I3 - Indiana IAIMS Initiative http://granite.medlib.iupui.edu/iaims Public health alerts Wed, 06 Jan 2010 20:44:54 +0000 http://wordpress.org/?v=2.7.1 en hourly 1 H1N1 Flu (Swine Flu) January 6, 2010 http://granite.medlib.iupui.edu/iaims/?p=671 http://granite.medlib.iupui.edu/iaims/?p=671#comments Wed, 06 Jan 2010 20:38:23 +0000 kkaneshi http://granite.medlib.iupui.edu/iaims/?p=671 H1N1 Flu (Swine Flu)

Information For Health Care Providers

Click here for Information for Your Patients

Click here for Indiana University H1N1 Web pages

Click here for News

From the Indiana State Department of Health

Excerpted from H1N1 Provider Agreement FINAL issued December 21, 2009

  • Indiana State Health Commissioner, Judy Monroe, MD, reports plenty of vaccine available to Indiana. To order vaccine (minimum of 100 doses) complete the provider agreement and fax to 317-233-3719. Vaccinations must be documented into the statewide vaccine registry CHIRP. Questions to: Angie Cierzniewski at 317-234-3072.

Excerpted from H1N1 Weekly Vaccine Update for Providers issued December 14, 2009

  • Historically, the 1957-58 Influenza pandemic was similar to what has been seen so far with 2009 H1N1. After a wave from mid-September to the end of November 1957, there was a second wave from January through March 1958.
  • CDC has released preliminary data on the number and types of adverse health events reported following vaccination with 2009 H1N1. Click here for full article.

END OF EXCERPT

Health care providers with concerns, comments, questions call ISDH Hotline at 1-877-499-0017 for assistance, 8:15am-4:45pm Monday-Friday.

Health Care Providers with questions e-mail HealthCommissioner@isdh.IN.gov

ISDH Websites for Medical Providers

H1N1 Influenza A for Medical Providers
this page includes:

H1N1 Flu Vaccine in Indiana

Google Maps Flu Shot Locator

ISDH has set up a hotline for the public to call about the H1N1 Flu and Vaccine: 1-877-826-0011 or TTY 1-888-561-0044 from 8:30a.m. to 4:45p.m., Monday-Friday. Indiana’s 93 local health departments will be determining how the H1N1 flu vaccine will be distributed in their communities, links to the departments may be found here.

State health officials recommend everyone over 6 months of age get the seasonal flu vaccine, note this is different and is not the H1N1 flu vaccine. The American Lung Association website has a flu clinic locator for clinics giving the seasonal flu vaccine.

Other Websites For Health Care Providers

For Your Patients

From the American Medical Association

Seasonal Influenza vs. 2009 H1N1 Influenza
Explains the differences between “seasonal flu” and the H1N1 flu (Swine flu).

Indiana State Department of Health

The ISDH has set up a number for the general public at 1-877-826-0011. This number is answered from 8:15 am to 4:45 pm, Monday thru Friday.

ISDH website: 2009 H1N1 Influenza A

Marion County Health Department

Marion County Flu Helpline has health educators available to respond to questions in English or Spanish, Monday thru Friday, from 8a.m. until 5p.m. 317-221-3366

Centers for Disease Control (CDC)

What to do if You Get Sick: 2009 H1N1 and Seasonal Flu

Resources for Parents and Caregivers

People at High Risk for Developing Flu-Related Complications

2009 H1N1 and Travel

Resources for the Deaf and Hard of Hearing


Indiana University H1N1 Web Pages

News

Indiana State Department of Health RSS

Grazr

Centers for Disease Control RSS

Grazr

]]> http://granite.medlib.iupui.edu/iaims/?feed=rss2&p=671 HHS H1N1 Webcast Today, Jan. 6, 2010 http://granite.medlib.iupui.edu/iaims/?p=665 http://granite.medlib.iupui.edu/iaims/?p=665#comments Wed, 06 Jan 2010 14:13:30 +0000 kkaneshi http://granite.medlib.iupui.edu/iaims/?p=665 HHS to Offer Special Webcast on H1N1 Flu

Note: this webcast should be added to the H1N1 Video Briefing Archive

http://www.benzinga.com/press-releases/b75310/hhs-to-offer-special-webcast-on-h1n1-flu

WASHINGTON–(BUSINESS WIRE)–

The U.S. Department of Health and Human Services (HHS) will host a Know What to Do about the Flu Webcast on Wednesday, January 6, 2010 from 1 –

2 p.m. EST. Experts will answer your questions about school-based vaccination clinics and children under age ten getting their second H1N1 vaccine. Participants include the director of the Centers for Disease Control and Prevention (CDC) National Center for Immunization and Respiratory Diseases, the director of the Rhode Island Medical Reserve Corps, which helped vaccinate 73 percent of Rhode Island’s children in school-based vaccination clinics and the Alexandria City Public Schools Health Services Coordinator who helped conduct successful school-based vaccination clinics in Alexandria, VA.

WHO: Dr. Anne Schuchat, Director, National Center for Immunization and Respiratory Diseases, (CDC)

Tom Lawrence, NREMT-P, Director, Rhode Island Medical Reserve Corps

Robin Wallin, RN, MSN, Health Services Coordinator, Alexandria City Public Schools

WHAT: Know What to Do about the Flu Webcast on school based vaccination clinics and children under age ten receiving their second H1N1 vaccine

WHEN: WEDNESDAY, January 6, 2010 at 1 – 2 p.m. EST

WHERE: Live on www.flu.gov/live

TO PARTICIPATE: Join the discussion by sending questions in advance or during the Webcast to hhsstudio@hhs.gov

]]> http://granite.medlib.iupui.edu/iaims/?feed=rss2&p=665 H1N1 Flu (Swine Flu) updated December 15, 2009 http://granite.medlib.iupui.edu/iaims/?p=648 http://granite.medlib.iupui.edu/iaims/?p=648#comments Tue, 15 Dec 2009 16:07:04 +0000 kkaneshi http://granite.medlib.iupui.edu/iaims/?p=648 H1N1 Flu (Swine Flu)

Information For Health Care Providers

Click here for Information for Your Patients

Click here for Indiana University H1N1 Web pages

Click here for News

From the Indiana State Department of Health

Excerpted from H1N1 Weekly Vaccine Update for Providers issued December 14, 2009:

  • Influenza activity continues to decline throughout the state. Starting December 20th, ISDH will begin sending vaccine to pharmacies registered in CHIRP, and is asking that clinics with the H1N1 vaccine begin vaccinating the general public, while still encouraging target groups to get vaccinated.
  • Historically, the 1957-58 Influenza pandemic was similar to what has been seen so far with 2009 H1N1. After a wave from mid-September to the end of November 1957, there was a second wave from January through March 1958.
  • CDC has released preliminary data on the number and types of adverse health events reported following vaccination with 2009 H1N1. Click here for full article.

END OF EXCERPT

Health care providers with concerns, comments, questions call ISDH Hotline at 1-877-499-0017 for assistance, 8:15am-4:45pm Monday-Friday.

Health Care Providers with questions e-mail HealthCommissioner@isdh.IN.gov

ISDH Websites for Medical Providers

H1N1 Influenza A for Medical Providers
this page includes:

H1N1 Flu Vaccine in Indiana

Google Maps Flu Shot Locator

ISDH has set up a hotline for the public to call about the H1N1 Flu and Vaccine: 1-877-826-0011 or TTY 1-888-561-0044 from 8:30a.m. to 4:45p.m., Monday-Friday. Indiana’s 93 local health departments will be determining how the H1N1 flu vaccine will be distributed in their communities, links to the departments may be found here.

State health officials recommend everyone over 6 months of age get the seasonal flu vaccine, note this is different and is not the H1N1 flu vaccine. The American Lung Association website has a flu clinic locator for clinics giving the seasonal flu vaccine.

Other Websites For Health Care Providers

For Your Patients

From the American Medical Association

Seasonal Influenza vs. 2009 H1N1 Influenza
Explains the differences between “seasonal flu” and the H1N1 flu (Swine flu).

Indiana State Department of Health

The ISDH has set up a number for the general public at 1-877-826-0011. This number is answered from 8:15 am to 4:45 pm, Monday thru Friday.

ISDH website: 2009 H1N1 Influenza A

Marion County Health Department

Marion County Flu Helpline has health educators available to respond to questions in English or Spanish, Monday thru Friday, from 8a.m. until 5p.m. 317-221-3366

Centers for Disease Control (CDC)

What to do if You Get Sick: 2009 H1N1 and Seasonal Flu

Resources for Parents and Caregivers

People at High Risk for Developing Flu-Related Complications

2009 H1N1 and Travel

Resources for the Deaf and Hard of Hearing


Indiana University H1N1 Web Pages

News

Indiana State Department of Health RSS

Grazr

Centers for Disease Control RSS

Grazr

]]> http://granite.medlib.iupui.edu/iaims/?feed=rss2&p=648 Beware of H1N1 Vaccination Phishing Scheme http://granite.medlib.iupui.edu/iaims/?p=619 http://granite.medlib.iupui.edu/iaims/?p=619#comments Wed, 02 Dec 2009 19:45:37 +0000 kkaneshi http://granite.medlib.iupui.edu/iaims/?p=619 Indiana Health Alert Network

This is an Official
Indiana Health Alert Network Advisory Message

Distributed via the Indiana Health Alert Network
12/2/2009 2:07:18 PM
IHAN-675-2009-12-2

Urgency Type: Advisory
Message Status: Actual
Message Type: Original

Fradulent Email Related to State Vaccination Program

The following message was received from the CDC regarding a phishing scheme related to H1N1 vaccination programs. Some of you may have received a preliminary copy of this message yesterday. After realizing the seriousness of the message, we decided to send it out again and we are requesting that you pass this message on to other medical and public health professionals that may not participate in the IHAN system.
The CDC/OCISO Cyber Security Incident Response Team (CSIRT) has received reports of fraudulent emails (phishing) referencing a CDC sponsored State Vaccination Program.

The messages request that users must create a personal H1N1 (swine flu) Vaccination Profile on the cdc.gov website. The message then states that anyone that has reached the age of 18 has to have his/her personal Vaccination Profile on the cdc.gov site.

The CDC has NOT implemented a state vaccination program requiring registration on www.cdc.gov. Users that click on the email are at risk of having malicious code installed on their system. OCISO reminds users to take the following steps to reduce the risk of being a victim of a phishing attack:

- Do not follow unsolicited links and do not open or respond to unsolicited email messages.

- Use caution when visiting un-trusted websites.

- Use caution when entering personal information online.

You can view an example of the Phishing email that some providers have received by clicking on the following link that will display the example email from the portal:

https://healthnet.isdh.in.gov/datacenter/apps/HANAlerts/Attachments/CDC%20fraudulent%20email.pdf

For H1N1 Flu (Swine Flu) information and links for Indiana Health Care Providers, click here

]]> http://granite.medlib.iupui.edu/iaims/?feed=rss2&p=619 H1N1 (Swine Flu) Updated November 16, 2009 http://granite.medlib.iupui.edu/iaims/?p=613 http://granite.medlib.iupui.edu/iaims/?p=613#comments Mon, 16 Nov 2009 16:59:28 +0000 kkaneshi http://granite.medlib.iupui.edu/iaims/?p=613 H1N1 Flu (Swine Flu)

Information For Health Care Providers

Click here for Information for Your Patients

Click here for Indiana University H1N1 Web pages

Click here for News

From the Indiana State Department of Health

Health care providers with concerns, comments, questions call ISDH Hotline at 1-877-499-0017 for assistance.

Health Care Providers with questions e-mail HealthCommissioner@isdh.IN.gov

ISDH Websites for Medical Providers

H1N1 Influenza A for Medical Providers
this page includes:

H1N1 Flu Vaccine in Indiana

Google Maps Flu Shot Locator

ISDH has set up a hotline for the public to call about the H1N1 Flu and Vaccine: 1-877-826-0011 or TTY 1-888-561-0044 from 8:30a.m. to 4:45p.m., Monday-Friday. Indiana’s 93 local health departments will be determining how the H1N1 flu vaccine will be distributed in their communities, links to the departments may be found here.

State health officials recommend everyone over 6 months of age get the seasonal flu vaccine, note this is different and is not the H1N1 flu vaccine. The American Lung Association website has a flu clinic locator for clinics giving the seasonal flu vaccine.

Other Websites For Health Care Providers

For Your Patients

From the American Medical Association

Seasonal Influenza vs. 2009 H1N1 Influenza
Explains the differences between “seasonal flu” and the H1N1 flu (Swine flu).

Indiana State Department of Health

The ISDH has set up a number for the general public at 1-877-826-0011. This number is answered from 8:15 am to 4:45 pm, Monday thru Friday.

ISDH website: 2009 H1N1 Influenza A

Marion County Health Department

Marion County Flu Helpline has health educators available to respond to questions in English or Spanish, Monday thru Friday, from 8a.m. until 5p.m. 317-221-3366

Centers for Disease Control (CDC)

What to do if You Get Sick: 2009 H1N1 and Seasonal Flu

Resources for Parents and Caregivers

People at High Risk for Developing Flu-Related Complications

2009 H1N1 and Travel

Resources for the Deaf and Hard of Hearing


Indiana University H1N1 Web Pages

News

Indiana State Department of Health RSS

Grazr

Centers for Disease Control RSS

Grazr

]]> http://granite.medlib.iupui.edu/iaims/?feed=rss2&p=613 9/25/2009 Updated Pediatric Antiviral Dosing Syringe and Compounding Information for 2009 H1N1 and Seasonal Flu http://granite.medlib.iupui.edu/iaims/?p=495 http://granite.medlib.iupui.edu/iaims/?p=495#comments Fri, 25 Sep 2009 20:26:03 +0000 kkaneshi http://granite.medlib.iupui.edu/iaims/?p=495 IHAN - Indiana State Department of Health - Advisory - 654 - Updated Pediatric Antiviral Dosing Syringe and Compounding Information for 2009 H1N1 and Seasonal Flu

 Note on Tamiflu Oral Suspension Syringe

The second issue that pharmacists and physicians may face is the need to ensure that the units of measure on the dosing dispenser and the dosing instructions match.  An oral dosing dispenser with 30 mg, 45 mg, and 60 mg graduations of Tamilfu is provided in the packaging for the manufacturer’s product rather than graduations in milliliters (mL) or teaspoons (tsp).  This can lead to patient or caregiver confusion and dosing errors.  When dispensing commercially manufactured Tamiflu,  oral suspension, pharmacists should ensure the units of measure on the dosing instructions match the dosing device provided.   If prescription instructions specify administration using mL or tsp, then the device included in the Tamiflu product package should be removed and replaced with an appropriate measuring device, such as an oral syringe if the prescribed dose is in milliliters (mL).

When dispensing Tamiflu oral suspension for children younger than 1 year of age, the oral dosing dispenser that is included in the product package should always be removed. Pharmacists and health care providers should provide an oral syringe that is capable of accurately measuring the prescribed milliliter (mL) dose, and counsel the caregiver how to administer the prescribed dose. Oseltamivir is authorized for emergency use in children younger than 1 year of age under an Emergency Use Authorization (EUA) issued by FDA. For the EUA, see http://www.cdc.gov/h1n1flu/eua/pdf/tamiflu-hcp.pdf.

For More Information:
2009-2010 Influenza Season: Information for Pharmacists: http://www.cdc.gov/H1N1flu/pharmacist/pharmacist_info.htm

Updated Interim Recommendations for the Use of Antiviral Medications in the Treatment and Prevention of Influenza for the 2009-2010 Season: http://www.cdc.gov/H1N1flu/recommendations.htm

Questions & Answers: Antiviral Drugs, 2009-2010 Flu Season:  http://www.cdc.gov/h1n1flu/antiviral.htm

Updated Interim Recommendations for Obstetric Health Care Providers Related to Use of Antiviral Medications in the Treatment and Prevention of Influenza for the 2009-2010 Season: http://www.cdc.gov/H1N1flu/pregnancy/antiviral_messages.htm

Antiviral Drugs: Summary of Side Effects: http://www.cdc.gov/flu/protect/antiviral/sideeffects.htm

For the FDA page on antiviral influenza drugs:
http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm100228.htm

For the FDA-approved package insert with instructions for the emergency compounding of an oral suspension from Tamiflu 75mg capsules see http://www.fda.gov/downloads/Drugs/DrugSafety/InformationbyDrugClass/UCM147992.pdf

For the FDA public health alert regarding Tamiflu (oseltamivir) for Oral Suspension: Potential Medication Errors see http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm183714.htm.

For additional information, you can also call CDC’s toll-free hotline, 800-CDC-INFO (800-232-4636) TTY: (888) 232-6348, which is available 24 hours a day, every day.

]]> http://granite.medlib.iupui.edu/iaims/?feed=rss2&p=495 7/14 IHAN Clinicians advised to Halt Use of Propofol from Tainted Lots http://granite.medlib.iupui.edu/iaims/?p=427 http://granite.medlib.iupui.edu/iaims/?p=427#comments Tue, 14 Jul 2009 01:07:56 +0000 kkaneshi http://granite.medlib.iupui.edu/iaims/?p=427 Indiana Health Alert Network

This is an Official
Indiana Health Alert Network Advisory Message

Distributed via the Indiana Health Alert Network
7/13/2009 7:17:51 PM
IHAN-641-2009-7-13

Urgency Type: Advisory
Message Status: Actual
Message Type: Original

Clinicians Advised to Halt Use of Propofol from Tainted Lots

This is an official
CDC Health Advisory

Distributed via Health Alert Network
July 13, 2009, 19:00 ET (7:00 PM ET)
CDCHAN-00296-09-07-13-ADV-N

Clinicians Advised to Halt Use of Propofol from Tainted Lots

The Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) have been investigating recent cases of febrile reactions among patients undergoing endoscopy in the United States.

This investigation has revealed that all of the case-patients received the anesthetic propofol from 100 ml vials manufactured by Teva Pharmaceuticals.

Testing done by the FDA has found that two lots of this product that were in use in facilities reporting febrile reactions were positive for elevated levels of endotoxin.

The lots are 31305429B and 31305430B.

Teva Pharmaceuticals is initiating a voluntary recall for these lots, and clinicians are advised to immediately stop using these lots of Teva Pharmaceuticals propofol.

CDC, FDA and Teva Pharmaceuticals are continuing to investigate this issue.

To date, all case-patients have recovered.

As additional information about the recall becomes available, an updated Health Alert Notice will be provided.

]]> http://granite.medlib.iupui.edu/iaims/?feed=rss2&p=427 Salmonellosis, serotype Typhimurium http://granite.medlib.iupui.edu/iaims/?p=47 http://granite.medlib.iupui.edu/iaims/?p=47#comments Fri, 06 Feb 2009 15:30:51 +0000 kkaneshi http://granite.medlib.iupui.edu/iaims/?p=47 For Physicians

As of 9PM EDT, Wednesday, February 4, 2009, 575 persons infected with the outbreak strain of Salmonella Typhimurium have been reported from 43 states. The number of ill persons identified in Indiana (9).

Multistate Outbreak of Salmonella Infections Associated with Peanut Butter and Peanut Butter–Containing Products — United States, 2008–2009
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm58e0129a1.htm

Salmonella Strains Tables for Outbreak Related to Peanut Butter and Peanut Containing Products
http://www.cdc.gov/salmonella/typhimurium/strains_table.html

Centers for Disease Control and Prevention in collaboration with the American Medical Association et. al. Diagnosis and Management of Foodborne Ilnesses, 2004
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5304a1.htm

Indiana State Department of Health Case Investigation Form
http://www.in.gov/isdh/files/49693_Salmonellosis.pdf

“Practice Guidelines for the Management of Infectious Diarrhea”
Clinical Infectious Diseases 2001; 32:331-50
http://www.journals.uchicago.edu/doi/pdf/10.1086/318514?cookieSet=1

PDA Version of the Practice Guidelines
http://www.idsociety.org/Content.aspx?id=5910

CDC Outbreak Page (includes information for the public):

Investigation Information for Outbreak of Salmonella Typhimurium Infections, 2008-2009
http://www.cdc.gov/salmonella/typhimurium/

To determine whether a product has been recalled, consumers can search the
list of recalled products at the Food and Drug Administration (FDA) website or
telephone the company that distributed the product at the phone number on the
package.

Consumers without internet access can telephone 1-800-CDC-INFO
(1-800-232-4636), 24 hours a day, 7 days a week, for product recall information
from the FDA website and for other information on salmonellosis.

FDA’s Salmonella Widget (below)
http://www.fda.gov/oc/opacom/hottopics/salmonellatyph/widget.html

]]> http://granite.medlib.iupui.edu/iaims/?feed=rss2&p=47 Influenza http://granite.medlib.iupui.edu/iaims/?p=39 http://granite.medlib.iupui.edu/iaims/?p=39#comments Mon, 05 Jan 2009 17:16:51 +0000 kkaneshi http://granite.medlib.iupui.edu/iaims/?p=39 For Physicians & Health Professionals

From the U.S. Centers for Disease Control and Prevention
Interim Antiviral Guidance for 2008-09, issued on December 19, 2008
http://www.cdc.gov/flu/professionals/antivirals/index.htm

Influenza-Associated Pediatric Mortality and Staphylococcus aureus co-infection issued on January 30, 2008
http://www2a.cdc.gov/HAN/ArchiveSys/ViewMsgV.asp?AlertNum=00268

Seasonal Flu and Staph Infections
http://www.cdc.gov/flu/professionals/flustaph.htm

2008–09 INFLUENZA PREVENTION & CONTROL RECOMMENDATIONS
Recommendations of the Advisory Committee on Immunization Practices (ACIP)
http://www.cdc.gov/flu/professionals/acip/index.htm

FluView: Weekly Influenza Surveillance Report
http://www.cdc.gov/flu/weekly/

More at: CDC Seasonal Influenza Information for Health Professionals
http://www.cdc.gov/flu/professionals/index.htm

Indiana State Department of Health Forms
Influenza Lab Submission - State Form 35212
http://www.in.gov/icpr/webfile/formsdiv/35212.pdf

Influenza-Associated Deaths Case Investigation - State Form 52576 (2-06)
http://www.in.gov/isdh/files/52576_InfluenzaAssocDeath.pdf

For the Public

From the U.S. Centers for Disease Control and Prevention
Preventing Seasonal Flu:  CDC Says “Take 3” Steps To Fight The Flu
http://www.cdc.gov/flu/protect/preventing.htm

Seasonal Flu: What To Do If You Get Sick: Symptoms, Treatment, Taking Care of Yourself
http://www.cdc.gov/flu/whattodo.htm

Seasonal Flu Information for Parents
http://www.cdc.gov/flu/parents/

Seasonal Flu: What You Should Know About…
http://www.cdc.gov/flu/whatyoushouldknow.htm

From the National Library of Medicine
MEDLINEPlus Flu
http://www.nlm.nih.gov/medlineplus/flu.html

]]> http://granite.medlib.iupui.edu/iaims/?feed=rss2&p=39 Shigellosis http://granite.medlib.iupui.edu/iaims/?p=33 http://granite.medlib.iupui.edu/iaims/?p=33#comments Fri, 22 Aug 2008 15:56:44 +0000 kkaneshi http://granite.medlib.iupui.edu/iaims/?p=33 Shigella infection (shigellosis) is an intestinal disease caused by a family of bacteria known as shigella. The main sign of shigella infection is diarrhea, which often is bloody.

For Physicians

Shigellosis: Clinical Differentials, Workup, Treatment, Medication, Followup (eMedicine)
http://www.emedicine.com/med/topic2112.htm

Shigellosis Case Investigation - State Form #49694 (R2/1-05) (Indiana State Department of Health )

http://www.in.gov/isdh/files/49694_Shigellosis.pdf (180kb, 5 pages)

Diagnosis and management of foodborne illnesses: A primer for physicians and other health care professionals, 2nd Edition February 2004
http://www.ama-assn.org/ama/pub/category/3629.html (fulltext pdf files)

For The Public
Factsheet, Preventing the Spread in Childcare Settings, Flyers in English and Spanish (Marion County Health Department)
http://www.mchd.com/shigella_prevention.htm

Shigella: Information for Parents (FamilyDoctor.org, American Academy of Family Physicians)
http://www.kidshealth.org/PageManager.jsp?dn=familydoctor&lic=44&cat_id=20028&article_set=23014&ps=104

Shigellosis (CDC)
http://www.cdc.gov/nczved/dfbmd/disease_listing/shigellosis_gi.html

]]> http://granite.medlib.iupui.edu/iaims/?feed=rss2&p=33