[HIV-STD-Prevention] Call to Action to Prevent Congenital Syphilis - Resources and a new webinar added! #u#

Mon Apr 8 11:15:10 PDT 2024

Please join us during National STI Awareness Week for:

"At a Crossroads: The Syndemic of Syphilis, Substance Use, and Child Welfare During Pregnancy" April 16, 2024, 2:30 pm -4:00 pm EST.

This webinar serves as an opportunity to highlight the need for a syndemic approach to provide more holistic care to people who use substances and are considering pregnancy, pregnant, or postpartum.

     *   The webinar will: Increase awareness on the syndemic interaction between substance use, syphilis, and policy during pregnancy and postpartum
     *   Share best practices to provide more holistic prevention, treatment, and care to people who use substances and are considering pregnancy
     *   Identify policy solutions to address the syndemic of substance use, syphilis, and the challenges in accessing prenatal health care

Register today: https://roseliassociates.zoomgov.com/webinar/register/WN_okM4f5H_SgG09MLPaHVeZA<https://urldefense.us/v3/__https:/roseliassociates.zoomgov.com/webinar/register/WN_okM4f5H_SgG09MLPaHVeZA__;!!Og_tST9LxTiQE1I!pKUptveReJwMiekDhADkWGDXnKWNCyKWqUR5qsuVOrt1E5QQmbYWKinrMkC9uM6dsq3U_h1sQzn9YMQe9PCWjkca-mol3A$>

Call to Action to Prevent Congenital Syphilis

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[OASH logo2]

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April 4, 2024
[CS Call to Action Banner]
Please share with all who encounter pregnant people.
Useful information and resources below.
[CS CDC banner]

"Addressing the resurgence of syphilis and congenital syphilis requires a concerted effort. We can collectively work towards reducing the incidence of syphilis and its devastating consequences, and we will turn the tide on the syphilis epidemic."
ADM Rachel L. Levine, Assistant Secretary for Health and chair of the National Syphilis and Congenital Syphilis Syndemic Federal Task Force
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What is congenital syphilis (CS)?

Congenital syphilis (CS) is a disease that occurs when a mother with syphilis passes the infection on to her baby during pregnancy. Learn more about syphilis<https://urldefense.us/v3/__https:/lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.eyJidWxsZXRpbl9saW5rX2lkIjoxMDAsInVyaSI6ImJwMjpjbGljayIsInVybCI6Imh0dHBzOi8vd3d3LmNkYy5nb3Yvc3RkL3N5cGhpbGlzL3N0ZGZhY3Qtc3lwaGlsaXMuaHRtP3V0bV9tZWRpdW09ZW1haWwmdXRtX3NvdXJjZT1nb3ZkZWxpdmVyeSIsImJ1bGxldGluX2lkIjoiMjAyNDAzMjcuOTI0MzY1NTEifQ.jW9JI7upr8l6hohI4wTwWwIKU0KnKFwtKg8Qcc7gT8I/s/1250766241/br/239658225259-l__;!!Og_tST9LxTiQE1I!pKUptveReJwMiekDhADkWGDXnKWNCyKWqUR5qsuVOrt1E5QQmbYWKinrMkC9uM6dsq3U_h1sQzn9YMQe9PCWjkdy_sHIEQ$>.

Almost 9 in 10 cases of newborn syphilis in 2022 might have been prevented with timely testing and treatment during pregnancy.

More than half were among people who tested positive for syphilis during pregnancy but did not receive adequate or timely treatment.

Nearly 40 percent were among mothers who were not in prenatal care.

One of the biggest risk factors for syphilis for some people is where they live. According to previous CDC data, in 2021, more than 70 percent of the U.S. population lived in counties<https://urldefense.us/v3/__https:/lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.eyJidWxsZXRpbl9saW5rX2lkIjoxMDEsInVyaSI6ImJwMjpjbGljayIsInVybCI6Imh0dHBzOi8vd3d3LmNkYy5nb3YvbmNoaHN0cC9hdGxhcy9zeXBoaWxpcz91dG1fbWVkaXVtPWVtYWlsJnV0bV9zb3VyY2U9Z292ZGVsaXZlcnkiLCJidWxsZXRpbl9pZCI6IjIwMjQwMzI3LjkyNDM2NTUxIn0.Yy2pkO77-7g_JWJXbtyHWxQ0blO2LNBNBiWXjfPdge8/s/1250766241/br/239658225259-l__;!!Og_tST9LxTiQE1I!pKUptveReJwMiekDhADkWGDXnKWNCyKWqUR5qsuVOrt1E5QQmbYWKinrMkC9uM6dsq3U_h1sQzn9YMQe9PCWjkdFzC17uw$> considered to have high rates of syphilis among reproductive-age women (above the Healthy People 2030 target<https://urldefense.us/v3/__https:/health.gov/healthypeople/objectives-and-data/browse-objectives/sexually-transmitted-infections/reduce-syphilis-rate-females-sti-03?utm_medium=email&utm_source=govdelivery__;!!Og_tST9LxTiQE1I!pKUptveReJwMiekDhADkWGDXnKWNCyKWqUR5qsuVOrt1E5QQmbYWKinrMkC9uM6dsq3U_h1sQzn9YMQe9PCWjkf1fu3EjQ$>).

How can CS affect a baby?

CS can have major health impacts on your baby. How CS affects your baby's health depends on how long you had syphilis and if - or when - you got treatment for the infection.

CS can cause:

  *   Miscarriage (losing the baby during pregnancy)
  *   Stillbirth (a baby born dead)
  *   Prematurity (a baby born early)
  *   Low birth weight
  *   Death shortly after birth

Babies born to women with untreated syphilis may be stillborn, or die from the infection as a newborn.

For babies born with CS, CS can cause:

  *   Deformed bones
  *   Severe anemia (low blood count)
  *   Enlarged liver and spleen
  *   Jaundice (yellowing of the skin or eyes)
  *   Brain and nerve problems, like blindness or deafness
  *   Meningitis
  *   Skin rashes

These outcomes can be prevented through appropriate screening and treatment.

In 2022, lack of timely testing and adequate treatment contributed to almost 90% of congenital syphilis cases in the United States, including substantial proportions of congenital syphilis cases in all U.S. Census Bureau regions and among all racial and ethnic groups.

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[CS Increasing rates]
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U.S. syphilis cases reach highest levels since the 1950s, creating a critical public health need

More than 3,700 cases of congenital syphilis were documented among newborns in 2022-more than 10 times the number diagnosed in 2012.

If untreated, syphilis can seriously damage the heart and brain and can cause blindness, deafness, and paralysis. When transmitted during pregnancy, it can cause miscarriage, lifelong medical issues, and infant death.

In response to the surging number of syphilis and congenital syphilis cases nationwide, the U.S. Department of Health and Human Services (HHS) is taking action to slow the spread with a focus on those most significantly impacted. Through the establishment of the National Syphilis and Congenital Syphilis Syndemic (NSCSS) Federal Task Force<https://urldefense.us/v3/__https:/lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.eyJidWxsZXRpbl9saW5rX2lkIjoxMDIsInVyaSI6ImJwMjpjbGljayIsInVybCI6Imh0dHBzOi8vd3d3Lmhocy5nb3YvYWJvdXQvbmV3cy8yMDIzLzExLzE1L3JlYWRvdXQtYWRtLXJhY2hlbC1sZXZpbmVzLXZpc2l0LWdlb3JnaWEtbGVhcm4taW1wYWN0cy1jb25nZW5pdGFsLXN5cGhpbGlzLXN5cGhpbGlzLmh0bWw_dXRtX21lZGl1bT1lbWFpbCZ1dG1fc291cmNlPWdvdmRlbGl2ZXJ5IiwiYnVsbGV0aW5faWQiOiIyMDI0MDMyNy45MjQzNjU1MSJ9.idV3u83OOQY52TPJkvIM8xzeIa8gqh9G4o9LDeuLrCQ/s/1250766241/br/239658225259-l__;!!Og_tST9LxTiQE1I!pKUptveReJwMiekDhADkWGDXnKWNCyKWqUR5qsuVOrt1E5QQmbYWKinrMkC9uM6dsq3U_h1sQzn9YMQe9PCWjkdlXK4b_A$>, the Department is utilizing its agencies, its expertise, and its stakeholder network to respond to the U.S. syphilis and congenital syphilis epidemic. The actions of the Task Force leverage federal resources to reduce rates, promote health equity, engage impacted communities and direct resources to support those most impacted.

HHS Announces Department Actions to Slow Surging Syphilis Epidemic<https://urldefense.us/v3/__https:/lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.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.KXAO4Uz25VjFEEYg7g-3_MDRuvQoScvWoAg7ok3zk2Q/s/1250766241/br/239658225259-l__;!!Og_tST9LxTiQE1I!pKUptveReJwMiekDhADkWGDXnKWNCyKWqUR5qsuVOrt1E5QQmbYWKinrMkC9uM6dsq3U_h1sQzn9YMQe9PCWjkegSdQzuw$>

CDC's 2022 STI Surveillance Report underscores that STIs must be a public health priority<https://urldefense.us/v3/__https:/lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.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.4iB1cg_iPVvBVv7oOHGCJyh6TbGAco0FQ0_NWIsWxdU/s/1250766241/br/239658225259-l__;!!Og_tST9LxTiQE1I!pKUptveReJwMiekDhADkWGDXnKWNCyKWqUR5qsuVOrt1E5QQmbYWKinrMkC9uM6dsq3U_h1sQzn9YMQe9PCWjkdzyE-uLQ$>

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[CS map comparison]
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[CS Missed opportunities graphic]
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Congenital syphilis rates are rapidly increasing in the United States and are at the highest level in at least 30 years (4). Barriers to congenital syphilis prevention are multifactorial, including those at the patient level, such as substance use and insurance status, and those at the system level, such as structural inequities, limited access to health care, and medication shortages (5,8,16,17,20). Addressing patient and system-level barriers to accessing testing, treatment, and care could help prevent congenital syphilis. Improvements in timely testing and appropriate treatment of syphilis through tailored strategies at local and national levels will help control the congenital syphilis epidemic in the United States. Vital Signs: Missed Opportunities for Preventing Congenital Syphilis - United States, 2022 | MMWR (cdc.gov)<https://urldefense.us/v3/__https:/lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.eyJidWxsZXRpbl9saW5rX2lkIjoxMDUsInVyaSI6ImJwMjpjbGljayIsInVybCI6Imh0dHBzOi8vd3d3LmNkYy5nb3YvbW13ci92b2x1bWVzLzcyL3dyL21tNzI0NmUxLmh0bT91dG1fbWVkaXVtPWVtYWlsJnV0bV9zb3VyY2U9Z292ZGVsaXZlcnkjOn46dGV4dD1CYXJyaWVycyUyMHRvJTIwY29uZ2VuaXRhbCUyMHN5cGhpbGlzJTIwcHJldmVudGlvbiwxNiUyQzE3JTJDMjApLiIsImJ1bGxldGluX2lkIjoiMjAyNDAzMjcuOTI0MzY1NTEifQ.drsionCPb5mgE46NTdHS7nkTmBZfi6J68U6M6FDxJIM/s/1250766241/br/239658225259-l__;!!Og_tST9LxTiQE1I!pKUptveReJwMiekDhADkWGDXnKWNCyKWqUR5qsuVOrt1E5QQmbYWKinrMkC9uM6dsq3U_h1sQzn9YMQe9PCWjkdxkbrF3Q$>

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[CS Screening]
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Professional Education Events
Missed Opportunities for Preventing Congenital Syphilis

Last month, HRSA collaborated with CDC's National Center for HIV, Viral Hepatitis, STD, and TB Prevention on a webinar about congenital syphilis for clinicians and other health care providers.

Congenital syphilis occurs when pregnant people with syphilis pass the infection to their babies. According to the CDC<https://urldefense.us/v3/__https:/lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.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.NsDJ03kMrMbPmmRo7axIzGyyx5MmniZZID2ANk8AT-4/s/1250766241/br/237383458360-l?utm_medium=email&utm_source=govdelivery__;!!Og_tST9LxTiQE1I!pKUptveReJwMiekDhADkWGDXnKWNCyKWqUR5qsuVOrt1E5QQmbYWKinrMkC9uM6dsq3U_h1sQzn9YMQe9PCWjkfxwmFKoQ$>, cases of congenital syphilis in the U.S. increased by 15% from 2019 to 2020, and by 32% from 2020 to 2021.  Syphilis and congenital syphilis are public health issues that require urgent attention and action.  Congenital syphilis is preventable, and this requires early screening, diagnosis, and treatment, to prevent potential lifelong consequences for affected families and communities.

This webinar provided an overview of congenital syphilis and explore missed opportunities for preventing congenital syphilis as well as interventions for prevention.

Watch recording here<https://urldefense.us/v3/__https:/lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.eyJidWxsZXRpbl9saW5rX2lkIjoxMTEsInVyaSI6ImJwMjpjbGljayIsInVybCI6Imh0dHBzOi8vd3d3Lnpvb21nb3YuY29tL3JlYy9wbGF5LzFoRGxNRHVPaS1RLWhtUTNBQ2RCRXZhaVhpa3MyZVg0UGk1cHRscFhDVG1HMmtFZzZQUmxORjQ3dmpRZVRDVGhDVEJ3TnlQOVYxcmx3Sk04LnpGdDVaY2xvVy1ycFdvVGI_YXV0b3BsYXk9dHJ1ZSZzdGFydFRpbWU9MTcwOTEzOTYwMTAwMCIsImJ1bGxldGluX2lkIjoiMjAyNDAzMTIuOTE2NjQxNTEifQ.K0NUxQTBoaVwnQ0jXgvy6aZtzLIfRz6VZbUJo-S7t4E/s/686680464/br/238649644927-l?utm_medium=email&utm_source=govdelivery__;!!Og_tST9LxTiQE1I!pKUptveReJwMiekDhADkWGDXnKWNCyKWqUR5qsuVOrt1E5QQmbYWKinrMkC9uM6dsq3U_h1sQzn9YMQe9PCWjkd3q93JgQ$>
NACCHO Indian Health Service Regional Syphilis Partnership Summits: Save-the-Dates

Southwest Indian Country Syphilis Partnership Summit: March 26-27, 2024, Fort McDowell, AZ.

Southern Plains Syphilis Partnership Summit: May 14-15, 2024 Oklahoma City, OK

NACCHO, Congenital Syphilis Community of Practice

The Congenital Syphilis Community of Practice (CoP) is a collaborative learning and knowledge-sharing forum for health department staff to enhance their capacity to implement or scale-up interventions to address congenital syphilis (CS) and syphilis among individuals of child-bearing capacity. The CoP aims to strengthen the capacity of local health department (LHD) staff to address CS, contribute best practices and lessons learned regarding the creation and implementation of CS interventions, and improve communication and strategic partnerships among LHDs to support CS prevention. Local Health Department Staff, register for the Congenital Syphilis Community of Practice.<https://urldefense.us/v3/__https:/lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.eyJidWxsZXRpbl9saW5rX2lkIjoxMjksInVyaSI6ImJwMjpjbGljayIsInVybCI6Imh0dHBzOi8vZG9jcy5nb29nbGUuY29tL2Zvcm1zL2QvMUd6eXNUS2xPV012Vng0LXhiaHRuVGdsQ1BiMm9jaUVwYndES1pLZFRsVVkvdmlld2Zvcm0_ZWRpdF9yZXF1ZXN0ZWQ9dHJ1ZSZ1dG1fbWVkaXVtPWVtYWlsJnV0bV9zb3VyY2U9Z292ZGVsaXZlcnkiLCJidWxsZXRpbl9pZCI6IjIwMjQwMjIwLjkwNDk1OTcxIn0.nTVtzuC0mYoi-3CPIR7smCDb7_4G1Q7qQ20ZuB7GICk/s/1250766241/br/237383458360-l?utm_medium=email&utm_source=govdelivery__;!!Og_tST9LxTiQE1I!pKUptveReJwMiekDhADkWGDXnKWNCyKWqUR5qsuVOrt1E5QQmbYWKinrMkC9uM6dsq3U_h1sQzn9YMQe9PCWjkfJR0906g$>

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Ready to Use Resources and Materials
[CS Brochure 1]

[CS brochure 2]

[CS brochure 3]

[CS brochure 4]
Syphilis_Prenatal_Screening_2023_1208_in-homePrint.pdf (cdc.gov)<https://urldefense.us/v3/__https:/lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.eyJidWxsZXRpbl9saW5rX2lkIjoxMDYsInVyaSI6ImJwMjpjbGljayIsInVybCI6Imh0dHBzOi8vd3d3LmNkYy5nb3Yvc3RkL3N5cGhpbGlzL3ByZW5hdGFsLXNjcmVlbmluZy9TeXBoaWxpc19QcmVuYXRhbF9TY3JlZW5pbmdfMjAyM18xMjA4X2luLWhvbWVQcmludC5wZGY_dXRtX21lZGl1bT1lbWFpbCZ1dG1fc291cmNlPWdvdmRlbGl2ZXJ5IiwiYnVsbGV0aW5faWQiOiIyMDI0MDMyNy45MjQzNjU1MSJ9.SbUdEcKfYmxLSBuHVBSoBqNrAEpemnziTCXIvXNh2Xs/s/1250766241/br/239658225259-l__;!!Og_tST9LxTiQE1I!pKUptveReJwMiekDhADkWGDXnKWNCyKWqUR5qsuVOrt1E5QQmbYWKinrMkC9uM6dsq3U_h1sQzn9YMQe9PCWjkfQTtmvwg$>
[CS social media]
Download Facebook and Twitter Graphic<https://urldefense.us/v3/__https:/lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.eyJidWxsZXRpbl9saW5rX2lkIjoxMDcsInVyaSI6ImJwMjpjbGljayIsInVybCI6Imh0dHBzOi8vd3d3LmNkYy5nb3Yvc3RkL3N0YXRpc3RpY3MvaW1hZ2VzL3NtL3N5cGhpbGlzLW5ld2Jvcm4tYmFiaWVzLTEyMDB4Njc1LTEucG5nP3V0bV9tZWRpdW09ZW1haWwmdXRtX3NvdXJjZT1nb3ZkZWxpdmVyeSIsImJ1bGxldGluX2lkIjoiMjAyNDAzMjcuOTI0MzY1NTEifQ.B2UFM_31X_XTyNlX5hXkq_K8K9qRDi0NMVGWTqfEkqg/s/1250766241/br/239658225259-l__;!!Og_tST9LxTiQE1I!pKUptveReJwMiekDhADkWGDXnKWNCyKWqUR5qsuVOrt1E5QQmbYWKinrMkC9uM6dsq3U_h1sQzn9YMQe9PCWjkdA_55EtQ$>
Download Instagram Graphic<https://urldefense.us/v3/__https:/lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.eyJidWxsZXRpbl9saW5rX2lkIjoxMDgsInVyaSI6ImJwMjpjbGljayIsInVybCI6Imh0dHBzOi8vd3d3LmNkYy5nb3Yvc3RkL3N0YXRpc3RpY3MvaW1hZ2VzL3NtL3N5cGhpbGlzLW5ld2Jvcm4tYmFiaWVzLTEwODB4MTA4MC0xLnBuZz91dG1fbWVkaXVtPWVtYWlsJnV0bV9zb3VyY2U9Z292ZGVsaXZlcnkiLCJidWxsZXRpbl9pZCI6IjIwMjQwMzI3LjkyNDM2NTUxIn0.vp03OIE3kSGnNNTbe9feuKn-bcAXS2V0l9U1Bc_pNe0/s/1250766241/br/239658225259-l__;!!Og_tST9LxTiQE1I!pKUptveReJwMiekDhADkWGDXnKWNCyKWqUR5qsuVOrt1E5QQmbYWKinrMkC9uM6dsq3U_h1sQzn9YMQe9PCWjkd_hrPtgg$>
[CS Spanish 1]<https://urldefense.us/v3/__https:/lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.eyJidWxsZXRpbl9saW5rX2lkIjoxMDksInVyaSI6ImJwMjpjbGljayIsInVybCI6Imh0dHBzOi8vd3d3LmNkYy5nb3YvbmNoaHN0cC9uZXdzcm9vbS9tdWx0aW1lZGlhLXJlc291cmNlcy9zdGQtbXVsdGltZWRpYS1yZXNvdXJjZXMuaHRtbD91dG1fbWVkaXVtPWVtYWlsJnV0bV9zb3VyY2U9Z292ZGVsaXZlcnkiLCJidWxsZXRpbl9pZCI6IjIwMjQwMzI3LjkyNDM2NTUxIn0.VgAatkSC2YB0_SvEnqmViGaYHobOEAUUKxgb4l0IdHU/s/1250766241/br/239658225259-l__;!!Og_tST9LxTiQE1I!pKUptveReJwMiekDhADkWGDXnKWNCyKWqUR5qsuVOrt1E5QQmbYWKinrMkC9uM6dsq3U_h1sQzn9YMQe9PCWjkcHjvC4CA$>
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[CS Spanish 2]<https://urldefense.us/v3/__https:/lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.eyJidWxsZXRpbl9saW5rX2lkIjoxMTAsInVyaSI6ImJwMjpjbGljayIsInVybCI6Imh0dHBzOi8vd3d3LmNkYy5nb3YvbmNoaHN0cC9uZXdzcm9vbS9tdWx0aW1lZGlhLXJlc291cmNlcy9zdGQtbXVsdGltZWRpYS1yZXNvdXJjZXMuaHRtbD91dG1fbWVkaXVtPWVtYWlsJnV0bV9zb3VyY2U9Z292ZGVsaXZlcnkiLCJidWxsZXRpbl9pZCI6IjIwMjQwMzI3LjkyNDM2NTUxIn0.oaUT7-sSZPFbS8bV2GnjwDO-uF3dIVaVCFeruyPPCt0/s/1250766241/br/239658225259-l__;!!Og_tST9LxTiQE1I!pKUptveReJwMiekDhADkWGDXnKWNCyKWqUR5qsuVOrt1E5QQmbYWKinrMkC9uM6dsq3U_h1sQzn9YMQe9PCWjkcIQDpFcw$>
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[CS Spanish 3]<https://urldefense.us/v3/__https:/lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.eyJidWxsZXRpbl9saW5rX2lkIjoxMTEsInVyaSI6ImJwMjpjbGljayIsInVybCI6Imh0dHBzOi8vd3d3LmNkYy5nb3YvbmNoaHN0cC9uZXdzcm9vbS9tdWx0aW1lZGlhLXJlc291cmNlcy9zdGQtbXVsdGltZWRpYS1yZXNvdXJjZXMuaHRtbD91dG1fbWVkaXVtPWVtYWlsJnV0bV9zb3VyY2U9Z292ZGVsaXZlcnkiLCJidWxsZXRpbl9pZCI6IjIwMjQwMzI3LjkyNDM2NTUxIn0.nP9JAP3roepxDNJpyBi0s_BgzOD6ugt2bqOV3oYdVYg/s/1250766241/br/239658225259-l__;!!Og_tST9LxTiQE1I!pKUptveReJwMiekDhADkWGDXnKWNCyKWqUR5qsuVOrt1E5QQmbYWKinrMkC9uM6dsq3U_h1sQzn9YMQe9PCWjkdkB1Sy7g$>
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[CS Spanish 4]<https://urldefense.us/v3/__https:/lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.eyJidWxsZXRpbl9saW5rX2lkIjoxMTIsInVyaSI6ImJwMjpjbGljayIsInVybCI6Imh0dHBzOi8vd3d3LmNkYy5nb3YvbmNoaHN0cC9uZXdzcm9vbS9tdWx0aW1lZGlhLXJlc291cmNlcy9zdGQtbXVsdGltZWRpYS1yZXNvdXJjZXMuaHRtbD91dG1fbWVkaXVtPWVtYWlsJnV0bV9zb3VyY2U9Z292ZGVsaXZlcnkiLCJidWxsZXRpbl9pZCI6IjIwMjQwMzI3LjkyNDM2NTUxIn0.6BToX-XHBQhYdIX0eNTrv5fw2xOSRNwpdyDAl_ibm08/s/1250766241/br/239658225259-l__;!!Og_tST9LxTiQE1I!pKUptveReJwMiekDhADkWGDXnKWNCyKWqUR5qsuVOrt1E5QQmbYWKinrMkC9uM6dsq3U_h1sQzn9YMQe9PCWjkeVYtNMOQ$>
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Disclaimer

Links to non-federal sites are included for your convenience. The U.S. Department of Health and Human Services (HHS) cannot attest to the accuracy of information provided by non-federal links. Linking to a non-federal site does not constitute an endorsement by HHS or any of its employees of the sponsors, information, or products presented on the site.  Also, the linked content may not comply with all U.S. government guidance for Web sites.

________________________________

[region 8 map]Susana Calderon, MPH

Regional Women's Health Analyst

Office of Regional Health Operations, Region 8

susana.calderon at hhs.gov<mailto:susana.calderon at hhs.gov>

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