{"id":10386,"date":"2025-03-01T14:07:51","date_gmt":"2025-03-01T19:07:51","guid":{"rendered":"https:\/\/dhss.delaware.gov\/dph\/dhan410\/"},"modified":"2025-03-02T00:54:35","modified_gmt":"2025-03-02T05:54:35","slug":"dhan410","status":"publish","type":"page","link":"https:\/\/dhss.delaware.gov\/dph\/php\/alerts\/dhan410\/","title":{"rendered":"php\/alerts\/dhan410 ~  Division of Public Health  &#8211; Delaware Health and Social Services &#8211; State of Delaware"},"content":{"rendered":"<div data-swiftype-index=\"true\">\n\n\n\n\n\n  <br>\n\n\n\n\n\n  <div class=\"container\" id=\"main_header\"> \n\n\n    <!-- BEGIN readspeaker div -->\n\n\n    <div class=\"rs_skip rsbtn rs_preserve\" id=\"readspeaker_button1\">\n\n\n      <a accesskey=\"L\" class=\"rsbtn_play\" href=\"https:\/\/app-na.readspeaker.com\/cgi-bin\/rsent?customerid=7262&#038;lang=en_us&#038;readid=main_content&#038;url=https:\/\/dhss.delaware.gov\/dph\/php\/alerts\/dhan410.html\" title=\"Listen to this page using ReadSpeaker\">\n\n\n        <span class=\"rsbtn_left rsimg rspart\"><span class=\"rsbtn_text\"><span>Listen<\/span><\/span><\/span>\n\n\n        <span class=\"rsbtn_right rsimg rsplay rspart\"><\/span>\n\n\n      <\/a>\n\n\n    <\/div>\n\n\n    <!-- END readspeaker div -->\n\n\n\n\n\n    \n\n\n    <header class=\"pull-left\">\n\n\n      <h1>Delaware Health Alert Network #<!--[type=EDIT name=\"DHAN Number\"]-->410 <!--[END]--> <\/h1>\n\n\n      <h2> <!--[type=EDIT name=\"DHAN Date\"]-->August 22, 2019 3:02 pm <!--[END]--> <\/h2>\n\n\n    <\/header>\n\n\n  <\/div><br>\n\n\n \n\n\n  <div class=\"container\">\n\n\n    <div class=\"row\">\n\n\n      <div class=\"col-md-3\" id=\"leftCol\">\n\n\n        <div class=\"panel-group\" id=\"accordion\">\n\n\n          <div class=\"panel sectionmenu_panel\">\n\n\n            <div class=\"panel-heading\">\n\n\n              <p class=\"panel-title\"><a class=\"agency_nav\" data-parent=\"#accordion\" data-toggle=\"collapse\" href=\"#collapseOne\"><strong><i class=\"fa fa-align-justify fa-fw\"><\/i> Public Health Menu<\/strong><\/a><\/p>\n\n\n            <\/div>\n\n\n\n\n\n            <div class=\"panel-collapse collapse in\" id=\"collapseOne\">\n\n\n              <div class=\"panel-body\" id=\"clf_nav\">\n\n\n                  <ul class=\"nav nav-stacked nav-pills-clf\" id=\"agency_sidebar\">\n    <li><a href=\"\/dph\/\"><h2>Home <i class=\"fa fa-home fa-fw\"><\/i><\/h2><\/a><\/li>\n    <li class=\"toplevel\"><a data-parent=\"#agency_sidebar\" data-toggle=\"collapse\" href=\"#HomeMenu\"><h2>About <i class=\"fa fa-caret-right fa-fw\"><\/i><\/h2><\/a>\n      <ul class=\"panel-collapse collapse\" id=\"HomeMenu\">\n        <li><a href=\"\/dph\/about.html\">About DPH<\/a><\/li>\n        <li><a href=\"\/dph\/sections.html\">Sections &#038; Programs<\/a><\/li>\n        <li><a href=\"\/dph\/ofclocations.html\">Office Locations<\/a><\/li>\n        <li><a href=\"\/dph\/contact.html\">Contact Info<\/a><\/li>\n      \n        <li><a href=\"\/calendars.html\" target=\"_blank\">Calendar<\/a><\/li>\n      <\/ul>\n    <\/li>\n    <li class=\"toplevel\"><a data-parent=\"#sidebar\" data-toggle=\"collapse\" href=\"#ServicesMenu\"><h2>Services <i class=\"fa fa-caret-right fa-fw\"><\/i><\/h2><\/a>\n      <ul class=\"panel-collapse collapse\" id=\"ServicesMenu\">\n        <li><a href=\"\/dph\/servicesaz.html\">A-Z Services<\/a><\/li>\n        <li><a href=\"\/dph\/hsp\/environmental.html\">Air &#038; Water Quality<\/a><\/li>\n        <li><a href=\"\/dph\/ss\/vitalstats.html\">Birth, Death, &#038; Marriage Records<\/a><\/li>\n        <li><a href=\"\/dph\/clinics.html\">Clinics<\/a><\/li>\n        <li><a href=\"\/dph\/healthdatastats.html\">Health Data &#038; Statistics<\/a><\/li>\n        <li><a href=\"\/dph\/php\/emsps.html\">Emergency Preparedness<\/a><\/li>\n        <li><a href=\"\/dph\/healthandwellness.html\">Health &#038; Wellness<\/a><\/li>\n        <li><a href=\"\/dph\/hsp\/healthyhomes.html\">Healthy Homes<\/a><\/li>\n        <li><a href=\"\/dph\/hsp\/healthywp.html\">Healthy Workplaces<\/a><\/li>\n        <li><a href=\"\/dph\/lab\/labs.html\">Laboratory<\/a><\/li>\n        <li><a href=\"\/dph\/hsp\/feir.html\">Restaurant Inspections<\/a><\/li>\n        <li><a href=\"\/dph\/screen.html\">Screening and Testing<\/a><\/li>\n        <li><a href=\"\/dph\/chca\/dphwichominf01.html\">WIC<\/a><\/li>\n        <li><a href=\"\/dph\/servicesadd.html\">Additional Services<\/a><\/li><li>\n      <\/li><\/ul>\n    <\/li>\n    <li class=\"toplevel\"><a data-parent=\"#sidebar\" data-toggle=\"collapse\" href=\"#InformationMenu\"><h2>Information <i class=\"fa fa-caret-right fa-fw\"><\/i><\/h2><\/a>\n        <ul class=\"panel-collapse collapse\" id=\"InformationMenu\">\n        <li><a href=\"\/dph\/factsheetsaz.html\">A-Z Fact Sheets<\/a><\/li>\n        <li><a href=\"\/dph\/pubreportsaz.html\">A-Z Publications &#038; Reports<\/a><\/li>\n        <li><a href=\"\/dph\/diseasesandconditions.html\">Diseases &#038; 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According to the CDC, the shortage is expected to last three \n\n\n\n\n\nto 10 months.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n<p>This notice alerts health care providers and facilities who test for tuberculosis (TB) and provides \n\n\n\n\n\nguidance on how to manage the shortage.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n<h2>Background<\/h2>\n\n\n\n\n\n<p>Two types of immunological methods (tuberculin skin tests (TSTs) and interferon-gamma release assay \n\n\n\n\n\n[IGRA] blood tests) are used for detecting <em>Mycobacterium tuberculosis<\/em> infection. TSTs and IGRAs are used \n\n\n\n\n\nfor the diagnosis of latent TB infection (LTBI) and can aid in the diagnosis of TB disease, though additional \n\n\n\n\n\nevaluation and testing is necessary to distinguish between LTBI and TB disease and to determine the appropriate \n\n\n\n\n\ntreatment.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n<p>Two FDA-approved PPD tuberculin antigen products are available in the U.S. for use in performing TSTs: \n\n\n\n\n\nAPLISOL\u00ae and TUBERSOL\u00ae (Sanofi Pasteur Limited).<\/p>\n\n\n\n\n\n\n\n\n\n\n\n<p>&#8220;Although overall test concordance is high, switching between PPD skin test products or TSTs and IGRAs in \n\n\n\n\n\nserial testing might result in apparent conversions from negative to positive or reversions from positive to \n\n\n\n\n\nnegative that might be attributable to inherent interproduct or intermethod discordance rather than change in \n\n\n\n\n\n<em>M. tuberculosis<\/em> infection status. Clinicians should assess test results based on the person\u2019s likelihood of \n\n\n\n\n\ninfection and risk for progression to TB disease, if infected<sup>1<\/sup>,&#8221; according to the CDC.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n<p>As a result of this shortage, supplies of TUBERSOL\u00ae may also run out.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n<h2>Recommendations<\/h2>\n\n\n\n\n\n<p>When the CDC announced the shortage, they also provided recommendations to providers on how to manage for the \n\n\n\n\n\nduration. Chief among them were to prioritize the allocation of TSTs to conserve PPD stock and to substitute with \n\n\n\n\n\nIGRAs to test for TB.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n<p>In Delaware, regulations for the following types of long-term care facilities specifically require the two-step \n\n\n\n\n\nTST in order to satisfy testing requirements:<\/p>\n\n\n\n\n\n<ul>\n\n\n\n\n\n<li>\u00a0\u00a0HIV homes<\/li>\n\n\n\n\n\n<li>\u00a0\u00a0Group homes for persons with mental illness<\/li>\n\n\n\n\n\n<li>\u00a0\u00a0Neighborhood homes for individuals with intellectual and\/or developmental disabilities<\/li>\n\n\n\n\n\n<li>\u00a0\u00a0Family care homes, and<\/li>\n\n\n\n\n\n<li>\u00a0\u00a0Intensive behavioral support and educational residence<\/li>\n\n\n\n\n\n<\/ul>\n\n\n\n\n\n\n\n\n\n\n\n<p>Recognizing this, for the duration of the APLISOL\u00ae shortage, the Division of Health Care Quality (DHCQ) will \n\n\n\n\n\nnot enforce the TST requirement and will allow use of the IGRA as an acceptable alternative for TB testing of new \n\n\n\n\n\nemployees and residents in these facilities. This does not suspend any testing requirements but allows for use of an \n\n\n\n\n\nalternative testing method in the facilities listed above. All other facility-specific relevant regulations already \n\n\n\n\n\nallow for the use of the IGRA.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n<p>At this time, Delaware is not authorizing deferment of testing.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n<p>DPH has been advised by the Centers for Medicare and Medicaid Services (CMS) that physicians may call their provider \n\n\n\n\n\nadvice line to see about negotiating reimbursement for the TB blood test on a case-by-case basis.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n<p>As of May 2019, per CDC recommendations, annual TB testing of health care personnel is not recommended unless there \n\n\n\n\n\nis a known exposure, or evidence of ongoing transmission.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n<p>As a reminder, a chest X-ray is not an appropriate first line diagnostic tool for TB, and for adults, should only be \n\n\n\n\n\nobtained if the individual has already tested positive with a TST or IGRA.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n<p>If you have any further questions or concerns, contact the Delaware Division of Public Health TB Program central office \n\n\n\n\n\nat 302-744-1053 or email the TB Program manager, Crystal Vicidomini, MSN\/MBA, RN (Crystal.Vicidomini@delaware.gov).<\/p>\n\n\n\n\n\n\n\n\n\n\n\n<h2>Additional Information<\/h2>\n\n\n\n\n\n\n\n\n\n\n\n<h3>CDC<\/h3>\n\n\n\n\n\n<ul>\n\n\n\n\n\n<li>Morbidity and Mortality Weekly Report (MMWR). Nationwide Shortage of Tuberculin Skin Test Antigens: CDC Recommendations for Patient Care and Public Health Practice.<br>\n\n\n\n\n\n<a href=\"https:\/\/www.cdc.gov\/mmwr\/volumes\/68\/wr\/mm6824a4.htm\">https:\/\/www.cdc.gov\/mmwr\/volumes\/68\/wr\/mm6824a4.htm<\/a><\/li>\n\n\n\n\n\n<li>CDC: Tools for Health Care Providers<br>\n\n\n\n\n\n<a href=\"https:\/\/www.cdc.gov\/mmwr\/volumes\/68\/wr\/mm6824a4.htm\">https:\/\/www.cdc.gov\/mmwr\/volumes\/68\/wr\/mm6824a4.htm<\/a><\/li>\n\n\n\n\n\n<li>CDC: Targeted Testing<br>\n\n\n\n\n\n<a href=\"https:\/\/www.cdc.gov\/tb\/publications\/ltbi\/targetedtesting.htm\">https:\/\/www.cdc.gov\/tb\/publications\/ltbi\/targetedtesting.htm<\/a><\/li>\n\n\n\n\n\n<\/ul>\n\n\n\n\n\n\n\n\n\n\n\n<h3>Delaware Code<\/h3>\n\n\n\n\n\n<ul>\n\n\n\n\n\n<li>Delaware Administrative Code. 3201: Skilled and Intermediate Care Nursing Facilities<br>\n\n\n\n\n\n<a href=\"http:\/\/www.hpm.umn.edu\/nhregsplus\/NHRegs_by_State\/Delaware\/Deleware_AdminCode_3201.pdf\">http:\/\/www.hpm.umn.edu\/nhregsplus\/NHRegs_by_State\/Delaware\/Deleware_AdminCode_3201.pdf<\/a><\/li>\n\n\n\n\n\n<li>Delaware Administrative Code. 3225: Assisted Living Facilities<br>\n\n\n\n\n\n<a href=\"http:\/\/regulations.delaware.gov\/AdminCode\/title16\/Department%20of%20Health%20and%20Social%20Services\/Division%20of%20Health%20Care%20Quality\/3225.shtml\">http:\/\/regulations.delaware.gov\/AdminCode\/title16\/Department%20of%20Health%20and%20Social%20Services\/Division%20of%20Health%20Care%20Quality\/3225.shtml<\/a><\/li>\n\n\n\n\n\n<li>Delaware Administrative Code. 3230: Rest (Residential) Home<br>\n\n\n\n\n\n<a href=\"http:\/\/regulations.delaware.gov\/AdminCode\/title16\/Department%20of%20Health%20and%20Social%20Services\/Division%20of%20Health%20Care%20Quality\/3230.shtml\">http:\/\/regulations.delaware.gov\/AdminCode\/title16\/Department%20of%20Health%20and%20Social%20Services\/Division%20of%20Health%20Care%20Quality\/3230.shtml<\/a><\/li>\n\n\n\n\n\n<li>Delaware Administrative Code. 3301: Group Home Facilities for Persons with AIDS<br>\n\n\n\n\n\n<a href=\"http:\/\/regulations.delaware.gov\/AdminCode\/title16\/Department%20of%20Health%20and%20Social%20Services\/Division%20of%20Health%20Care%20Quality\/3301.shtml\">http:\/\/regulations.delaware.gov\/AdminCode\/title16\/Department%20of%20Health%20and%20Social%20Services\/Division%20of%20Health%20Care%20Quality\/3301.shtml<\/a><\/li>\n\n\n\n\n\n<li>Delaware Administrative Code. 3305: Group Homes for Persons with Mental Illness<br>\n\n\n\n\n\n<a href=\"http:\/\/regulations.delaware.gov\/AdminCode\/title16\/Department%20of%20Health%20and%20Social%20Services\/Division%20of%20Health%20Care%20Quality\/3305.shtml\">http:\/\/regulations.delaware.gov\/AdminCode\/title16\/Department%20of%20Health%20and%20Social%20Services\/Division%20of%20Health%20Care%20Quality\/3305.shtml<\/a><\/li>\n\n\n\n\n\n<li>Delaware Administrative Code. 3310: Neighborhood Homes for Individuals with Intellectual and\/or Developmental Disabilities<br>\n\n\n\n\n\n<a href=\"http:\/\/regulations.delaware.gov\/AdminCode\/title16\/Department%20of%20Health%20and%20Social%20Services\/Division%20of%20Health%20Care%20Quality\/3310.shtml\">http:\/\/regulations.delaware.gov\/AdminCode\/title16\/Department%20of%20Health%20and%20Social%20Services\/Division%20of%20Health%20Care%20Quality\/3310.shtml<\/a><\/li>\n\n\n\n\n\n<li>Delaware Administrative Code. 3315: Family Care Homes<br>\n\n\n\n\n\n<a href=\"http:\/\/regulations.delaware.gov\/AdminCode\/title16\/Department%20of%20Health%20and%20Social%20Services\/Division%20of%20Health%20Care%20Quality\/3315.shtml\">http:\/\/regulations.delaware.gov\/AdminCode\/title16\/Department%20of%20Health%20and%20Social%20Services\/Division%20of%20Health%20Care%20Quality\/3315.shtml<\/a><\/li>\n\n\n\n\n\n<li>Delaware Administrative Code. 3320: Intensive Behavioral Support and Educational Residence<br>\n\n\n\n\n\n<a href=\"http:\/\/regulations.delaware.gov\/AdminCode\/title16\/Department%20of%20Health%20and%20Social%20Services\/Division%20of%20Health%20Care%20Quality\/3320.shtml\">http:\/\/regulations.delaware.gov\/AdminCode\/title16\/Department%20of%20Health%20and%20Social%20Services\/Division%20of%20Health%20Care%20Quality\/3320.shtml<\/a><\/li>\n\n\n\n\n\n<li>Delaware Administrative Code. 3330: Dialysis Centers<br>\n\n\n\n\n\n<a href=\"http:\/\/regulations.delaware.gov\/AdminCode\/title16\/Department%20of%20Health%20and%20Social%20Services\/Division%20of%20Health%20Care%20Quality\/3330.shtml\">http:\/\/regulations.delaware.gov\/AdminCode\/title16\/Department%20of%20Health%20and%20Social%20Services\/Division%20of%20Health%20Care%20Quality\/3330.shtml<\/a><\/li>\n\n\n\n\n\n<li>Delaware Administrative Code. 4402: Adult Day Care Facilities<br>\n\n\n\n\n\n<a href=\"http:\/\/regulations.delaware.gov\/AdminCode\/title16\/Department%20of%20Health%20and%20Social%20Services\/Division%20of%20Public%20Health\/Health%20Systems%20Protection%20(HSP)\/4402.shtml\">http:\/\/regulations.delaware.gov\/AdminCode\/title16\/Department%20of%20Health%20and%20Social%20Services\/Division%20of%20Public%20Health\/Health%20Systems%20Protection%20(HSP)\/4402.shtml<\/a><\/li>\n\n\n\n\n\n<li>Delaware Administrative Code. 4403: Free Standing Birthing Centers<br>\n\n\n\n\n\n<a href=\"http:\/\/regulations.delaware.gov\/AdminCode\/title16\/Department%20of%20Health%20and%20Social%20Services\/Division%20of%20Health%20Care%20Quality\/3330.shtml\">http:\/\/regulations.delaware.gov\/AdminCode\/title16\/Department%20of%20Health%20and%20Social%20Services\/Division%20of%20Health%20Care%20Quality\/3330.shtml<\/a><\/li>\n\n\n\n\n\n<li>Delaware Administrative Code. 4405: Free Standing Surgical Centers<br>\n\n\n\n\n\n<a href=\"http:\/\/regulations.delaware.gov\/AdminCode\/title16\/Department%20of%20Health%20and%20Social%20Services\/Division%20of%20Public%20Health\/Health%20Systems%20Protection%20(HSP)\/4405.shtml\">http:\/\/regulations.delaware.gov\/AdminCode\/title16\/Department%20of%20Health%20and%20Social%20Services\/Division%20of%20Public%20Health\/Health%20Systems%20Protection%20(HSP)\/4405.shtml<\/a><\/li>\n\n\n\n\n\n<li>Delaware Administrative Code. 4406: Home Health Agencies<br>\n\n\n\n\n\n<a href=\"http:\/\/regulations.delaware.gov\/AdminCode\/title16\/Department%20of%20Health%20and%20Social%20Services\/Division%20of%20Public%20Health\/Health%20Systems%20Protection%20(HSP)\/4406.shtml\">http:\/\/regulations.delaware.gov\/AdminCode\/title16\/Department%20of%20Health%20and%20Social%20Services\/Division%20of%20Public%20Health\/Health%20Systems%20Protection%20(HSP)\/4406.shtml<\/a><\/li>\n\n\n\n\n\n<li>Delaware Administrative Code. 4410: Skilled Home Health Agencies<br>\n\n\n\n\n\n<a href=\"http:\/\/regulations.delaware.gov\/AdminCode\/title16\/Department%20of%20Health%20and%20Social%20Services\/Division%20of%20Public%20Health\/Health%20Systems%20Protection%20(HSP)\/4410.shtml\">http:\/\/regulations.delaware.gov\/AdminCode\/title16\/Department%20of%20Health%20and%20Social%20Services\/Division%20of%20Public%20Health\/Health%20Systems%20Protection%20(HSP)\/4410.shtml<\/a><\/li>\n\n\n\n\n\n<li>Delaware Administrative Code. 4469:  Personal Assistance Services Agencies<br>\n\n\n\n\n\n<a href=\"http:\/\/regulations.delaware.gov\/AdminCode\/title16\/Department%20of%20Health%20and%20Social%20Services\/Division%20of%20Public%20Health\/Health%20Systems%20Protection%20(HSP)\/4469.shtml\">http:\/\/regulations.delaware.gov\/AdminCode\/title16\/Department%20of%20Health%20and%20Social%20Services\/Division%20of%20Public%20Health\/Health%20Systems%20Protection%20(HSP)\/4469.shtml<\/a><\/li>\n\n\n\n\n\n<li>Delaware TB Program<br>\n\n\n\n\n\n<a href=\"\/dph\/dpc\/tbelimination.html\">https:\/\/www.dhss.delaware.gov\/dph\/dpc\/tbelimination.html<\/a><\/li>\n\n\n\n\n\n<\/ul>\n\n\n\n\n\n\n\n\n\n\n\n<p><sup>1<\/sup>Nationwide Shortage of Tuberculin Skin Test Antigens: CDC Recommendations for Patient Care and Public Health Practice. MMWR Morb Mortal Wkly Rep 2019;68:552\u2013553. DOI: <a href=\"http:\/\/dx.doi.org\/10.15585\/mmwr.mm6824a4\">http:\/\/dx.doi.org\/10.15585\/mmwr.mm6824a4<\/a><\/p>\n\n\n\n\n\n\n\n\n\n\n\n<p>************************************<\/p>\n\n\n\n\n\n\n\n\n\n\n\n<p>You are receiving this email because you are a registered member of the Delaware Health Alert Network.\n\n\n\n\n\nIf you are not a member and would like to subscribe, please register at <a href=\"https:\/\/healthalertde.org\">https:\/\/healthalertde.org<\/a><\/p>\n\n\n\n\n\n\n\n\n\n\n\n<br>\n\n\n\n\n\n<br>\n\n\n\n\n\n<p class=\"smalltext\"><a href=\"http:\/\/www.adobe.com\/products\/acrobat\/readstep2.html\"><img loading=\"lazy\" decoding=\"async\" alt=\"Download Adobe Acrobat Reader\" height=\"21\" src=\"\/wp-content\/uploads\/dhss\/img\/getacro60.gif\" width=\"60\"><\/a> Please note: Some of the files available on this page are in Adobe PDF format which requires Adobe Acrobat Reader.  A free copy of Adobe Acrobat Reader can be downloaded directly from <a href=\"http:\/\/www.adobe.com\/products\/acrobat\/readstep2.html\">Adobe <\/a>. If you are using an assistive technology unable to read Adobe PDF, please either view the corresponding text only version (if available) or visit Adobe&#8217;s <a href=\"http:\/\/access.adobe.com\">Accessibility Tools page<\/a>.<\/p>\n<!--[END]-->\n\n\n  \n\n\n        <div class=\"panel panel-danger\">\n\n\n          <div class=\"panel-heading\">    \n\n\n      <h2>Categories of Health Alert messages:<\/h2>\n\n\n       <\/div>\n\n\n       <div class=\"panel-body\">\n\n\n      <ul>\n\n\n        <li><strong>Health Alert:<\/strong> Conveys the highest level of importance; warrants immediate action or attention.<\/li>\n\n\n        <li><strong>Health Advisory:<\/strong> Provides important information for a specific incident or situation; may not require immediate action.<\/li>\n\n\n        <li><strong>Health Update:<\/strong> Provides updated information regarding an incident or situation; unlikely to require immediate action.<\/li>\n\n\n            <\/ul>\n\n\n         <div><strong>NOTE: This page is for informational purposes only and dated material (e.g. temporary websites) may not be available.<\/strong><\/div>\n\n\n          <\/div> \n\n\n        <\/div><br>  \n\n\n\n\n\n      <\/div>\n\n\n    <\/div>\n\n\n  <\/div><!-- \/container -->\n\n\n  <\/div>","protected":false},"excerpt":{"rendered":"<p>Listen Delaware Health Alert Network #410 August 22, 2019 3:02 pm Public Health Menu Home About About DPH Sections &#038; Programs Office Locations Contact Info Calendar Services A-Z Services Air &#038; Water Quality Birth, Death, &#038; Marriage Records Clinics Health Data &#038; Statistics Emergency Preparedness Health &#038; Wellness Healthy Homes Healthy Workplaces Laboratory Restaurant Inspections [&hellip;]<\/p>\n","protected":false},"author":8,"featured_media":0,"parent":9294,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"class_list":["post-10386","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10386","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/users\/8"}],"replies":[{"embeddable":true,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/comments?post=10386"}],"version-history":[{"count":1,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10386\/revisions"}],"predecessor-version":[{"id":11562,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10386\/revisions\/11562"}],"up":[{"embeddable":true,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/9294"}],"wp:attachment":[{"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/media?parent=10386"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}