This is an official

CDC HEALTH UPDATE

Distributed via Health Alert Network
December 3, 2012, 16:55 ET (4:55 PM ET)
CDC HAN-0337

Update: Additional Contamination Identified in Medical Products from New England Compounding Center

Summary: As part of the ongoing investigation of the multistate outbreak of fungal meningitis and other infections, the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) continue to test medical products from the New England Compounding Center (NECC) in Framingham, Mass.  CDC and FDA are reporting today additional microbial contamination identified in NECC products, which updates the November 1, 2012 Health Alert Network advisory. This update includes the following key points:

• CDC and FDA have identified additional microbial contamination in unopened vials of betamethasone, cardioplegia, and triamcinolone solutions distributed and recalled from NECC.
• These include bacteria known as Bacillus, and fungal species including Aspergillus tubingensis, Aspergillus fumigatus, Cladosporium species, and Penicillium species. 
• Although rare, some of the identified Bacillus species can be human pathogens. Some of the fungal organisms identified, particularly Aspergillus fumigatus, are known to cause disease in humans. It is not known how product contamination with these organisms could affect patients clinically. 
• To date, although CDC has received reports of illness in patients who have received the medications listed in the table below, including some patients who had evidence of meningeal inflammation, CDC and public health officials have no reports of laboratory-confirmed bacterial or fungal meningitis, spinal, or paraspinal infections caused by these products.
• The available epidemiological and laboratory data do not, at this time, support evidence of an outbreak of infections linked to usage of non-methylprednisolone NECC products.
• CDC's recommendations to healthcare providers for diagnosing and treating symptomatic patients who have received NECC products have not changed as a result of these findings.
• CDC continues to recommend that clinicians remain alert for the possibility that infections may have resulted from injection of NECC products, and that routine laboratory and microbiologic tests, including bacterial and fungal cultures, should be obtained as deemed necessary by treating clinicians.
• Clinicians should continue to report infections potentially related to NECC products to FDA's MedWatch and to state health departments.

Background
On September 26, 2012, NECC voluntarily recalled three lots of preservative-free methylprednisolone acetate (PF) 80mg/ml¹ associated with the multistate outbreak of fungal meningitis and other infections. As previously confirmed by CDC and FDA, the fungus Exserohilum rostratum was identified from two different lots of NECC-supplied, preservative-free methylprednisolone acetate (Lot #06292012@26 and Lot #08102012@51); testing on the third implicated lot of preservative-free methylprednisolone acetate (Lot #05212012@68) has yet to identify fungal growth.  Two types of fungus not known to be human pathogens were also identified from product from the two tested lots, namely Rhodotorula laryngis and Rhizopus stolonifer. Among these fungal organisms, only Exserohilum rostratum has been associated with human infections in this outbreak.

On October 6, NECC expanded its recall to include all products in circulation that were distributed from its facility in Framingham, Mass.  As part of the ongoing investigation, FDA and CDC have been testing various NECC products for evidence of contamination. Laboratory testing at CDC and FDA has found bacterial and/or fungal contamination in unopened vials of betamethasone, cardioplegia, and triamcinolone solutions distributed and recalled from NECC, as shown in the table below.

Laboratory-Confirmed Organisms from Product Samples Associated with NECC Recalled Lots of Betamethasone, Cardioplegia, and Triamcinolone Solutions
Medication	Lot Number	Bacterial and Fungal Contamination
Betamethasone 6 mg/mL injectable –5 mL per vial	08202012@141	Paenibacillus pabuli/amolyticus, Bacillus idriensis, Bacillus flexus, Bacillus simplex, Lysinibacillus sp., Bacillus niacini, Kocuria rosea, Bacillus lentus
Betamethasone 6 mg/mL injectable –5 mL per vial	07032012@22	Bacillus niabensis, Bacillus circulans
Betamethasone 12 mg/mL injectable – 5 mL per vial	07302012@52	Bacillus lentus, Bacillus circulans, Bacillus niabensis, Paenibacillus barengoltzii/timonensis
Betamethasone 6mg/mL injectable – 5 mL per vial	08202012@44	Bacillus lentus, Bacillus firmus, Bacillus pumilus
Betamethasone 6 mg/mL injectable – 5 mL per vial	08152012@84	Penicillium sp., Cladosporium sp.
Triamcinolone* 40mg/mL injectable – 1 mL per vial	06062012@6	Bacillus lentus, Bacillus circulans
Triamcinolone 40 mg/mL injectable – 2 mL per vial	08172012@60	Aspergillus tubingensis, Penicillium sp.
Triamcinolone 40mg/mL injectable – 10 mL per vial	08242012@2	Aspergillus fumigatus
Cardioplegia solution 265.5 mL per bag	09242012@55	Bacillus halmapalus/horikoshii, Brevibacillus choshinensis

*Identification of other bacteria for this product is pending.

Recommendations to Healthcare Providers

FDA released a MedWatch Safety Alert on October 15 stating that the sterility of any injectable drugs, including ophthalmic drugs that are injectable or used in conjunction with eye surgery, and cardioplegic solutions produced by NECC is of significant concern.  The safety alert further advised healthcare providers to follow-up with patients who were administered any of these products purchased from or distributed by NECC on or after May 21, 2012. A sample notification letter to assist with this process is available.

CDC’s recommendations to healthcare providers for diagnosing and treating symptomatic patients who have received NECC products have not changed as a result of the laboratory findings reported here. CDC continues to recommend that clinicians remain vigilant for the possibility that infections may have resulted from injection of NECC products, and that routine laboratory and microbiologic tests, including bacterial and fungal cultures, should be obtained as deemed necessary by treating clinicians.

There has been no prior systematic surveillance for adverse events following epidura
l steroid injections; however, infection is a known, although likely rare, risk that has been documented in the medical literature.  To date, although CDC is aware of reports of illness in patients who have received these medications, including some patients who had evidence of meningeal inflammation, CDC and other public health officials have no reports of laboratory-confirmed bacterial or fungal meningitis, or spinal or paraspinal infections caused by these products.  The available epidemiological and laboratory data do not, at this time, support evidence of an outbreak of infections linked to usage of non-methylprednisolone NECC products.
However, because it is possible that some of the organisms listed in the table above can cause human disease, clinicians should continue to include bacterial and/or fungal infection in the differential diagnosis when evaluating symptomatic patients who were exposed to these medications, including consideration of empiric antifungal therapy.

Consultation with an infectious disease specialist is strongly encouraged to help make treatment decisions in these cases.  If the evaluation of these patients is suggestive of fungal infection, please consult existing CDC treatment guidance associated with this outbreak.

Physicians should continue to report infections potentially related to NECC products to FDA's MedWatch and to state health departments.

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NECC lots of methylprednisolone acetate (PF) 80mg/ml:
     Methylprednisolone Acetate (PF) 80 mg/ml Injection, Lot #05212012@68, BUD 11/17/2012
     Methylprednisolone Acetate (PF) 80 mg/ml Injection, Lot #06292012@26, BUD 12/26/2012
     Methylprednisolone Acetate (PF) 80 mg/ml Injection, Lot #08102012@51, BUD 2/6/2013

The Centers for Disease Control and Prevention (CDC) protects people's health and safety by preventing and controlling diseases and injuries; enhances health decisions by providing credible information on critical health issues; and promotes healthy living through strong partnerships with local, national, and international organizations.

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http://emergency.cdc.gov/HAN/han00337.asp

Project Wildfire: A Community Approach to Surviving Wildfires

 

Project Wildfire: A Community Approach to Surviving Wildfires

Categories: General, Natural Disasters, Preparedness, Response

December 3rd, 2012 10:49 am ET  -  Blog Administrator

By Kate Lighthall

Project Wildfire in Deschutes County, Oregon has been recognized by CDC’s Office of Public Health Preparedness and Response’s (OPHPR) Learning Office and the CDC Foundation as a community effort that reflects and embodies FEMA’s Whole Community approach to emergency management.

Although central Oregon experiences other natural and man-made disasters, wildfires are by far the biggest threat here, especially during the summer months.  In an average year, we experience 450 fires that burn 50,000 acres and homes, threaten lives and impact the economy.  Following two devastating wildfires that burned in Bend, Oregon in 1990 and again in 1996, the Fire Chief of Deschutes County, Oregon, Gary Marshall, received a phone call from Safeco Insurance offering to contribute to the purchase of new firefighting equipment. Marshall politely declined Safeco’s offer because he had a more effective, long-term solution in mind that involved educating the public about the risks of wildfires.

Marshall asked Safeco Insurance if they would invest in an education program designed to teach people to help themselves prepare for wildfires. “A new piece of equipment might save one more home,” Marshall said. “But to really save homes, individuals have to take responsibility for their property before a fire.” His ultimate aim: To change the values and behaviors of citizens for generations to come. 

Safeco agreed and FireFree was born.  FireFree is a year-round educational program that was launched to promote 10 simple steps that homeowners can take to protect their homes from wildfires and reduce their risk of loss.  The number one FireFree tip, and the main focus of the behavior change campaign, is to create “defensible space,” a minimum 30-foot buffer zone around a house that can be created in one weekend, and easily maintained.  To encourage citizens to prepare for wildfires, FireFree partners with Deschutes County Department of Solid Waste and Deschutes Recycling to provide free collection and recycling of yard debris and waste during the spring.  Later in the fall, residents can recycle their yard debris at Deschutes Recycling for half price.  The program ran with the tagline, “It’s quick. It’s simple. It’s everybody’s responsibility.”  Sixteen years later, FireFree continues to effectively change attitudes and behaviors about wildfires.

This initial program became part of a larger endeavor.  County elected officials took notice of these efforts and passed a county ordinance that created Project Wildfire to help manage and support FireFree, as well as provide long-term wildfire mitigation strategies.  At the core of Project Wildfire’s organization is a community driven approach, with a diverse membership that provides a wealth of local knowledge and broad educational outreach.

The FireFree story is just one of Project Wildfire’s accomplishments.  Since the initial push in the late 1990s to educate communities in Deschutes County, Project Wildfire has become the local coordinating group that facilitates, educates, and disseminates efforts about the importance of wildfire safety across the community.  Project Wildfire is the facilitator and caretaker of seven Community Wildfire Protection Plans (CWPPs), coordinates a countywide Sweat Equity (FireFree based) Program, and Evacuation Preparedness program and is recognized as a wildfire mitigation resource across the state and the nation.
While Project Wildfire has accomplished much over the last decade, our achievement is due in no small part to our successful working relationships with our partners.  We continue to implement programs that encourage neighbor-to-neighbor education and understanding while leveraging opportunities for public/private partnerships. 

The Whole Community Approach

The “Whole Community” is FEMA’s philosophical approach on how to conduct emergency management in a way that integrates the needs, capabilities, and resources across the community. It attempts to engage the full capacity of the private and nonprofit sectors, including businesses, faith-based organizations, and the general public, in conjunction with the participation of federal, state, local, territorial, and tribal government partners. 

Project Wildfire has been identified as one of seven programs to continue their Whole Community work during the pilot program period October 2012 – March 2013. During this time, we will provide a learning opportunity for CDC and CDC Foundation staff to gather information on what works well in starting and maintaining community programs, identifying strategies to create and build partnerships, and techniques to empower local action. The project findings will outline recommendations for fostering a Whole Community approach to emergency management, sustainability, and program replication. 

We’re proud to be one of the seven community organizations selected as a promising example of FEMA’s Whole Community model.  We look forward to highlighting the progress we’ve made toward preparedness in Deschutes County, Oregon and contributing to a national effort to make sure America is prepared for emergencies.

To learn more about Project Wildfire, please contact Kate Lighthall at klighthall@bendcable.com or visit us on the web at www.ProjectWildfire.org or www.FireFree.org.

Follow #PromisingExample on Twitter to learn about the other six communities that embody a whole community approach to emergency management.

The Great Debate: Practical vs Ph.D. to get ahead in DC....

http://drezner.foreignpolicy.com/posts/2012/11/29/so_you_want_to_get_a_phd_to_work_in_dc
So you want to get a Ph.D. to get ahead in DC....

Posted By Daniel W. Drezner Thursday, November 29, 2012 - 2:37 PM Share

So, my post about good and bad reasons to get a Ph.D. in political science has made a few waves.  I'd like to clarify, endorse and respond to some of the feedback I've received. 

Just to recap, here was the primary point of my post:

Even standard political science departments are littered with students who have sterling resumes, glittering letters of recommendation from well-connected fixtures of the foreign policy community, and that disturbing tendency to look past the task at hand to plot out steps three, four and five of their Ascent to Greatness.
Here's the thing about these students: 95 percent of them will not earn a Ph.D. -- and most of the rest who do get it will only have done so by finding the most pliant dissertation committee alive. Ambition and intelligence can get someone through college and a professional degree. It can even get someone through Ph.D.-level coursework. What it can't do is produce an above-the-bar dissertation.
In my day, I've known too many students who were talented in many ways, and yet got stymied at the dissertation phase. For people who have succeeded at pretty much everything in life to that point, a Ph.D. seems like just another barrier to transcend. It's not. Unless you are able to simultaneously love and critically dissect your subject matter, unless you thrive in an environment where people are looking forward to picking apart your most cherished ideas, you won't finish.

Now, some of the comments and tweets about this post suggested that I was pooh-poohing the idea of getting a Ph.D. if you don't want to become a professor.  To be clear:  that is not what I was trying to say.  Indeed, if anything, given the state of the academic job market I heartily endorse "non-traditional" career paths for Ph.D.s.  Furthermore, as Joshua Foust notes in his response, "If you want to succeed in Washington, a PhD is the quickest path to it. Anything less is just an uphill battle." 

There is no shame in going from a doctoral program to a job in DC, and I was certainly not implying that there should be. 

Foust offers a strong counter-explanation for why aspiring policy wonks should go for a Ph.D.:

[A] PhD offers a better way for many [than getting a professional M.A.]. PhDs are usually funded, which means they cost nothing to the student (stipends may not be much, but that’s a separate matter — the financial loads are drastically different). They also take a lot longer, say 5 years minimum but more likely 7 if you’re young and right out of undergrad.

Even so, that PhD is more or less free. Entering the DC workforce with a PhD, instead of a Masters, is an instant leg-up. For organizations like think tanks, it instantly signals research skills; for NGOs it signifies a strong work ethic. And for many government jobs, contractor jobs, or jobs at IGOs like the World Bank or IMF, it is a basic minimum requirement for most non-admin jobs. In almost any field, having a PhD is a shortcut to the initial round of CV scrutiny — an easy and quick way to sort candidates.

Now, let's assume Foust is correct about the money (doctoral students about to comment that a doctorate is not "more or less free" -- I know!!  I'm not asserting this, Foust is!!  Go bug him!!!).  It seems like the Ph.D. is the smart play then, right? 

Wrong.  Foust is assuming that the choice is a binary one -- between climbing the policy ladder without a a doctorate or with a doctorate.   The point of my initial post is that there's a third possibility, and it's the one that will fell people getting a Ph.D. for professional reasons only -- that one will start a Ph.D. program but never finish. 

First of all, that is, by far, the worst outcome.  Matt Groening can express this far better than I: 

In all seriousness, life is not quite this bad for those who fail to finish.  It's not great, however.  For those who recognize early on that the Ph.D. is not for them, it's OK.  Exiting a doctoral program after, say, three years with a terminal masters is about as graceful an exit as one can execute. 

The more years one stays in, however, the greater the pain of exiting.  There's a lot of psychological scarring, and the networks built up in a doctoral program are likely inferior to those that would be built up via a lower-level policy job.  And I'd wager that it's precisely the ambitious, career-minded DC types who are less likely to cut and run -- because their entire life experience to date suggests that quitting is the wrong course of action. 

Furthermore, not finishing a Ph.D. is not exactly uncommon.  Click on this slide show about Ph.D. attrition rates from the Council of Graduate Schools, and note the following three facts:

1)  Only 46% of all entrants finish their Ph.D. after seven years in a program.   
2)  For social science Ph.D.s, that figure is even lower -- 41%
3)  If you extend it out to ten years, the lowest completion rate among the social sciences is political science -- only 44% complete a doctorate after a decade.  In other words, entering a Ph.D. program and then not finishing is the modal outcome. 

Foust is likely correct that getting a Ph.D. gives one a leg up in the DC policy wonk rat race.  But I know I'm correct when I say that starting but not finishing a Ph.D. is the worst possible career trajectory.  It is this outcome that I'm harping on when I'm warning ambitious go-getter policy wonks to think long and hard about why they want to get a doctorate.  It can't just be to win "The Game." 

Now, to be fair, Tara Maller makes a valid point when she notes that "personal challenges" can fell a Ph.D. candidate.  However, I would argue that the biggest impediment to finishing is not having a clear idea of what's involved in getting a doctorate in the first place.   In an email from Afghanistan, Lieutenant Colonel Jason Dempsey -- a Columbia Ph.D. and published scholar -- made this point: 

Part of the dynamic I think is 'degree-inflation' where everyone has a master's, so it seems logical that to distinguish yourself from the pack that a PhD is the next logical step.  While finishing my dissertation I had quite a few officers who had just finished MA or MPA programs asking how they could proceed to a PhD, with no idea that they were two entirely separate animals.

I've also had to break it to people that publishing an academic book is not the road the glory it might seem from afar, and that the most you can expect out of it beyond the intrinsic reward of contributing to an ongoing discussion is a box of very heavy 'business cards'....
Knowing what you are getting into and the need to fully embrace the topic are key to success.  Sometimes that will align with a non-academic career-- probably more often not....  The difference between an MA and a PhD isn't incremental but fundamental, and that is a hard gap to bridge when coming from an institution that is decidedly pragmatic and application-oriented as a matter of survival.

Dempsey's point is the one I was trying to ham-handedly make in my last post.  It is natural for people in DC to believe that the Ph.D. is the next logical step after a professional or masters degree.  It.  Is.  Not. 

When asked about whether getting a Ph.D. is a good idea, I usually tell men that writing a dissertation is the closest experience they will have to being pregnant -- except that instead of nine months they'll be carrying that sucker for 2-5 years.  I then tell women that, of course, writing a dissertation is not remotely close to being pregnant -- but take the most volatile relationship from your past and then multiply that volatility by a factor of fifty.  That's what it's like.  And I haven't even gotten to the incredible socialization pressures within graduate school to feel like you should pursue an academic career instean of a non-academic one. 

Despite these barriers, is it possible to simply "grind out" the Ph.D. without loving the subject matter and the process?  Yeah, in theory.  I've met one or two extraordinary people in my day who were able to pull that off.  But -- and I cannot stress this enough -- I've met far more people who thought they could grind it out and then met their ruin on the shoals of some doctoral program.  These are the people who stay in a doctoral program long after everyone else knows that the jig is up.  That is the fate I am warning policy wonks  away from. 

There is no shame in thinking that a Ph.D. gives one a leg up in the Beltway job market.  But that cannot and should not be the primary reason to get a doctorate.  What separates a Ph.D. from other degrees is the scholarly act of writing a dissertation.  If there is no genuine fascination with the subject matter, if there is no love of the topic, then there is a 99.5% probability of failure.  That has to be the primary driver.  If it's fame and fortune, then the professional degree route -- a J.D., an M.B.A. or a M.A.L.D. -- is the better route for you. 

Steve Saideman sums up why I'm making this argument so vehemently: 

An MA is a professional degree for the policy-maker but most PhDs are not that.  They require patience, analytical rigor, the ability to think theoretically, to be open to criticism, and so on.  So, [Dan] has seen those who are in it just for the stamp flounder and fail. 

That's correct.  Maybe I'm exaggerating the costs of failure here -- but I don't think so. 

So, to conclude.  There is no shame in getting a Ph.D. with the intention of pursuing a non-academic career.  Foust is correct that there are certain material rewards that come with earning a Ph.D.  But unlike other degrees, those rewards cannot be the principal reason you choose to pursue a doctorate.  That is the recipe for misery and heartbreak. 

Critical Infrastructure: Possible EPA Grants To Protect Water Systems From Climate Change

Cardin Seeks EPA Grants To Protect Water Systems From Climate Change

Posted: November 19, 2012

 

Sen. Benjamin Cardin (D-MD), chairman of the Senate subcommittee overseeing EPA's water program, is seeking to create a new, $250 million EPA grant program to help strengthen wastewater and drinking water systems from threats posed by the effects of climate change, a growing focus since Hurricane Sandy damaged systems in the Northeast.

The senator Nov. 14 submitted an amendment to S. 3525, a bill intended to authorize hunting and fishing programs, to allow EPA to provide grants to update municipal water systems to withstand changes in hydrological flows caused by climate change, the latest in a slew of efforts by Democratic lawmakers to gain more funding for water infrastructure.

The measure appears likely to gain support from lawmakers whose states were hit by the storm. For example, Sen. Frank Lautenberg (D-NJ) told a Nov. 15 Senate environment committee hearing on legislation authorizing Army Corps of Engineers projects that there is a need for such funding given the effects of the recent storm.
"During Sandy, we also saw outdated water infrastructure lead to two water treatment facilities breaking down, with millions of gallons of sewage leaking into Newark Bay as a result. This shouldn't happen. There's no excuse not to have modernized water infrastructure," he said.

S. 3525, which was introduced Sept. 10 by Sen. Jon Tester (D-MT), seeks to require that not less than 1.5 percent of land put aside each year under the Land And Water Conservation Fund be made available for recreational access such as hunting and fishing and calls for extending wetlands conservation project funding among other things.

Although the bill addresses several GOP priorities, such as limiting lead in hunting ammunition and fishing tackle from regulation under the Toxic Substances Control Act (TSCA), the bill currently lacks Republican sponsors. The bill is slated for a floor vote Nov. 26.

Cardin's amendment seeks to create a "'Water Infrastructure Resiliency and Sustainability Program," which will require EPA to issue grants totaling $50 million for each year from 2013 through 2017 "for the purpose of increasing the resiliency or adaptability of the water systems to any ongoing or forecasted chances (based on the best available research and data) to the hydrological conditions of a region of the United States."

Entities eligible to seek the grants include community water treatment works, water systems, storage and transport systems and floodwater runoff management infrastructure.

The amendment seeks to set aside funds "exclusively to assist in the planning, design, construction, implementation, operation, or maintenance" of projects that address water conservation, efficiency, enhance watershed management, support the adoption of advanced water treatment technologies, modify or replace existing systems and "not further exacerbate stresses on ecosystems or cause redirected impacts by degrading water quality or increasing net greenhouse gas emissions."
The funding can also be used for flood mitigation measures, including modifying levies and preventing development in floodplains. Priority for grants will be given to those systems that are at the most "immediate risk of facing significant negative impacts due to changing hydrologic conditions." Cardin, who chairs the senate environment committee's water panel, has long championed water infrastructure needs, including the need for re-authorization of EPA's State Revolving Fund grant program.
Senators' Amendments
In addition to Cardin's amendment, Sen. Olympia Snowe (R-ME) is offering an amendment seeking a biennial progress report from EPA on the implementation of the Gulf Hypoxia Action Plan 2008 in the Gulf of Mexico.

The amendment calls for the reports to "assess the progress made toward nutrient load reductions, the response of the hypoxic zone and water quality throughout the Mississippi/Atchafalaya River Basin, and the economic and social effects." Data in the reports could be used to "recommend appropriate action continue to implement or, if necessary, revise the strategy set forth in the Gulf Hypoxia Plan 2008."

The plan, enacted in June 2008, seeks to address excess nutrient runoff from 12 states in the Mississippi River watershed, including a goal of reducing "the 5-year running average of the areal extent of the hypoxic zone to less than 5,000 square kilometers by 2015," although the plan acknowledges reaching the goal is likely impossible.

Meanwhile, GOP Sen. Orrin Hatch (UT) is seeking to use the bill to require EPA to do an economic impact analysis of a revised national ambient air quality standard (NAAQS) for particulate matter, particularly as it effects the agricultural sector -- granting the agency a year reprieve from finalizing the NAAQS to complete the review. And the senator has submitted language that would amend the bill to include a prohibition of the regulation of green house gasses under the Clean Air Act, the authority EPA has pointed to in its green house gas reduction efforts.

http://insideepa.com/Inside-EPA-General/Inside-EPA-Public-Content/cardin-seeks-epa-grants-to-protect-water-systems-from-climate-change/menu-id-565.html?S=LI&goback=%2Egde_1826367_member_191091139

Webinars: Two-Part Basic Agent Flood Insurance Course

Two-Part Basic Agent Flood Insurance Course Webinars conducted by the National Flood Insurance Program Part One: December 4 11:00 am - 1:00 pm EST REGISTER FOR BOTH SESSIONS Part Two: December 5 11:00 am - 1:00 pm EST THIS IS A TWO-PART COURSE Attendees must attend both sessions in order to cover all required topics as mandated by the Flood Insurance Reform Act (FIRA) of 2004. WHAT YOU WILL LEARN This course addresses basic flood insurance issues as well as some more advanced components. At the conclusion of both sessions, attendees with little or no prior NFIP experience will understand how to build a flood insurance policy from the ground up. More experienced attendees will develop an even better understanding of: A Standard Flood Insurance Policy's major coverage areas FEMA's Elevation certificate Increased Cost of Compliance coverage And much more! CONTINUING EDUCATION No continuing education credits are offered for this course in any state. REGISTRATION INFORMATION This course is FREE, but space is limited so register early. To register, please use the link above. Please do not reply to this email. If you have questions regarding NFIP Training, please write to nfiptraininginfo@h2opartnersusa.com or view the NFIP schedule. Sign Up for NFIP Agent Training Bulletins The National Flood Insurance Program is administered by the Federal Emergency Management Agency (FEMA), a component of the U.S. Department of Homeland Security National Flood Insurance Program Training | www.nfipiservice.com/training nfiptraininginfo@h2opartnersusa.com | (800) 427-4661