma Action Plan
Food Allergies and Disasters
Care for Special Need Children and Youth in an Emergency
Advance Directives for Behavioral Health Individuals

National Preparedness Month

National Preparedness Month is recognized every September to raise awareness about ways to prepare for emergencies and disasters, either natural or man-made. The 2022 theme, A Lasting Legacy, focuses on the importance of protecting every life by preparing for disasters. Ultimately, these efforts will help us create and preserve a long-lasting legacy.

Keeping this theme in mind, the Federal Emergency Management Agency (FEMA) recommends four key steps to prepare for and respond to disasters.

  1. Make a plan. 
    • Discuss a shelter plan
    • Have a specified evacuation route
      • Hurricanes are very common in Coastal Virginia, so it’s important to know your evacuation zone if you reside in a high-risk area
    • Decide on how members of the household will best communicate with one another 
    • Prepare an an emergency preparedness kit that includes
      • Water (for drinking and sanitation)
      • Non-perishable food
      • Battery-powered or hand crank radio
      • Flashlight
      • First aid kit
      • Extra batteries
  2. Consider specific needs within your household, such as:
    • Certain ages may require special considerations, such as specified food for infants or necessary medication for elderly family members
    • Dietary restrictions or needs may require certain lower sodium foods or gluten-free items
    • Disabled individuals may require a wheelchair, a cane, or other assistive devices
    • Identify any language barriers that may exist
    • Be cognizant of religious values or beliefs
    • Supplies will be needed for pets or services animals
  3. Fill out a family emergency plan or use it as a guide to creating your own. 
  4. Practice your plan with your friends, family, or household. 

For more information about creating a plan, visit www.ready.gov/plan.

The CDC also recommends planning ahead by staying…

  • Healthy: Know how to protect your safety and wellness.
  • Connected: Discuss ways to communicate with family, friends, and caregivers.
  • Calm: Practice ways to stay cool, calm, and collected during emergency situations.
  • Informed: Find reliable sources of health and emergency information.

Once you finish planning, it’s time to take action. Make sure to remember your…

  • Personal needs: Gather enough food, water, and medical supplies to last at least three days.
  • Prescriptions: Talk to your doctor about creating an emergency supply of prescription and necessary over-the-counter medications
  • Practical skills: Learn self-help and life-saving skills to use during an emergency.
  • Power sources: Prepare for power outages with backup power sources.
  • Paperwork: Collect and protect important documents and medical records.

 

Sources and Resources:
www.ready.gov/september
www.ready.gov/plan
www.cdc.gov/prepyourhealth/takeaction
www.vaemergency.gov/know-your-zone