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Daily Dose

Another Reason Why It's Important to Vaccinate Your Child

I was in the office yesterday on a busy pre-holiday Monday. I went into an examining room late in the afternoon to see a two-year-old who looked “pretty sick”. I was in the office yesterday on a busy pre-holiday Monday. I went into an examining room late in the afternoon to see a two-year-old who looked “pretty sick”. 

Her mother told me that her daughter had developed a fever and a swollen eye over the last 8 hours and that “she had never seen her this sick.” She thought that her daughter had had a mosquito bite the week before and that maybe that was why her eyelid and the area beneath her eye was swollen and red. But the bite had gone away days ago, and now she had a fever. I glanced at her chart and had one of those “ah-ha” moments when I realized that the little girl had never been immunized. Not one vaccine, never!! This made me put on my thinking cap from days gone by. It used to be a fairly common occurrence to see a child in the one- to three-year-old age range in the office with a swollen eyelid and area around the eye, who also had a fever and looked ill. The infection is called peri-orbital cellulitis (an infection of the soft tissue surrounding the eye), and is typically caused by a bacteria named Haemophilus Influenza (H. Flu). This bacteria was renowned for causing meningitis, epiglottitis, periorbital cellulitis and blood infections. A vaccine was developed in the late 80’s (our office participated in the clinical trials) and since that time when children began routinely receiving HIB vaccine it had become quite uncommon to see infections due to this bacteria. But today, I was reminded of the risk of developing diseases that could be prevented with vaccines. The mother was very concerned and kept asking me how her daughter might have “gotten sick with this bacteria?” Just because there is an immunization, does not mean that the bacteria is no longer lurking in our nasal passages, on surfaces and all sorts of places. We often forget that kids may still get sick with these illnesses that we “had forgotten” about. I had to return to my first days of practice to remember that I wanted to get a blood culture on her to make sure that the bacteria had not invaded her blood stream, and to watch her in the office as we got her fever down and looked at her lab results. I was trying to decide if she needed to be admitted or could be treated as an outpatient. Thankfully, after lowering her temperature and getting back her lab work, she looked a little better. She was treated with an injection (ouch) of a broad-spectrum antibiotic and will be seen again in the morning to make sure her eye has improved and that she is also feeling better. In the meantime the reality of vaccine preventable diseases is still on my mind. Why would a parent not want to prevent any illness in their child that they possibly could? The reality that these infections may still occur became too close today. I think these parents may be re-thinking vaccines. If they are not, I am thankful that the frequency of these infections is rare, as the majority of my patients are immunized and will continue to be!! We have not eradicated these diseases; they have just been prevented by immunizations. That’s your daily dose, we’ll chat again tomorrow.

Daily Dose

Dispelling The Vaccine and Autism Myth

Dr. Sue discusses the link between vaccines and autism.After interviewing Alison Singer, co-founder of The Autism Science Foundation on the radio show this weekend, I thought it was imperative to re-iterate that The Lancet, a well respected British medical journal (somewhat like our JAMA), retracted the study done in 1998 by Dr. Andrew Wakefield that first suggested a link between the MMR vaccine and autism.

It is extremely rare for a journal to retract an article, which means that the study will no longer be considered an official part of scientific literature. This is just another step towards dispelling the decade long myth that linked the MMR vaccine to the development of autism. If you do recall, Dr. Wakefield’s study was even sited by “noted vaccine expert” Jenny McCarthy when she too took it upon herself to personally link her son’s autism to his vaccines. Hopefully, she has read the latest retraction by The Lancet as it seems that Dr. Wakefield falsified data that was used in his study. Dr. Wakefield and two of his colleagues have also been found by the General Medical Council of the U.K. to have “acted dishonestly and irresponsibly” in conducting their research. It was the longest trial in history for the GMC to conduct and Dr. Wakefield was found to have more than 30 charges against him. Unfortunately, Dr. Wakefield continues to “practice” in an autism clinic outside of Austin, Texas.  How he can legally do that that really escapes me! Why is the medical board in the United States allowing that? This story has been developing since 2004 when 10 of the 13 co-authors of Dr. Wakefield’s paper disavowed the study after a journalist reported that Dr. Wakefield had several conflict of interests as well as had used unethical methods in obtaining data, both of which made the study invalid. Despite that, parental fears as well as sensationalized media reports (back to Jenny McCarthy), caused enough public hysteria to cause parents to “opt out” of the MMR vaccine. Due to decreased immunization rates in UK and other European countries, measles cases have risen to record numbers and there has even been a death in an unvaccinated child secondary to a measles infection. In the first 6 months of 2008, measles cases were reported in the U.S. having been “imported” by un-immunized children who unknowingly acquired measles while vacationing in Europe, and subsequently infected other un-immunized children.  Fortunately, that “mini-epidemic” did not continue to spread as had been feared, but never the less there were over 130 cases of measles in the U.S. that year, higher than reported for decades. Measles outbreaks continue to be problematic in other countries as well, and should be on the radar screen for anyone who is traveling outside of the United States. The scientific evidence dispelling the link between vaccines and autism is compelling. The scientific community has never been able to replicate Dr. Wakefield’s results (now known to be falsified) and millions of research dollars have been spent to “undo” the damage and anti-vaccine sentiment which started with the Wakefield article. We now need to re-focus the research dollars on finding the causes of autism. Scientists have made recent breakthroughs on the genetic link to autism and will continue to try to understand how genes may be involved in development of autism. These are vital areas for funding research, rather than continued pre-occupation by some to discredit the science behind life saving vaccines. Bottom line, get your child vaccinated, read good science and pray that more vaccines are developed to prevent disease. It is a matter of life and death. That's your daily dose. We'll chat again tomorrow! The Autism Science Foundation

Your Child

Back-To-School Immunizations


Is your child up-to-date on his or her immunizations for the new school year?

Each state has its own set of immunization requirements, but there are a few that are found in nearly all states. Make sure you know which are required for your child’s school.

The typical list includes:

DTaP (Diphtheria, Tetanus, Pertussis)

·      Most children have five dosages by the time they start school, including one after their fourth birthday

·      Remember that children also need a tetanus booster when they are around 11 to 12 years old

·      The Tdap vaccine (Boostrix or Adacel) is recommended for teens and adults to protect them from pertussis in 2006 and replaces the previous Td vaccine that only worked against tetanus and diphtheria

MMR (Measles, Mumps, Rubella)

·      Two doses of MMR are usually required by school entry. In the past, the second dose was given when a child was either 4 to 6 years old or 12 years old. Now, it is usually given earlier, but some older children may not have gotten two doses yet.

·      Having two doses of MMR is important in this age of measles outbreaks.

IVP (Polio)

·      Most children have four or five dosages by the time they start school, including one after their fourth birthday.

Varivax (Varicella, or the Chickenpox vaccine)

·      Your older child will need the chickenpox shot if he has not already had chickenpox in the past. Most toddlers young receive it when they are 12 to 18 months old. Although younger children used to be given just one dose, it is now required that kids get a chickenpox booster shot when they are 4 to 6 years old. Older kids should get their booster at their next well child visit or as soon as they can so that they don't get chickenpox.

Hepatitis B

·      A series of three shots that is now started in infancy. Older children are usually caught up by 12 years of age if they haven't received this vaccine yet.

Hepatitis A

·      A set of two shots for children over 12 months years of age. All infants and toddlers are now getting this shot as a part of the routine childhood immunization schedule, but there is currently no plan for routine catch-up immunization of all unimmunized 2- to 18-year-old children, unless they live in a high-risk area with an existing hepatitis A immunization program or if the kids are themselves high risk. Kids are high risk for example, if they travel to developing countries, abuse drugs, have clotting-factor disorders, or chronic liver disease, etc.

·      Hepatitis A vaccine is required to attend preschool in many parts of the United States.


·      While required for school entry, children do not usually receive this shot after they are five years of age, so children who have missed this shot don't usually need to get caught up before school starts if they are older than 5 years old.


·      A vaccine that can help to prevent infections by the pneumococcal bacteria, which is a common cause of blood infections, meningitis and ear infections in children.

·      Prevnar is typically given between the ages of two months and five years, and isn't approved for older kids, so your older child wouldn't need this shot if he didn't get it when he was younger. It is often required to attend preschool though.

·      A newer version of Prevnar, which can provide coverage against 13 strains of the pneumococcal bacteria, is approved and replaces the older version (Prevnar 7) in 2010, which means that many older children in preschool may need another dose of Prevnar 13, even if they finished the Prevnar 7 series.

·      Another version of this vaccine is available for certain older high-risk children though, including kids with immune system problems, although that wouldn't be required for school.

Meningococcal vaccine

·      Menactra and Menveo, the newest versions of the meningococcal vaccine, is now recommended for children who are 11 to 12 years old, with a booster dose when they are 15 to 18 years old.

The American Academy of Pediatrics (AAP) recommends that all school age children stay up-to-date on all their immunizations.

As well as the vaccines recommended above, AAP includes a few others in its 2016 list. They include:


·      Administer influenza vaccine annually to all children beginning at age 6 months. For most healthy, non-pregnant persons aged 2 through 49 years, either LAIV or IIV may be used. However, LAIV should NOT be administered to some persons, including 1) persons who have experienced severe allergic reactions to LAIV, any of its components, or to a previous dose of any other influenza vaccine; 2) children 2 through 17 years receiving aspirin or aspirin-containing products; 3) persons who are allergic to eggs; 4) pregnant women; 5) immunosuppressed persons; 6) children 2 through 4 years of age with asthma or who had wheezing in the past 12 months; or 7) persons who have taken influenza antiviral medications in the previous 48 hours.

Human papillomavirus (HPV)

·      Administer a 3-dose series of HPV vaccine on a schedule of 0, 1-2, and 6 months to all adolescents aged 11 through 12 years. 9vHPV, 4vHPV or 2vHPV may be used for females, and only 9vHPV or 4vHPV may be used for males.

·      The vaccine series may be started at age 9 years,

·      Administer the second dose 1 to 2 months after the first dose (minimum interval of 4 weeks), administer the third dose 16 weeks after the second dose (minimum interval of 12 weeks) and 24 weeks after the first dose.

·      Administer HPV vaccine beginning at age 9 years to children and youth with any history of sexual abuse or assault who have not initiated or completed the 3-dose series.

Many states have added an “opt out” choice for parents on some vaccines but not all. For the health and safety of all children, the AAP recommends that parents follow each state’s immunizations requirements and not opt out unless there is a medical necessity.

Story sources: Vincent Iannelli, MD,



Your Child

HPV Vaccine: More Effective Than Thought


A study out of New Mexico finds that the vaccine against human papillomavirus (HPV) infection, which doctors believe causes most cases of cervical cancer, could be much more effective than previously thought.

"After eight years of vaccination, the reduction in the incidence of cervical neoplasia [abnormal growth of cells], including pre-cancers, have been reduced approximately 50 percent. This is greater than what was expected -- that's pretty exciting," said lead researcher Cosette Wheeler. She is a professor of pathology and obstetrics and gynecology at the University of New Mexico, in Albuquerque.

Researchers also found that one or two doses of the vaccine may provide as much protection as the recommended three.

"Right now, the recommendation is three doses for girls and boys before the 13th birthday, so that you are protected before you become exposed," Wheeler explained.

"People thought that three doses of vaccine were necessary, but there's a lot of people who are getting one and two doses, and people are getting protection from one or two doses," she said.

Another benefit is that the vaccines protect against more types of HPV than they were designed to do, noted Wheeler.

Other studies have pointed to the effectiveness of the vaccine, but this is the first study to show declines in precancerous lesions across a large population.

This study even took into account changes in Pap test screening over the last 10 years.

In 2009, the American College of Obstetrics and Gynecology said most women under 21 do not need Pap test screening and recommended longer times between screening. In 2012, the U.S. Preventive Services Task Force said women, regardless of age, do not need to get screened more than every three years, Wheeler said.

If these changes were not taken into account, the effect of the vaccine would appear even greater than it already is, because it would assume that more women were being screened than actually were, she said.

"Parents and doctors should pay attention. These vaccines are highly efficacious," Wheeler said.

Cervical cancer can take decades to develop so it’s important to protect children before they become sexually active.

The Centers for Disease Control and Prevention (CDC) recommends that the HPV vaccine be given to vaccine is preteen boys and girls at age 11 or 12 so they are protected before ever being exposed to the virus. The HPV vaccine also produces a more robust immune response during the preteen years. Finally, older teens are less likely to get heath check-ups than preteens. If your teen hasn't gotten the vaccine yet, talk to their doctor or nurse about getting it for them as soon as possible.

For the study, Wheeler and colleagues collected data on young women tested for cervical cancer with Pap tests from 2007 to 2014, who were part of the New Mexico HPV Pap Registry. New Mexico should be considered representative of the whole country, Wheeler said.

One expert said the findings make the case for HPV vaccination even stronger.

"These data highlight and provide even more evidence as to the efficacy of the vaccine in preventing HPV infections and related diseases," said Fred Wyand, a spokesman for the American Sexual Health Association/National Cervical Cancer Coalition.

Wyand suggests that one way to increase HPV vaccination rates is for health providers to stress the importance of the vaccine to parents.

Another way is to “normalize” the vaccine.

"Rather than treat it as something exotic, it should just be offered as part of the routine adolescent vaccine program," Wyand said.

The report was published online Sept. 29 in the journal JAMA Oncology.

Story sources: Steven Reinberg,


Daily Dose

Exercise Patience During Swine Flu Season

I imagine that you may be getting tired of reading my blogs on swine flu, and I can assure you, we are all (pediatricians that is) tired of talking about it too. But, from the phone calls that our office is being inundated with, there are still more questions and concerns about the H1N1 (swine) flu.

Fortunately, in our part of the country it seems that we have started to see fewer “flu-like” illnesses and the waiting rooms at our office are not quite as crowded. That may not be the same in other areas of the country as now 46 states report widespread flu activity. Even though we seem to be seeing fewer cases of presumed H1N1 flu in our area, we do not know, and no one knows, if this virus is going to quietly fade away, or if we will see a second wave of H1N1 later this year and into 2010.  Unless you can truly predict the future, we will all just have to wait and see. With that being said, the H1N1 vaccine is becoming more widely available and there are prioritized groups that should begin getting vaccinated. There are two types of H1N1 vaccine, just like the seasonal flu vaccine. There is an injectable “killed” vaccine and there is a live-attenuated nasal vaccine (similar to seasonal Flu-mist nasal spray). Children between six months and two years of age should receive the injectable flu vaccine. This injectable vaccine should also be given to pregnant women and to children ages two to 24 years who have underlying chronic medical conditions that prevent them from taking the nasal flu mist (refer to to see the list of those conditions) for those children between the ages of two to 24 years who are otherwise healthy, the injectable or nasal H1N1 vaccine may be given (it is approved for use up to 50 years of age). The other targeted group to receive the H1N1 vaccine is parents, siblings and caregivers of infants under six months of age. Again, the majority of those may receive the nasal vaccine and injectable may be used when appropriate for older individuals. In our office the most current problem comes with trying to prioritize groups that receive the first doses of vaccine and to explain to others that they too will get the vaccine once the vaccine supply increases, as it should in the next several weeks. This is a true lesson in patience, and in taking turns, just like we teach our own children. Those with the most risk should get the first doses of vaccines. Don’t you agree? There is just not a way to vaccinate 100 million people in a day. Lastly, the Centers For Disease Control and Prevention in a news conference yesterday, reiterated that antivirals like Tamiflu, should be given to children who are at higher risk for complications. Tamiflu should not be given “routinely” to those patients who are above the age of two years, and who do not to appear to be extremely ill. It does not need to be given to all household contacts. For most, the illness is self-limited and may be treated with rest, fever control, hydration and TLC (tender loving care, for the younger set that looks at me like, “what does that mean?”). In all cases your doctor needs to see any child who seems to be having respiratory distress, is not taking fluids, or seems to be getting worse rather than better after several days. So, continue to wash your hands, cover your mouths and get your vaccines, as they are available. We have a long way to go this flu season and besides coughing into your elbow. I hope PATIENCE may be the other lesson everyone learns during the fall and winter this year. That’s your daily dose, we’ll chat again soon.

Daily Dose

Pertussis Cases Continue to Rise

Pertussis cases on the rise around the country with 10 deaths in California.I have been reading a lot about the pertussis outbreak that has been hitting California, where there are now over 8,000 cases of pertussis, and 10 infants who have died from whooping cough.  But pertussis is not only affecting those in California, the number of pertussis cases are on the rise across the country.

The CDC reported that there were over 17,000 pertussis cases in 2009, and when the 2010 numbers are tallied the number will most likely be higher. Pertussis is also probably under-reported so there are quite likely many more cases than the numbers show, and many cases of pertussis that may be missed as a diagnosis. With that being said it is important to re-iterate the need for both infants, children, adolescents and adults to get their pertussis immunizations. Whooping cough is an infectious disease and the best way to prevent disease is by vaccinating.  What we all forget is that infants are not immunized until 6 – 8 weeks of age, and that one immunization against pertussis does not provide immunity. The reason that the DTaP vaccine is given at 2, 4 and 6 months of age is to confer adequate immunity after 3 doses, and that immune response is boosted again between 15- 18 months of age. As young parents have their new baby immunized, they sometimes feel that their child is “protected” immediately, and that is not really the case.  It takes several doses of vaccine to confer adequate antibody and while a baby is building their own antibody the best way to protect them is by immunizing the older population. This is called passive immunity, which protects a newborn infant by preventing disease in those people who are around the new baby. Whether that is a grandparent, aunt, uncle, nephew, niece, or any of the numerous family members and friends that welcome a newborn, the pertussis (whooping cough vaccine) that is given to the general population protects the newborn baby. The Tdap vaccine that is recommended for use in individuals from the age of 10–64 is the vaccine that is now in the news. So many adults “forget” that immunizations do not stop after you leave the pediatrician’s office.  Adults continue to need vaccines to protect themselves from diseases, including whooping cough. It is amazing that many of my own friends cannot “remember” the last time they  had a shot, which likely means that they have not received the newer Tdap, which protects you from tetanus, diphtheria and pertussis. Doctors need to spread the word that adults also need immunizations, because that terrible persistent cough that you thought might never go away, could indeed, unknowingly be a case of pertussis, which might infect a newborn infant. Just today the Advisory Committee on Immunization Practice (ACIP) recommended that the Tdap vaccine be given to even older individuals, who may come into contact with newborn infants. That means that seniors who are 65 or older are also encouraged to get vaccinated with a newer Tdap if they will be in close contact with infants under the age of 1 year. While the country is seeing outbreaks we must become aggressive in keeping the pediatric population up to date on their vaccines, but in this case the vector may be the grandparent who long ago lost their immunity to whooping cough. I can’t think of a better baby gift, so go get your Tdap and protect that precious newborn. P.S.  A flu shot is important too, so get a “twofer” now. That’s your daily dose for today.  We’ll chat again tomorrow. Send your question or comment to Dr. Sue!

Daily Dose

Why Vaccinate Your Child?

1:15 to read

Getting your child immunized against mumps, measles and rubella (MMR) may provide even more protection than previously thought. An interesting article was just published in the journal Science pointing out yet another reason to get your children vaccinated.  

While measles is still uncommon in the United States (but there have been over 170 cases this year), there are over 140,000 deaths around the world every year due to this disease. Studies have shown that once you have the measles you are more susceptible to other infections for up to 2 years.  But, in countries where most measles cases occur the researchers found that the children who had received the measles vaccine had a reduced death rate for up to 5 years, which suggests that the vaccine somehow provides protection against other illnesses.

A medical student at Emory University (bet he is going to be a great doctor) working with others from around the world found that the measles virus might cause “immunological amnesia”. It seems that the measles virus kills a large number of memory cells, which are white cells that prevent subsequent infections by the same disease. After the measles the body’s immune system somehow “forgets” to remember diseases  it has already beaten, which would then put you at increased risk of being susceptible to diseases you shouldn’t be vulnerable to.

While more research is necessary this secondary protection may be yet another reason to get vaccinated!! Good science continues to show us the value of vaccines....this study was funded in part by the Melinda and Bill Gates foundation which is doing incredible work around the world on vaccines and eradicating vaccine preventable diseases.  For this I am a grateful doctor.

Daily Dose

Politics & Vaccines

1:30 to read

As we head into another election cycle, I bet many of you watched the recent GOP debates (23.1 million viewers).  I too was watching and listening, but I must say my ears perked up when I heard several of the candidates discuss the issue of childhood vaccines.  Suddenly I was hearing politicians or political “wanna bees” discussing whether or not children should receive vaccines?  I held my breath as I heard several of the candidates, some of whom are even physicians who presumably understand science, discuss vaccine safety, alternative vaccine schedules and the relationship of vaccines to autism.

I truly was aghast to hear Donald Trump discuss his anecdote of a child who purportedly had their vaccines and suddenly “became autistic” (which is a diagnosis made over time). Then there was Dr. Ben Carson, a pediatric neurosurgeon who stated  “we are probably giving way too many vaccines in too short a period of time”.  Had he forgotten children with meningitis?  As I sat in front of the TV and groaned I heard Dr. Rand Paul add, “vaccines are one of the greatest medical discoveries of all time, but even if science doesn’t doesn’t say bunching them up is a problem, you ought to be able to spread vaccines out a little bit”. Has he done a study to show that alternative schedules work?

Many of their statements were based on “faulty logic”, and had “no scientific basis” and some were entirely anecdotal. Numerous studies from around the world have proven that there is no link between vaccines and autism. Vaccines have only gotten safer and are essential for public health.  Stick to the facts…were the fact checkers watching?  Where was the rebuttal?

As a pediatrician who discusses vaccines with patients on a daily basis I must say I was horrified by these statements.  If politicians want to weigh in on childhood vaccines then it is incumbent upon them to be “briefed” and up to speed about the science behind the childhood vaccine schedule and vaccine safety.   While they are learning about foreign policy, economic decision making and the recent issues surrounding global immigration ( all of which seem to be more of a political policy issue than childhood vaccines) maybe they need a crash course in public health.  Misinformation about vaccines from those who have a national television audience is unacceptable. Having a child “go un-immunized”  due to statements that were made during  the GOP debate, has the potential to harm many children. Just look at the recent measles outbreak….these are serious issues. 

The president of the AAP quickly released a statement endorsing the childhood vaccination schedule, the importance of vaccines and vaccine safety. Many pediatricians as well as other physicians have also re-iterated the importance of vaccines being given according to the vaccine schedule. As Dr. Remley stated, “what is best for children is to be fully immunized”. plain and simple. I am hopeful that the 23 million debate watchers heard her message.

Daily Dose

Why Doctors Fire Patients

1.30 to read

There was an article in the WSJ entitled “more doctors dismissing patients who refuse vaccines for their children”.  It was interesting to me as I too now only accept new patients who are going to vaccinate their children. This was not an easy decision on my part, and prior to the decision I had several families who refused vaccines completely, and another group that followed “an alternative” vaccine schedule. Even so, I was never comfortable with their decision and it always gave me pause and sleepless nights when their children would get sick. 

During the height of the debate over vaccine safety and the possible link to autism it seemed like much of my day was spent “debunking” vaccine myths. I spent a great deal of time discussing the reasons behind the AAP/ACIP (American Academy of Pediatrics and the Advisory Committee on Immunization Practices) recommended vaccine schedule and also explaining how vaccinations had saved lives, actually millions of lives. 

As more and more data was gathered, and the Wakefield papers were discredited, it became apparent that there was not a link between vaccines and autism. The arguments about thimerasol in vaccines were also moot as thimerasol is no longer the preservative used in vaccines (except for flu vaccine). With all of this being said I decided to take a stand and vaccinate all of my new patients, according to AAP guidelines. 

I discuss this decision with families even before their child is born. I tell them that it is important to pick a pediatrician that shares their beliefs as the  doctor patient relationship is a long one in pediatrics. (hopefully cradle to college)  It is analogous to dating; why would you pick a date on a match site if you held opposite beliefs to begin with?  

The same goes with picking a pediatrician, you need to start off the relationship on common ground. Even if there may be some other disagreements on subjects down the road, I think you need to begin the relationship holding similar beliefs. 

I have practiced long enough that I remember doing spinal taps in my office and treating children with meningitis or bacterial sepsis. There were long nights spent in the ICU with families and unfortunately a few patients died, while other survived but are deaf or have other residual effects from their disease.  It was devastating to me and I can’t even imagine for those families. I also bet that those families would have given anything to have a meningitis vaccine or a chickenpox vaccine for their now deceased children. 

I understand that every parent has to make their own decision for their children. At the same time I believe that it is also “my practice” and I get to choose how I practice pediatrics. With that being said, my parents choose to vaccinate their children and we happily start off the parenting/doctoring partnership together.  I also sleep better at night not worrying that their child will contract a vaccine preventable disease. 

That’s your daily dose for today.  We’ll chat again tomorrow.


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