evidence: Open Forum Infect Dis 2017 ; [...] Clin Infect Dis 2011 ; [...] Allegany, Cattaraugus, Chautauqua, Erie, Niagara, Orleans, Genesee, Wyoming *Based on NYS DOH Population Health Improvement Program Regional Map. https://www.health.ny.gov/community/programs/population_health_improvement/docs/contact_sheet.pdf.