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Chickenpox (Varicella)
Vaccine
Chickenpox vaccine is a routine immunization for all
children in the USA. All children should receive one
dose of chickenpox vaccine between 12 and 18 months
of age, or at any age after that, if they have never
had chickenpox. Adults and adolescents 13 years of age
or older should receive 2 doses of the vaccine, 4-8
weeks apart. Chickenpox vaccine should not be given
during pregnancy, and female patients should not become
pregnant for at least 1 month after immunization.
Chickenpox is a viral infection that is highly contagious
and usually quite mild, but it can be serious, especially
in young infants and adults. Any person who has ever
had chickenpox in the past has lifelong immunity and
does not need this vaccine. Once otherwise healthy people
contact chickenpox, the disease rarely ever occurs a
second time. Before the availability of the vaccine
in 1995, approximately 10,000 persons with chickenpox
required hospitalization every year in the USA; close
to 100 deaths from chickenpox occurred annually.
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Cholera Vaccine
Cholera vaccine (injectable) has been available for
nearly a century, but Wyeth-Ayerst Laboratories stopped
manufacturing it in the summer of 2000. Many countries,
including Canada, license an oral cholera vaccine, although
there is no evidence that it is more effective than
the injectable formulation. The oral vaccine is not
available in the USA. Cholera vaccine is no longer listed
in a separate section in the International Certificate
of Vaccination and is not officially required for
entry into any country. The vaccine is a 2-dose series
separated by 1-4 weeks. Booster doses for travelers
at high-risk are recommended every 6 months. It is not
recommended for children younger than 6 months of age.
Cholera is a potentially life-threatening, tropical
disease that causes severe and profuse diarrhea. Because
it is an extremely rare disease in international travelers
from the USA, and the vaccine may have significant side
effects and is probably not more than 50% effective,
it is not recommended by the World Health Organization.
The Centers for Disease Control (CDC) recommends it
only for travelers at high risk who work and live in
highly endemic areas under less than adequate sanitary
conditions.
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Diphtheria-Tetanus-acellular
Pertussis (DTaP); Diphtheria-Tetanus-Pertussis (DTP);
Diphtheria-Tetanus (DT) Vaccines
DTaP vaccine is a routine childhood immunization in
the USA. This is a 5-dose series starting at 2 months
of age and finishing at 4-6 years of age. It is frequently
given in combination with Haemophilus influenzae
(Hib) vaccine. It is never administered after the
7th birthday. Following completion of the DTaP, DTP,
or DT series (by the 7th birthday), Td
vaccine is given at 11-12 years of age if at least
5 years have elapsed since the last dose of DTaP, DTP
or DT.
Diphtheria is a serious disease characterized by a
very sore throat, difficulty breathing, paralysis, and
heart failure. It is very rare in the USA because of
the high immunization rates in children and young adults.
Pertussis, or whooping cough, may be a serious disease,
especially in infants. It is characterized by choking
and coughing - often prolonged. It is highly contagious.
Tetanus, or lockjaw, is a very serious disease that
may follow a cut, burn, or wound. It causes serious
muscle spasms and frequently ends in death. In the USA
it is a very rare disease because almost all children
and young adults have received the vaccine.
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Haemophilus
influenzae type b (Hib) Vaccine
Hib vaccine is a routine childhood immunization in the
USA. This is a 4-dose series (it may be a 3-dose series
depending on the brand of Hib vaccine used) starting
at 2 months of age and finishing at 12-15 months of
age. Many health care providers give this vaccine in
combination with DTaP vaccine. It is not generally recommended
for children after the 5th birthday.
Haemophilus influenzae type b disease is a serious,
contagious bacterial infection. Before the availability
of the Hib vaccine in 1987, Haemophilus influenzae
was the leading cause of bacterial meningitis among
children under 5 years of age in the USA. Haemophilus
influenzae infection may also cause pneumonia, ear
infections, sinus infections, and other severe infections.
Because infection with Hib is rare after 5 years of
age, older children and adults do not routinely need
this vaccine.
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Hepatitis
A Vaccine
In 2000, hepatitis A vaccine became a routine immunization
for some children in the United States who are 2-12
years of age. In 2001, the recomendation is extended
to age 2-18 years of age and to persons in certain high-risk
groups such as persons traveling to countries where
hepatitis A is moderately or highly endemic, men who
have sex with men, users of injectable and noninjectable
drugs, persons who have clotting-factor disorders, persons
working with nonhuman primates, and person with chronic
liver disease. This vaccine is recommended for
routine immunization in this age group only for selected
states (Alaska, Arizona, California, Idaho, Oklahoma,
Oregon, Nevada, New Mexico, South Dakota, Utah, and
Washington) and should be considered for routine
immunization in a few other states (Arkansas, Colorado,
Missouri, Montana, Texas, and Wyoming). Hepatitis A
vaccine is a 2-dose series with a minimum of 6 months
recommended between doses. The duration of protection
is many years and there is no specific booster recommendation
at this time. In 2005, the minimum age to receive this
vaccine was lowered to 1 year.
In May, 2001 the FDA licensed and approved a new combination
hepatitis A and hepatitis B vaccine for adults 18 years
of age and older. It is recommended for persons who
are, or will be, at risk of infection with hepatitis
A and B viruses. It is administered in 3 doses, 1 each
at 0, 1, and 6 months. At this time, the cost of the
vaccine is not covered by any medical insurance plan.
Hepatitis A is a serious, contagious viral infection
of the liver, most commonly transmitted person-to-person
between close contacts or by contaminated food and water
(such as uncooked fruits and vegetables, shellfish,
and ice). The disease is very common in developing countries
but also occurs in the USA. In the USA approximately
one-third of all cases occur in children under 15 years
of age. Children are frequently not very ill with the
disease and recover quickly, but they may spread it
to other people, especially household members and playmates.
Once a person contracts a hepatitis A infection, they
have lifelong immunity and will never need the vaccine.
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Hepatitis
B Vaccine
Hepatitis B vaccine is a routine immunization for all
children and adolescents in the USA who are 18 years
of age and younger. Hepatitis B vaccine is a 3-dose
series with 1 month recommended between dose 1 and 2,
and 5 months recommended between dose 2 and 3. The duration
of protection is many years and there is no specific
booster recommendation at this time.
In May, 2001 the FDA licensed and approved a new combination
hepatitis A and hepatitis B vaccine for adults 18 years
of age and older. It is recommended for persons who
are, or will be, at risk of infection with hepatitis
A and B viruses. It is administered in 3 doses, 1 each
at 0, 1, and 6 months. At this time, the cost of the
vaccine is not covered by any medical insurance plan
Hepatitis B is a serious viral infection of the liver
transmitted by blood, blood products, objects contaminated
with blood, and sexual contact. It can also be transferred
from mother to infant at the time of birth, but it is
not transmitted by breastfeeding. Hepatitis B infection
can cause chronic liver disease, including cancer of
the liver. When an infant contracts the disease at birth,
it will cause a chronic carrier state up to 90% of the
time and serious liver disease up to 25% of the time.
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Immune Serum Globulin
Although immune globulin is scarce in the USA,
it is currently available at the Camino Medical Group
International Travel Clinic.
Travelers seeking immediate protection against hepatitis
A and travelers too young to receive the hepatitis A
vaccine should receive a single dose of immune globulin
(also known as IG, immune serum globulin, ISG, or gamma
globulin). This gives protection for 3-5 months, depending
on the amount of IG given. IG is administered deep intramuscularly
in larger children, adolescents, and adults .
IG is not a vaccine. Although IG contains human blood
products, it has never been shown to transmit infectious
disease. It is effective for the prevention of hepatitis
A for international travelers and it is also effective
if used for the prevention of hepatitis A immediately
after a known exposure. Since the introduction of hepatitis
A vaccine (for persons over age 2) in 1995, the use
of IG has markedly decreased.
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Influenza
Vaccines
The Vaccine
There are two types of influenza vaccine:
- Injectable, inactivated (killed)
influenza vaccine, sometimes called the "flu shot"
has been used for many years, and is injected into
the shoulder.
- Live, intranasal influenza vaccine
(trade name FluMist™) is licensed for use during the
influenza season (October - March). It is sprayed
into the nostrils rather than injected into the muscle.
Both vaccines are the same formulation. Protection
develops about 2 weeks after either vaccine and may
last up to one year.
Influenza Vaccine Availability
The injectable "flu shot" will be available at
our "Flu Express" for Camino Medical Group patients
only. Contact the Camino
Medical Group for specific times and dates.
The intranasal influenza vaccine
will be available only at the Camino Medical Group Travel
Clinic at 325 North Mathilda Avenue, Sunnyvale, CA,
94085 (408 733-4380). The clinic is a walk-in clinic
with no appointment needed. The hours are 9 a.m. - 11:30
a.m. and 1:30 p.m. - 3:30 p.m. Monday through Friday.
It is not a covered service under any health care insurance
so the patient is responsible for payment.
The Disease
Influenza is a highly contagious respiratory disease.
It is caused by a virus that spreads from person-to-person.
It is a particularly serious disease in people with
chronic disease, residents of long-term care facilities,
pregnant women, and children 6 months to 18 years of
age receiving chronic aspirin therapy. Influenza causes
an average of 36,000 deaths each year in the U.S., mostly
among the elderly. Many candidates for influenza vaccine
are also candidates for pneumococcal vaccine.
Who Should Be Vaccinated?
An annual influenza vaccine is recommended for:
- People 50 years of age and older
- Healthy children 6 - 23 months of
age
- Residents of long-term care facilities
- People with long-term health problems,
such as heart disease, lung disease, asthma, kidney
disease, diabetes, anemia, etc.
- People with weakened immune systems,
such as HIV/AIDS, or patients undergoing treatment
with steroids, chemotherapy or radiotherapy
- People 6 months to 18 years of age
on long-term aspirin treatment
- Pregnant women
- Physicians, nurses, family members,
or anyone else coming in close contact with people
at risk of serious influenza.
An annual influenza vaccine is encouraged
for:
- Household
contacts and out-of-home caretakers of infants from
0 - 23 months of age
- People who provide essential community
services
- People at high risk for flu complications
who travel to the Southern hemisphere between April
and September, or who travel to the tropics or in
organized tourist groups at any time
- People living in dormitories or
under other crowded conditions, to prevent outbreaks
- Anyone else who wants to reduce
their chance of catching influenza.
Candidates for the intranasal vaccine
include:
- School-aged children 5 years or
older
- People in large families
- Adults in frequent contact with
school-aged children (including family members and
teachers)
- Adults in frequent contact with
other adults (including working adults, travelers
and college students).
The Side Effects
Although vaccines, like medications, are capable of
causing serious side effects, the risk from an influenza
(injectable or intranasal) vaccine is extremely small.
The injectable influenza vaccine may cause fever, aches,
or minor soreness, redness, or swelling at the injection
site within 1-2 days after vaccination. The intranasal
vaccine is a live vaccine and may cause, in children
5 - 17 years of age, runny nose, nasal congestion, fever,
headache, muscle aches, abdominal pain or occasional
vomiting. In adults, occasional runny nose, nasal congestion,
sore throat, headache cough, chills, or tiredness/weakness
may occur.
Further Information
Additional information about influenza and influenza
vaccination is available from the Centers for Disease
Control and Prevention (CDC), at http://www.cdc.gov/nip/flu/default.htm
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Japanese
Encephalitis Vaccine
Japanese encephalitis (JE) vaccine is a 3-dose series
administered on days 0, 7, and 30. Because of the potential
for adverse and allergic reactions, patients should
remain in areas with access to medical care for 10 days
after each injection, and the last dose should be given
a minimum of 10 days before travel.
JE is a severe inflammation of the brain transmitted
by mosquitoes. JE vaccine should be considered by people
who plan to live in areas of Asia where JE is endemic
or epidemic (the Indian subcontinent, Japan, Guam, the
former USSR, Malaysia, and the Western Pacific Islands)
and for travelers whose activities include trips into
rural, farming areas. JE is typically found seasonally
in areas where pigs are raised and where rice paddies,
marshes, and standing pools of water provide breeding
grounds for mosquitoes and feed for birds.
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Lyme Disease
Vaccine
Lyme disease vaccine is no longer available
in the USA.
Lyme disease vaccine was licensed in the USA in 1998.
It was considered for persons from 15-70 years of age
who have frequent or prolonged exposure to outdoor,
wooded areas infested with deer ticks. The highest risk
of Lyme disease occurs in just eight states: Connecticut,
Delaware, Maryland, New Jersey, New York, Pennsylvania,
Rhode Island, and Wisconsin. Lyme disease vaccine was
a 3-dose series: 1 dose initially, followed by a second
dose 1 month later, and a third dose 12 months after
the initial dose. The vaccine was considered about 75-80%
effective. It was not protective for strains of Lyme
disease found outside the USA.
Lyme disease is a disease of the skin, joints, muscles,
nerves, and heart that is transmitted by the bite of
deer ticks. Almost 25% of the cases occur in children.
The disease can be prevented with a combination of immunization,
protective clothing, insect repellents, and prompt removal
of ticks from the body. Lyme disease can be treated
with antibiotics.
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Measles-Mumps-Rubella
(MMR) Vaccines
MMR vaccine is a routine childhood immunization in the
USA. This is a 2-dose series given initially on or after
the 1st birthday and again at 4-6 years of age, but
it is acceptable to give the 2 doses any time with as
little as 1 month between them. The MMR vaccine should
not be given during pregnancy, and female patients should
not become pregnant for at least 1month after immunization.
For babies age 6-11 months traveling to countries where
measles is endemic (e.g., India), a single dose of monovalent
measles vaccine (MMR is acceptable) is recommended.
If the vaccine is given at age 6-11 months, a routine
MMR is still recommended at age 1 year or as soon after
as practical.
Measles, mumps and rubella (German measles) are highly
contagious, viral diseases that are rare in the USA
because of the high level of childhood immunization
rates. Immunization of adolescents and young adults
with a rubella-containing vaccine is especially important
in preventing congenital rubella syndrome (CRS).
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Meningococcal
Vaccine
Meningococcal vaccine should be considered for college
freshmen, particularly those that plan to live in dormitories.
Some colleges require meningococcal vaccine for entering
freshmen. All colleges should provide information about
meningococcal disease and the availability of the vaccine.
Meningococcal vaccine is a single dose injection. It
is recommended for international travelers to the "meningitis
belt" of Africa from December through June and pilgrims
returning to the Hajj or Umra in Saudi Arabia. Outbreaks
occur intermittently in India, Mongolia, Nepal, and
Pakistan. It is also indicated for people 2 years of
age or older who lack a spleen or suffer from some immune
deficiencies. A booster dose, when indicated, is recommended
2-5 years later.
Meningococcal infections, usually meningitis, are serious
bacterial infections with a 10% fatality rate. The infection
is most common in children and young adults and people
living in crowded conditions. Intimate contact and airborne
contamination from infected individuals spread the disease.
Some people are carriers of the disease but are not
sick themselves.
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Pneumococcal
Vaccines
Pneumococcal conjugate vaccine is a 4-dose series
given at 2, 4, and 6 months of age with a booster at
12-15 months of age. PCV is also recommended for children
2-5 years of age who have sickle cell disease, have
a damaged spleen or no spleen, have HIV/AIDS, have other
diseases that affect the immune system, i.e., diabetes
or cancer, or take medications that affect the immune
system, i.e., chemotherapy or steroids. PCV should be
considered for children 2-5 years of age who are 24
- 35 months of age, are of Alaska Native, American Indian
or African-American descent, or attend group child care.
It is not recommended for children after the 5th birthday.
Another pneumococcal vaccine, called pneumococcal polysaccharide
vaccine (PPV23), is a routine immunization for all adults
over age 65. It is never used in children under 2 years
of age, but it is sometimes recommended for people over
2 years of age who are at risk for pneumococcal bacterial
infections.
Pneumococcal disease may cause meningitis, pneumonia,
middle ear infections, and other serious infections.
The highest rates of these pneumococcal infections occur
in children under 2 years of age and adults over 40
years old.
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Polio
Vaccines
Oral polio vaccine (OPV) is no longer recommended
as a routine vaccine in the USA; only injectable polio
vaccine is used. OPV is no longer manufactured in the
USA. It is still widely used in the rest of the world.
Polio vaccine is a routine childhood immunization in
the USA. This is a 4-dose series starting at 2 months
of age and finishing at 4-6 years of age. To eliminate
the risk of serious side effects of the oral polio vaccine
(OPV), injectable polio vaccine (IPV) is the recommended
vaccine for all doses of the series. There is no recommendation
for routine booster immunization for children or adults
after completion of the 4-dose series.
Polio is a serious viral infection that was very common
before the introduction of polio vaccine in 1955. Since
that time, polio has essentially disappeared in the
USA. No wild (infectious) case of polio has been reported
in the USA during the last 20 years and there has not
been a case of wild polio in the entire Western Hemisphere
in almost 10 years. However, an outbreak of poliomyelitis
is occurring in the Dominican Republic and Haiti. Since
July 2000, a total of 3 laboratory-confirmed cases due
to vaccine-derived poliovirus type 1 have been identified
and an additional 16 persons with acute flaccid paralysis
are now under investigation in the Dominican Republic.
In Haiti, a single laboratory-confirmed case of paralytic
polio has been reported.
It is still expected that polio, like smallpox before,
will be eradicated worldwide within the next 5 years.
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Rabies Vaccine
Rabies vaccine is indicated for international travelers
venturing into areas of possible rabies exposure, particularly
if post-exposure treatment is not available, and for
any person exposed to the rabies virus. The primary
series of intramuscular vaccine is a total of three
injections given at 0, 7, and 21 or 28 days. A single
booster dose is recommended for persons in high-risk
categories as often as every 2 years.
Rabies is a viral infection of the central nervous
system. Dogs are the most common source of rabies, especially
in Latin America, Africa and Asia (except Taiwan, Hong
Kong, Singapore, Brunei, Maldives, and Japan). More
than 30% of rabies cases in the USA occur in returning
travelers and immigrants who received dog bites while
abroad. Almost 60% of the human cases of rabies diagnosed
in the USA have been associated with exposure to bats.
In the case of a bat bite, inhalation of aerosolized
bat secretions (e.g., spelunkers), scratch or mucous
membrane exposure, post-exposure treatment is recommended
even if evidence of exposure is not visible but there
is reasonable probability that an exposure may have
occurred. Other sources of rabies are skunks, raccoons,
foxes, jackals, groundhogs, domestic cats, mongooses
and, particularly in countries in southwestern Asia,
wolves. It is rare to find rabies in rabbits, squirrels,
gerbils, rats, mice, chipmunks, or guinea pigs.
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Smallpox Vaccine
At this time, smallpox vaccine is not available to
the general public and the Camino Medical Group does
not have the vaccine.
Click here for detailed
information on Smallpox Vaccine, including availability,
side effects and precautions.
Smallpox is a serious, highly communicable viral disease
characterized by an incubation period of approximately
7-17 days. During the next 2-4 days a combination of
fever, malaise, and body ache develops, followed by
a generalized skin eruption. All the skin lesions proceed
simultaneously through various stages of redness, blistering
(pustules), and scarring during a period of 7-10 days.
The disease has a mortality of 20-40% during epidemics,
but may be prevented by immunization. Contact, particularly
face-to-face, with an active case or contact with the
immediate surroundings, i.e., bodily fluids or contaminated
objects, of an active case transmits it from person
to person.
Smallpox vaccine was discontinued as a routine vaccine
in the USA in 1971 and the last naturally occurring
case of smallpox occurred in Somalia in 1977. In 1982,
smallpox vaccination was no longer required for international
travelers and the International Certificate of Vaccination
form no longer included a space to record smallpox vaccination.
Also, in 1982, the production of smallpox vaccine in
the USA was discontinued, but because of the current
increasing threat of the reintroduction of smallpox
from international terrorists, the vaccine is again
being produced in the USA. The United States currently
has sufficient quantities of the vaccine to vaccinate
every single person in the country in an emergency.
However, at this time, smallpox vaccine is not recommended
for the general public.
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Tetanus-Diphtheria Acellular
Pertussis (Tdap) Vaccine
Td vaccine is a routine childhood immunization in
the USA for those 7 years of age and older. Following
completion of the DTaP, DTP,
or DT series (by the 7th birthday), Tdap is given at
11-12 years of age if at least 5 years have elapsed
since the last dose of DTaP, DTP or DT. Subsequent Tdap
boosters are recommended every 10 years.
Tetanus, or lockjaw, is a very serious disease that
may follow a cut, burn or wound. It causes serious muscle
spasms and frequently ends in death. Diphtheria is a
serious disease characterized by a very sore throat,
difficulty breathing, paralysis, and heart failure.
Both diseases are very rare in the USA because of the
high immunization rates in children and young adults.
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Typhoid
Fever Vaccines
Typhoid fever vaccine has at least 4 formulations (oral
suspension, oral capsule, and 2 injectable formulations)
worldwide, but only the injectable Typhim Vi and the
oral vaccine are currently available in the USA. Typhim
Vi is a single dose vaccine used in persons 2 years
of age or older. A booster dose is recommended every
2 years. Oral typhoid vaccine is taken on alternate
days for a total of 4 capsules. It is only approved
for persons 6 years of age and older. A booster dose
is recommended every 5 years. The capsules must be refrigerated
and taken with a cool liquid approximately 1 hour before
eating.
Typhoid fever is an acute, life-threatening bacterial
disease introduced into the body from contaminated food
and water. It presents as a febrile infection of the
intestinal tract, but it is not necessarily associated
with diarrhea. It is a concern particularly in India,
Mexico, and Peru.
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Yellow
Fever Vaccine
Yellow fever vaccine is a single dose injection. Per
international regulation, a booster dose is required
every 10 years and the vaccine must be given not less
than 10 days prior to date of entry. It should not be
given to children under 9 months of age unless they
are at very high risk. The vaccine is only available
at federal centers or vaccination centers designated
by state health departments.
Yellow fever is a severe viral infection of the liver
transmitted by mosquitoes. International regulations
require proof of yellow fever vaccination for travel
to and from certain countries in South America and Africa.
Because of the international regulation of this vaccine,
all vaccinees should receive an International Certificate
of Vaccination (the small, yellow immunization book)
completed, signed, and validated with the center's stamp
where the vaccine was given. It is a good habit to carry
the International Certificate of Vaccination
with your passport at all times when traveling. In practice,
international regulations for yellow fever vaccine may
be strictly, but randomly, enforced, particularly for
persons traveling from South America or Africa to Asia.
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Vaccines
No Longer Available in the USA
Cholera Vaccine
Lyme Disease Vaccine
Plague Vaccine
Polio Vaccine, Oral (OPV)
Rabies, Intradermal Vaccine
Smallpox Vaccine
Tick-Borne Encephalitis Vaccine
Typhoid, injectable (Wyeth-Ayerst Laboratories)
Typhus Fever Vaccine
Based
on: CDC, Health Information for International Travel
2008, DHHS, Atlanta, GA, 2008; CDC, Epidemiology
and Prevention of Vaccine-Preventable Diseases,
11th Edition, DHHS, Atlanta, GA, 2008; and Dr.
Richard Thompson's book Travel
and Routine Immunizations - A Practical Guide for
the Medical Office, 2008, Shoreland, Inc.
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