Trivializing the Flu – It’s What Healthy Adults Tend To Do

September 27, 2016 3 comments

It’s not uncommon for healthy adults to skip their annual flu vaccine.  In fact, it’s estimated that only about 40% of adults receive an influenza vaccine each year – a preventive measure that the CDC recommends for everyone age 6 months of age and older, with rare exception.

While adults tend to understand that the flu can be dangerous and sometimes even deadly, they often don’t get vaccinated because they just don’t consider themselves at risk.

Why? 

I imagine it’s because we’re living in a time when modern medicine is so advanced.  The average American just doesn’t consider it likely that a healthy adult could die from something so common as the flu? One would imagine that those at greatest risk of death from flu would be young children, the elderly or people who have underlying health conditions, right?

ceciliaheadshot-250x378While it is true that there are certain demographics of people who may be more likely to suffer severe consequences from flu, it does not mean that a healthy adult is not also at risk of hospitalization or death. As Michael Pulgini explains, the flu is “aggressive, sneaky, and potentially deadly” and “no one is invincible” just because you are young, strong, or healthy.

You see, Michael is one of those healthy adults who refused the flu shot last season, citing that he felt it wasn’t necessary and suspecting it might make him sick.  Michael ended up contracting the flu, but recovered after about five days of body aches, fever, runny nose and cough.

But what continues to haunt Michael today is the fact that his wife also fell victim to the flu – but sadly, she never recovered.  

Michael now lives with the horrifying memory of watching his beautiful wife Cecilia suffer and die from the very disease that he had previously trivialized.

After Michael had recovered, Cecilia started to show signs of illness, such as runny nose, body aches and pains, and a weird symptom that caused her upper lip to swell.  She made several visits to the doctor, and the last visit occurred about eight or nine days after her first symptoms appeared.  This time, she was complaining of shortness of breath.  The doctor gave her an injection to help open up her airways, but within 30 hours Cecilia was in terrible distress and her breathing was very rapid and shallow.  A chest x-ray at the hospital showed one lung was completely covered in puss and fluid from an infection.

cecilialipDoctors explained that the influenza virus continued to replicate, hitting Cecilia full force and completely overpowering her body’s ability to fight off the infection.

They also told Michael something he will never forget;

“If she had been vaccinated against influenza, there was a 90% chance she wouldn’t be here [in the hospital] like this.”

Sadly, Cecilia was put into a medically induced coma.  They intubated her and put her on a ventilator since she was unable to breathe on her own. All the while, Michael believed in his heart that she would pull through because she was young and strong.

But Michael was wrong.  He explains,

Read more…

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Preventing Shingles Today and the Promise of New Vaccines Tomorrow

September 22, 2016 Leave a comment

The timing could not have been worse.

It was the holiday season and many family members were traveling great distances to converge on “Mom’s House”.  To complicate matters even more, one family member was temporarily living with her mom as a result of being on bed rest for the duration of her high risk pregnancy.

Her mother, who was a fairly active woman in her mid-70 without any health problems, was complaining about back pain.  She believed she had strained a muscle but couldn’t seem to get relief.  When the rash appeared a few days later, it became clear that she had shingles.

It really shouldn’t have come as much of a surprise. 

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About one of every three people in the U.S. will get shingles during their lifetime, and the risk increases with age. For immune compromised individuals, the risk of shingles increases by as much as 50 fold. In fact, every year in the U.S. approximately one million people are affected by shingles.  

If you’ve ever known someone who has suffered with this disease, you’ll know why you would want to prevent it. 

Shingles can cause severe and long-lasting pain.  While the shingles rash typically resolves in about a month for most people, the pain is very difficult to treat.  Other symptoms include fever, headache, chills, upset stomach, muscle weakness, skin infection, scarring.  Shingles can also develop in the eyes and cause vision loss.  Additionally, in about 10-18% of cases, patients will suffer with postherpetic neuralgia (PHN) which is a condition best described as a lingering, burning, stabbing, throbbing, or shooting pain that can last weeks, months or even years.

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So with one mom down with shingles, her daughter grew concerned over the arrival of her new baby.  Would it be possible for her newborn to contract the virus?  

Fortunately, people don’t catch shingles from other people.  Rather, shingles (also called herpes zoster) is caused by a reawakening of the varicella zoster virus (VZV) that causes chickenpox. After contracting chickenpox, the virus lives in the nervous system for years – even decades – until something causing it to reawaken.  Sometimes it’s reawakened by a waking of the immune system from advancing age or immune-suppressive drugs used to treat cancers.  But what’s hardest to accept is that most cases of shingles occur among adults who are otherwise healthy.  Even having suffered with shingles doesn’t prevent someone from having it again.  In fact, a reoccurrence of shingles happens in about 6% of people.

In the case of the mother and pregnant daughter sharing a home, the possibility existed that the newborn baby, too young for varicella vaccine, could potentially be at risk of contracting chickenpox if she were to come into contact with the rash of the infected grandmother.  This is why the family was advised by their doctors to be extra diligent in washing hands after touching any of the open sores.

screen-shot-2016-09-22-at-3-21-06-pmWhile there are verified cases of shingles in people of all ages – even adolescents – the risk of shingles appears to peak in those age 65 and older (as seen in the chart at left).

So, while scientist have been observing an increase in the incidence of zoster since 1993, they attribute the rise in cases to an aging population as well as a population who is increasingly immune compromised.

To complicate matters further, experts explain that the epidemiology of zoster has been changing and it’s unclear exactly why.  The current vaccine, which we know to have poor efficacy in the high risk elderly, also does not provide long-lasting protection. However, it can reduce the risk of shingles by half (51%) and reduces the risk of prolonged pain at the rash site by 67%.

When shingles vaccine was first licensed in 2006, it was approved for use in people age 50 and over.  In fact, the research at that time determined that the shingles vaccine had a 70% efficacy  among people ages 50-59.  However, the efficacy was reduced when administered to older individuals, and protection continued to decline significantly at 5-10 years post vaccination.

So, when the Advisory Committee on Immunization Practices (ACIP) announced their adult vaccine recommendations in 2008, they recommended one dose of shingles vaccine be administered to adults at age 60 and older.  Their decision was based on the belief that vaccine administrations should be timed to achieve the greatest reduction in burden of disease and the related  complications.  Since there was insufficient evidence of long-term protection offered by the zoster vaccine, it was believed that vaccinating persons under 60 years of age may not help protect people when the incidence of herpes zoster and it’s complications were at their highest.

While it appears that there has been a downward trend in childhood cases of shingles since 2005, most likely as a result of increased varicella vaccination among children, current shingles vaccine uptake among adults 60 and over is lower than most other adult recommended vaccines at just 27.9%.  If uptake were greater it is suspected that we would be seeing fewer cases.

In looking ahead, we are hopeful that two new shingles vaccines will prove to be more effective.

Read more…

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Physicians Can Help Influence Vaccine Opinions By Engaging Patients on Social Media

September 8, 2016 2 comments

posterDr. John Merrill-Steskal has spent 22 years as a Family Medicine Physician.  He believes that doctors can help promote healthy behaviors by becoming more engaged on social media. Throughout the past year, in an effort to help shape public perception on a variety of medical topics such as vaccines, Dr. Merrill-Steskal has begun hosting a monthly radio show,  blogging at Triple Espresso MD, and contributing guest posts on other blogs such as KevinMD.  We welcome his latest contribution:

Vaccine hesitancy: It’s time to go on offense

by John Merrill-Steskal, MD

The term “vaccine hesitancy” is a relatively recent term in medicine, a term used to describe patients who are worried about the safety, efficacy, or necessity of receiving immunizations. Vaccines are safe and have a proven track record of saving lives. As a result, doctors have been caught somewhat off guard by the notion that anyone would have second thoughts about the benefits of immunization.

Recommendations commonly publicized on how to respond to the vaccine hesitant patient are admirable, and have a calm, respectful tone.  For example, doctors are encouraged to engage patients and respond to their concerns, while giving a clear message to recommend vaccination. Since treating patients disrespectfully or with disdain will only serve to alienate them further, being respectful, calm, and clear in our communication is our best chance at tipping the scales in favor of vaccination

The problem with this approach, however, is that physicians are on the defensive before a discussion even begins. And as in sports, a good defense without an offense will not win the game. Because of where we talk to patients, doctors are at a critical disadvantage: the physical place in which physicians engage patients about vaccines is typically the exam room, and by the time patients have arrived to the clinic they may well have already formed their opinions about vaccines.

As a result, physicians are forced to respond and react to concerns, and must attempt to reclaim ground that has already been lost. In other words, because of the nature of where physicians physically interact with and engage patients, we are by default always on the defensive as we work to dispel myths and misinformation regarding vaccine safety or efficacy.

To make a true difference on vaccine hesitancy, I think doctors must engage patients where the dialog is happening in real time: in the world of social media.

Every day patients acquire information, discuss concerns, and formulate opinions within the realm of social media.  By the time a patient enters the exam room, their mind may already be made up about vaccines. While our discussions with individual patients in exam rooms will always be important, it is becoming equally important for physicians to enter the dialog where it is being created, before the patient arrives at the clinic. Physicians need to pay attention to what patients are talking about on social media, and need to be a part of that dialog.  If we don’t, we will always be on the defensive.

If we are to advance vaccination, physicians must leave the safety of the exam room and meet patients where their opinions are being created.  Start a blog, tweet an opinion grounded in science, or engage patients online; by having a stronger voice in social media, doctors have the opportunity to be more influential in shaping opinions before our patients have become “hesitant“.

It is time to go on the offensive, and is the only way we will win the game.

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Dr. Merrill-Steskal is joined by a guest on his monthly radio show.

 

Dr. John Merrill-Steskal has recently been accepted to the 2016 American Academy of Family Physicians Vaccine Science Fellowship, an elite fellowship program which only accepts two providers per year.  We look forward to learning more about his work in the area of immunization education and we suggest readers also check out his other immunization related blog posts such as Past and Present: Rubella and Zika and Can the anti-vaccine movement be convinced with more positive messages?  

You can follow him on Twitter @MerrillSteskal.

Every Child By Two (host of the Shot of Prevention blog) welcomes guest blog posts on a variety of vaccine related issues.  The views and opinions expressed in these guest posts do not necessarily represent the views of the Every Child By Two organization.
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Triumph Over Smallpox Reminds Us That Vaccines Help Prevent Disease Every Day

August 31, 2016 Leave a comment

Every Child By Two’s State of the ImmUnion campaign is honoring National Immunization Awareness Month (#NIAM16) with a Blog Relay highlighting the importance of vaccines across the lifespan and across the nation.

Parker.Heidi__vertical_0In this guest post, we hear from Heidi Parker, MA, Executive Director of Immunize Nevada.  She reminds us that promoting health and preventing disease is not just a cause to recognize during the month of August; instead, it is something we need to do each and every day.

By Heidi Parker, MA, Executive Director of Immunize Nevada

Dr. Donald A. Henderson passed away recently, with little media attention or fanfare. This is alarming, considering “saving millions of lives” was listed as one of his life accomplishments.

22Henderson1-obit-master768In case you’re wondering who he is, Dr. Henderson led the global effort to eradicate smallpox — a disease that, in the 20th century and before it was extinguished, was blamed for at least 300 million deaths. Clearly, his triumph over smallpox proved the power of vaccines.

During National Immunization Awareness Month, we are reminded that promoting health and preventing disease is not just a cause to recognize during the month of August; instead, it is something we need to do each and every day.

We must be relentless, much like Dr. Henderson was. Why? Because our news feeds continue to be filled with stories of vaccine-preventable diseases – a teen dies from meningococcal disease; a summer camp closes due to a whooping cough outbreak; college campuses battle mumps; measles spreads at music festivals; an infant too young to be vaccinated dies from pertussis; the list goes on.

In the United States, vaccines have reduced — and in some cases, eliminated — many of the diseases that killed or severely disabled people just a few generations ago. My great-grandfather died during the 1918 Influenza Flu Pandemic, along with millions of others; but decades later, our family is protected from this deadly virus when we get our annual flu shot. By vaccinating children against rubella (German measles), the risk that pregnant women will pass this virus on to their fetus or newborn has been dramatically decreased, and birth defects associated with that virus are now rarely seen. Countless examples like these demonstrate, day after day, vaccines are one of public health’s greatest achievements.

Unfortunately, tens of thousands of Americans still suffer serious health problems, are hospitalized, and even die from vaccine-preventable diseases. Read more…

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I Want Parents to Know About the Additional Meningococcal Vaccine That Could Have Saved My Daughter

August 25, 2016 1 comment
This guest post has been written by Patti Wukovits, a Registered Nurse and Executive Director of The Kimberly Coffey Foundation, as part of National Immunization Awareness Month’s week-long focus on the importance of preteen and teen vaccination.

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As a mother and a nurse, I was vigilant in having both of my children up-to-date on all recommended vaccinations, including meningococcal vaccination. I was under the common misconception, as many parents are, that the meningococcal vaccine that my daughter received would fully protect her from meningococcal disease, when in fact, it didn’t protect her against meningitis B. The meningococcal vaccine (MCV4) only protects against four of the five common groups (ACWY), leaving adolescents and young adults vulnerable to meningitis B. Meningitis B is a type of bacterial meningitis, also known as meningococcal disease, which is a potentially fatal bacterial infection that can kill a healthy person within 24 hours.KimberlyCoffey

When my daughter Kimberly Coffey died in 2012 from bacterial meningitis, a vaccine was not available to protect her. But since 2014, meningitis B vaccination has been available in the United States. Kimberly was a perfectly healthy 17-year-old high school senior, and I believe she would be alive today if meningitis B vaccination had been available to her.

I established The Kimberly Coffey Foundation in Kimberly’s honor to educate other parents and health care providers about meningitis B, also known as MenB.

It’s critical that parents know that MenB vaccination is now available, and that without requesting MenB vaccination in addition to the common meningococcal vaccine (MCV4), their child will not be fully protected against meningococcal disease and MenB.

The Kimberly Coffey Foundation has partnered with Pfizer on the National Meningococcal Disease Awareness Survey to gain a better understanding of parents’ knowledge of meningococcal disease and its available vaccines.  This 2016 survey revealed that nearly 4 out of 5 parents didn’t know their child wasn’t fully immunized against the five common groups of meningococcal disease unless they had two meningococcal vaccines (MCV4 and MenB).

The bottom line is this – without adding MenB vaccination, we are going to lose more lives. There will continue to be more college outbreaks, especially since MenB has been responsible for several recent college outbreaks in the United States.  According to data released by the CDC, MenB currently accounts for approximately 50% of meningococcal disease in the United States among persons aged 17-22 years old. MenB vaccination is available for individuals ages 10-25, and public health insurance and most private insurance plans provide coverage.  However, your child’s provider may not mention it.

I want parents to have the knowledge to request MenB vaccination, in addition to the meningococcal vaccine, so that their children can potentially be fully protected against this devastating disease.

As a mother who lives every day with the heartache of not seeing my beautiful daughter live the full life she deserved, I know only too well how important MenB vaccination is. My daughter Kimberly’s life was one too many lost to this terrible disease.

KimberlyCoffeyFoundationLogoI will be Kimberly’s voice as I continue to promote awareness of meningococcal disease, which includes MenB. I don’t ever want another parent to experience what I have. And more important, I don’t want another person to experience what Kimberly did when she battled for her life.

Kimberly contracted MenB two years too early—two years before the MenB vaccine was made available.  She didn’t have the protection of the MenB vaccination, but your children can. Please protect your children – because YOU can.

 

For more information about meningitis B and the MenB vaccine, please visit the Kimberly Coffey Foundation at www.kimberlycoffeyfoundation.org.

 

Every Child By Two (host of the Shot of Prevention blog) welcomes guest blog posts on a variety of vaccine related issues.  The views and opinions expressed in these guest posts do not necessarily represent the views of the Every Child By Two organization.
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The State of the ImmUnion in Maine: Tweens, Teens and Vaccines

August 23, 2016 1 comment

Every Child By Two’s State of the ImmUnion campaign is honoring National Immunization Awareness Month (#NIAM16) with a Blog Relay highlighting the importance of vaccines across the lifespan and across the nation.

In this fourth guest post, we learn how Maine has made great strides in stepping up the state’s vaccination rates for infants, babies and young children to at or above national levels. But when it comes to adolescents, Maine – like many other states – still has some catching up to do.

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At Vax Maine Kids, they’re working hard to make sure parents know how to protect their childrenfrom several serious illnesses that can strike during the teen years.

DrGabeCivielloThis guest post by Franklin Health Pediatrics pediatrician, Dr. Gabe Civiello, highlights the importance of vaccines for preteens and teens and explains what Maine is doing to improve adolescent immunization rates.

By Gabriel Civiello, MD in collaboration with Vax Maine Kids

Healthcare providers all across Maine are celebrating the recent rebound in vaccination rates for our youngest children. In fact, our childhood immunization rates rank among the highest in the country. According to the 2014 National Immunization Survey, over 85% of Maine toddlers are up-to-date on their recommended vaccinations, and kindergarten non-medical exemption requests fell to 3.9% during the 2014-2015 school year.

Teenage Couple Sitting On Bench In Mall Taking SelfieThe trends aren’t quite as positive for Maine’s preteens and teens, however. Nationwide, as children grow into their preteen and teen years, under immunization becomes much more common—and Maine is no exception. In fact, Maine’s vaccination rates for the meningococcal vaccine and the tetanus, diphtheria, and pertussis (Tdap) vaccine are below the national average and the lowest in New England. Following the national trend, human papillomavirus (HPV) vaccine rates in Maine are at least half of the rates of the other adolescent vaccines.

Why are immunization rates lower for Maine teens?

  • Preteens and teens have lower attendance at well child visits. If they aren’t seeing their healthcare provider on a regular basis, they and their parents aren’t being reminded of the CDC-recommended vaccination schedule (and the importance of sticking to it). When teens see a provider solely for sick visits or emergencies, vaccinations may not come up in the discussion as often as they should.
  • Critical vaccines for teens are not required for school attendance in Maine. Teens are allowed to attend school without getting the meningococcal vaccine and the HPV vaccine, and Maine is one of only three states that doesn’t require the Tdap vaccine. By leaving these vaccines out of school requirements, parents may get the impression that their children don’t need them.
  • The HPV vaccine remains as poorly understood and under-utilized (by families and providers), in Maine as it is elsewhere in the country. We aren’t communicating the importance of safely vaccinating adolescents against the common cancers caused by the HPV virus before they become sexually active as well as we could.

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There is good news for Maine teens in the NIS data, however. Our HPV vaccination rates are higher than the national average. This tells us that Maine parents and providers want to protect our children all the way into adulthood, and that HPV vaccine rates will likely improve with better communication about the vaccine.

 Which diseases threaten Maine teens, and which vaccines can protect them?

There are four vaccines that are routinely recommended for all preteens between 11 and 12 years of age. Teens also need a booster dose of meningococcal vaccine at age 16, and teens may also need additional vaccines based on risk factors, travel, or if they missed previous doses. The vaccines routinely recommended for preteen and teen girls and boys are:

  • Quadrivalent meningococcal conjugate vaccine, which protects against four types of meningococcal disease. Meningococcal disease is caused by bacteria and is a leading cause of bacterial meningitis – a serious infection around the brain and spinal cord – in teens and young adults. Two doses are needed for full protection.
  • HPV vaccine, which protects against several types of HPV. HPV can cause cancers of the cervix, vulva and vagina in females and cancers of the penis in males. In both females and males, HPV infection can also lead to head/neck cancers, anal cancer and genital warts. Three doses are needed for full protection.
  • Tdap vaccine, which is a booster shot against tetanus, diphtheria and pertussis. Pertussis (whooping cough) can keep kids out of school and activities for weeks. Infants, for whom pertussis can be deadly, are often infected by an older sibling or adult. A Tdap vaccine is recommended between the ages of 11-12 (with boosters for tetanus and diphtheria (Td) needed every 10 years throughout adulthood).
  • Flu vaccine, because even healthy kids can get influenza, and it can be serious. All preteens and teens, should get the flu vaccine every year.

What is Maine doing to raise awareness of and access to the immunizations Maine teens need?instagram_preteens_teens

Read more…

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10 Things You Need to Know About Vaccines for Children

August 17, 2016 21 comments

 

instagram_childrenEvery Child By Two’s State of the ImmUnion campaign is honoring National Immunization Awareness Month (#NIAM16) with a Blog Relay highlighting the importance of vaccines across the lifespan.  

In this third guest post, we hear about the importance of protecting babies and young children from vaccine-preventable diseases from the perspective of a statewide non-profit.  The mission of the Colorado Children’s Immunization Coalition is to mobilize diverse partners and families in an effort to advance children’s health through immunizations.

By the Colorado Children’s Immunization Coalition

To celebrate the gift of vaccines and to remind parents, grandparents, caregivers, and others of the important role vaccines play in their little one’s early years, we’re highlighting the top 10 things parents should know about childhood immunizations.

1. Vaccines save lives.

COGuestBlogPost_20-year-infographicSimply put, vaccines work! The World Health Organization estimates that vaccines save 2.5 million children’s lives every year. In fact, immunization is considered one of the greatest public health achievements of the 20th century.

Vaccines have reduced and, in some cases, eliminated many diseases that killed or severely disabled people just a few generations ago. For example, smallpox vaccination eradicated that disease worldwide, and we’re getting closer than ever to a polio-free world.

Here in Colorado, vaccination prevented more than 8,600 child hospitalizations in just one year!

2. Vaccines are safe.

Vaccines are thoroughly tested before licensing and carefully monitored after they are licensed to ensure that they are safe. See The Journey of Your Child’s Vaccine infographic to learn more about the vaccine testing and approval process. 

Like any medication or medical intervention, vaccines can cause adverse reactions. The most common vaccine side effects are mild (e.g. a sore arm or mild fever). In many cases, the risk of a serious allergic reaction to a vaccine is 1 in one million. Vaccines will involve some discomfort and may cause pain, redness, or tenderness at the site of injection, but this is minimal compared to the pain, trauma, and possible long-term complications of the diseases these vaccines prevent. The disease-protection benefits of getting vaccines are much greater than the risk of possible side effects. Not vaccinating places children at risk for dangerous and potentially fatal vaccine-preventable illnesses.

The Centers for Disease Control and Prevention (CDC) recommended schedule is a safe and effective way to protect your child against 14 diseases by the age of two.

3. Young children are especially vulnerable to vaccine-preventable diseases and their complications.

Children under the age of five are most at risk for vaccine-preventable diseases and their complications. In 2014, 63.8 percent of children hospitalized with vaccine-preventable disease in Colorado were four years of age or younger. Unfortunately, in the same year over 25.7 percent of two-year-olds in Colorado had not received all recommended vaccines.

Child care facilities, preschool programs and schools are prone to outbreaks of infectious diseases. Children in these settings can easily spread illnesses to one another due to poor hand washing, not covering their coughs, and other factors such as interacting in crowded environments. Make sure you are sending your child to child care and school safe!

4. Vaccine-preventable diseases still exist.

Diseases like polio, measles, and mumps are not diseases of the past; vaccine-preventable diseases are still common in many parts of the world. However, most young parents in the U.S. have never seen the devastating effects that diseases like measles or rubella can have on a family or community, and the benefits of vaccination are often taken for granted. But the truth is they still exist.

For example, measles continues to be brought into the United States by unvaccinated travelers who are infected while in other countries. When measles gets into communities of unvaccinated people in the U.S. (such as people who refuse vaccines for religious, philosophical or personal reasons), outbreaks are more likely to occur. While we have the ability to prevent these diseases from harming our most vulnerable, such as babies, the elderly and the immunocompromised, gaps in immunization coverage have allowed these diseases to sneak back into our daily lives. Last year’s measles outbreak was a perfect example of how quickly infectious diseases can spread when they reach groups of people who aren’t vaccinated.

Diseases know no boarders, and with an increasingly transient global society it is more important than ever to ensure our little ones are protected.

5. Vaccines also save money.

Read more…

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