Dr. Mary-Margaret Anne Fill, MD, MPH1, Lindsey Sizemore, MPH, CPH1, Michael Rickles1, Kelly C Cooper, MD MPH2, Connie Buecker3, Heather Mullins, MPH4, John R. Dunn, DVM, PhD, EMBA1, William Schaffner, MD5, Tim F. Jones, MD1 and Carolyn N Wester, MD, MPH1, (1)Tennessee Department of Health, Nashville, TN, (2)Knox County Health Department, Knoxville, TN, (3)Chattanooga-Hamilton County Health Department, Chattanooga, TN, (4)Sullivan County Regional Health Department, Blountville, TN, (5)Vanderbilt University School of Medicine, Nashville, TN