countermeasures). The new, joint indicator might read as follows: Local and/or state public health has identified, engaged, and trained governmental and nongovernmental agencies to participate in and taken the necessary steps to establish sites for mass distribution of vaccine (or other countermeasures).

Within the framework provided by the Ten Essential Public Health Services, these indicators correspond to Essential Service 7 and 8.

• Does the agency have lists with contact information, addresses, and letters of agreement with all planned distribution sites in the community? (state or local, depending on which is managing the distribution process)

• Does the operational plan (which should be consistent with CDC guidelines) include rosters of staff, with contact information, functional role descriptions, and evidence of training for all personnel on the roster? (state or local, depending on which is managing the distribution process)

• Are there written collaborative agreements with all agencies that would be involved in some aspect of vaccination/distribution of countermeasures (school districts, EMS, law enforcement, etc.)? (state or local, depending on which is managing the distribution process)

These indicators are closely related and should be integrated. “Differential diagnosis” is more clearly worded as “confirming the diagnosis of….” The new, combined indicator might read as follows: Local and/or state public health agency has trained health care personnel and has core personnel available to provide technical assistance in confirming the diagnosis of smallpox syndrome.

Within the framework provided by the Ten Essential Public Health Services, these indicators correspond to Essential Service 2 and 8.

• Is there a plan for ongoing education and training of health care providers and evidence of its implementation? (state or local, depending on specific state plan)

• Do local public health agencies have contact information at every