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pdfLong-term Health Outcomes of Peace Corps Volunteers
Investigators and Responsibilities
Name
Kathrine Tan,
MD MPH
Title, Affiliation
Medical
Officer, CDC
Susan
Henderson, MD
MPH
Epidemiologist,
Peace Corps
Jodi Vanden Eng,
MS
Biostatistician,
CDC
Tom Wilkinson,
MD
Medical
Officer,
Peace Corps
Associate
Director,
Peace Corps
Epidemiologist,
Peace Corps
Paul Jung, MD
Rennie Ferguson
Paul Arguin, MD
Domestic Unit
Team Lead,
CDC
Roles and Responsibilities
Principal Investigator. Develop study, write protocol, manage
OMB and IRB clearance, implement study, analyze data, present
results to Peace Corps, write and edit abstract and manuscript,
submit abstract to a conference and manuscript to a journal,
present results at a major conference if invited
Investigator. Technical assistance for study development, review
and edit protocol, provide technical assistance for study
implementation and analysis, review and edit abstract and
manuscript
Investigator. Technical assistance for analytic plan in protocol,
data cleaning and management, complex data analysis, review
abstract and manuscript (especially analytic methods and results
sections)
Investigator. Review protocol, review abstract and manuscript
Investigator. Review protocol, review abstract and manuscript
Study implementer and data manager. Manages database of
returned Volunteers, assists with study implementation,
specifically disseminating survey link to returned Volunteers.
Senior author, co-principal investigator. Review protocol,
provide technical support and subject matter expertise for study
implementation and data analysis, review manuscript
Summary
Adherence to chemoprophylaxis in long-term travelers like Peace Corps Volunteers (PCVs) is a challenge,
and a previous survey of PCVs found that fear of latent side effects (diseases that might develop years
after taking antimalarials for prolonged periods of time) was one of the top factors associated with
nonadherence. There is a dearth of studies on the risk of latent effects of prophylaxis. The multi-year
deployment of PCVs to malaria-endemic areas presents a good opportunity to examine if long-term
malaria prophylaxis puts users at higher risk of developing certain diseases in the future. The results of
such a study would provide some evidence with which to address fears of latent side effects in order to
improve adherence to malaria prophylaxis. We propose to determine if use of malaria
chemoprophylaxis among PCVs is associated with long-term health outcomes. A matched-cohort study
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is proposed, in which PCVs who completed service between 1995–2014 will be surveyed using an
internet-based questionnaire. Risk for developing disease will be compared between those who took
prophylaxis and those who did not. Data dissemination will take the form of a report to Peace Corps,
abstract submitted to an international conference, and a manuscript submitted to a peer-reviewed
journal.
I. Background and Rationale
Malaria chemoprophylaxis is a key strategy for preventing malaria when traveling to malaria-endemic
areas. Long-term travelers (those traveling for 6 or more months) to malaria-endemic areas have
reported poor adherence to malaria prophylaxis, and a literature review found that 15-82% of long-term
travelers to Africa reported getting malaria. 1, 2 Reasons cited for poor adherence have included fear of
long-term adverse events, conflicting advice, and complicated dosing strategies. 1 An example of longterm travelers on antimalarials for an extended period of time, are Peace Corps Volunteers (PCVs), who
are posted internationally for at least two years. A recent survey of Peace Corps Volunteers serving in
malaria-endemic areas in Africa found that fear of latent side effects (i.e. disease that might develop
after discontinuing antimalarials) was one of the top reasons for non-adherence to prophylaxis. 3
The latent adverse effects of long-term malaria prophylaxis are not well known, and if any exist, these
effects would vary by drug. Most of the literature available examines side effects experienced during,
not after, long-term use of some, but not all, of the antimalarials. 4, 5, 6 There is some limited evidence in
the literature of persistent adverse events, that is, adverse events that start while taking the drug and
persist even after discontinuation. For example, use of chloroquine at 250 mg/day for more than 5
years is associated with an estimated 1% risk of developing oculotoxicity, which may progress even after
discontinuation of the drug;7 however usual prophylaxis dosing is weekly. For mefloquine, there have
been rare case reports of persistent dizziness despite discontinuation. 8 Furthermore, the definition of
“long-term” use may vary from less than 6 months to years of use in different studies. 6, 9 There are no
studies on the latent effects of long-term malaria prophylaxis.
The multi-year deployment of PCVs to malaria-endemic areas presents a good opportunity to examine if
long-term malaria prophylaxis puts users at higher risk of developing certain diseases in the future. The
results of such a study would provide some evidence with which to address fears of latent effects of
malaria prophylaxis in order to improve adherence among long-term travelers such as PCVs.
Furthermore, PCVs usually serve in challenging conditions with potential exposures that might put them
at risk for other diseases, and the safety and health of PCVs is a priority for Peace Corps. While the data
generated in this proposed study will not be comprehensive for exposures, many health outcomes will
be collected. The data generated from this study can help Peace Corps understand long-term health
outcomes of PCVs in terms of prevalence of select diseases in comparison to the general US population.
Objectives
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1. To determine whether or not use of malaria chemoprophylaxis increases risk of developing
various diseases among former PCVs.
2. To describe the prevalence of select diseases among returned PCVs in comparison to the general
US population.
II. Methods
Study population
Inclusion criteria are broad in that all PCVs who served between 1995–2014 will be invited and are
eligible to participate.
Study design
A matched-cohort study is proposed. An anonymous, internet-based survey will be disseminated to
returned PCVs. Because self-reported symptoms might not be as dependable, the study will focus on
actual diagnoses that were made before, during and after taking malaria prophylaxis. Diagnoses made
after leaving Peace Corps will be described in respondents as a whole. Then, the risk of developing
these disease diagnoses will be compared among those who took any malaria prophylaxis to those who
did not take prophylaxis using 1:3 matching. The study will focus on select diseases (see outcomes of
interest below). Because we do not want to bias responses to the survey by highlighting adverse events
and malaria prophylaxis, the consent form, as well as the questions in the survey, will emphasize the
broader purpose of looking at disease outcomes in general.
Sampling and sample size
If one person who took prophylaxis is matched to three people who did not, and aiming for a study with
power=0.80 and an alpha=0.05, the exact sample size needed would depend on the prevalence of
disease, and how big of a difference between the two groups we would like to detect. For example, if
we wanted to be able to detect a 25% difference between the two groups in the prevalence of a more
common disease, like coronary heart disease with a prevalence of about 6% in the general population,
the sample size needed would be about 3,320 people who took prophylaxis and 9,960 people who did
not take prophylaxis. To maximize sample size, all PCVs in the database will be invited to participate.
Peace Corps maintains a database of returned PCVs with 65,000 PCVs who served between 1995–2014.
It is also possible that for some returned PCVs, especially the ones who served further in the past, the
contact information is not up to date. To try to get at these returned PCVs, we will also do respondentdriven sampling. PCVs contacted via email stored in the returned PCV database will be asked to invite
other PCVs who they might know to participate in the survey. To invite others, the participant can
forward the invitation email containing a link to the survey.
Outcomes of interest
The outcomes of interest are self-reported diseases diagnosed by a medical professional, requiring
ongoing management or medication, and with an onset after leaving Peace Corps and select nonmedical outcomes (the need to wear glasses/contacts, and social indicators like marital/partnership
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status and employment), reported since completing malaria prophylaxis. The disease diagnoses of
particular interest will be based on feared long-term adverse events reported in a prior survey of PCVs 3 ,
and those extrapolated from known or suspected adverse events of antimalarials. In the prior survey,
the top-feared latent adverse effects due to malaria prophylaxis were: neuropsychiatric events
(depression, anxiety, and insomnia), cancer (unspecified), and "sun sensitivity". So the diagnoses to be
examined will include depression, anxiety, insomnia, and select cancers including skin cancer. As for
diagnoses of interest related to known or suspected adverse events of antimalarials, we will examine
the following. Mefloquine is known to cause neuropsychiatric adverse events in 10-15% of those taking
it, so diagnoses such as dementia, depression, vestibular dysfunction, seizures, or psychoses would be of
interest. Melfoquine is also known to affect cardiac conductivity resulting in arrhythmias, so cardiac
diagnoses such as arrhythmias, myocardial infarction, and congestive heart failure will be examined.
Doxycycline is known to cause gastrointestinal disturbances so gastric, duodenal, or esophageal ulcers
would be of interest, as well as recurrent yeast infections. Chloroquine has been associated with
pruritus and rash, so dermatologic conditions such as psoriasis will be of interest. Long-term use of
chloroquine has been associated with oculotoxicity, which will also be examined. For malarone,
abnormal liver function tests have been reported with use, so fatty liver, cirrhosis, liver failure, and liver
cancer will be examined. Non-medical outcomes such as wearing glasses/contacts or social indicators
like divorce or employment will be used as indirect indicators of long-term health effects.
Because these outcomes could also be associated with predisposing conditions and could result from
other exposures, factors such as diagnoses while in Peace Corps, habits (smoking, drinking, and
exercising), assignment while in Peace Corps, and occupation will be asked.
Data collection and pilot testing of instrument
An internet-based survey will be created on Survey Monkey (Appendix A). Questions to be asked
include: country served, whether or not prophylaxis was required at assigned site; prophylactic drug
taken; length of time on the drug; when prophylaxis was stopped; degree of adherence; select medical
diagnoses during and since leaving Peace Corps; medications; habits; and demographics.
This survey will be pilot tested among 10 returned PCVs to determine clarity of questions as well as
length of time to complete. Based on this pilot test, the data collection instrument will be further
refined. The data collection instrument in Appendix A has the totality of the scope of questions to be
asked. The pilot will be used to either refine wording of the questions for clarity, or to cut out questions
if too lengthy; no questions beyond the scope of the survey in Appendix A will be added.
The Peace Corps data manager will disseminate a link to the survey to the returned PCVs in their
database. Each returned PCV will be emailed a unique ID number. These returned PCVs will be asked to
invite other returned PCVs whom they might know to take the survey, and to use the same ID number.
To maximize response rate, a reminder email containing a link to the survey and the unique ID number
will be sent two and four weeks after the initial email. After the survey link is e-mailed, the Peace Corps
data manager will destroy any documentation of ID numbers. The purpose of the ID number is to
anonymously link groups of invited PCVs together so that we know the proportion of participants
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sampled via respondent driven sampling versus those in the original Peace-Corps-originated invitation.
This will be useful to get the response rate for the original invitation. When the surveys are completed,
Survey Monkey sends the data directly to CDC.
Aggregate data on demographics (age, sex) of the returned PCVs invited to do the survey will be
provided by Peace Corps.
Data management
Data from completed surveys will be sent from Survey Monkey directly to CDC, so it will have no
identifying data. CDC will house, manage, and clean the database. Once the main objectives of the
study have been completed, the dataset will be maintained by CDC for future analytic interests. Any
additional analyses or proposed secondary manuscripts beyond the scope of this protocol will require a
written proposal outlining the rationale, objectives, analytical methods, and data dissemination plans,
and must be approved by the investigators at both Peace Corps and CDC.
Data analysis
Data will be analyzed using SAS v9.3. Response rate will be calculated. Representativeness of our
sample will be examined by comparing the demographics of our sample to the aggregate demographic
data of PCVs serving 1995–2014 obtained from Peace Corps.
The exposure of interest is malaria prophylaxis, and outcomes of interest are select disease diagnoses.
Volunteers who took malaria prophylaxis will be matched to volunteers who took no prophylaxis at a 1:3
ratio based on age, and gender. Demographics and characteristics of these two groups will be described
and compared. Then, risk for developing a disease will be compared between those who took
prophylaxis and those who didn't. This risk of disease will be stratified by type of antimalarial. To see if
those who took prophylaxis might be at risk for developing certain diseases sooner, we will examine
time between finishing Peace Corps (1 month after finishing) and development of disease among those
who took prophylaxis and those that did not.
For the secondary objective, prevalence of select diseases among returned PCVs will be compared to
those of the general US population within the same age, sex, and ethnic categories when appropriate.
III. Ethical issues
Consent
The consent form (Appendix B) will appear prior to starting the survey. Only those who consent will be
allowed to proceed with the survey.
Confidentiality
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Peace Corps will e-mail a link to the survey using their database of returned PCVs. Each PCV will be
given a random ID number to enter into the online data form, but those invited via respondent driven
sampling will use the same ID number as the inviter. After the emails are sent out to the returned PCVs,
this list of random ID numbers will be destroyed. No identifying or contact information of returned PCVs
will be given to CDC. Surveys will also not collect identifying information. When surveys are completed,
Survey Monkey sends the anonymous data directly to CDC. There will be no link between the survey
responses and participants' e-mail or identity.
Risks and adverse events
There is minimal risk to participation in this survey as it is anonymous, but there may be some
discomfort with answering personal questions about one's health.
Participant incentives
No incentives will be given to survey participants.
IV. Dissemination of Findings
Findings will be presented to Peace Corps via both a presentation and a more detailed written report.
An abstract will also be submitted to a scientific conference, and a manuscript will be submitted to a
peer-reviewed journal.
V. Timeline
Activity
Dates
Protocol development and ethics
April 2014–June 2015
clearance
Office of Management and Budget June–December 2015
clearance* (and pilot testing of
survey)
Study implementation
February 2016
Data analysis
March-April 2016
Report writing and CDC clearance
May–August 2016
Data dissemination
August 2016
* It will take 3-4 weeks to complete OMB paperwork, then once submitted, the length of time required
for clearance will be at least 6 months.
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Appendix A: Survey to be administered via Survey Monkey. Goal is a less than 15-minute survey to
optimize response. Skip patterns will be used to minimize time. Flesch– Kincaid Reading Level : 12+
Peace Corps has partnered with the Centers for Disease Control and Prevention to determine what the
long term health effects of Peace Corps service, if any, are. The investigators have developed an online
survey for returned Peace Corps Volunteers to complete. This survey will help us better understand the
long-term quality of health of Volunteers after leaving Peace Corps.
The following questions are about your time as a Peace Corps Volunteer.
1.
2.
3.
4.
5.
6.
7.
8.
In what country did you serve as a Peace Corps Volunteer? If you served in more than one
country, please list the country that you served in first (Drop down menu with list of countries,
When did you start your Peace Corps training in that country? (MM/YYYY)
When did you finish your Peace Corps Service, either by COS/ ET/ Medical Separation/
Evacuation in that country? (MM/YYYY)
What was your primary work assignment as a Peace Corps Volunteer?
a. Education
b. Agriculture
c. Community economic development
d. Youth in development
e. Environment
f. Health
g. Other (specify)
What best describes the location of your assignment?
a. Rural (Less than 1,000 people per square mile. Ex: village or town with dirt roads)
b. Urban (1,000 or more people per square mile. Ex: capital city of the country)
While in Peace Corps, were you exposed to cook fires or cook stoves:
a. No (skip questions below)
b. Yes, indoors
c. Yes, outdoors
d. Yes, both indoors and outdoors
a) (If answer is b, c, or d above) How many hours/week were you exposed? ______
hrs/wk
While in Peace Corps, what were the two main water safety measures, if any, did you take?
a)iodine tablets b)boiled water c) filtered water using a Peace Corps approved filter d) other
(specify) e) not applicable f) none
What statement best describes your use of mosquito repellent during Peace Corps:
a. I used a DEET-containing mosquito repellent every day.
b. I used some type of mosquito repellent every day.
c. I used a DEET-containing mosquito repellent most days.
d. I used some type of mosquito repellent most days.
e. I used a DEET-containing mosquito repellent some days.
f. I used some type of mosquito repellent some days.
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g. I used a DEET-containing mosquito repellent rarely (less than once a week).
h. I used some type of mosquito repellent rarely (less than once a week).
i. I never used a mosquito repellent.
9. While in the Peace Corps, were you ever diagnosed by a Peace Corps Medical Officer with the
following: (checkboxes)
Skin problems (select any that apply): None ( )
( ) Acne
( ) Skin cancer
( ) Allergic dermatitis (allergic rash)
( ) Psoriasis
( ) Contact dermatitis (rash from contact with
something)
( ) Other (specify)_____________________
( ) Fungal infection of skin (also called “ring
worm”)
Heart or circulation problems (select any that apply): None ( )
( ) Arrhythmia
( ) Myocardial infarction (heart attack)
( ) Cardiomyopathy
( ) Other (specify) _____________________
( ) Congestive heart failure
( ) Hypertension (high blood pressure)
Gastrointestinal or stomach problems (select any that apply): None ( )
( ) Amoebas
( ) Gastroesophageal reflux (GERD) or
heartburn
( ) Crohn’s disease or inflammatory bowel
disease
( ) Giardia
( ) Cirrhosis
( ) Irritable bowel syndrome (IBS)
( ) Duodenal ulcers
( ) Liver failure
( ) Esophageal ulcers
( ) Peptic Ulcers
( ) Fatty liver
( ) Roundworms/helminths
( ) Gastroenteritis, unspecified
( ) Other (specify)______________________
8
Genital , reproductive, or urinary tract problems (select any that apply): None ( )
( ) Abnormal PAP smear
( ) Vaginal yeast infection(s)
( ) Miscarriage(s)
( ) Other (specify)__________________
( ) Urinary tract infection(s)
Immunologic, rheumatologic, or oncologic (cancer) problems such as (select any that apply): None ( )
( ) Breast cancer
( ) Osteoarthritis
( ) Gastric cancer
( ) Prostate cancer
( )Leukemia
( ) Rheumatoid arthritis
( ) Liver cancer
( ) Other (specify)______________________
( ) Lymphoma
Infectious diseases (select any that apply): None ( )
( ) Amoebas
( ) Malaria
( ) Antibiotic resistant infections
( ) Positive PPD (skin test for tuberculosis),
latent tuberculosis
( ) Chikungunya
( ) Schistosomiasis
( ) Dengue
( ) Skin infections
( ) Eye infection
( ) Sexually transmitted disease
( ) Gastrointestinal infection (not listed here)
( ) Active Tuberculosis
( ) Giardia
( ) Other (specify)______________________
( ) Leishmaniasis
Metabolic or hormonal problems (select any that apply): None ( )
9
( ) Diabetes
( ) Hypothyroidism
( ) Hyperlipidemia (high cholesterol)
( ) Other (specify)_______________________
( ) Hyperthyroidism
Musculoskeletal problems (select any that apply): None ( )
( ) Fracture (specify bone)______________
( ) Tendon rupture
( ) Joint injury specify: __knee __ankle
__shoulder __hip __back __other
(specify____________)
Neurologic (brain, sensory, or nerve) problems *select any that apply): None ( )
( ) Cluster headache
( ) Seizures
( ) Dementia
( ) Tension headache
( ) Hearing loss
( ) Tinnitus
( ) Insomnia
( ) Vestibular disorder (vertigo)
( ) Migraines
( ) Other (specify)
( ) Neuropathy
Eye problems (select any that apply): None ( )
( ) Cataracts
( ) Keratitis
( ) Corneal ulcer
( ) Retinopathy
( ) Glaucoma
Lung problems (select any that apply): None ( )
( ) Asthma
( ) Other (specify)______________________
( ) Chronic obstructive lung disease
10
Psychiatric problems: None ( )
( ) Adjustment disorder
( ) Panic Disorder
( ) Anxiety disorder
( ) Schizophrenia
( ) Bipolar disorder
( ) Other
(specify)______________________________
( ) Depression
10. Prior to Peace Corps, were you ever diagnosed by a health care provider with the following:
(checkboxes)
Skin problems (select any that apply): None ( )
( ) Acne
( ) Skin cancer
( ) Allergic dermatitis (allergic rash)
( ) Psoriasis
( ) Contact dermatitis (rash from contact with
something)
( ) Other (specify)_____________________
Heart or circulation problems (select any that apply): None ( )
( ) Arrhythmia (irregular heartbeat)
( ) Myocardial infarction (heart attack)
( ) Cardiomyopathy
( ) Other (specify) _____________________
( ) Congestive heart failure
( ) Hypertension (high blood pressure)
Gastrointestinal or stomach problems (select any that apply): None ( )
( ) Amoebas
( ) Duodenal ulcers
( ) Crohn’s disease
( ) Esophageal ulcers
( ) Cirrhosis
( ) Fatty liver
11
( ) Liver failure
( ) Gastroesophageal reflux (GERD) or
heartburn
( ) Peptic Ulcers
( ) Giardia
( ) Other (specify)______________________
( ) Inflammatory bowel disease
( ) Irritable bowel syndrome (IBS)
Genital , reproductive, or urinary tract problems (select any that apply): None ( )
( ) Miscarriages
( ) Other (specify)__________________
( ) Recurrent urinary tract infections
( ) Recurrent vaginal yeast infections
Immunologic, rheumatologic, or oncologic (cancer) problems such as (select any that apply): None ( )
( ) Breast cancer
( ) Prostate cancer
( ) Gastric cancer
( ) Rheumatoid arthritis
( )Leukemia
( ) Other (specify)______________________
( ) Liver cancer
( ) Lymphoma
Infectious diseases (select any that apply): None ( )
( ) Amoebas
( ) Malaria
( ) Antibiotic resistant infections
( ) Skin infections
( ) Dengue
( ) Tuberculosis
( ) Gastrointestinal infection (not listed here)
( ) Other (specify)______________________
( ) Giardia
Metabolic or hormonal problems (select any that apply): None ( )
12
( ) Diabetes
( ) Hypothyroidism
( ) Hyperlipidemia (high cholesterol)
( ) Other (specify)_______________________
( ) Hyperthyroidism
Musculoskeletal problems (select any that apply): None ( )
( ) Fracture (specify bone)______________
( ) Tendon rupture
Neurologic (brain, sensory, or nerve) problems *select any that apply): None ( )
( ) Cluster headache
( ) Seizures
( ) Dementia
( ) Tension headache
( ) Hearing loss
( ) Tinnitus
( ) Insomnia
( ) Vestibular disorder (vertigo)
( ) Migraines
( ) Other (specify)
( ) Neuropathy
Eye problems (select any that apply): None ( )
( ) Cataracts
( ) Keratitis
( ) Corneal ulcer
( ) Retinopathy
( ) Glaucoma
Lung problems (select any that apply): None ( )
( ) Asthma
( ) Other (specify)______________________
( ) Chronic obstructive lung disease
13
Psychiatric problems: None ( )
( ) Anxiety disorder
( ) Schizophrenia
( ) Bipolar disorder
( ) Other
(specify)______________________________
( ) Depression
11. While in Peace Corps, were you prescribed a medication to prevent malaria? (Y/N)
a. If yes, antimalarial prescribed [atovaquone/proguanil (malarone), chloroquine,
doxycycline, mefloquine (Lariam), other]
i. What statement best describes how you took the medication while in Peace
Corps:
1. I took the medication as prescribed.
2. I took the medication as prescribed most of the time.
3. I took the medication about half of the time.
4. I rarely took the medication (less than half of the time).
5. I never took the medication.
ii. Approximate length of time actually taking the medication: ## months
iii. Last time malaria prophylaxis taken during Peace Corps (if you completed a trip
directly after COS in an area which required malaria prophylaxis, last time it was
taken) MM/YYYY
b. Were you prescribed any other medication for malaria prophylaxis? (Y/N)
i. If no, continue to Q12
ii. If yes, why was a different medication prescribed?
1. Side effects from original antimalarial
2. Deployment to a different area requiring a different antimalarial
iii. Antimalarial prescribed [atovaquone/proguanil (malarone), chloroquine,
doxycycline, mefloquine (Lariam)]
1. Approximate length of time on new antimalarial ____ months
iv. What statement best describes how you took the medication while in Peace
Corps:
1. I took the medication as prescribed.
2. I took the medication as prescribed most of the time.
3. I took the medication about half of the time.
4. I rarely took the medication (less than half of the time).
5. I never took the medication.
v. Approximate length of time actually taking the medication: ## months
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vi. Last time malaria prophylaxis taken during Peace Corps MM/YYYY
vii. Have you taken malaria prophylaxis since leaving Peace Corps? Y/N
1. If yes, approximate number of courses since PC ____
The next few questions will help us understand your current state of health
12. Since leaving Peace Corps have you ever been diagnosed by a health care provider with the
following:
Skin problems (select any that apply): None ( )
( ) Acne
( ) Skin cancer
( ) Allergic dermatitis (allergic rash)
( ) Psoriasis
( ) Contact dermatitis (rash from contact with
something)
( ) Other (specify)_____________________
For each disease checked:
Year of diagnosis: YYYY
Have you taken medications for the conditions you have listed? No/Yes
If no: next question
If yes: Please select all medication that you have ever taken for the diagnoses listed.
Note that both the generic and brand names are given, and only one (either generic or
brand name) needs to be selected.
( ) Accutane
( ) Fabior
( ) Adalimumab
( ) Hydrocortisone cream
( ) Amnesteem
( ) Humira
( ) Anthralin
( ) Isotretinoin
( ) Avage
( ) Methotrexate
( ) Calcipotriene
( ) Rheumatrex
( ) Calcitrene
( ) Sorilux
( ) Claravis
( ) Sotret
( ) Dovonex
( ) Tazarotene
( ) Doxycycline
( ) Tazorac
15
( ) Tetracycline
( ) Other(specify)
________________
( ) Trexall
( ) Zithranol
Heart or circulation problems (select any that apply): None ( )
( ) Arrhythmia (irregular heartbeat)
( ) Hypertension (high blood pressure)
( ) Cardiomyopathy
( ) Myocardial infarction (heart attack)
( ) Congestive heart failure
( ) Other (specify) _____________________
( ) High cholesterol
For each disease checked:
Year of diagnosis: YYYY
Have you taken medications for the conditions you have listed? No/Yes
If no: next question
If yes: Please select all medication that you have ever taken for the diagnoses listed.
Note that both the generic and brand names are given, and only one (either generic or
brand name) needs to be selected.
( ) Accupril
( ) Atenolol
( ) Acebutolol
( ) Atorvastatin
( ) Aceon
( ) Atromid
( ) Adalat
( ) Avalide
( ) Altace
( ) Avapro
( ) Altocor
( ) Benazepril
( ) Altoprev
( ) Benicar
( ) Amlodipine
( ) Betaxolol
( ) Atacand
( ) Bisoprolol
16
( ) Blocadren
( ) Furosemide
( ) Brevibloc
( ) Hydrochlorothiazide
( ) Cardene
( ) Hyzaar
( ) Cardizem
( ) Inderal
( ) Calan
( ) Irbesartan
( ) Candesartan
( ) Irbesartan and hydrochlorothiazide
( ) Capoten
( ) Isoptin
( ) Captopril
( ) Isradipine
( ) Carteolol
( ) Kerlone
( ) Cartrol
( ) Lasix
( ) Colestid
( ) Lescol
( ) Corgard
( ) Levatol
( ) Coumadin
( ) Lipex
( ) Covera
( ) Lipitor
( ) Cozaar
( ) Lipostat
( ) Crestor
( ) Lisinopril
( ) Diltiazem
( ) Lopid
( ) Diovan
( ) Lopressor
( ) Dynacirc
( ) Losartan
( ) Enalapril
( ) Losartan and hydrochlorothiazide
( ) Eprosartan
( ) Lotensin
( ) Esmolol
( ) Lotrel
( ) Felodipine
( ) Lovastatin
( ) Fluvastatin
( ) Mavik
( ) Fosinopril
( ) Metoprolol
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( ) Mevacor
( ) Quinapril
( ) Micardis
( ) Ramipril
( ) Monopril
( ) Rosuvastatin
( ) Moexipril
( ) Sectral
( ) Nadolol
( ) Selektine
( ) Niacin
( ) Simvastatin
( ) Niaspan
( ) Sular
( ) Nicardipine
( ) Telmisartan
( ) Nicolar
( ) Teveten
( ) Nifedipine
( ) Timolol
( ) Nimodipine
( ) Toprol
( ) Nimotop
( ) Tenormin
( ) Nisoldipine
( ) Trandolapril
( ) Norvasc
( ) Tricor
( ) Olmesartan
( ) Univasc
( ) Pravastatin
( ) Valsartan
( ) Pravachol
( ) Vasotec
( ) Penbutolol
( ) Verapamil
( ) Preindopril
( ) Verelan
( ) Pindolol
( ) Visken
( ) Plendil
( ) Warfarin
( ) Prinivil
( ) WelChol
( ) Procardia
( ) Zebeta
( ) Propranolol
( ) Zestril
( ) Questran
( ) Ziac
18
( ) Zocor
( ) Other(specify) ________________________
Gastrointestinal or stomach problems (select any that apply): None ( )
( ) Amoebas
( ) Giardia
( ) Crohn’s disease
( ) Inflammatory bowel disease
( ) Cirrhosis
( ) Irritable bowel syndrome (IBS)
( ) Duodenal ulcers
( ) Liver failure
( ) Esophageal ulcers
( ) Peptic Ulcers
( ) Fatty liver
( ) Other (specify)______________________
( ) Gastroesophageal reflux (GERD) or
heartburn
For each disease checked:
Year of diagnosis: YYYY
Have you taken medications for the conditions you have listed? No/Yes
If no: next question
If yes: Please select all medication that you have ever taken for the diagnoses listed.
Note that both the generic and brand names are given, and only one (either generic or
brand name) needs to be selected.
( ) Adalimumab
( ) Cimetidine
( ) Apriso
( ) Cimzia
( ) Asacol
( ) Ciprofloxacin (Cipro)
( ) Azathioprine
( ) Colazal
( ) Azulfidine
( ) Colace
( ) Balsalazide
( ) Cortisone acetate
( ) Certolizumab
( ) Cyclosporine
19
( ) Delzicol
( ) Natalizumab
( ) Dexamethasone
( ) Nexium
( ) Dipentum
( ) Olsalazine
( ) Dulcolax
( ) Pantoprazole
( ) Esomeprazole
( ) Pegol
( ) Famotidine
( ) Pepcid
( ) Flagyl
( ) Prednisolone
( ) Giazo
( ) Prednisone
( ) Humira
( ) Prevacid
( ) Hydrocortisone
( ) Protonix
( ) Infliximab
( ) Prilosec
( ) Lialda
( ) Ranitidine
( ) Lansoprazole
( ) Remicade
( ) Maalox
( ) Sulfasalazine
( ) Mercaptopurine
( ) Tagamet
( ) Mesalamine
( ) Tysabri
( ) Methotrexate
( ) Tums
( ) Methylprednisolone
( ) Zantac
( ) Metronidazole
( ) Other (specify) ______________________
( ) Mylanta
Genital , reproductive, or urinary tract problems (select any that apply): None ( )
( ) Miscarriages
( ) Other (specify)__________________
( ) Recurrent urinary tract infections
( ) Recurrent vaginal yeast infections
20
For each disease checked:
Year of diagnosis: YYYY
Have you taken medications for the conditions you have listed? No/Yes
If no: next question
If yes: Please select all medication that you have ever taken for the diagnoses listed.
Note that both the generic and brand names are given, and only one (either generic or
brand name) needs to be selected.
( ) Amoxicillin-clavulanate
( ) Levofloxacin
( ) Augmentin
( ) Macrodantin
( ) Bactrim
( ) Monistat
( ) Ciprofloxacin (Cipro)
( ) Nitrofurantoin
( ) Diflucan
( ) Septra
( ) Fluconazole
( ) Sulfamethoxazole-trimethoprim
( ) Furadantin
( ) Other (specify)______________________
( ) Gyne-Lotrimin
( ) Levaquin
Immunologic, rheumatologic, or oncologic (cancer) problems such as (select any that apply): None ( )
( ) Breast cancer
( ) Prostate cancer
( ) Gastric cancer
( ) Rheumatoid arthritis
( )Leukemia
( ) Other (specify)______________________
( ) Liver cancer
( ) Lymphoma
For each disease checked:
21
Year of diagnosis: YYYY
Have you taken medications for the conditions you have listed? No/Yes
If no: next question
If yes: Please select all medication that you have ever taken for the diagnoses listed.
Note that both the generic and brand names are given, and only one (either generic or
brand name) needs to be selected.
( ) Abatacept
( ) Humira
( ) Actemra
( ) Hydrocortisone
( ) Adalimumab
( ) Hydroxychloroquine
( ) Advil
( ) Ibuprofen
( ) Aleve
( ) Imuran
( ) Anakinra
( ) Infliximab
( ) Arava
( ) Kineret
( ) Azathioprine
( ) Leflunomide
( ) Azasan
( ) Methotrexate
( ) Azulfidine
( ) Methylprednisolone
( ) Certolizumab
( ) Motrin
( ) Chemotherapy for cancer
( ) Naproxen sodium
( ) Cimzia
( ) Neoral
( ) Cortisone acetate
( ) Orencia
( ) Cyclosporine
( ) Plaquenil
( ) Dexamethasone
( ) Prednisolone
( ) Enbrel
( ) Prednisone
( ) Etanercept
( ) Radiation therapy
( ) Gengraf
( ) Remicade
( ) Golimumab
( ) Rituxamab
22
( ) Rituxan
( ) Tofacitinib
( ) Sandimmune
( ) Trexall
( ) Simponi
( ) Xeljanz
( ) Sulfasalazine
( ) Other (specify) _______________________
( ) Tocilizumab
Infectious diseases (select any that apply): None ( )
( ) Amoebas
( ) Skin infections
( ) Antibiotic resistant infections
( ) Tuberculosis
( ) Dengue
( ) Urinary tract infections (kidney, bladder)
( ) Gastrointestinal infection (not listed here)
( ) Vaginal yeast infections
( ) Giardia
( ) Other (specify)______________________
( ) Malaria
( ) Pneumonia
For each disease checked:
Year of diagnosis: YYYY
Have you taken medications for the conditions you have listed? No/Yes
If no: next question
If yes: Please select all medication that you have ever taken for the diagnoses listed.
Note that both the generic and brand names are given, and only one (either generic or
brand name) needs to be selected.
( ) Amoxicillin
( ) Augmentin
( ) Amoxicillin-clavulanate
( ) Azithromycin
( ) Artemether-lumefantrine
( ) Bactrim
( ) Atovaquone-proguanil
( ) Carbapenem
23
( ) Ceclor
( ) Gyne-lotrimin
( ) Cefaclor
( ) Hydroxychloroquine
( ) Cefadroxil
( ) Imipenem
( ) Cefipime
( ) Isoniazid
( ) Cefixime
( ) Keflex
( ) Cefpodoxime
( ) Lariam
( ) Cefprozil
( ) Levaquin
( ) Ceftin
( ) Levofloxacin
( ) Ceftriaxone
( ) Lorabid
( ) Cefuroxime
( ) Loracarbef
( ) Cefzil
( ) Macrodantin
( ) Cephalexin
( ) Malarone
( ) Chloroquine
( ) Mefloquine
( ) Cilastin
( ) Meropenem
( ) Ciprofloxacin (Cipro)
( ) Metronidazole
( ) Clindamycin
( ) Monostat
( ) Coartem
( ) Nitrofurantoin
( ) Diflucan
( ) Polymyxin B
( ) Doxycycline
( ) Primaquine
( ) Duricef
( ) Pyrazinamide
( ) Ethambutol
( ) Quinine
( ) Flagyl
( ) Rifampin
( ) Fluconazole
( ) Septra
( ) Furadantin
( ) Sulfamethoxazole-trimethoprim
( ) Gatifloxacin
( ) Suprax
24
( ) Tetracycline
( ) Zithromax
( ) Vantin
( ) Other (specify) _______________________
( ) Zinacef
Metabolic or hormonal problems other than menopause (select any that apply): None ( )
( ) Diabetes
( ) Hypothyroidism
( ) Hyperlipidemia (high cholesterol)
( ) Other (specify)_______________________
( ) Hyperthyroidism
For each disease checked:
Year of diagnosis: YYYY
Have you taken medications for the conditions you have listed? No/Yes
If no: next question
If yes: Please select all medication that you have ever taken for the diagnoses listed.
Note that both the generic and brand names are given, and only one (either generic or
brand name) needs to be selected.
( ) Actos
( ) Cholybar
( ) Alogliptin
( ) Crestor
( ) Altocor
( ) Diabeta
( ) Altoprev
( ) Fenofibrate
( ) Amaryl
( ) Fluvastatin
( ) Atorvastatin
( ) Gemfibrozil
( ) Avandia
( ) Glimepiride
( ) Baycol
( ) Glipizide
( ) Cerivastatin
( ) Glucophage
( ) Cholestyramine
( ) Glucotrol
25
( ) Glyburide
( ) Prandin
( ) Glynase
( ) Pravastatin
( ) Insulin
( ) Pravachol
( ) Januvia
( ) Questran
( ) Lescol
( ) Repaglinide
( ) Linagliptin
( ) Rezulin
( ) Lipex
( ) Rosiglitazone
( ) Lipitor
( ) Rosuvastatin
( ) Lipobay
( ) Saxagliptin
( ) Lipostat
( ) Selektine
( ) Lopid
( ) Simvastatin
( ) Lovastatin
( ) Sitagliptin
( ) Micronase
( ) Starlix
( ) Metformin
( ) Torvast
( ) Mevacor
( ) Tradjenta
( ) Nateglinide
( ) TriCor
( ) Nesina
( ) Troglitazone
( ) Niacin
( ) Zocor
( ) Nicotinic acid
( ) Other (specify) _______________________
( ) Onglyza
( ) Plioglitazone
Musculoskeletal problems (select any that apply): None ( )
( ) Fracture (specify bone)______________
( ) Tendon rupture
( ) Osteoporosis
26
For each disease checked:
Year of diagnosis: YYYY
Have you taken medications for the conditions you have listed? No/Yes
If no: next question
If yes: Please select all medication that you have ever taken for the diagnoses listed.
Note that both the generic and brand names are given, and only one (either generic or
brand name) needs to be selected.
( ) Acetaminophen (Tylenol)
( ) Ibandronate
( ) Actonel
( ) Motrin
( ) Advil
( ) Naproxen
( ) Alendronate
( ) Raloxifine
( ) Aleve
( ) Risendronate
( ) Aspirin
( ) Zolendronic acid
( ) Boniva
( ) Other (specify) _______________________
( ) Evista
( ) Fosomax
Neurologic (brain, sensory, or nerve) problems *select any that apply): None ( )
( ) Cluster headache
( ) Seizures
( ) Dementia
( ) Tension headache
( ) Hearing loss
( ) Tinnitus
( ) Insomnia
( ) Vestibular disorder (vertigo)
( ) Migraines
( ) Other (specify)
( ) Neuropathy
27
For each disease checked:
Year of diagnosis: YYYY
Have you taken medications for the conditions you have listed? No/Yes
If no: next question
If yes: Please select all medication that you have ever taken for the diagnoses listed.
Note that both the generic and brand names are given, and only one (either generic or
brand name) needs to be selected.
( ) Acetaminophen
( ) Diphen
( ) Aleve
( ) Dimenhydrinate
( ) Almotriptan
( ) Diphenhydramine
( ) Amerge
( ) Doxepin
( ) Amoxapine
( ) Dramamine
( ) Amitriptyline
( ) Dramamine Less Drowsy Formula
( ) Anafranil
( ) Eletriptan
( ) Antivert
( ) Epitol
( ) Aptiom
( ) Equetro
( ) Aventyl
( ) Eslicarbazepine acetate
( ) Axert
( ) Frovatriptan (Frova)
( ) Benadryl
( ) Gabapentin
( ) Bonine
( ) Gabitril
( ) Carbamazepine
( ) Gabrene
( ) Carbatrol
( ) Ibuprofen
( ) Clomipramine
( ) Imipramine
( ) Depakote
( ) Imitrex
( ) Desipramine
( ) Maprotiline
( ) Dilantin
( ) Maxalt
28
( ) Meclizine
( ) Sumatriptan
( ) Motrin
( ) Surmontil
( ) Naproxen
( ) Tegretol or Tegretol-XR
( ) Naratriptan
( ) Tiagabine
( ) Neurontin
( ) Tofranil
( ) Normpramin
( ) Trileptal
( ) Nortriptyline
( ) Trimipramine
( ) Oxcarbazepine
( ) Tylenol
( ) Pamelor
( ) Valproic acid (or valproate)
( ) Phenytek
( ) Vertin
( ) Phenytoin
( ) Vigabatrin
( ) Pregabalin
( ) Vivactil
( ) Progabide
( ) Zolmitriptan
( ) Proptriptyline
( ) Zomig
( ) Relpax
( ) Zonalon
( ) Rizatriptan
( ) Other (specify)_______________________
( ) Sabril
( ) Silenor
Eye problems (select any that apply):
Do you currently wear glasses? Y/N
Other eye problems: None ( )
( ) Cataracts
( ) Keratitis
( ) Corneal ulcer
( ) Retinopathy
( ) Glaucoma
( ) Other (specify) _______________________
29
For each disease checked:
Year of diagnosis: YYYY
Have you taken medications for the conditions you have listed? No/Yes
If no: next question
If yes: Please select all medication that you have ever taken for the diagnoses listed.
Note that both the generic and brand names are given, and only one (either generic or
brand name) needs to be selected.
( ) Betaxolol
( ) Timoptic
( ) Betoptic
( ) Xalatan
( ) Latanoprost
( ) Other (specify)________________________
( ) Timolol
Lung problems (select any that apply): None ( )
( ) Asthma
( ) Restrictive lung disease
( ) Chronic obstructive pulmonary disease
(COPD) or emphysema
( ) Other (specify)______________________
( ) Pneumonia
For each disease checked:
Year of diagnosis: YYYY
Have you taken medications for the conditions you have listed? No/Yes
If no: next question
If yes: Please select all medication that you have ever taken for the diagnoses listed.
Note that both the generic and brand names are given, and only one (either generic or
brand name) needs to be selected.
30
( ) Accolate
( ) Montelukast
( ) Albuterol
( ) Nedocromil sodium
( ) Albuterol-ipratropium bromide
( ) Orapred
( ) Accuneb
( ) Pirbuterol
( ) Aerobid
( ) Prednisone
( ) Alupent
( ) Prednisolone
( ) Asmanex
( ) Prelone
( ) Azmacort
( ) Proair
( ) Beclomethasone
( ) Proventil
( ) Budesonide
( ) Pulmicort
( ) Combivent
( ) Salmeterol
( ) Cromolyn sodium
( ) Serevent
( ) Deltasone
( ) Singulair
( ) DuoNeb
( ) Symbicort
( ) Flovent
( ) Tilade
( ) Flunisolide
( ) Triamcinolone
( ) Fluticasone
( ) Ventolin
( ) Foradil
( ) Xoponex
( ) Formoterol
( ) Zafirlukast
( ) Intal
( ) Zileuton
( ) Levalbuterol
( ) Zyflo
( ) MAxair
( ) Other (specify) _______________________
( ) Metaproterenol
( ) Mometasone
31
Psychiatric problems: None ( )
( ) Anxiety disorder
( ) Schizophrenia
( ) Bipolar disorder
( ) Other(specify)________________________
( ) Depression
( ) Obsessive-compulsive disorder
For each disease checked:
Year of diagnosis: YYYY
Have you taken medications for the conditions you have listed? No/Yes
If no: next question
If yes: Please select all medication that you have ever taken for the diagnoses listed.
Note that both the generic and brand names are given, and only one (either generic or
brand name) needs to be selected.
( ) Amitriptyline
( ) Desipramine
( ) Amoxapine
( ) Desvenlafaxine
( ) Anafranil
( ) Diazepam
( ) Asendin
( ) Doxepin
( ) Aventyl
( ) Droleptan
( ) Bupropion
( ) Droperidol
( ) Celexa
( ) Duloxetine
( ) Citalopram
( ) Escitalopram
( ) Clomipramine
( ) Eldepryl
( ) Clonazepam
( ) Emsam
( ) Clozapine
( ) Effexor
( ) Clozaril
( ) Fluoxetine
( ) Cymbalta
( ) Fluvoxamine
32
( ) Geodon
( ) Phenelzine
( ) Haloperidol
( ) Phenobarbital
( ) Imipramine
( ) Pimozide
( ) Inapsine
( ) Pristiq
( ) Isocarboxazid
( ) Proptriptyline
( ) Lexapro
( ) Prozac
( ) Lullan
( ) Quetiapine
( ) Luvox
( ) Remeron
( ) Maprotiline
( ) Risperdal
( ) Marplan
( ) Risperidone
( ) Midazolam
( ) Saphris
( ) Mirtazapine
( ) Sarafem
( ) Nardil
( ) Selegiline
( ) Nefazodone
( ) Serenace
( ) Normpramin
( ) Seroquel
( ) Nortriptyline
( ) Sertraline
( ) Olanzapine
( ) Silenor
( ) Oleptro
( ) Surmontil
( ) Orap
( ) Tofranil
( ) Pamelor
( ) Tranylcypromine
( ) Parnate
( ) Trazodone
( ) Paroxetine
( ) Trimipramine
( ) Paxil
( ) Venlafaxine
( ) Perospirone
( ) Vivactil
( ) Pexeva
( ) Wellbutrin
33
( ) Zelapar
( ) Zonalon
( ) Zeldox
( ) Zyprexa
( ) Ziprasidone
( ) Other (specify) ______________________
( ) Zoloft
Lastly, these questions will help us understand if you might be in a group at higher risk for certain
diseases.
13. Have you ever smoked cigarettes? (Y/N)
a. If yes, do you currently smoke cigarettes? (Y/N)
i. If yes, how much? (## )packs per day for (##) years
ii. If no, how much did you used to smoke? (##) packs per day for (##) years
14. Do you drink alcohol? (Y/N)
b. If yes, how many drinks per week? (##)
15. How many days per week do you exercise vigorously for at least 30 minutes ? (0-7)
16. Highest level of education achieved (High school, some college, associate's degree, bachelor's
degree, graduate degree, professional degree)
17. Occupational status:
c. Fulltime b. Part-time c. Unemployed, not on disability d. On disability e. retired f.
other (specify)
18. Marital status: a) married, or long-term partnership b) divorced c) single, not previously
divorced
19. Age (##)
20. Sex (M/F)
21. Ethnicity (Hispanic or Latino, Not Hispanic or Latino)
22. Race (American Indian/Alaska Native, Native Hawaiian/Other Pacific Islander, Black or AfricanAmerican, Asian, White, Other)
34
Appendix B: Consent Form (to be shown online prior to entering the survey) Flesch-Kincaid level 6.6
Introduction and purpose
The Centers for Disease Control and Prevention (CDC) and Peace Corps are conducting a survey to learn
about long-term health outcomes among Peace Corps Volunteers (PCVs). This survey will help us
understand what diseases for which PCVs might be at risk. To do this, we are conducting anonymous
surveys among PCVs who served between 1995–2014. We would like to invite you to take part in this
survey.
Procedures
Taking this survey is up to you. Participating will not cost you anything. If you agree, we will ask you
some questions about your health since leaving Peace Corps. You can choose not to answer any
questions that you wish for any reasons. The survey will take 20 minutes to complete. Once completed,
the survey results will be sent to CDC.
Confidentiality
Survey results will be compiled and analyzed as a group. Although aggregate results will be shared with
Peace Corps, no information that can identify you individually will be collected or shared. Survey data
will be kept private to the extent allowed by law.
Risks/benefits
This survey has little risk. The information we collect could benefit PCVs by improving the knowledge of
PCMOs on the health risks of PCVs.
Cost
The only cost to you for being in the survey is your time. You will not be paid to take part in this survey.
Right to refuse or withdraw
It is up to you to join the assessment or to withdraw at any time. You can choose to skip any questions
you do not want to answer. While taking the survey, if you decide that you do not want to take part,
you can simply stop answering questions.
Persons to contact
If, at any time, you have questions or problems related to this assessment, you may contact Kathrine
Tan (404) 718-4701, e-mail: [email protected]
I have read the above information and:
___ I consent to participate (when clicked, the program will continue to the survey)
___ I do NOT consent to participate (when clicked, the screen will read "Thank you for your time." and
will NOT continue to the survey)
35
References
1.
2.
3.
4.
5.
6.
7.
8.
9.
Chen LH, Wilson ME, Schlagenhauf P, 2006. Prevention of malaria in long-term travelers. JAMA
296: 2234-44.
Cunningham J, Horsley J, Patel D, Tunbridge A, Lalloo DG, 2014. Compliance with long-term
malaria prophylaxis in British expatriates. Travel Med Infect Dis.
Landman KZ, Tan KR, Arguin PM, 2015. Adherence to malaria prophylaxis among Peace Corps
Volunteers in the Africa region, 2013. Travel Med Infect Dis 13: 61-8.
Korhonen C, Peterson K, Bruder C, Jung P, 2007. Self-reported adverse events associated with
antimalarial chemoprophylaxis in peace corps volunteers. Am J Prev Med 33: 194-9.
Lobel HO, Miani M, Eng T, Bernard KW, Hightower AW, Campbell CC, 1993. Long-term malaria
prophylaxis with weekly mefloquine. Lancet 341: 848-51.
Shanks GD, Roessler P, Edstein MD, Rieckmann KH, 1995. Doxycycline for malaria prophylaxis in
Australian soldiers deployed to United Nations missions in Somalia and Cambodia. Mil Med 160:
443-5.
Marmor MF, Kellner U, Lai TY, Lyons JS, Mieler WF, American Academy of O, 2011. Revised
recommendations on screening for chloroquine and hydroxychloroquine retinopathy.
Ophthalmology 118: 415-22.
Food and Drug Administration, 2013. Drug Safety Communication: FDA approves label changes
for antimalarial drug mefloquine hydrochloride due to risk of serious psychiatric and nerve side
effects. US: FDA.
Overbosch D, 2003. Post-marketing surveillance: adverse events during long-term use of
atovaquone/proguanil for travelers to malaria-endemic countries. J Travel Med 10 Suppl 1: S1620; discussion S21-3.
36
| File Type | application/pdf |
| Author | Tan, Kathrine (CDC/CGH/DPDM) |
| File Modified | 2015-10-20 |
| File Created | 2015-10-20 |