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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

Measles Outbreak

1:30 to read

Entering Disneyland where the sign reads, “The Happiest Place on Earth”, it does not also say, “Beware of Infectious Diseases!”.  But, if you think about it...what better place to contract any infectious disease than Disneyland where many of the visitors are under the age of 12 years....and I know from my own experiences as a parent taking children to Disney...even if not feeling well nothing stops a child at Disney. That means not even a fever.  (Other parents have reported the same thing to me when they went;  fever/tylenol and then off to theme park). 

So, now reports of at least 70 cases (and counting) of measles which children have contracted while visiting Disneyland in December. Not all of the confirmed cases have even been in California with cases are now in Utah, Washington, Colorado and Mexico.  With continued new cases, and our mobile population, unintentional exposures will occur, so unfortunately there are expected to be more cases.

Measles is a VACCINE PREVENTABLE DISEASE!!!  I repeat, you can prevent measles but that means your child needs to receive an MMR at 1 year and again between 4-5 years of age.  About 3/4 of the current new measles cases were unvaccinated, by choice.  Several of the children were too young to receive the vaccine and so they were unprotected for that reason.  Orange County (home of Disneyland) has one of the highest rates of vaccine refusers, and Dr. Bob Sears practices there as well where he admits that “many/most” of his patients refuse some vaccines.  In my humble opinion he has had a big impact with families who are making vaccine choices. Dr. Sears' books are “wishy washy” on this subject and he has proposed an “alternative vaccine schedule” which has not been scientifically proven to work. Dr. Paul Offit a pre-eminent scientist, doctor and vaccine proponent has some good articles discussing his feelings about alternative vaccine schedules. Feel free to check them out. 

Enough of the soap box...but this should be yet another wake up call that many of the diseases younger parents think are “not around” are indeed showing a resurgence.  Measles cases are the highest they have been for over 20 years in the U.S. Pertussis (whooping cough) rates are still on the rise here as well.  Polio continues to be a problem in other parts of the world despite huge efforts in vaccinating and trying to eradicate this disease.

Fortunately, there have been no deaths in the latest measles outbreak but there have been hospitalizations.  Only hoping people go get their children vaccinated as there is no other way to stop this.  It makes so much sense and seems simple. There are so many places to get a vaccine!! 

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!

Your Child

Getting Ready for a New School Year!


As summer break begins to wind down, preparations for a new school year are gearing up.  Whether it’s the first day of school for your little one or your teen’s first year of college, making the transition from vacation to a daily schedule requires some pre-planning.

Typically, the most difficult changeover for everyone is getting used to a regulated bedtime routine. Getting enough sleep will help family members handle the switch better. I know that’s much easier said than done, but it's worth the effort. Now is a good time to start preparing for a new school year schedule.

As pediatrician, Dr. Sue Hubbard, has said previously in her Daily Dose article, a couple of weeks before the start of a new school year is when families should start getting used to a new schedule.

“In order to try and minimize grouchy and tired children (and parents too) during those first days of school, going to bed on time will be a necessity. Working on re-adjusting betimes now will also make the transition from summer schedule to school schedule a little easier. If your children have been staying up later than usual, try pushing the bedtime back by 15 minutes each night and gradually shifting the bedtime to the “normal” hour. At the same time, especially for older children, you will need to awaken them a little earlier each day to re-set their clocks for early morning awakening,” Hubbard noted.

Another important detail to take care of before school begins is making sure your child is current on all immunizations. Each state has its own requirements and exemptions. In Texas for instance:

K-12 grades are required to have - the Tetanus/ Diphtheria/ Pertussis (Tdap) vaccine, Measles, Mumps and Rubella (MMR) vaccine, the Polio vaccine, Hepatitis B vaccine, and the varicella vaccine. K through 6th grade are also required to get the Hepatitis A vaccine and 7th through 12 grades, a meningococcal vaccine.

Also highly recommended, but not a state law requirement, is the Human Papillomavirus Vaccination (HPV) for boys and girls.

You can find out exactly what your state’s school immunization program is by logging onto and clicking on your state.

And lets not forget our college bound students! Universities have their own policies, but these vaccines and booster shots are highly recommended by physicians and most universities: Meningococcal conjugate vaccine (MenACWY), Tdap, HPV vaccine and the seasonal flu vaccine. Be sure to check with your child’s school to see what specific vaccines are required or suggested.

The first day of school for kindergarteners and / or first-graders can be unsettling for kids and parents. Here are a few ways you can help your child face the uncertainty:

·      Remind your child that there are probably a lot of students who are uneasy about the first day of school. This may be at any age. Teachers know that students are nervous and will make an extra effort to make sure everyone feels as comfortable as possible.

·      Point out the positive aspects of starting school.  She'll see old friends and meet new ones. Refresh her positive memories about previous years, when she may have returned home after the first day with high spirits because she had a good time.

·      Find another child in the neighborhood with whom your student can walk to school or ride on the bus.

·      If it is a new school for your child, attend any available orientations and take an opportunity to tour the school with your child before the first day.

·      If you feel it is needed, drive your child (or walk with him or her) to school and pick them up on the first day.

Nutrition is an important factor in children doing well in school. During the summer break kids often get off schedule with their eating habits. Start the early morning routine at least a week before school actually starts so that everyone has a chance to get used to having and preparing breakfast early.

Studies have shown that children who eat healthy, balanced breakfasts and lunches are more alert throughout the school day and earn higher grades than those who have an unhealthy diet. 

Back-to-school- shopping, new schedule arrangements, homework time and space, immunizations, after-school sports and activities – they’re all part of a new school year.

One way to help keep everybody on track is with a calendar that is placed where everyone can see it and update it.

Here’s to a new school year that is full of learning, exciting experiences and good grades!



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.

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,



Daily Dose

Thimerosal In Flu Vaccines

Confusion about thimerosal in flu vaccinesI received an email from a reader who “had a problem with my statement about vaccines being thimerosal free”.  Since 2001 all vaccines given to children under the age of 6 are thimerosal free, with the exception of the influenza vaccine.

She is correct in pointing out that influenza vaccines may contain a minimal amount of thimerosal (a mercury based preservative), but influenza vaccines are also available thimerasol free.  The LAIV (live nasal vaccine/flumist), is also thimerasol free and is available for use in children 2 and older.

Although injectable influenza vaccines may contain a minimal amount of thimerosal, the amount is negligible and is deemed safe by both the FDA and the CDC. Infants are not receiving a series of vaccines containing thimerasol, and at most would receive 2 influenza vaccines after they are 6 months of age during the first season that they are vaccinated, and subsequently would receive one dose per year thereafter.  There are also thimerasol free influenza vaccines available (this year both seasonal and “swine flu” vaccines) for use. By the time a child is 2 years of age, they would at most have received 3 doses of an influenza vaccine that had  0.01% thimerasol or less which would be between <1 mcg – 25 mcg/0.5ml vaccine dose. (Do you know how much mercury is in the fish you eat or other products you consume daily?)  After the age of 2 parents may choose to have their child immunized for influenza with the LAIV nasal vaccine that is also thimerasol free. As with many things in life one must weigh the risk benefit ratio, in this case of giving a vaccine that contains minimal thimerasol. In my opinion the science has quite eloquently proven that there is not a link between the preservative thimerasol and autism. With that being said,  I also believe that the risk of an infant developing flu and having complications from their infection, far outweighs any hypothetical or anecdotal concern about thimerasol. As I have said before, we know what does not cause autism and it was not thimerasol in vaccines. In fact the rate of diagnosis of autism has gone up, rather than down, since thimerasol was removed from vaccines. We need to continue to devote research dollars to finding the cause of autism. In the meantime, I stand corrected and wanted to give all of you more detailed information about thimerasol and influenza vaccines. That's your daily dose.  We'll chat again tomorrow! Send your question to Dr. Sue! (click here)

Daily Dose

Acetaminophen & Vaccines

1:30 to read

A recent article in Lancet was quite thought provoking as it studied the common practice of giving infants a dose of acetaminophen (Tylenol) with their routine immunizations.

Many parents and some pediatricians routinely dose their infants with acetaminophen prior to receiving their vaccines at two, four and six months of age. In the study of 459 infants from 10 different centers in the Czech Republic, patients were randomized to either receive three doses of acetaminophen every six to eight hours at the time of vaccination or no acetaminophen. The researchers then looked at both the reduction of febrile reactions post vaccination and at antibody titers among the two groups. Interestingly, there were both some expected and some not so expected results. Not surprisingly, the group that received acetaminophen had a lower incidence of fever post immunization. Of those that received acetaminophen 94 out of 226 (42 percent) developed a fever, compared to 154 out of 233 (66 percent) in the non-treated group after their primary immunization series. After booster vaccination 64 out of 178 (36 percent) in the treated group and 100 out of 172 (58 percent) developed fever. So the widespread perception by both many parents and doctors that routine acetaminophen use with vaccination does reduce the incidence of fever was supported.

The most interesting result of this study was the vaccine antibody response in the acetaminophen treated group. Surprisingly, antibody responses to several of the routinely administered vaccines (including tetanus, diphtheria, h. flu, and pneumococcal serotypes) were lower in the group who received routine acetaminophen. This was also seen after booster doses of the same vaccines between 15 to 18 months of age. The hypothesis is that acetaminophen may reduce the inflammatory response and that this may also induce less of an immune response. So, it would seem prudent to no longer encourage routine use of acetaminophen with vaccines unless a baby develops significant fever, or is at risk for fever and febrile seizures. As a parent you are always trying to “protect” you child, and this would include any pain or fever that might develop with vaccination. Now we have science to show how this may actually provide less protection, against disease. Thought provoking!

That’s your daily dose, we’ll chat again tomorrow.


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Keeping it fun for kids with food allergies during Halloween.

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