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Swine Flu argument.

There is quite a bit of info here:
http://www.phac-aspc.gc.ca/sars-sras/ic-ci/sars-respmasks-eng.php

Let's not get all in a tizzy and wrapped around the axle about masks. Knowledge is power.

Fit testing a N95 is not rocket science. All employers, in Ontario, supplyng the mask to their employees, are responsible to teach the employee how to don and fit test the mask. If you go buy your own, from a safety supply, etc, in most cases the vendor will be able to show you the procedure. The use of aromatics and pressure testing is not required for general users not using a tight fitting mask.

A protective mask can offer protection, but there's no evidence inexpensive surgical masks can protect against flu virus particles small enough to be inhaled into the lower respiratory tract or the lungs. It's unclear how effective surgical masks are in blocking flu virus particles that are bigger and therefore likely to settle in the nose and throat of an exposed person. Normal surgical masks, like the one used by a dental hygenist are not sufficient because most don't protect down to the micron level. They won't filter out smaller particles and don't provide a good seal.

Workplaces should always employ engineering controls including physical controls such as ventilation requirements in buildings, and relative humidity and temperature controls. Also administrative controls such as handwashing, covering your mouth when you sneeze or cough or seeking medical care when you're sick.

If you're in the market for a mask, don't go to the hardware store and pick up one that you'd use while sanding drywall. Covering your mouth and nose with a bandana won't do you much good either.

The best bet for protective masks are what are referred to as "N95 respirators," a commonly used term in Canada that refers to NIOSH-certified, disposable, particulate-filtering, half-facepiece respirators.

Not all high-quality masks are labeled N95. Health Canada says masks should offer protection equivalent to N95 to be considered effective. Such masks should:

Filter particles one micron in size or smaller.
Have a 95 per cent filter efficiency.
Provide a tight facial seal (less than 10% leak).

N95 respirators protect against the inhalation of nasopharyngeal, tracheobronchial and alveolar sized particles.

Surgical masks worn by an infected person may play a role in the prevention of influenza transmission by reducing the amount of infectious material that is expelled into the environment.

Both surgical masks and N95 respirators offer a physical barrier to contact with contaminated hands and ballistic trajectory particles, such as particles expelled by a sneeze or a cough. The efficiency of the filters of surgical masks to block penetration of alveolar and tracheobronchial sized particles is highly variable.

Because of the possible inability of the 'surgical' mask to block penetration and provide a sealed fit the inability to ensure a sealed fit, the surgical masks offer no significant protection against the inhalation of alveolar and tracheobronchial sized particles.

I've include here some stuff from the Health Care Regulations and the Occupational Health & Safety Act. These are the law for Ontario employers and employees and are Provincial, not Federal, but most other government agencies have something similar. As well, the Health Care regs apply to hospitals and long term care facilities, but the Industrial regs, and others, also have a provision for supply, training and use of PPE (personal protective equipment).

PPE is only effective if used correctly; if used improperly PPE will provide a false sense of security, but no real protection. Workers have a right to be trained about how to use PPE properly—such training should cover how PPE is applied, as well as in what order it should be removed to avoid contamination. The Occupational Health and Safety Act directs employers in Sec 25 (1) (a) that, “the equipment, materials, and protective devices as prescribed are provided”

And in Sec 25 (2) (a) to “provide information, instruction, and supervision to a worker to protect the health and safety of that worker”.

In addition, Health Care Regulation 10 states,

“A worker who is required by his or her employer, or by this Regulation, to wear or use any protective clothing, equipment or device shall be instructed and trained in its care, use, and limitations before wearing or using it for the first time and at regular intervals thereafter and the worker shall participate in such instruction and training”.

Subsection 2 goes on to direct that the equipment shall be properly used and maintained, that it must be a proper fit, it should be properly inspected for damage and deterioration, and be stored in a convenient, clean and sanitary location when not in use. It is clear in the Act, therefore, that employers bear a responsibility to ensure that workers are trained to use PPE correctly, and that the equipment be kept in good order.

Workers, however, also have responsibilities under the Act:

· to work in compliance with the Act (Sec 28.1.a)

· to use or wear protective devices or clothing that the employer requires to be used or worn (Sec 28.1.b)

· to report the absence or defect in any equipment or protective device of which the worker is aware (Sec 28.1.c).

· to report violations of the Act (Sec 28.1.d)

This means that workers need to INSIST upon training to ensure they know how to properly use their PPE. Direct contact with a H1N1 patient, or contact with an environment contaminated by large respiratory droplets, might have led Health Care Workers to contaminate themselves as they removed their PPE. So if the employer is not providing adequate training, or fit-testing, workers have the responsibility to raise the matter with their employer to protect the safety of themselves, their co-workers, patients, and the broader community. Joint Health and Safety Committees (JHSC) need to ensure that the employer is training workers on PPE, and then continue to monitor and evaluate the PPE training provided to workers.

Most workplaces have some sort of either a JHSC or a Worker Representative, depending on provincial and federal jurisdiction. If you have a work safety concern, it is your right to contact them and have them work on your behalf to alleviate that concern.
 
Misuse of mask makes me think about people working with gloves but keeping them for everything, might protect them, but their gloves are contaminating everything around.

In hospital you will witness often medical doctors, nurses and lab tech keeping their lab coats and uniforms, even their shoes cover when they go for lunch or chat/smoke outside!

Common sense is not always there!
 
A catfight *COUGH* argument over swine flu. ::)

http://www.nbcnewyork.com/news/local-beat/Swine-Flu-Fears-Lead-to-Girl-on-Girl-Brawl-on-NYC-Subway-68801572.html

Swine Flu Fears Lead to Girl-on-Girl Brawl on D Train
By BRIAN RIES
Updated 10:41 AM EST, Tue, Nov 3, 2009

After a rough spring that saw as many as 20 to 40 percent of New Yorkers exposed to H1N1, subway riders have resorted to defending themselves with their fists.

Violence struck on a southbound D train Monday morning after two women got into an argument over one's refusal to cover her mouth while coughing. It ended with her spitting on the other, a punch, and the second woman dragging the first to the floor of the car by her hair.

(...)

"No one got the conductor -- it just seemed like a shouting match -- but as the train pulled into 42nd Street, the coughing woman spit on the other, provoking what sounded like a punch from the reaction of the crowd (we didn't directly see it). Then the cougher attempted to exit the train as the doors were open, but the second woman grabbed her by the back of the hair, violently yanking her down to the floor."

Be careful out there transit riders, and remember, cover your mouth, wash your hands, and don't spit on each other.

(...)
 
H1N1 flu has, officially, moved from pandemical panic to just plain silly. CBC Radio One in Ottawa news is now discussing the fact that there is no vaccine for animals but at least one pet ferret (the little furry animal not the neat recce car) has died. A veterinarian did offer some good advice: wash your hands often and cough into your elbow. Gee! That's news!
 
Australia currently is vacinating all its citizens who are in country right now. All for free.

I'll be getting my jab within a fortnight. You can't beat free "insurance'.

Australia has already had it's first round with Mr Swine this past winter of 2009, and next year it will be back, and some say stronger and more deadly. I am off to the USA in December, and this is the North's flu season. 

OWDU
 
I've come accross  some news from some minor sites, this situation doesn't make sense to me, if there was a problem why are major news companies not covering this? With that being said why would people lie about this if it is not true? Open discussion. =)

http://mignews.com.ua/en/articles/378527.html
Besides swine influenza, AN3N2, AN2N2 and group B have been found in the territory of Ukraine. In particular, at present at least 8 different viruses are circulating in the territory of Bukovyna. Such conclusions are made by experts of regional sanitary epidemiological stations following the results of almost 6,000 studies on the identification of acute respiratory viral infections, said the chief state sanitary doctor of the Chernivtsi Region Oleksandr Svitlichny on November 11 at the briefing.

According to him, all the acute respiratory viral infections, which are currently circulating in the territory of Bukovina, are treated. However, due to the fact that they collided, clinical disease and the tactics of his treatment change. Therefore, a doctor needs to know exactly which virus is detected in the patient.

Among the viruses that are registered in Bukovina, Oleksander Svitlychny told about AH3N2, AH2N2, AH1N1, a large group of influenza B, parainfluenza viruses of three types, reports proUA.com.

Ministry of Health notes the lack of vaccines against seasonal types of influenza and influenza A (H1N1) in the world, the first deputy chief sanitary doctor Ludmyla Muharska told about it in the air of TVi IV channel on November 11.

She noted that the Ministry of Health asked the World Health Organization with a request to reserve the vaccine for Ukraine. Also Ludmyla Muharska stressed that during the epidemic there is a definite strategy for vaccination of the population.

"When the active epidemic has begun, population does not need mass vaccination, and it is absolutely correct opinion, and we support it," - she said and added that the vaccination of risk groups with a purpose to have to individual protection or closed groups is necessary, Ukrainian News reported.

As a reminder, experts believe vaccination against influenza A (H1N1) is possible during the epidemic.

Ministry of Health has confirmed 213 deaths of influenza and acute respiratory viral infections as of November 11 in 21 Regions, Kyiv and Crimea, Health Ministry states. Out of 213 deaths 24 fatal cases are recorded over the past day, Ukrainian News reported.

Since October 29 81 cases of death has been recorded in the Lviv Region, 30 - in the Ivano-Frankivsk Region, 22 - in the Chernivtsi Region, 20 - in the Ternopil Region, 8 – in the Kyiv and Khmelnitsky Regions, and 7 - in the Rivne and Volyn Regions, 6 - in Kyiv, 4 - in the Vinnytsa Region, 3 - in the Donetsk Region, 2 - in the Transcarpathian, Zaporozhye, Poltava, Kharkiv and Chernihiv Regions, and 1 - in Crimea, Odessa, Kherson, Cherkasy, Zhytomyr, Mykolayiv and Sumy Regions.

In general, since October 29, 1 mn 192,481 people have become sick with influenza and acute respiratory viral infections. Since the beginning of the epidemic 62,462 people have been hospitalized, 25,968 people have been released. In Kyiv 83,243 people ill with influenza and acute respiratory viral infections are recorded.

05:46 p.m. 85 cases of pandemic influenza A/H1N1 are confirmed in Ukraine, including 16 – fatal one. This was reported by chief doctor of the Central sanitary-epidemiological station Lyubov Nekrasova at a press conference in Kyiv on Thursday.

"According to the preliminary conclusion, we can assume that today this type of virus (A/H1N1 - editor.) prevails in the country, and most of all the diseases are caused by this same type of virus. But now other types of viruses are circulating - a seasonal influenza and respiratory viruses" , - she added.

Lyubov Nekrasova reported that since the beginning of the epidemic 533 samples had been taken, out of them 108 specimens were analyzed and pandemic influenza A/H1N1 is confirmed in 85 cases.

She also noted that currently there is no need to conduct research on each case of disease, because the cost of a study is Hr 220.

In addition, Lyubov Nekrasova stressed that the spread of the virus occurs so rapidly that it is necessary need to define a certain number of studies for the objective analysis, which would confirm indeed the majority of cases among men is a pandemic of influenza A/H1N1. These studies should be done in order to understand how to act when the next wave of the epidemic will appear, Interfax-Ukraine reports.

Lyubov Nekrasova also said that the central laboratory conducts up to 50-60 researches daily. "According to these data, we can say that up to 85 percents of all positive results is influenza A/H1N1," - she said.


http://translate.google.com/translate?hl=en&sl=uk&u=http://tsn.ua/ukrayina/bogoslovska-v-ukrayini-pochalasya-epidemiya-chumi-a-ne-gripu.html&ei=4yz8So2DIMWAnQeQwNSZBQ&sa=X&oi=translate&ct=result&resnum=3&ved=0CBIQ7gEwAg&prev=/search%3Fq%3D%25D0%25A3%25D0%


There were a few more articles only I can't for the life of me remeber where I encountered them. =(.  If anyone else has anything post then lets get this talk going again. I personally think that there mite be a  coverup and it's for population control. but that's me.
 
CANADIAN F0RCES said:
I personally think that there mite be a  coverup and it's for population control. but that's me.

You think these strains of flu were man made to deliberately kill people??

I think it's just an unfortunate coincidence.  It's too bad they were concentrating too much on the H1N1 vaccine and not so much on the seasonal one.

Ukraine - We have more of the political flu than real A/H1N1 of seasonal flu - President

Not sure why someone would create a potentially lethal strain of a disease and then use drugs specifically meant to fight it.

WHO Urges Doctors To Use Antiviral Drugs Sooner To Prevent Swine Flu Deaths

I think the issue in the Ukraine (and surrounding areas), is more of a political issue and that they probably are lying about the situation.

Ukraine WHO and the Geopolitics of Swine Flu Panic
 
I'm going for my H1N1 in about 20 minutes, if you do not hear from me on this site then maybe all the conspiracy theories are true.  I am sure my doctor who got the shot himself has a death wish for him and myself
 
riggermade said:
I'm going for my H1N1 in about 20 minutes, if you do not hear from me on this site then maybe all the conspiracy theories are true.  I am sure my doctor who got the shot himself has a death wish for him and myself

Pfft.  I got it over two weeks ago and I'm fine......really...... 
2.gif


;)
 
I know its only been 1/2 hour but no extra appendages growing yet and nothing has fell off...still breathing...
 
Meh...I didn't get the shot, got the flu, and I'm still alive and kicking.
All they play in the news are the people that are dying from H1N1 (not that they aren't important) but there's no airtime for the people like me who just get a week off to catch up on sleep and try not to infect anyone else. Besides, now that I've had it, I hear that I've got immunity so that's not a bad thing.
 
Yikes.  :o

http://ca.news.yahoo.com/s/afp/091120/health/health_flu_who_mutation

GENEVA (AFP) - The World Health Organisation said Friday that a mutation had been found in samples of the swine flu virus taken following the first two deaths from the pandemic in Norway.

However, it stressed that the mutation did not appear to cause a more contagious or more dangerous form of A(H1N1) influenza and that some similar cases observed elsewhere had been mild.

(...)
 
Although this is geared towards bacteria, Norway's solutions are practical, low cost and are not panic inducing. Vaccination is still the best course of action with viral infactions, but applying some of these principles also will help slow the spread of disease:

http://news.yahoo.com/s/ap/20091231/ap_on_re_us/when_drugs_stop_working_norway_s_answer

Solution to killer superbug found in Norway
AP
 
By MARTHA MENDOZA and MARGIE MASON, Associated Press Writers Martha Mendoza And Margie Mason, Associated Press Writers – Thu Dec 31, 12:01 am ET

OSLO, Norway – Aker University Hospital is a dingy place to heal. The floors are streaked and scratched. A light layer of dust coats the blood pressure monitors. A faint stench of urine and bleach wafts from a pile of soiled bedsheets dropped in a corner.

Look closer, however, at a microscopic level, and this place is pristine. There is no sign of a dangerous and contagious staph infection that killed tens of thousands of patients in the most sophisticated hospitals of Europe, North America and Asia this year, soaring virtually unchecked.

The reason: Norwegians stopped taking so many drugs.

Twenty-five years ago, Norwegians were also losing their lives to this bacteria. But Norway's public health system fought back with an aggressive program that made it the most infection-free country in the world. A key part of that program was cutting back severely on the use of antibiotics.

Now a spate of new studies from around the world prove that Norway's model can be replicated with extraordinary success, and public health experts are saying these deaths — 19,000 in the U.S. each year alone, more than from AIDS — are unnecessary.

"It's a very sad situation that in some places so many are dying from this, because we have shown here in Norway that Methicillin-resistant Staphylococcus aureus (MRSA) can be controlled, and with not too much effort," said Jan Hendrik-Binder, Oslo's MRSA medical adviser. "But you have to take it seriously, you have to give it attention, and you must not give up."

The World Health Organization says antibiotic resistance is one of the leading public health threats on the planet. A six-month investigation by The Associated Press found overuse and misuse of medicines has led to mutations in once curable diseases like tuberculosis and malaria, making them harder and in some cases impossible to treat.

Now, in Norway's simple solution, there's a glimmer of hope.

---

Dr. John Birger Haug shuffles down Aker's scuffed corridors, patting the pocket of his baggy white scrubs. "My bible," the infectious disease specialist says, pulling out a little red Antibiotic Guide that details this country's impressive MRSA solution.

It's what's missing from this book — an array of antibiotics — that makes it so remarkable.

"There are times I must show these golden rules to our doctors and tell them they cannot prescribe something, but our patients do not suffer more and our nation, as a result, is mostly infection free," he says.

Norway's model is surprisingly straightforward.

• Norwegian doctors prescribe fewer antibiotics than any other country, so people do not have a chance to develop resistance to them.

• Patients with MRSA are isolated and medical staff who test positive stay at home.

• Doctors track each case of MRSA by its individual strain, interviewing patients about where they've been and who they've been with, testing anyone who has been in contact with them.

Haug unlocks the dispensary, a small room lined with boxes of pills, bottles of syrups and tubes of ointment. What's here? Medicines considered obsolete in many developed countries. What's not? Some of the newest, most expensive antibiotics, which aren't even registered for use in Norway, "because if we have them here, doctors will use them," he says.

He points to an antibiotic. "If I treated someone with an infection in Spain with this penicillin I would probably be thrown in jail," he says, "and rightly so because it's useless there."

Norwegians are sanguine about their coughs and colds, toughing it out through low-grade infections.

"We don't throw antibiotics at every person with a fever. We tell them to hang on, wait and see, and we give them a Tylenol to feel better," says Haug.

Convenience stores in downtown Oslo are stocked with an amazing and colorful array — 42 different brands at one downtown 7-Eleven — of soothing, but non-medicated, lozenges, sprays and tablets. All workers are paid on days they, or their children, stay home sick. And drug makers aren't allowed to advertise, reducing patient demands for prescription drugs.

In fact, most marketing here sends the opposite message: "Penicillin is not a cough medicine," says the tissue packet on the desk of Norway's MRSA control director, Dr. Petter Elstrom.

He recognizes his country is "unique in the world and best in the world" when it comes to MRSA. Less than 1 percent of health care providers are positive carriers of MRSA staph.

But Elstrom worries about the bacteria slipping in through other countries. Last year almost every diagnosed case in Norway came from someone who had been abroad.

"So far we've managed to contain it, but if we lose this, it will be a huge problem," he said. "To be very depressing about it, we might in some years be in a situation where MRSA is so endemic that we have to stop doing advanced surgeries, things like organ transplants, if we can't prevent infections. In the worst case scenario we are back to 1913, before we had antibiotics."

---

Forty years ago, a new spectrum of antibiotics enchanted public health officials, quickly quelling one infection after another. In wealthier countries that could afford them, patients and providers came to depend on antibiotics. Trouble was, the more antibiotics are consumed, the more resistant bacteria develop.

Norway responded swiftly to initial MRSA outbreaks in the 1980s by cutting antibiotic use. Thus while they got ahead of the infection, the rest of the world fell behind.

In Norway, MRSA has accounted for less than 1 percent of staph infections for years. That compares to 80 percent in Japan, the world leader in MRSA; 44 percent in Israel; and 38 percent in Greece.

In the U.S., cases have soared and MRSA cost $6 billion last year. Rates have gone up from 2 percent in 1974 to 63 percent in 2004. And in the United Kingdom, they rose from about 2 percent in the early 1990s to about 45 percent, although an aggressive control program is now starting to work.

About 1 percent of people in developed countries carry MRSA on their skin. Usually harmless, the bacteria can be deadly when they enter a body, often through a scratch. MRSA spreads rapidly in hospitals where sick people are more vulnerable, but there have been outbreaks in prisons, gyms, even on beaches. When dormant, the bacteria are easily detected by a quick nasal swab and destroyed by antibiotics.

Dr. John Jernigan at the U.S. Centers for Disease Control and Prevention said they incorporate some of Norway's solutions in varying degrees, and his agency "requires hospitals to move the needle, to show improvement, and if they don't show improvement they need to do more."

And if they don't?

"Nobody is accountable to our recommendations," he said, "but I assume hospitals and institutions are interested in doing the right thing."

Dr. Barry Farr, a retired epidemiologist who watched a successful MRSA control program launched 30 years ago at the University of Virginia's hospitals, blamed the CDC for clinging to past beliefs that hand washing is the best way to stop the spread of infections like MRSA. He says it's time to add screening and isolation methods to their controls.

The CDC needs to "eat a little crow and say, 'Yeah, it does work,'" he said. "There's example after example. We don't need another study. We need somebody to just do the right thing."

---

But can Norway's program really work elsewhere?

The answer lies in the busy laboratory of an aging little public hospital about 100 miles outside of London. It's here that microbiologist Dr. Lynne Liebowitz got tired of seeing the stunningly low Nordic MRSA rates while facing her own burgeoning cases.

So she turned Queen Elizabeth Hospital in Kings Lynn into a petri dish, asking doctors to almost completely stop using two antibiotics known for provoking MRSA infections.

One month later, the results were in: MRSA rates were tumbling. And they've continued to plummet. Five years ago, the hospital had 47 MRSA bloodstream infections. This year they've had one.

"I was shocked, shocked," says Liebowitz, bouncing onto her toes and grinning as colleagues nearby drip blood onto slides and peer through microscopes in the hospital laboratory.

When word spread of her success, Liebowitz's phone began to ring. So far she has replicated her experiment at four other hospitals, all with the same dramatic results.

"It's really very upsetting that some patients are dying from infections which could be prevented," she says. "It's wrong."

Around the world, various medical providers have also successfully adapted Norway's program with encouraging results. A medical center in Billings, Mont., cut MRSA infections by 89 percent by increasing screening, isolating patients and making all staff — not just doctors — responsible for increasing hygiene.

In Japan, with its cutting-edge technology and modern hospitals, about 17,000 people die from MRSA every year.

Dr. Satoshi Hori, chief infection control doctor at Juntendo University Hospital in Tokyo, says doctors overprescribe antibiotics because they are given financial incentives to push drugs on patients.

Hori now limits antibiotics only to patients who really need them and screens and isolates high-risk patients. So far his hospital has cut the number of MRSA cases by two-thirds.

In 2001, the CDC approached a Veterans Affairs hospital in Pittsburgh about conducting a small test program. It started in one unit, and within four years, the entire hospital was screening everyone who came through the door for MRSA. The result: an 80 percent decrease in MRSA infections. The program has now been expanded to all 153 VA hospitals, resulting in a 50 percent drop in MRSA bloodstream infections, said Dr. Robert Muder, chief of infectious diseases at the VA Pittsburgh Healthcare System.

"It's kind of a no-brainer," he said. "You save people pain, you save people the work of taking care of them, you save money, you save lives and you can export what you learn to other hospital-acquired infections."

Pittsburgh's program has prompted all other major hospital-acquired infections to plummet as well, saving roughly $1 million a year.

"So, how do you pay for it?" Muder asked. "Well, we just don't pay for MRSA infections, that's all."

---

Beth Reimer of Batavia, Ill., became an advocate for MRSA precautions after her 5-week-old daughter Madeline caught a cold that took a fatal turn. One day her beautiful baby had the sniffles. The next?

"She wasn't breathing. She was limp," the mother recalled. "Something was terribly wrong."

MRSA had invaded her little lungs. The antibiotics were useless. Maddie struggled to breathe, swallow, survive, for two weeks.

"For me to sit and watch Madeline pass away from such an aggressive form of something, to watch her fight for her little life — it was too much," Reimer said.

Since Madeline's death, Reimer has become outspoken about the need for better precautions, pushing for methods successfully used in Norway. She's stunned, she said, that anyone disputes the need for change.

"Why are they fighting for this not to take place?" she said.

____

Martha Mendoza is an AP national writer who reported from Norway and England. Margie Mason is an AP medical writer based in Vietnam, who reported while on a fellowship from The Nieman Foundation at Harvard University.
 
A very good article. Unfortunately, north americans are so pill centric that it will be an uphill battle. At least in my emerg, we're very reluctant to prescribe antibiotics. Hopefully that contributes to some local success.
 
Given H1N1 vaccine in military, November 18, 2009.  Immediately following the shot, the following symptoms occurred and became permanent: dizziness, fever, fatigue, coughing, irregular heartbeat, tightness in chest and throat, diarrhea, shortness of breath, night sweats, abdominal pain and cramps.  Within several months following the vaccination, I passed out several times, had a seizure and was diagnosed with Multiple Sclerosis, Irritable Bowel Syndrome, Orthostatic Hypotension, Chronic Fatigue, and eventually AFIB.  My pre-vaccination health was at a high athletic level for military standards which included pre-qualification for special forces.  Immediately following the vaccination I was unable to maintain any physical fitness without increasing the severity of symptoms.  Eventually I was released from the military as disabled but was denied medical coverage.  Following my release I requested copies of my military medical records and became aware of several of the above diagnosis which I was not advised of while in the military, specifically for Multiple Sclerosis and Chronic Fatigue Syndrome.  IF YOU HAVE EXPERIENCED ADVERSE REACTIONS TO THIS VACCINATION, PLEASE POST A REPLY.
 
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