Home > Expert Insights, General Info, In the News, Preventable Diseases, Science & Research > Vaccines On the Go: What You Should Know

Vaccines On the Go: What You Should Know

The Children’s Hospital of Philadelphia’s Vaccine Education Center is an excellent resource for both parents and healthcare professionals.  The extensive website provides a close-up look at every vaccine as well as specific explanations about the science, safety and important considerations regarding vaccines.  There is even a feature that allows the public to submit specific questions for review and response by immunization experts.

vec-app-iphoneNow, with their new free mobile app for iPhones Vaccines on the Go: What You Should Know, the Vaccine Education Center is extending their accessibility and putting critical vaccine information in the hands of those who need it, when they need it.

The app, available now through the Apple App Store, is cleverly designed to provide extensive information about vaccines, the diseases they prevent, and common vaccine safety concerns such as autism, thimerosal and the number of vaccines on the schedule.  Additionally, the app addresses the various types of vaccines and how they’re made, and includes links to the recommended immunization schedules for children, teens and adults.  It provides users with the ability to access an extensive library of videos, Q&A sheets and booklets while utilizing engaging graphics that help depict disease characteristics, such as levels of contagiousness and typical disease timelines.

There is even a useful function that allows parents to develop a list of questions and save them along with other notes that they would like to discuss with their doctor.  If they prefer to get their questions answered right away, they can utilize the app to send a direct email to the Vaccine Education Center for follow-up.  And of course, no app would be complete without a few items of entertainment and this app delivers the fun with vaccine related games such as hangman, match and memory.


SVEC Materials Companion Kito whether you’re someone with limited knowledge about vaccines, or an expert in infectious diseases or immunology, we encourage you to download the app and provide your feedback in the comments below.

What do you find most helpful?  And what would you like to see expanded or improved upon?

Your input will likely be considered in the development of future updates to the app.


Also, by submitting a comment on this post, you’ll be automatically entered into Every Child By Two’s free drawing to receive a special Vaccine Education Center Materials Companion Kit, pictured above.  The winner will be chosen at random on September 27th and contacted via email on September 30th.

  1. laura rendler
    September 6, 2013 at 11:00 am

    I just downloaded this app and I LOVE the fact it has a schedule based on how old a child is as to what shots they should be getting! I really hope more parents download this and continue to vaccinate! Watching your babies die of a preventable disease is something no parent should live with!


  2. September 11, 2013 at 1:14 am

    It is notable that the Children’s Hospital of Philadelphia’s Vaccine Education Center webpage on the Measles/Mumps/Rubella (MMR) vaccine does not include information about the option for titre testing to verify a response to the first dose of live MMR vaccine.

    For information, I have recently forwarded (6 September 2013) a detailed letter to Paul Offit regarding the arbitrary second dose of the live Measles/Mumps/Rubella (MMR) vaccine. I have also posted an article about this on my website, including a link to the letter: http://over-vaccination.net/2013/09/06/paul-offit-and-the-mmr-booster/

    There are further arguments I wish to make about this subject, but my three page letter summarises some major issues from my perspective.

    I suggest this is a side of the MMR situation which has had little airing, and the general public is not being properly informed about this matter. Certainly parents of small children are not being properly informed about their options. There may also be legal aspects to be investigated.

    I await a response from Professor Offit, I expect him to be accountable on this matter.

    Elizabeth Hart


  3. September 11, 2013 at 1:18 am

    Why is titer testing more economical? Please provide the peer reviewed papers showing it is preferable.

    And why is drawing blood with freaking large needles better than giving a vaccine?


  4. dingo199
    September 11, 2013 at 4:29 am

    Oh dear. Elizabeth and her animal vaccines. Now spamming the internet with another one of her hobby horse notions.

    The only possible justification I could ever envisage for checking measles titres is where someone did have a severe allergic reaction to MMR vaccine, and the risk of giving a booster shot is considered to be to great. Then, ascertaining whether the child did or did not have a reasonable immune response to the first shot would have some possible merit, just to establish a degree of psychological reassurance. To do it routinely seems quite pointless (pun intended), and would as Chris says, be expensive, as well as unpleasant.


  5. September 11, 2013 at 5:41 am

    @Elizabeth – given the overall safety profile of the MMR (detailed below), what evidence (specific evidence – real and verified) would lead you to believe that your option should even be considered (or would be a legitimate practice)?



  6. September 12, 2013 at 2:15 am

    ‘Chris’ it is incidental whether titre testing is more ‘economical’. This comes down to a matter of individual choice. Parents of small children, and adults who may be pressed to have MMR vaccination, must be given the opportunity to have titre testing, even if they have to pay for it themselves. This is their right in our democratic society.
    As things stand in the US for example, children are first vaccinated with the MMR around 12-15 months, and then again around 4-6 years. So, if the child didn’t respond to the first vaccine this means they are left unprotected for around three to five years.
    If measles, mumps and rubella are as dangerous as we’re led to believe, it makes sense to have the option of a titre test at a suitable interval after initial vaccination to verify a response.
    As for your comment “and why is drawing blood with freaking large needles better than giving a vaccine?”, I had a general blood test last week as part of my annual check-up. I didn’t notice that the needle was “freaking large”. I barely noticed the needle, it was just a mild pin-prick. Certainly no more painful than a vaccine needle. (I presume children in MMR vaccine trials had blood testing to determine antibody status: http://www.merck.com/product/usa/pi_circulars/m/mmr_ii/mmr_ii_pi.pdf)
    Titre testing is evidence based medicine, and I think it could be very economical on a widespread basis.
    Again, it’s a matter of choice. More cautious people might prefer to have the option of a blood test rather than an arbitrary vaccination. This is their choice and their right in our democratic society.
    The Authorizing Legislation of the US National Vaccine Injury Compensation Program, Sec. 300aa-26, which states legal representatives of any child or any individual receiving a vaccine set forth in the Vaccine Injury Table should be provided with information on the vaccine, including “a concise description of the benefits of the vaccine” and “a concise description of the risks associated with the vaccine”, is pertinent. (Refer to my letter to Professor Offit for further information: http://over-vaccination.net/2013/09/06/paul-offit-and-the-mmr-booster/)


  7. September 12, 2013 at 2:29 am

    Ms. Hart, I asked for PubMed indexed research showing it is better to take titers instead of giving two MMR vaccine doses. Include how many times and when those titers should be taken.

    Why do you not care about the economics? Are you so cavalier about all financial matters, especially the use of the money from taxpayers who fund the NHS? Cough up the economic data. It should be similar to this:
    J Infect Dis. 2004 May 1;189 Suppl 1:S131-45.
    An economic analysis of the current universal 2-dose measles-mumps-rubella vaccination program in the United States.

    By the way the National Vaccine Injury Compensation Program has only paid out for 422 injuries that may have occurred due to a measles containing vaccine in twenty five years. Considering that four million children are born in the USA each year, and that equates (low estimates) to six million MMR doses given each year… that is about four million times 25, or a hundred million MMR vaccines. Now take the 422 and divide by the hundred million and you have a chance of .00000422 chance of injury, or .000422%. And the NVICP is generous, you just have to show symptoms showed up in a certain window of time.

    Now answer my questions with real data, not random websites. Just post the PubMed indexed studies from a qualified reputable researcher to support your notion it is better to draw blood and pay for lab reports than to give each child two MMR doses.


  8. September 12, 2013 at 2:37 am

    ” that is about four million times 25, or a hundred million MMR vaccines. ”

    Should be “that is about six million times 25, or a hundred million MMR vaccines.”

    So that is one hundred and fifty million doses… so 422 divided by that is: 0.0000028 or .00028%. Do tell us why that is a huge risk.


  9. September 12, 2013 at 2:59 am

    ‘Dingo199’, I have forwarded a well-considered and referenced letter on MMR vaccination to Professor Offit for his response. It is entirely appropriate that I post it here on the Shot of Prevention website, which refers to The Children’s Hospital of Philadelphia’s Vaccine Education Center in this post. Professor Offit is the Director of the Vaccine Education Center and is accountable on this matter. If you read my letter you would have seen that Professor Offit has acknowledged the option of titre testing after MMR vaccination, although it is notable there is currently no mention of this on the MMR page on the Vaccine Education Center website.

    To suggest that I am “spamming the internet” with my argument is ridiculous. What is alarming is that people such as yourself and others are determined to ridicule and stifle citizens who raise well-founded concerns about over-vaccination of people. Other supposedly ‘science’ forums are similarly aggressive in their quest to shut down debate on this matter. See for example Ben Goldacre’s Bad Science Forum: http://over-vaccination.net/forums/bad-science/ Even university and research sector forums are not above reproach in this regard, see for examples Australia’s The Conversation forum: http://over-vaccination.net/forums/the-conversation-forum/


  10. September 12, 2013 at 3:00 am

    ‘Lawrence’, have you read my letter to Professor Offit? See point 4. “Vaccination and safety matters” on page 3: http://over-vaccination.net/2013/09/06/paul-offit-and-the-mmr-booster/


  11. September 12, 2013 at 3:15 am

    For information, here is the link to Paul Offit’s Expert Answer: “Does my child still need a booster shot if a blood test shows that he’s already immune to a disease?” http://www.babycenter.com/404_does-my-child-still-need-a-booster-shot-if-a-blood-test-show_1463679.bc

    I reiterate, it is citizens’ right to be properly informed and to make an informed decision on medical interventions such as vaccination.

    As Professor Offit is a person with a designated responsibility for vaccination practice, I await his response to my letter with interest.


  12. September 12, 2013 at 3:41 am

    I am sorry, Ms. Hart, but you have not posted a valid economic argument to request blood titers in favor of getting just two MMR vaccines. Please provide that data, or we will assume that you just like to spend other people’s money.

    Random websites like “Over Vaccination” are opinion pieces and not valid evidence.


  13. September 12, 2013 at 4:44 am

    @Elizabeth – I have a feeling you may be waiting for quite some time….


  14. dingo199
    September 12, 2013 at 4:14 pm

    Strain typing of viruses is quite easily performed (assuming someone can pay!)
    It is quite normal for molecular DNA technology to be used in court cases for this reason (eg transmission of HIV).
    I assume the same would apply to these viruses. The question might arise in court that there could be more than one source of the infection – that assessment would rely on the history of contact /epidemiology.


  15. dingo199
    September 12, 2013 at 4:15 pm

    sorry wrong thread!


  16. September 13, 2013 at 1:11 am

    ‘Chris’ your reference to millions of doses of MMR vaccine being given in the US each year is chilling, as many of these doses are being forced upon children who are likely to have already seroconverted after initial vaccination with the live MMR vaccine.

    In Australia the new vaccination schedule dictates that children be vaccinated with MMR at 12 months, with a repeat dose including varicella/chickenpox (MMRV) at 18 months.(1) I am questioning the ethics of forcing children who are likely to be already immune to the individual components of the initial MMR vaccine to be revaccinated with the MMRV at 18 months.

    As for your argument that the rate of adverse reactions is low, I have no confidence in the adverse experience reporting system, in particular the possibility of long-term adverse reactions being recognised and reported.

    Again, this is a matter of informed choice. People should be properly informed of their options, including titre testing to verify a response to live MMR vaccination, which they might opt to pay for themselves. We do have that right in our democratic society. People can spend their money how they please, why not for titre testing? And the MMR vaccines are not ‘free’.

    Really, I’m intrigued by your antagonistic attitude to a person’s right to opt for titre testing. I’m not making an ‘anti-vaccination’ argument here. Your authoritarian dictates are ludicrous.

    As for your inference that we should all be ruled by PubMed indexed studies, otherwise described as the often industry-funded ‘peer-reviewed’ literature, you really do need to get a grip. More discerning citizens are becoming increasingly suspicious of the industry-funded scientific/medical establishment, and the alarming degree of power being exerted by such over citizens’ bodily autonomy, and an escalation of lucrative vaccine products.

    It’s time we had some critical examination of the links between the pharmaceutical industry, governments and empire-builders such as the CDC, NIH, WHO, GAVI, Gates Foundation etc. There are important political and ethical issues to consider here.

    Somehow I don’t think this matter will progress further on this forum of ‘pseudonyms’. I’ll continue to put my arguments to people with real names and responsibility, and demand accountability. It’s going ‘on the record’ anyway.

    1. National Immunisation Program Schedule from 1 July 2013. Australian Government, Department of Health and Ageing: http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/4CB920F0D49C61F1CA257B2600828523/$File/nip-schedule-card-hib-menc-update.pdf


  17. September 13, 2013 at 1:12 am

    ‘Lawrence’, re your comment “I have a feeling you may be waiting for quite some time…” Do you think? Well it comes down to accountability doesn’t it? If people put themselves out there demanding medical interventions for healthy people, they can expect to be held accountable. I’ve also copied a number of other academics on my letter as witnesses, and circulating the letter widely. Somebody might catch on some time.


  18. September 13, 2013 at 5:37 am

    @elizabeth – if the research has shown that the overall effectiveness of a vaccine goes up when given in multiple doses – making it less likely that the immunity will wane with age and more effective during time when the disease would be most dangerous for the child, then why wouldn’t it be recommended?

    Again, you ignore the decades of clinical and research work that has been done that, over and over again, shows the excellent safety profile and effectiveness of vaccines (done by multiple groups, agencies, regulatory bodies and research institutions worldwide) – are you saying they are all in on it?



  19. September 13, 2013 at 12:55 pm

    Ms. Hart, you have not provided the relative costs of testing children with a blood test versus providing them a second MMR test. You seem to want to be a bit and free and easy with Australia’s NHS’s funds. Perhaps you should actually be campaigning their new government to change the vaccine schedule to substitute blood draws. Not us.

    We are in the USA and the second MMR vaccine is given after age four years. It is actually quite sadistic to make all four year old children get a blood draw (it is rather traumatic).

    Also, “Chris” is my real name and not pseudonym. I also have the same avatar almost everywhere I post. I do not see how that is relevant to you providing the costs to your proposal.


  20. September 13, 2013 at 1:41 pm

    @Elizabeth – yes “millions” of doses of the MMR have been given, now being given as the MMRV as well….and the safety profile is excellent, with very few serious reactions.

    So, unless you can prove otherwise, changing the current process is unnecessary.


  21. September 16, 2013 at 1:00 am

    ‘Lawrence’ re your comment “if the research has shown that the overall effectiveness of a vaccine goes up when given in multiple doses – making it less likely that the immunity will wane with age and more effective during time when the disease would be most dangerous for the child, then why wouldn’t it be recommended?”

    Do you have a reference for your statement in relation to the live MMR vaccine?

    Please note it is inappropriate to talk in general terms about vaccines as these are all individual products. I am discussing the ‘live’ MMR vaccine and most children are likely to seroconvert and be immune after the first effective shot. Once the child is immune after vaccination with an effective ‘live’ MMR vaccine, no further revaccination (or titre testing) is likely to be beneficial for that child.


  22. September 16, 2013 at 1:04 am

    ‘Lawrence’ re your reference to “the excellent safety profile and effectiveness of vaccines…”. The Cochrane Collaboration’s systematic review of MMR vaccination notes that: “The design and reporting of safety outcomes in MMR vaccine studies, both pre- and post-marketing, are largely inadequate.” http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004407.pub3/abstract


  23. September 16, 2013 at 1:11 am

    Ms. Hart, have you discussed your plan to pull blood from all eighteen month old children in Australia, testing it for measles titers with the new government in Canberra? Surely, you have written some letters. Do make sure you have those cost estimates, because politicians are always keen on not spending taxpayer funded NHS money.

    Do you have the Australia Vaccination Network working with you to change the laws pertaining to your country’s public health policy towards measles? It seems that they have recently been the center of a couple of laws there, so they are effective in some ways.


  24. September 16, 2013 at 1:13 am

    Further to my previous comment which included reference to live MMR vaccine effectiveness, it should be noted that, in regards to effectiveness, there does appear to be a question mark over the mumps component of the Merck MMR II vaccine: http://www.merck.com/product/usa/pi_circulars/m/mmr_ii/mmr_ii_pi.pdf

    Refer to this report from the Courthouse News Service: “Class Says Merck Lied About Mumps Vaccine”, 27 June 2012: http://www.courthousenews.com/2012/06/27/47851.htm

    Civil Action No. 10-4374 (CDJ) against Merck makes some startling allegations in this regard: http://www.courthousenews.com/2012/06/27/MerckUnsealed.pdf

    This is an intriguing story which I haven’t as yet had time to pursue. If anybody posting here has any relevant information on the current status of this case I’d be very interested to hear it.


  25. September 16, 2013 at 1:27 am

    Don’t change the subject. Especially when the effectiveness of mumps components are very well known in the real medical literature:
    J Infect. 2005 Nov;51(4):294-8. Epub 2004 Nov 5.
    Comparative efficacy of Rubini, Jeryl-Lynn and Urabe mumps vaccine in an Asian population.

    Clin Infect Dis. 2008 Dec 1;47(11):1458-67. doi: 10.1086/591196.
    Mumps outbreaks in vaccinated populations: are available mumps vaccines effective enough to prevent outbreaks?

    Now have you done the relative costs of doing blood titers to MMR boosters yet? Have you contacted your legislators in Canberra? Or even your state’s public health department with your grand plan?


  26. September 16, 2013 at 1:42 am

    ‘Chris’, yes, I have forwarded letters on this subject to the (then) Australian Federal Health Minister Tanya Plibersek, and also to Professor Terry Nolan, Chair of the Australian Technical Advisory Group on Immunisation (ATAGI). You can read the summary on the MMR ‘booster’ page on my website: http://over-vaccination.net/questionable-vaccines/mmr-jab/

    Both parties have failed to respond to my enquiries, an example of the appalling lack of accountability on this matter. Recently there has been a change of government in Australia, so I will be pursuing this matter with the new Federal Health Minister, and others, in due course.

    Re your reference to the ‘NHS’. The National Health Service (NHS) is the health service of the UK. In Australia our health service is called Medicare.

    Yes, it would be very interesting to have some objective costing of titre testing after vaccination. In fact this could open a very large can of worms about verifying immunisation after vaccination generally.

    In the meantime, parents of small children, and others who may be pressured to be revaccinated with a second dose of live MMR vaccine, should be advised of the option of antibody titre testing to verify a response to vaccination with the initial dose, even if they choose to pay for this themselves…

    Re the Australian Vaccination Network (AVN). Yes, I have forwarded my letter to Health Minister Tanya Plibersek to Meryl Dorey of the AVN. I am unaware of the AVN taking any action in this regard.


  27. September 16, 2013 at 2:00 am

    Good, don’t bother us until you get an answer from them.


  28. September 16, 2013 at 2:05 am

    Ms. Hart:

    Yes, it would be very interesting to have some objective costing of titre testing after vaccination. In fact this could open a very large can of worms about verifying immunisation after vaccination generally.

    Just a wee bit of advice. You would be able to get a more positive response if you actually did the that costing yourself. Make sure you get good documentation for your accounting. I am quite surprised that you had not already investigated the costs.

    Sorry about no getting the nomenclature correct. It is your country, not ours. But still, if you want to change any policies you should have had that cost data already at hand. You have much work to do, and this American blog is no place to change Australian policy.


  29. September 16, 2013 at 2:06 am

    ‘Chris’ re your comment: “It is actually quite sadistic to make all four year old children get a blood draw (it is rather traumatic)”.

    I’m not actually arguing “to make all four year old children get a blood draw”. I’m arguing that parents of small children, and others who may be pressured to have an abitrary second live MMR vaccination, should be informed of the option to have an antibody titre test, even if they choose to pay for this themselves.

    You suggest that a blood test is ‘rather traumatic’? Children aren’t known to light up at the prospect of a vaccine needle either… Let the parents decide in the best interests of their own child.

    Paul Offit has also acknowledged the option of an antibody titre test after MMR vaccination: http://www.babycenter.com/404_does-my-child-still-need-a-booster-shot-if-a-blood-test-show_1463679.bc


  30. September 16, 2013 at 2:13 am

    ‘Chris’, again, re your comment: “It is actually quite sadistic to make all four year old children get a blood draw (it is rather traumatic)”.

    According to the Information Sheet for Merck’s M-M-R II (Measles, Mumps, and Rubella Virus Vaccine Live) “clinical studies of 284 triple seronegative children, 11 months to 7 years of age, demonstrated that M-M-R II is highly immunogenic and generally well tolerated. In these studies, a single injection of the vaccine induced measles hemagglutination-inhibition (HI) antibodies in 95%, mumps neutralizing antibodies in 96%, and rubella HI antibodies in 99% of susceptible persons. However, a small percentage (1-5%) of vaccinees may fail to seroconvert after the primary dose”: http://www.merck.com/product/usa/pi_circulars/m/mmr_ii/mmr_ii_pi.pdf

    How do you think these responses were ascertained?


  31. September 16, 2013 at 2:34 am

    “I’m arguing that parents of small children, and others who may be pressured to have an abitrary second live MMR vaccination, should be informed of the option to have an antibody titre test, even if they choose to pay for this themselves.”

    Then you can pay to publicize that, but not on blogs like this. Get flyers printed and posted at baby stories in your city. Make sure you have all your ducks in a row… like the medical literature and all of the costs tabulated.

    And that should include all of the risks. Blood draws are not risk free, nor are they always !00% accurate.


  32. September 16, 2013 at 2:38 am

    Oh, you said: “Paul Offit has also acknowledged the option of an antibody titre test after MMR vaccination”…

    He says: “But the test is expensive (more than $100), and experts contend there’s no downside to a second shot.”

    You are going to have to tell us with real evidence why spending that much cash to have a kid stuck with a really big needle is so much better than just getting another MMR vaccine.


  33. September 16, 2013 at 2:40 am

    ‘Chris’, the cost of antibody titre testing is incidental to my argument. As I have now said repeatedly, parents of small children, or others who are pressured to have an arbitrary second dose of live MMR vaccine, could choose to pay for the test themselves. Do you understand? They could choose to pay for the test themselves… They have to be informed it exists first, and it would appear in most instances they are not being informed. Do you understand? They’re not being informed that vaccination ‘best practice’ for dogs is actually more advanced than for children… Who knew?!

    (Of course most pet owners don’t know about vaccination ‘best practice’ either, as most vets prefer to revaccinate with ‘live’ vaccines every year or every three years. It’s more lucrative for them. Which raises the topic of professional responsibility and ethics…)

    As far as costings for mass antibody titre testing are concerned, who knows it could turn out to be cheaper. Or random population surveys could be undertaken. There may be all sorts of angles to consider on this form of progressive evidence-based medicine… In the meantime, people need to be given the opportunity to provide ‘informed consent’ before the medical intervention of arbitrary revaccination with a second dose of live MMR vaccine.


  34. September 16, 2013 at 2:47 am

    “‘Chris’, the cost of antibody titre testing is incidental to my argument.”

    You are awfully cavalier with other people’s money.

    “As far as costings for mass antibody titre testing are concerned, who knows it could turn out to be cheaper.”

    Prove it. Do not make pronouncements on public health policy without having actual data. If you are going to play the role of the Public Health Policy Officer for All of Australia, and the Rest of the World, make sure you have All of the Data.

    You cannot even answer simple questions on the cost, safety and necessity. Why should we care about your opinions? Prove to us your plan is better with real safety and cost data. Don’t go saying “it should be done” just because you say so.


  35. September 16, 2013 at 2:57 am

    Ms. Hart:


    Do you have something against my given name? It is actually quite a common name, and comes with lots of variations. Would you prefer that I address you as ‘Liz” or just ‘Beth’? Which I will as long as you put scare quotes around my name.


  36. dingo199
    September 16, 2013 at 4:16 am

    “Elizabeth”, you seem to be arguing at cross purposes with yourself.

    In your crusade to get kids titre tested so they don’t need a second MMR booster shot, you seem to acknowledge that MMR is highly effective. I am glad you think so. Many antivaccine propagandists say vaccination doesn’t work; I am glad you are not one of those.

    However, you now seem to be hedging your bets, and saying that MMR vaccine is not all that effective (eg quoting lower rates of mumps efficacy). I am sure you understand that arguing from this standpoint merely reinforces how important it is for kids to get their MMR boosters, don’t you?

    When you do your “costing” exercise for your new vaccination strategy, I hope you factor in the fact that testing all kids after one shot (at $100 a pop) in order to identify the 40% who need a booster vaccine is likely to be hugely uneconomic, considering how cheap MMR vaccine is, and how safe the booster shots are.

    Will you provide parents with information sheets that tells them that nearly 50% of the kids having your expensive titre tests will still need to go on and have the booster shots regardless, and their kids need yet more jabs?


  37. September 16, 2013 at 5:24 am

    @elizabeth – as to the lack of safety information about the MMR, I would point you to this series of studies:



  38. Chris
    September 16, 2013 at 8:32 am

    Also, dingo199, Ms. Hart needs to include testing for mumps and rubella in her cost analysis.


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