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News Reports for February 9, 2010

by: NewsDiary

Fri Feb 05, 2010 at 23:02:42 PM EST


Reminder: Please do not post whole articles, just snippets and links. Thanks!!

Azerbaijan
•  Soldier dies of acute inflammation accompanied by hemorrhage (Link)

Cambodia
•  Cambodia culls bird flu-affected ducks (Link)

Indonesia
•  Health Ministry Remains Diligent (Link)

Israel
•  Gov't moves to stop delivery of more swine flu vaccines (Link)

Nepal
•  Bird sacrifice banned at Manakamana, Kalika temples (Link)

Senegal
•  Senegal confirms H1N1 outbreak (Link) Map link (Link)

Singapore
•  Tourist arrivals down 4.3% (Link)

Tasmania
•  Two new swine flu cases spark warnings in Tasmania (Link)

Ukraine
•  387 cases of A/H1N1 flu confirmed in Kyiv, including 54 deaths (Link)

United States
•  OH: Cavialiers' fan health awareness- Precaution or Ploy? (Link)
•  OR: Camas H1N1 Patient Emerges From Coma (Link)

Vietnam
•  Bird flu is spreading rapidly in many provinces (Link)

General
•  CIDRAP: WHO decision on flu vaccine strains expected next week (Link)
•  New outbreaks of bird flu (H5N1) in Asia (Link)
•  Protective immunity against influenza (Link)
•  Update 1-Roche licenses new flu-fighting technology (Link)
•  Millions of H1N1 Doses Will Expire on Feb. 15 (Link)

Commentary
•  Recombinomics: More Severe H1N1 Increases In Mississippi (Link)


•  H (Link)

NewsDiary :: News Reports for February 9, 2010

News for February 8, 2010 is here.


US Influenza-Like Illness Reports
Week ending Jan. 30, 2010

Influenza-Like Illness Reports for England & Wales
Week ending Dec 20, 2009


Thanks to all of the newshounds!
Special thanks to the newshound volunteers who translate international stories - thanks for keeping us all informed!

Other useful links:
CDC A(H1N1) Site
WHO A(H1N1) Site
WHO H5N1 human case totals, last updated February 8, 2010
Charts and Graphs on H5N1 from WHO
Google Flu Trends (U.S.)
CDC Weekly Influenza Summary
Map of seasonal influenza in the U.S.
CIDPC (Canada) Weekly FluWatch
European CDC Influenza News
UK RCGP Weekly Data on Communicable and Respiratory Diseases
Flu Wiki Main Page

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Vietnam: Bird flu is spreading rapidly in many provinces
Bird flu is now spreading rapidly in many provinces after a long period of containment, (Snip) The provinces of Ca Mau, Ha Tinh, Dien Bien, Soc Trang, Kon Tum and Quang Tri have all reported cases of bird flu infection in the last 21 days. Quang Tri is the latest province to confirm a bird flu outbreak in Trieu Phong district. It has culled 400 birds in a farm and is carrying out measures to prevent any further spread of the disease.

The DAH asked these provinces to step up their preventive measures and vaccination campaigns, during the Tet holiday when demand for poultry products increasing. The Minister of Agriculture and Rural Development, Cao Duc Phat, has urged provinces and cities to oversee the slaughtering of cattle and poultry in certain places and ban the sales of cattle and poultry products of unknown origins. (Snip) http://english.vovnews.vn/Home...

Life is not measured by the number of breaths we take, but by the moments that take our breath away. --Unknown

     


Why cattle?
Can cows get bird flu? Just curious...  

Keep the information coming!

[ Parent ]
To prevent/control outbreaks of Foot & Mouth Disease
Foot-and-Mouth Disease is a severe, highly communicable disease of cattle, pigs, sheep, goats and deer.  It is caused by one of the smallest disease producing viruses known. There are several different strains of the virus that cause the disease. (Snip) Humans do not catch the virus.  The disease is characterized by blister-like lesions on the tongue, nose and lips, in the mouth, on the teats and between the toes which then burst, leaving painful ulcers. The blisters cause a heavy flow of sticky, foamy saliva that hangs from the mouth.  Infected animals sway from one foot to the other due to the tenderness of the feet. Although older cattle usually do not die from the infection, they suffer a severe illness which leaves them in a weakened state. They have high fevers, stop eating, give less milk and become lame.

The virus is extremely contagious and spreads rapidly unless it is contained. This usually requires quarantining infected farms, followed by slaughtering and burning all susceptible animals. Anyone having contact with animals in infected countries should not go near susceptible animals for at least five days.  Because the virus is spread so easily, countries with the disease are banned from exporting animals and their products, creating further economic hardship. (Snip) http://cattletoday.info/foot_m...

Life is not measured by the number of breaths we take, but by the moments that take our breath away. --Unknown

     


[ Parent ]
WHO decision on flu vaccine strains expected next week
CIDRAP: Influenza experts will meet from Feb 14 to 19 at the World Health Organization (WHO) headquarters in Geneva to decide which flu strains to recommend for use in vaccines for the Northern Hemisphere's 2010-11 flu season, (Snip) the CDC said the vaccine, as in past years, is likely to be trivalent (covering three strains), "although committee members may consider other options." In line with a WHO recommendation made last September, the seasonal vaccine that Australia will use for its upcoming winter flu season includes the pandemic H1N1 virus along with an H3N2 strain and an influenza B strain. The US Food and Drug Adminstration's vaccine advisory committee will meet Feb 22 to consider the WHO's vaccine recommendation, (Snip) The panel normally follows the WHO's lead.
CDC statement on vaccine strain selection. http://www.cidrap.umn.edu/cidr...  

Life is not measured by the number of breaths we take, but by the moments that take our breath away. --Unknown

     


Cambodia culls bird flu-affected ducks
Cambodian authorities have begun a mass killing of ducks after confirming a fresh outbreak of the deadly bird flu virus.

The cull comes after more than 15,000 ducks died last week in the southern province of Takeo and samples tested positive on Tuesday for the H1N1 avian influenza virus, (Snip) the sale of duck meat and its transport from the affected villages would be banned, reports state. http://www.vetsweb.com/news/ca...  

Life is not measured by the number of breaths we take, but by the moments that take our breath away. --Unknown

     


Nepal: Bird sacrifice banned at Manakamana, Kalika temples
GORKHA, Feb. 9: The District Livestock Service Office, Gorkha has prohibited sacrificing pigeons, roosters, ducks and other birds at the Manakamana Temple at Manakamana VDC and at the Kalika Temple in Gorkha Municipality in the district. A meeting of chiefs of different offices based in the Gorkha district took this decision as a measure of high alertness to prevent the spread of bird flu after cases of this disease were found in Pokhara recently.

(Snip) the devotees will not be allowed to offer poultry sacrifice at the temples until further notice. (Snip)  the sacrifice of he-goats has not been banned at these shrines. http://www.myrepublica.com/por...

Life is not measured by the number of breaths we take, but by the moments that take our breath away. --Unknown

     


Senegal confirms H1N1 outbreak
Africa - The Senegalese Minister of Health and Preventive Medicine, Modou Diagne Fada, confirmed that the country had been hit by the epidemic AH1N1 influenza. According to earlier reports, the first cases were detected in the religious city of Touba and nearby Diourbel (located in the central part of the country). These places where the scene of religious festivities, as hundreds of thousands of followers of the Mouride Muslim Brotherhood, last week gathered to celebrate the 115th edition of "Grand Magal" of Touba, (Snip)

Health Minister Diagne Monday convened a press briefing not only to confirm the outbreak of the disease, but also to allay fears, saying that the country was equipped enough to contain the situation. According to the Health Minister, 14 cases of influenza A H1N1 were recorded between the three districts of Dagana, Diourbel and Touba.
(Snip)
According to health experts, Senegal does not yet have a preventive vaccine. But the Senegalese Health Minister is already calling for patients suspected of infection to be isolated until examination confirms their cases. ''We have enough resources to deal with influenza AH1N1,'' (Snip) ''We will deal with all cases and we have the means.'' The minister noted that among those infected none had died, and that all had in fact ''been taken care of, treated and returned home.'' http://www.africanews.com/site...  
Map Link: http://maps.google.com/maps?hl...

Life is not measured by the number of breaths we take, but by the moments that take our breath away. --Unknown

     


More Severe H1N1 Increases In Mississippi
Recombinomics Commentary

All their temperatures were in the 103-104 F degree range and they exhibited the classic picture of "aching-all-over-like-I've-been-run-over-by-a-semi" with uncontrollable dry cough and extremely depressed energy levels. These folks were dramatically sicker than anyone I saw with H1N1 which I described in an earlier column as "Flu Lite." The typical case of swine flu I treated in the office struck me as being about a third as debilitating as seasonal flu.

I treated these recent patients with Tamiflu and they all got better but it took longer than in previous years. I have always told flu victims in the past that, once they started on Tamiflu, they would feel better within 24 hours. Most would tell me they felt brand new the next day. This year that advice didn't work. Most of these unfortunates were in bed for three or four days and didn't feel a bit better until the third day.

The above comments of a General Practitioner in Mississippi raise concerns that the increasing severity in recent flu patients in Region 4 is widespread.  Although this practitioner thinks his patients have seasonal flu, there have been no significant influenza A seasonal flu reports in MS or elsewhere in the US this season.  Seasonal H1N1 has not been reported in 7 weeks, (Snip)

Earlier reports described more severe cases in Memphis, TN as well as UNC University Hospital in Chapel Hill, NC.  (Snip) the per cent positive rate for swine H1N1 has increased to 25% for NC and 13% for Region 4 in the latest update.  Region 4 also reported the first upward swings in swine H1N1 in the fall,
(Snip)
Although widespread disinformation campaigns have been discounting the current pandemic, these anecdotal reports suggest H1N1 cases are increasing and more severe.  Anecdotal reports also indicate school absenteeism is on the rise, but swine flu symptoms are being reported as bronchitis, allergies, stomachs flu, or seasonal flu, as happened during the swine flu outbreak in the fall. Details on rising school absenteeism, which appears to be approaching 10% in some schools districts in the south, as well as sequence data from the more severe cases, would be useful. http://www.recombinomics.com/N...

Life is not measured by the number of breaths we take, but by the moments that take our breath away. --Unknown

     


Azerbaijan: Soldier dies of acute inflammation accompanied by hemorrhage
2/9/2010 - An Azerbaijani Interior Troops soldier died from a disease December 25. Based on a preliminary medical report, Azerbaijani soldier (Snip) died of acute inflammation accompanied by hemorrhage, (Snip) The source refuted the information about that the soldier died because of the vaccine against swine flu. http://hisz.rsoe.hu/alertmap/w...

Life is not measured by the number of breaths we take, but by the moments that take our breath away. --Unknown

     


Two new swine flu cases spark warnings in Tasmania
There have been two new cases of swine flu in Tasmania as authorities prepare to vaccinate 350,000 people before a predicted second wave of the virus hits. Primary school-aged siblings from the south of the state were infected with the H1N1 virus by a relative visiting from the UK last month.

(Snip) the outbreak has not spread but the Deputy Director of Public Health Chrissie Pickin says it is a warning for parents to vaccinate their children. "Children are really the super spreaders of this disease, not necessarily the ones who get it most severely, but perhaps the ones who can pass it on to others who are more vulnerable," she said. Dr Pickin says vaccinating children will reduce the severity of a second wave.
(Snip)
The Health Service is offering free vaccines at festivals and pharmacies around the state. http://au.news.yahoo.com/a/-/a...

Life is not measured by the number of breaths we take, but by the moments that take our breath away. --Unknown

     


Ukraine: 387 cases of A/H1N1 flu confirmed in Kyiv, including 54 deaths
http://www.kyivpost.com/news/c...

[note: this is from Feb 2nd, but I didn't see it posted]

A total of 387 cases of infection by A/H1N1 swine flu have been confirmed in Kyiv, leading to 54 deaths since Nov. 2, 2009 through Jan. 31, 2010, the press service of Kyiv State Administration reported on Monday, with reference to First Deputy Head of Kyiv City State Administration Irena Kylchytska.

At the same time, a decline in the infection rate for influenza and acute respiratory diseases has been seen in Kyiv since Dec. 28, 2009.

According to official data, the infection rate for flu and acute respiratory diseases declined during the first three weeks of this year, to a level lower than the epidemic threshold. However, on January 25-31 this year a slight rise in the infection rate was observed (of 5%) linked to the end of the school holidays and pupils' return to schools. A total of 20,860 people fell ill with flu and acute respiratory diseases during this period, which was 1.5 times lower than the epidemic threshold.  

Keep the information coming!


New outbreaks of bird flu (H5N1) in Asia
In three Asian countries, the high pathogenic bird flu virus H5N1 broke out, according to OIE reports.
In the South of Burma, the disease has been detected on a poultry farm with 2,500 animals. (Snip)

In Nepal, the virus has been found on a poultry farm with 235 birds. In Cambodia, the virus has been found on a farm with 31,000 birds. http://www.vetsweb.com/news/ne...

(Note: Outbreaks are also occurring in Vietnam, Indonesia, India, Bangladesh and probably other countries too. Of course China has no bird flu, never has had any and will not have any in the future!!)

Life is not measured by the number of breaths we take, but by the moments that take our breath away. --Unknown

     


Health Ministry Remains Diligent
February 9, 2010, http://www.thejakartapost.com/...
Jakarta:  The Health Ministry has continued monitoring any possible outbreaks of the H5N1 (avian flu) and H1N1 (previously known as swine flu) viruses, despite the limited number of infections reported among humans.

"We're still monitoring existing [flu transmission] cases. We received a few reports in January," deputy health minister Tjandra Yoga Aditama told Antara on Tuesday.

The ministry recorded 20 bird flu cases in the period between Jan. 1 and Jan. 28, 2009, 19 of which were fatal..  In the June-September period last year, Indonesia recorded H1N1 virus outbreaks resulting in 1,097 people being infected nationwide, 10 of them died.  

"I am opposed to any form of tyranny over the mind of man."  Thomas Jefferson


Singapore: Tourist arrivals down 4.3%
THE number of visitors to Singapore fell by 4.3 per cent last year to 9.7 million, driving the revenue from the sector down 19 per cent to S$12.4 billion, the Singapore Tourism Board (STB) said on Tuesday.

The number was still slightly higher than the STB's target of 9 to 9.5 million visitors, which, analysts said, was conservative.

The tourism industry fell short of 700,000 tourists in 2008 - the first time it missed its targets since annual goals were set in 2003.

But the outlook is brightening. Tourist arrivals in December reached 971,000 - the highest monthly level ever recorded. This added to the turnaround in the last quarter of the year, said STB chief Aw Kah Peng on Tuesday.

'It is a significant drop. But if you think about how airfares and, particularly accommodation, have fallen, those categories would have contributed to more than a 20 per cent drop,' she said, citing the global recession and H1N1 flu pandemic as the main culprits. 'Therefore, immediately it has a drag on total toruism receipts. So in that sense, we are not particularly surprised that our receipts have come down.'
http://www.straitstimes.com/Br...


OH: Cavialiers' fan health awareness- Precaution or Ploy?
The outbreak of the H1N1 virus has caused the Cleveland Cavaliers to take proactive measures.  Aside from placing multiple hand sanitizer stations in each bathroom, the team has decided to remove all public water fountains from Quicken Loans Arena to avoid possible spread of any virus.  In return, the arena offers free nine-ounce cups of water that are located at each concession stand.

And while this is considered to be cutting-edge by the team, some patrons feel that the team is simply using this as a measure to increase concession sales.

The Akron Beacon Journal's Marla Ridnour touched on this decision, giving both sides of the story.
Perhaps the Cavs are being trendsetters and other professional venues will follow their lead. Perhaps the H1N1 hysteria that made hand sanitizers a must-have item in many women's purses was just the beginning of increased awareness on personal health issues.

But in the same...

Standing in line for the complimentary cup subjects fans to the temptations of hot dogs, pizza, popcorn and nachos while they wait. How many have the willpower to take that free water and head back to his or her seat otherwise empty-handed?
snip>
Corporations across America have weened away from using the public style of water fountains.  However, most - in turn - provide water coolers or even bottled water for employee use.  The Cavaliers appear to be attempting this feat, but through individually pre-poured cups.  The basis behind this decision can be debated, but as the Cavaliers had a scare of H1N1 earlier this season, it is not a reach to assume that this decision is entirely made with the welfare of the fan in mind.
http://www.waitingfornextyear....

Comment: Remeber when cigarettes were like a buck, and you got a pack of matches with them. Try asking for a pack of matches at a gas station...
...Oh Sorry, we have lighters.
I believe they might be reinstalling the fountains.


OR: Camas H1N1 Patient Emerges From Coma
PORTLAND, Ore. -- A Camas man who has been battling the H1N1 flu virus for weeks is showing signs of improvement, his wife said Monday.

Tom Trautman was hospitalized before Christmas and placed in a medically induced coma. He is still in intensive care at Legacy Emanuel Hospital in north Portland but is awake and eating solid food.

His wife of 23 years, Becky Trautman, said Tom began to feel sick in November. He contracted pneumonia and then H1N1.

She said her husband has a long recovery ahead of him.

"He needs to learn how to eat, to sleep, to walk, things like that. He can't walk right now because he's so weak and it's been a long time," she said.
http://www.kptv.com/news/22504...


Indonesia: Health ministry remains diligent of possible flu outbreaks
The Health Ministry has continued monitoring any possible outbreaks of the H5N1 (avian flu) and H1N1 (previously known as swine flu) viruses, despite the limited number of infections reported among humans.

"We're still monitoring existing [flu transmission] cases. We received a few reports in January," deputy health minister Tjandra Yoga Aditama told Antara on Tuesday.

The ministry recorded 20 bird flu cases in the period between Jan. 1 and Jan. 28, 2009, 19 of which were fatal..  

http://www.thejakartapost.com/...


Canada: Avian flu contained to one B.C. farm: CFIA
OTTAWA -- Officials testing flocks of turkeys within a three-kilometre radius of an Abbotsford, B.C., turkey farm found contaminated with avian influenza this week say there is no evidence that the virus has spread.

The Canadian Food Inspection Agency says all commercial flocks of turkeys at 23 neighbouring farms in the Vancouver suburb have tested negative for the H5 strain of avian flu.

Testing and monitoring of the farms will continue for a 21-day period.

The nearby farms remain under quarantine, the agency said.

Earlier this week, approximately 60,000 birds on the infected farm were killed with carbon dioxide gas. Cleanup crews have begun composting the carcasses at the two barns to ensure the virus is rendered inactive.

After seven to 10 days, remains will then be removed from the barn to complete the composting process.

In 2004, 17 million chickens were culled in B.C.'s Fraser Valley, the largest cull in Canadian history. No humans were injured or died as a result from this outbreak.

http://www.vancouversun.com/en...


This is recycled news
from January 2009.  See summary here.

(www.vancouversun.com is not a very reliable news source because they don't date their articles.)


[ Parent ]
Thought that sounded familiar. Thanx, Aloha! n/t


[ Parent ]
Jennifer Aniston 'helping Mexico' with birthday holiday
Jennifer Aniston chose to celebrate her 41st birthday in Mexico to help boost the country's tourism industry.

The former "Friends" actress jetted off to the sun-soaked resort of Los Cabos last week with pals Courteney Cox, Sheryl Crow and rumored love interest Gerard Butler for a week of fun leading up to her birthday on Wednesday.

And Aniston has revealed she chose the destination to help encourage others to return to Mexico for holidays following the recent swine flu outbreak, which crippled the country last year.

She tells Access Hollywood she arranged the trip after a male friend suggested it to her: "He said to me, 'You come to Mexico all the time and Mexico is really hurting right now because of the swine flu and the drug trafficking and all of this sort of stuff but it's not all of Mexico.' These people survive on us coming down and spending money and coming here to these beautiful places. It sort of made sense to sort of say 'Hey, let's help out Mexico.' Let's shout out to these kids in Tijuana at El Faro. That's sort of our birthday celebration this year."
http://blog.seattlepi.com/peop...


Israel: Gov't moves to stop delivery of more swine flu vaccines
There are currently 4.6 m. doses in the country as only 700,000 have been used.
Due to the very low demand for H1N1 flu vaccine - less than a tenth of the population has gone for the 7.3 million doses ordered - the Health Ministry has asked that the last two million of them not be shipped to Israel.

The company will give the ministry credit for these vaccines, the ministry said on Tuesday.
http://www.jpost.com/Headlines...


Ethiopia: Protective immunity against influenza
Influenza epidemics are the cause of three to five million cases of severe illness every year and approximately 250,000 to 500,000 of these cases are fatal. Epidemics occur during autumn and winter in regions with a temperate climate, while in some tropical countries influenza viruses circulate throughout the year with one or two peaks during the rainy seasons. Mainly the young, elderly and subjects with chronical medical conditions are at risk for developing severe disease after seasonal influenza virus infection. Therefore, the World Health Organization (WHO) recommends annual vaccination of these subjects, which is an effective measure to protect them against influenza and its complications.

The genome of influenza viruses consists of eight gene segments of negative sense RNA and since these viruses lack proofreading activity during their replication, they can accumulate mutations under selective pressure. This way, influenza viruses can escape from recognition by virus-neutralizing antibodies that are induced by previous infections or vaccinations. Indeed, the highest degree of variations is observed in the antigenic sites of the hemagglutinin against which virus neutralizing antibodies are directed. As a result of this antigenic variation, the influenza vaccine that contains components of three currently circulating influenza viruses (A/H1N1, A/H3N2 and B viruses) has to be updated almost every year to match the circulating strains. Since the selection of the vaccine strains and vaccine production has to be carried out before the start of the influenza season, there is some uncertainty in this prediction and mismatches do occur occasionally. In addition to the small gradual antigenic changes of currently circulating influenza virus strains (antigenic drift), occasionally new influenza viruses of novel subtypes are introduced into the human population. The subtypes of these viruses are defined by the envelope glycoproteins of these viruses, the hemagglutinin (HA) and the neuraminidase (NA). Wild aquatic birds are the natural reservoir of all subtypes of influenza from which there is spillover to other (domestic) birds and mammalian species, like pigs, horses and men.

Because antibodies against these viruses are virtually absent in the human population, these viruses may cause pandemic outbreaks of influenza affecting a substantial proportion of the human population. In the last century, three pandemics occurred, which were caused by influenza A viruses of the H1N1, H2N2 and H3N2 subtypes. Recently, influenza A viruses of swine origin have caused the first pandemic of the 21st century. These new pandemic viruses are the result of the exchange of gene segments originating from human, classical swine and avian-like influenza viruses and have emerged and spread worldwide within a few months. As of 30 December 2009 at least 12220 people have been killed due to infection with the influenza A/H1N1(2009) virus. Since not all fatal cases are reported, the real number of fatal cases is most likely much higher.

The current pandemic caused by the new influenza A(H1N1) virus and the current pandemic threat caused by the highly pathogenic avian influenza A viruses of the H5N1 subtype have renewed the interest in the development of vaccines that can induce broad protective immunity.
http://www.ethiopianreview.com...

Targets for the Induction of Protective Immunity Against Influenza A Viruses
http://www.mdpi.com/1999-4915/...


Ethiopia may be a misnomer. The paper is from the Netherlands. n/t


[ Parent ]
Tech: UPDATE 1-Roche licenses new flu-fighting technology
WASHINGTON, Feb 8 (Reuters) - Roche AG's (ROG.VX) Genentech unit has licensed an experimental new technology that uses antibodies to fight influenza, including H1N1 swine flu, Harvard's Dana Farber Cancer Institute said on Monday.

Dana-Farber said it and the Sanford-Burnham Medical Research Institute had signed a license agreement with Genentech, giving the company exclusive rights to manufacture, develop and market human monoclonal antibodies to treat and protect against group 1 influenza viruses.

Dr. Wayne Marasco at Dana-Farber, Robert Liddington at Sanford-Burnham and Ruben Donis of the the Centers for Disease Control and Prevention discovered the antibody technology and reported on it a year ago this month.

The antibodies -- immune system proteins that attach to invaders such as viruses -- can be used as direct treatment for flu. They also might be used to protect front-line workers and others at high risk during pandemics.

In studies, the antibodies -- generated from the blood of 57 volunteers -- neutralized a wide range of influenza viruses.

Influenza viruses cloak themselves in lollipop-shaped proteins called hemagglutinin and neuraminidase, which mutate regularly and give influenza A strains the "H" and "N" designations in their names.

http://www.reuters.com/article...


Millions of H1N1 Doses Will Expire on Feb. 15
All lots of monovalent 2009 H1N1 influenza vaccine in pre-filled syringes manufactured by Sanofi Pasteur-and not included in two earlier recalls-have a shorter expiration period than indicated on the label, according to a new health alert from the Centers for Disease Control and Prevention (CDC).

To ensure that the vaccine meets potency standards, the vaccine-which had previous expiration dates ranging from March 2011 to June 2011-should be used by Feb. 15, the manufacturer said. These lots were shipped between November 2009 and January 2010.[snip]

http://www.healthleadersmedia....

"The truth does not change according to our ability to stomach it."  Flannery O'Connor


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