CDC Reports Cases 18-29 of H3N2v Virus Infection; Continues to Recommend Interim Precautions When Interacting with Pigs

August 3, 2012 –This week CDC reports 12 additional human infections with influenza A (H3N2) variant* virus in 3 states: Hawaii (1 case), Ohio (10 cases) and Indiana (1 case). The H3N2v virus contains the M gene from the human influenza A(H1N1)pdm09 (2009 H1N1) virus, as have the previous 17 cases detected since July 2011. All of this week’s reported cases occurred in people who had direct or indirect contact with swine prior to their illness.The 10 cases in Ohio were associated with attendance at a fair where reportedly ill swine were present. The H3N2v case reported by Indiana also occurred in a person who attended a fair where swine were present. CDC continues to recommend preventive actions people can take to make their fair experience a safe and healthy one.
The number of cases of infection with H3N2v viruses with the M gene from the 2009 H1N1 virus detected in the United States since July 2011 now totals 29 [Hawaii (1), Indiana (7), Iowa (3), Ohio (10), Maine (2), Pennsylvania (3), Utah (1), and West Virginia (2)]. Twenty-three of these cases reported swine contact prior to illness onset. Among those 29 cases, 19 cases were associated with fairs where swine were present. Most human illness with H3N2v virus infection has resulted in signs and symptoms of influenza (fever, cough, runny nose, sore throat, muscle aches); 3 hospitalizations have occurred. All of the people hospitalized had high risk conditions. (See "people who are at greater risk of serious influenza-related complications" below.) All H3N2v virus cases have recovered fully.
According to USDA, swine influenza surveillance, this swine H3N2 virus with the pandemic M gene has been detected in swine in a number of U.S. states. This virus may be circulating widely in U.S. swine at this time. It should be noted, however, that influenza viruses have not been shown to be transmissible to people through eating properly handled and prepared pork (pig meat) or other products derived from pigs.
It is possible that acquisition of the M gene from the 2009 H1N1 virus may allow H3N2v viruses to be more transmissible from pigs to people and from person-to-person.
Late summer is typically fair season across the United States, and fairs are a setting that can provide many opportunities for exposures to occur between pigs and people. CDC continues to advise people to take recommended precautions when interacting with pigs or their environments, including frequent hand washing and avoiding contact with pigs that appear ill. The National Association of State Public Health Veterinarians has developed the "Compendium of Measures to Prevent Disease Associated with Animals in Public Settings, 2011" to provide some preventive actions that are applicable to people raising swine, showing swine at fairs, or attending fairs.
This includes:

• Wash your hands frequently with soap and running water before and after exposure to animals.
• Never eat, drink or put things in your mouth while in animal areas and don’t take food or drink into animal areas.
• Young children, pregnant women, people 65 and older and people with weakened immune systems should be extra careful around animals.
• If you have animals – including swine – watch them for signs of illness and call a veterinarian if you suspect they might be sick.
• Avoid close contact with animals that look or act ill, when possible.
• Avoid contact with pigs if you are experiencing flu-like symptoms.
• If you must come in contact with pigs while you are sick, or if you must come in contact with pigs known or suspected to be infected, or their environment, you should use appropriate protective measures (for example, wear protective clothing, gloves, masks that cover your mouth and nose, and other personal protective equipment) and practice good respiratory and hand hygiene.**

Additionally, in response to recent human cases of H3N2v virus infection, CDC would like to convey the following information:

1. Children younger than 5 years, people 65 years and older, pregnant women, and people with certain chronic medical conditions (like asthma, diabetes, heart disease, weakened immune systems, and neurological or neurodevelopmental conditions) are at high risk from serious complications if they get influenza. These people should consider avoiding exposure to pigs and swine barns this summer, especially if sick pigs have been identified.
2. Studies conducted by CDC have indicated that children younger than 10 years old would have little to no immunity against H3N2v virus, whereas adults may have some cross-protective immunity. Most cases of H3N2v have occurred in children at this time.
3. There are two FDA–approved drugs that are expected to be effective in treating illness associated with H3N2v virus infection. The antiviral drugs oseltamivir (Tamiflu) and zanamivir (Relenza) – which are used to treat infection with human seasonal influenza viruses –are also expected to be effective in treating H3N2v virus. Antiviral treatment is most effective when started as soon as possible after illness onset. (For more information about influenza antiviral medications, please see What You Should Know About Flu Antiviral Drugs.)
4. Signs and symptoms of H3N2v virus infection cannot be differentiated from those caused by other respiratory infections, including seasonal influenza virus infection.
5. Rapid influenza diagnostic tests may not detect H3N2v virus in human respiratory specimens (false negative results). If H3N2v virus infection is suspected because of recent exposure to pigs or to an ill person who had contact with pigs, testing of respiratory specimens should be done at a state health department.
6. Influenza viruses have not been shown to be transmissible to people through eating properly handled and prepared pork (pig meat) or other products derived from pigs. For more information about the proper handling and preparation of pork, visit the USDA website fact sheet "Fresh Pork from Farm to Table"

Other CDC recommendations related to H3N2v for the public are available in "Fact Sheet: Protect Yourself Against H3N2v".
Guidance for health care professionals is available at "Information for Health Care Professionals".

Background

Influenza is a contagious respiratory illness caused by infection with influenza viruses. Human influenza viruses infect people and swine influenza A viruses infect pigs. Occasionally, influenza viruses can spread between people and pigs. While this isn’t common, it can happen. When a swine influenza A virus infects a person, these viruses are called "variant viruses."
While swine influenza A viruses seldom infect humans, such infections can occur. Human infections with swine viruses are thought to occur in the same way that seasonal influenza viruses spread among people. Pigs that are infected shed influenza virus – possibly in coughs or sneezes – and people who are nearby can breathe the virus in. Infection also may occur by a person touching a surface or object that has virus on it and then touching their own mouth or nose."
Signs of swine flu in pigs can include fever, depression, coughing (barking), discharge from the nose or eyes, sneezing, breathing difficulties, eye redness or inflammation, and going off feed. Some pigs infected with influenza viruses, however, may have no symptoms at all.

More Information

• More information about the case in Hawaii is available in "An influenza A (H3N2) variant virus, known as H3N2v virus, has been confirmed in a Maui adult resident. An investigation into the source of this person’s illness is currently ongoing".
• More information about the situation in Ohio is available in a press release from the Ohio Department of Health: "Health Officials Confirm Flu Virus Strain from Butler County Fair".
• More information about the situation in Indiana is available in "Health Officials Continue to Investigate Flu Illness".
• More information about H3N2v is available on the CDC website at Information on H3N2 Variant Influenza A Viruses.
• More information on swine influenza can be found in What People Who Raise Pigs Need To Know About Influenza (Flu) .
• Additional information and materials, including educational posters [389 KB, 1 page] that can be displayed around animal exhibits, also are available in the "Compendium of Measures to Prevent Disease Associated with Animals in Public Settings, 2011".
• More information for people who are at greater risk for influenza complications is available at on the CDC website at People at High Risk of Developing Flu–Related Complications.

* A "variant" designation is applied when a virus that normally circulates in swine is found in humans.
** These recommendations are taken from Compendium of Measures to Prevent Disease Associated with Animals in Public Settings, 2011 and What People Who Raise Pigs Need To Know About Influenza (Flu).

Help Yourself, Help your Family, Help your Community



Help Yourself, Help your Family, Help your Community - Become a Community Emergency Response Team Member and learn how to prepare for an emergency.

The Community Emergency Response Team (CERT) Program educates people about disaster preparedness for hazards that may impact their area and trains them in basic disaster response skills, such as fire safety, light search and rescue, team organization, and disaster medical operations. Using the training learned in the classroom and during exercises, CERT members can assist others in their neighborhood or workplace following an event when professional responders are not immediately available to help. CERT members also are encouraged to support emergency response agencies by taking a more active role in emergency preparedness projects in their community.

The next Monongalia County CERT Basic Training will be held June 9th and 23rd at the Monongalia County Health Department. For more information or to register online go to:

https://sites.google.com/site/moncert/home

Prevent the Spread of Norovirus

 

Noroviruses spread easily, causing more than 20 million gastroenteritis cases each year in the U.S. There's no vaccine to prevent norovirus infection and no drug to treat it. Wash your hands often and follow simple tips to stay virus-free.

Noroviruses are a group of related viruses. Infection with these viruses affects the stomach and intestines and causes an illness called gastroenteritis (GAS-tro-en-ter-I-tis; inflammation of the stomach and intestines).

Anyone Can Get Norovirus

Anyone can be infected with noroviruses and get sick. Also, you can get norovirus illness more than once during your life. The illness often begins suddenly. You may feel very sick, with stomach cramping, throwing up, or diarrhea.
Noroviruses are the most common cause of gastroenteritis in the United States. CDC estimates that each year more than 20 million cases of acute gastroenteritis are caused by noroviruses. That means about 1 in every 15 Americans will get norovirus illness each year. Norovirus is also estimated to cause over 70,000 hospitalizations and 800 deaths each year in the United States.

Many Names, Same Symptoms

You may hear norovirus illness called "food poisoning" or "stomach flu." It is true that food poisoning can be caused by noroviruses. But, other germs and chemicals can also cause food poisoning. Norovirus illness is not related to the flu (influenza), which is a respiratory illness caused by influenza virus.
Symptoms of norovirus infection usually include diarrhea, throwing up, nausea, and stomach cramping.
Other, less common symptoms may include low-grade fever, chills, headache, muscle aches, and general sense of fatigue.
Norovirus illness is usually not serious. Most people get better in 1­ to 2 days. But, norovirus illness can be serious in young children, the elderly, and people with other health conditions; it can lead to severe dehydration, hospitalization and even death.
You may get dehydrated if you are not able to drink enough liquids to replace the fluids lost from throwing up or having diarrhea many times a day. Symptoms of dehydration include a decrease in urination, a dry mouth and throat, and feeling dizzy when standing up. Children who are dehydrated may also cry with few or no tears and be unusually sleepy or fussy.
The best way to prevent dehydration is to drink plenty of liquids. Oral rehydration fluids are the most helpful for severe dehydration. But other drinks without caffeine or alcohol can help with mild dehydration. However, these drinks may not replace important nutrients and minerals that are lost due to vomiting and diarrhea.
If you think you or someone you are caring for is severely dehydrated, contact your doctor. For more information on norovirus and dehydration, see How is viral gastroenteritis treated?

Norovirus Spreads Quickly

Norovirus can spread quickly from person to person in crowded, closed places like long-term care facilities, daycare centers, schools, hotels, and cruise ships. Noroviruses can also be a major cause of gastroenteritis in restaurants and catered-meal settings if contaminated food is served.

Norovirus and Food

Norovirus is a leading cause of disease from contaminated foods in the United States. Foods that are most commonly involved in foodborne norovirus outbreaks include leafy greens (such as lettuce), fresh fruits, and shellfish (such as oysters). However, any food item that is served raw or handled after being cooked can become contaminated with noroviruses.

The viruses are found in the vomit and stool of infected people. You can get it by

• Eating food or drinking liquids that are contaminated with norovirus (someone gets stool or vomit on their hands, then touches food or drink).
• Touching surfaces or objects contaminated with norovirus and then putting your hand or fingers in your mouth.
• Having direct contact with a person who is infected with norovirus (for example, when caring for someone with norovirus or sharing foods or eating utensils with them).

People with norovirus illness are contagious from the moment they begin feeling sick until at least 3 days after they recover. But, some people may be contagious for even longer. 

Norovirus: No Vaccine and No Treatment

There is no vaccine to prevent norovirus infection. Also, there is no drug to treat people who get sick from the virus. Antibiotics will not help if you have norovirus illness. This is because antibiotics fight against bacteria, not viruses. The best way to reduce your chance of getting norovirus is by following some simple tips.

Stop the Spread of Norovirus

Practice proper hand hygiene

Wash your hands carefully with soap and water, especially after using the toilet and changing diapers and always before eating or preparing food. If soap and water aren't available, use an alcohol-based hand sanitizer. These alcohol-based products can quickly reduce the number of germs on hands in some situations, but they are not a substitute for washing with soap and water.

Take care in the kitchen

Carefully wash fruits and vegetables, and cook oysters and other shellfish thoroughly before eating them.

Do not prepare food while infected

People with norovirus illness should not prepare food for others while they have symptoms and for 3 days after they recover from their illness. (see For Food Handlers: Norovirus and Working with Food)

Clean and disinfect contaminated surfaces

After throwing up or having diarrhea, immediately clean and disinfect contaminated surfaces by using a bleach-based household cleaner as directed on the product label. If no such cleaning product is available, you can use a solution made with 5 tablespoons to 1.5 cups of household bleach per 1 gallon of water.

Wash laundry thoroughly

Immediately remove and wash clothing or linens that may be contaminated with vomit or stool. Handle soiled items carefully—without agitating them—to avoid spreading virus. If available, wear rubber or disposable gloves while handling soiled clothing or linens and wash your hands after handling. The items should be washed with detergent at the maximum available cycle length and then machine dried.

Content from CDC

WV Poison Center: Saving Lives 24/7

What do you do if your toddler eats something in your yard at 11 a.m.? What if you brush your teeth with antibiotic ointment at 6 a.m.? What do you do if you take too much medicine at 1 a.m.? The West Virginia Poison Center (WVPC) provides free, confidential advice 24 hours a day, 7 days a week, 365 days a year. The Poison Center is always available; we never close!

1-800-222-1222

The WVPC receives calls regarding children, adults, seniors, and animals. Even healthcare professionals, such as doctors and nurses, utilize our service for treatment recommendations.

The WVPC can answer questions about:

• Accidental poisonings of children and adults
• Drug overdoses
• Bites and Stings
• Reactions to drugs and chemicals
• Drug interactions
• Poisoning of animals
• Chronic lead poisoning
• Toxic or non-toxic plan information
• Poisonings from drugs of abuse

All calls to the WVPC are free and confidential. The Poison Center take calls in many different languages and for the hearing impaired. If you have a question or concern, the WVPC can handle it!

Trained medical professionals (nurses, pharmacists, physicians) are ready to help you with any poison question you have at any time of day.

You never know when you may need the WVPC. Program our number into your cell phones and keep our number available at home. Remember, if you even suspect a poisoning, call the WVPC at 1-800-222-1222.

About the West Virginia Poison Center:

The West Virginia Poison Center provides comprehensive emergency poison information, prevention and educational resources to West Virginians 24 hours a day, seven days a week, 365 days a year. The WVPC is staffed by nurses, pharmacists and physicians with special training in treatment of poisonings. Located in Charleston, WV, the WVPC is a part of West Virginia University-Charleston Division. Toll-free: 1-800-222-122. Website: www.wvpoisoncenter.org.

National Poison Prevention Week - One Person's Story

Cathy’s Story – A Poison Tragedy

by the American Association of Poison Control Centers

Fifty years ago, in 1962, 3-year-old Philip was rushed to the nearest hospital, 30 minutes away.  Tragically, he had found and drunk a bottle of rat poison.  Though all attempts were made to save his life, he lived only a few more hours.  50 years later, his sister, Cathy Seifried of Kingwood, Texas, is still grieving.  According to Cathy, her brother’s death, a tragedy in itself, had long-lasting effects on her entire family as grief, sadness and remorse took its toll.  “I had good parents,” says Seifried. “They managed to function and go through the daily motions … but as a family, we were broken.” 

Today, Seifried focuses her efforts into supporting poison control centers.  She feels that had her family had access to the education, outreach, and support that today’s poison centers offer, her family might have eluded terrible heartbreak and devastation.

The nation celebrates the 50^th anniversary of National Poison Prevention Week March 18 through 24, 2012. National Poison Prevention Week was first proclaimed by President Kennedy in 1962 to raise awareness about the dangers of poisoning. Much progress has been made in poisoning prevention in the years since. In 1972, for example, more than 200 children in the U.S. died as a result of poisoning.  By 2007, that number dropped to 39. However, there is still much work to be done: poisoning is now the leading cause of death from unintentional injuries in the United States – ahead of motor vehicle crashes and guns.

Just one phone number—1-800-222-1222—will put you in touch with your local poison center.  According to the American Association of Poison Control Centers, 57 poison centers are in operation throughout the country, assuring coverage in all 50 states, Puerto Rico, Guam, American Samoa, U.S. Virgin Islands, and the Federated States of Micronesia.  These centers take calls 24 hours a day, seven days a week, 365 days a year.  Calls to the center are free and confidential and are answered by experts in poisoning treatment and prevention.  Callers have access to poison advice in more than 150 languages.

In 2011, federal budget cuts reduced funding for poison control centers by 36 percent.  Poison centers, which handle about 4 million calls a year, are now in jeopardy; further cuts will make it difficult for poison centers to continue providing life-saving services.

Poison centers are for everyone.  Parents and babysitters call poison centers when young children have become exposed to toxic substances.  Seniors use poison centers when they fear they may have made an error in taking their medicine.  And doctors, nurses, pharmacists and emergency room staff place 1,400 calls daily to the Poison Help number for treatment advice on drug- or poison-related cases.  Poison centers are also a highly cost-effective source of health care.  For every dollar spent on poison centers, 7 dollars are saved in unnecessary health-care costs.  On average, 70 percent of callers are able to be treated at home, thus avoiding the far more costly hospital or doctor’s office visits.  Poison centers also provide outreach to their communities, taking proactive steps to reduce both the number and severity of poison exposures.  It is estimated that poison center services, in addition to saving lives, are three times as cost-effective as child safety seats, bicycle helmets and smoke detectors and are as cost-effective as childhood immunizations.

What can you do to prevent poisonings?

·        Keep medicines and cleaning supplies locked up and away from children.  Children act fast.  Unfortunately, so do poisons. 

·        Always use your glasses to read your prescription bottle, and only take medicine with the lights on.  These simple actions can prevent accidents.

·        Ask visitors to keep purses and luggage containing medicine out of reach of children at all times.

·        Install carbon monoxide detectors and check batteries at least twice a year.

·        Keep the1- 800-222-1222 number accessible and programmed into your phone. Your local poison center can send you magnets and stickers with the number.  Call the Poison Help number even if it’s not an emergency.  When in doubt, check it out.

·        Support legislation that funds local poison centers.  

“Philip has been gone for 50 years,” says Seifried. “I know there are many other stories just like his. For their sakes, please get involved with your local poison center in promoting poisoning prevention and the Poison Help number. You can make a difference.” 

The American Association of Poison Control Centers supports the nation’s 57 poison centers in their efforts to prevent and treat poison exposures. Poison centers offer free, confidential, expert medical advice 24 hours a day, seven days a week. We take calls in more than 150 languages and from the hearing impaired.

For questions about poison or if you think someone has been exposed to a poison, call 1-800-222-1222 to reach your local poison center.

It starts with you - What role will you play in an emergency?

No matter where you live, no matter who you are, we all have a role in hometown preparedness. What role will you play? Become a member of Monongalia County CERT (Community  Emergency Response Team) and be prepared to help yourself, your family and your community.

 

Community Emergency Response Team Training

The Community Emergency Response Team (CERT) Program educates people about disaster preparedness for hazards that may impact their area and trains them in the following basic disaster response skills:

1. Fire safety
2. Light search and rescue
3. Team organization
4. Disaster medical operations

Training includes classroom learning and hands-on exercises.

When: training occurs on two separate Saturdays – March 10 and 17

(Must complete both days of training to become certified. Both days can be completed on consecutive Saturdays or the first day training can be completed during this training cycle and the second training day can be completed during the next training cycle.)

Time: 8 AM-5 PM

Where: Monongalia County Health Department Training Room

Continental breakfast and lunch will be provided.

Class size will be a maximum of 20 students.

Cost: There is NO Charge for CERT Training

To register:

Email tlkrafczyk@gmail.com

 Or call 304-598-5155

To register online go to website: https://sites.google.com/site/moncert/home

How to Dispose of Unused Medicine

Is your medicine cabinet filled with expired drugs or medications you no longer use? How should you dispose of them?

Most drugs can be thrown in the household trash, but consumers should take certain precautions before tossing them out, according to the Food and Drug Administra­tion (FDA). A few drugs should be flushed down the toi­let. And a growing number of community-based "take-back" programs offer another safe disposal alternative.

Guidelines for Drug Disposal

FDA worked with the White House Office of National Drug Control Policy (ONDCP) to develop the first consumer guidance for proper disposal of prescrip­tion drugs. Issued by ONDCP in February 2007 and updated in October 2009, the federal guidelines are summarized here:

• Follow any specific disposal instructions on the drug label or patient information that accompanies the medication. Do not flush prescription drugs down the toilet unless this information specifically instructs you to do so.

• Take advantage of community drug take-back programs that allow the public to bring unused drugs to a central location for proper disposal. Call your city or county government's household trash and recycling service (see blue pages in phone book) to see if a take-back program is available in your community. The Drug Enforcement Administration, working with state and local law enforcement agencies, is sponsoring National Prescription Drug Take Back Days

 (www.deadiversion.usdoj.gov) throughout the United States.

Take drugs out of their original containers and mix them with

an undesirable substance, such as used coffee grounds . 0 0

If no instructions are given on the drug label and no take-back programs are available
your area, throw the drugs in the household trash, but first:

• Take them out of their original containers and mix them with an undesirable substance, such as used coffee grounds or kitty litter. The medication will be less appealing to children and pets, and unrecognizable to peo­ple who may intentionally go through your trash.

• Put them in a sealable bag, empty can, or other container to prevent the medication from leaking or breaking out of a garbage bag.

FDA's Deputy Director of the Office of Compliance Ilisa Bernstein, Pharm.D., J.D., offers some addi­tional tips:

• Before throwing out a medicine container, scratch out all identifying information on the prescription label to make it unreadable. This will help protect your identity and the privacy of your personal health information.

• Do not give medications to friends. Doctors prescribe drugs based on a person's specific symptoms and medical history. A drug that works for you could be dangerous for someone else.

• When in doubt about proper disposal, talk to your pharmacist.

Bernstein says the same disposal meth­ods for prescription drugs could apply to over-the-counter drugs as well.

Why the Precautions?

Disposal instructions on the label are part of FDA's "risk mitigation" strategy, says Capt. Jim Hunter, R.Ph., M.P.H., senior program manager on FDA's Controlled Substance Staff. When a drug contains instructions to flush it down the toilet, he says, it's because FDA, working with the manufacturer, has determined this method to be the most appropriate route of disposal that

Drugs such as powerful narcotic pain relievers and other controlled sub­stances carry instructions for flushing to reduce the danger of unintentional use or overdose and illegal abuse.

For example, the fentanyl patch, an adhesive patch that delivers a potent pain medicine through the skin, comes with instructions to flush used or left­over patches. Too much fentanyl can cause severe breathing problems and lead to death in babies, children, pets, and even adults, especially those who have not been prescribed the drug. "Even after a patch is used, a lot of the drug remains in the patch," says Hunter, "so you wouldn't want to throw something in the trash that contains a powerful and potentially dangerous narcotic that could harm others."

Environmental Concerns

Despite the safety reasons for flushing drugs, some people are questioning the practice because of concerns about trace levels of drug residues found in surface water, such as rivers and lakes, and in some community drinking water supplies. However, the main way drug residues enter water systems is by people taking medications and then naturally passing them through their bodies, says Raanan Bloom, Ph.D., an environmental assessment expert in FDA's Center for Drug Evaluation and Research. "Most drugs are not com­pletely absorbed or metabolized by the body, and enter the environment after passing through waste water treat­ment plants."

A company that wants FDA to approve its drug must submit an application package to the agency. FDA requires, as part of the application package, an assessment of how the drug's use would affect the environment. Some drug applications are excluded from the assessment requirement, says Bloom, based on previous agency actions.

"For those drugs for which envi­ronmental assessments have been required, there has been no indica­ flushing," says Bloom. In addition, according to the Environmental Pro­tection Agency, scientists to date have found no evidence of adverse human health effects from pharmaceutical residues in the environment.

Nonetheless, FDA does not want to add drug residues into water sys­tems unnecessarily, says Hunter. The agency reviewed its drug labels to identify products with disposal directions recommending flush­ing or disposal down the sink. This continuously revised listing can be found at FDA's Web page on Disposal of Unused Medicines

www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm

Another environmental concern lies with inhalers used by people who have asthma or other breathing prob­lems, such as chronic obstructive pul­monary disease. Traditionally, many inhalers have contained chlorofluo­rocarbons (CFC's), a propellant that damages the protective ozone layer. The CFC inhalers are being phased out and replaced with more environ­mentally friendly inhalers.

Depending on the type of prod­uct and where you live, inhalers and aerosol products may be thrown into household trash or recyclables, or may be considered hazardous waste and require special handling. Read the handling instructions on the label, as some inhalers should not be punctured or thrown into a fire or incinerator. lb ensure safe disposal, contact your local trash and recycling facility.

Find this and other Consumer Updates at

www.fda.gov/ForCorisumers/ConsumerUpdates