women COVID vaccines

What Women Should Know about the COVID-19 Vaccines

Our concierge primary care doctors in Jupiter have been monitoring the news for the most recent updates on the coronavirus vaccines. As we’ve been finding out more, we want to share the latest news with you. Today, we discuss what women should know about the COVID-19 vaccines.

Pregnant women

Last month the Centers for Disease Control and Prevention (CDC) finally resolved the question of whether pregnant women could safely receive COVID-19 vaccines. The question arose because the initial trials for the vaccines had excluded pregnant women. As a result, different health organizations had offered conflicting guidance.

But CDC Director Rochelle Walensky said during a recent White House coronavirus briefing that vaccine-reporting systems had shown no safety concerns. This includes women in their third trimester and for their babies.

“We know that this is a deeply personal decision,” she said, “and I encourage people to talk to their doctors and their primary care providers to determine what is best for them and for their baby.”

This is welcome news for women. Many want to receive the vaccine, but have been leery of taking it for fear of harming their unborn babies.

In fact, just the opposite seems to be true, according to several recent preliminary studies. These have consistently shown women who received one of the mRNA vaccines (either Pfizer or Moderna) while pregnant appear to pass COVID-19 antibodies to their babies before birth. And at least one study has detected antibodies in the mothers’ breast milk. (Such studies have not yet been conducted on the newer Johnson & Johnson vaccine.)

The discovery of COVID-19 antibodies in pregnant women’s umbilical cord blood confirmed earlier observations. Mothers could transfer immunity to their babies by receiving the vaccine. This is good news, since babies (and young children) cannot yet be vaccinated for the coronavirus. It also protects their mothers, according to the CDC. Pregnancy is a high-risk factor for severe illness and complications from COVID-19, including preterm birth,

Mammograms and the vaccine

Getting mammograms shortly after receiving a coronavirus vaccine, however, is another story. That’s because the timing of the vaccine can affect the read of the mammogram, according to a recent report from West Palm Beach on WPTV.

Dr. Courtney Hoey, a breast radiologist at Good Samaritan Medical Center, told the station that radiologists do more than just examine the breast tissue for signs of cancer.

“We don’t just look at abnormalities within your breast tissue,” she said. “We look at things like the skin and lymph nodes in the underarm area.” Because a COVID-19 vaccine—specifically, the Moderna vaccine—can cause temporary swelling in the nodes under the arm where women receive the vaccine, this can affect the accuracy of the mammogram.

Such swelling is a good sign, she said, because it means the immune response is working. But it could necessitate a follow-up ultrasound just to be sure.

Nevertheless, she advises women not to hesitate receiving the vaccine, because that’s more important. Unless there are breast issues such as new symptoms, pain, lumps, or nipple discharge, it’s better to get the vaccine as soon as possible, she said.

If you feel you need a mammogram due to such issues, go ahead and do both. Let your radiologist know that you’ve just had the vaccine, and they can take that into account.

The Johnson & Johnson vaccine

With the Johnson & Johnson vaccine, of the 15 cases of rare blood clots reported, all occurred in women under age 60. Three of those have died, while seven remain hospitalized, four in critical condition.

Washington Post columnist Dr. Leana Wen estimates 15 cases out of eight million equals a risk of less than two in a million. But for women under 50, the risk rises to about one in 80,000. On the other hand, the CDC estimates for every million doses of the vaccine in women under age 50, 12 deaths would be prevented.

The CDC and the U.S. Food and Drug Administration (FDA) conducted a thorough review during a “pause” in distribution last month. The panel concluded that the vaccine’s distribution should resume with no restrictions.

Dr. Francis Collins, director of the National Institutes of Health (NIH), spoke with NBC’s Chuck Todd. He said the vaccine’s benefits outweigh the risk from possible blood clots.

“We clearly have a situation where the benefits greatly outweigh the risks, even for younger women,” he said on “Meet the Press” late last month.

Women under age 50 who are concerned about the blood clot risk with the Johnson & Johnson vaccine can opt for one of the other two if they’re available. If you don’t have a choice, we agree with Collins. The risk of those rare blood clots is weighed against the risk of dying from COVID-19- there’s no comparison. We recommend you get your COVID-19 vaccine as soon as possible.

If you have any concerns about these or other issues related to the vaccines, please don’t hesitate to ask us.

Needle phobia

Conquering Needle Phobia to Save Your Life

You don’t believe any of the misinformation you’ve been seeing online about the coronavirus vaccines. You really want protection from its deadly effects. But, as more vaccines become available, you’re dragging your feet in making an appointment due to a needle phobia.

Because no matter how many times you’ve seen the endless videos of people getting their shots, you still get a sick feeling in the pit of your stomach every time. Maybe you’ve even signed off social media and refused to watch television news because they won’t stop showing people getting jabbed.

Our Jupiter, Florida, concierge primary care doctors understand what you’re going through. We see a lot of this from our patients. Even before the rollout of the coronavirus vaccines, some of our patients have always had a difficult time getting shots or having their blood drawn.

A common phobia

It’s not funny, and it’s not a sign of weakness. It’s common in all ages, with men as well as women.

“Just by me injecting a needle into one of my patients—this was a grown adult man—he passed out,” Dr. John Morrison, a primary care provider with Advent Health Wesley Chapel in Tampa, told WTSP-10. “And I probably see that once every couple of months in a grown adult.”

The American Psychiatric Association’s Diagnostics and Statistical Manual of Mental Health Disorders (DSM-5) recognized it in 1994. It’s called “trypanophobia,” or the fear of injections. And this deep-seated type of phobia is not something anyone can talk you out of.

Considered one of the top 10 fears, fear of needles affects an estimated 50 million Americans. And it can cause people to avoid necessary medical attention. In the case of the coronavirus vaccine, it could cost you your life.

According to Psychology Today, “Needle phobia is real . . . and the symptoms can make getting a shot extremely uncomfortable. These range from mild to severe and can include dizziness, fainting, anxiety, insomnia, panic attacks, increased blood pressure, fast heart rate, and avoidance. Just the thought of getting a shot can bring on symptoms in some people.”

A fourth-year medical student at Thomas Jefferson University in Philadelphia, Pennsylvania, Amanda Walker regularly gives injections and inserts IV needles in patients. But she recently told CNN she has a needle phobia of her own.

“I’ll start to get really clammy, and then get cold sweats,” she said, describing her reactions to injections she gets herself. “Then I pass out.” Nevertheless, she intends to become a pediatrician, and says her own phobia will help when she’s dealing with her younger patients.

What doesn’t help needle phobia

It’s critical that as many people as possible receive the coronavirus vaccine. Not only will it protect themselves, but also to protect the population as a whole as well as to stop the rampant virus mutations.

But for those who have a needle phobia, whether it’s mild or severe, ridicule and scorn don’t help. Telling people to “put on your big-boy/girl pants and deal with it” is condescending, uninformed, and unhelpful.

Avoidance is also not helpful, however, either for reining in the pandemic or for one’s overall physical or mental health.

“I tell all my patients with any kind of anxiety that avoidance is actually fuel for anxiety,” Kristin Kunkle, a psychologist at the Washington Anxiety Center of Capitol Hill in D.C., told The Washington Post. “The more you avoid something, the worse it gets.”

What does help needle phobia

Here are some strategies that can help you cope with getting the vaccine.

  • For several days before your appointment, practice relaxation exercises: deep breathing, progressive muscle relaxation, or mindfulness training. Then use these when the time comes.
  • Let the person giving the shot know that you have a problem. It won’t be the first time they’ve heard it, and they have ways to help.
  • Bring along a distraction: a friend, an engrossing book, or some engaging phone apps. And avoid looking at the needle. Instead, focus intently on something else in the room.
  • For a severe phobia, you may need longer-term therapy such as cognitive behavioral therapy (CBT), which involves gradual desensitization.

Here’s a little argument you can have with yourself that might help: Would you rather have one shot to prevent COVID-19 or a whole lot of shots, IV needles, and blood draws if you end up hospitalized with the illness?

If you have a fear of needles, or any hesitation at all about receiving the coronavirus vaccine, please let us know. We can provide anti-anxiety medication if necessary, or a skin-numbing cream or pain-blocking gels. The important thing is to get the vaccine as soon as you can get an appointment.

after COVID vaccination

What You Can Do After Your COVID-19 Vaccination

Only about 10 percent of the U.S. population has been fully vaccinated for the SARS-CoV-2 coronavirus. But vaccine supplies and distribution have been ramping up. The government expects to have vaccine available for everyone who wants it by the end of May. So our concierge doctors at MD 2.0 in Jupiter want to share the guidelines recently released by the Centers for Disease Control and Prevention (CDC) spelling out what you can do after your COVID-19 vaccination.

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covid variants

Understanding COVID-19 Variants

Our concierge doctors are receiving many questions from our patients about the numerous COVID-19 variants. They want to know what they mean for the vaccine and how worried we should be about them. The U.K. variant, known as B.1.1.7, is spreading more rapidly in Florida at the moment than in any other state. We felt this would be a good time to summarize what we know about all of these questions.

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vaccine effects

What to Expect from the Coronavirus Vaccine

Our concierge doctors are receiving questions as the two approved coronavirus vaccines become more widely available. So we decided to answer many of those questions on the effects of the vaccine here.

The latest

The vaccine rollout has gone more slowly than anticipated. First, there aren’t as many doses available of either vaccine as had been promised originally. There are approximately 200 million Americans in need of the vaccine, which means 400 million total doses for two shots. But there are currently only about 100 million doses available, and approximately three percent of the population has been vaccinated.

Second, there has been confusion and controversy regarding who should be first in line to receive a shot, who should be next, and so on.

Finally, until the end of December, the federal government did not allocate enough money for states to pay for training additional vaccinators, adequately storing and distributing the vaccine, etc. The economic stimulus package passed in December allocated $8 billion for states. But health officials say it will take time to receive the money and implement necessary protocols.

In the coming weeks, however, these problems should begin to be resolved. Experts expect the vaccines to be more available to those who need it: front-line health care and essential workers, seniors in long-term care facilities, and those at high risk of contracting COVID-19. It will likely take longer than that for the general public to begin receiving vaccines.

Effectiveness

Both the Pfizer-BioNTech and Moderna vaccines require two doses for maximum effectiveness. Both vaccines show in early trials to deliver immunity rates around 95 percent. The flu shot generally has an effectiveness rate of between 30-50 percent.

While it is still too early to be certain, it appears the vaccines could take as long as 28 days to create the promised level of immunity. Although, one recent study found immunity can begin within 12 days. (The flu shot takes between 10-14 days for full effectiveness.)

There has also been controversy regarding whether to make sure everyone receives both doses. Some argue one will be enough for now, given the nationwide shortage. Experts still haven’t settled the question. But more are now leaning toward the concept of giving as many people as possible at least some protection– meaning, just a single dose initially until the supply shortage eases. Early research seems to show a single dose may confer between 80-90 percent protection, thereby strengthening that argument.

Health officials say at least 70 percent of the population must be inoculated in order to receive so-called “herd immunity.”

By the way, there is zero chance of contracting the virus from the shot. Unlike traditional vaccines that introduce a weakened or dead virus into the body, both COVID-19 vaccines use messengerRNA (mRNA) to trigger immunity.

And no, the mRNA won’t change your DNA. It never enters the nucleus of the cells where the DNA resides.

Side effects

When we talk about side effects, we mean both the allergic reactions noted in relatively few individuals and the expected aftereffects of a standard vaccination.

Allergic reactions

According to the CDC, nearly two million people received one of the coronavirus vaccines in the first week it was available. It said at least 29 of the had a severe allergic reaction called anaphylaxis. This condition can be life threatening, and must be treated immediately with an emergency injection of epinephrine.

“This is still a rare outcome,” said Dr. Nancy Messonnier, head of the CDC’s National Center for Immunization and Respiratory Diseases, during a media briefing. “Right now, the known and potential benefits of the current COVID-19 vaccines outweigh the known and potential risks of getting COVID-19.”

If you have a history of severe allergic reactions that require you to carry an Epi pen, check with us before being vaccinated.

Normal after-effects

Many of those who have already received the vaccine reported no side effects. Research from the vaccines trials reported most people can expect to experience at least one side effect from the shot. And that’s normal, as the body swings into action to mobilize its immune defenses against the coronavirus. It can also happen with the flu vaccine.

Reported side effects include

  • headache
  • fatigue
  • muscle soreness and aches
  • joint pain
  • pain, redness, or swelling at the injection site

These generally go away in a day or two. We believe such short-term discomfort is a small price to pay to keep from getting COVID-19. Just ask the “long haulers,” whose lives have been disrupted for months with lingering, debilitating effects from the virus.

If you have any questions about the effects of the vaccine, please let us know.

children COVID

All Children in Study Show Blood Vessel Damage from COVID-19

From the onset of the coronavirus pandemic, it became clear the majority of those most affected by COVID-19 infections were adults over the age of 65. The severity of the illness and deaths decreases in younger people. Many began to believe we didn’t have to worry about children when it came to the virus.

Children may be carriers and able to infect others. But many thought if they should become ill, in most cases they’ll exhibit either mild symptoms or none at all.

Dangerous misconception

Our concierge doctors want to warn you that this is a misconception. At least 120 children in the U.S. have died from COVID-19. And a new study last month at the Children’s Hospital of Philadelphia (CHOP) found a disturbing result of coronavirus infection in children. They found elevated levels of a biomarker (C5b9) related to blood vessel damage, even in those with minimal or no symptoms.

They also found a high proportion of children with SARS-CoV-2, the coronavirus that causes COVID-19, were also diagnosed with a condition called thrombotic microangiopathy (TMA). TMA leads to clots in small blood vessel. It has been linked to severe COVID-19 symptoms in adults.

“We do not yet know the clinical implications of this elevated biomarker in children with COVID-19 and no symptoms or minimal symptoms,” co-senior study author David T. Teachey, MD, said in a news release. Teachey is the Director of Clinical Research at the Center for Childhood Cancer Research at CHOP.

“We should continue testing and monitoring children with SARS-CoV-2 so that we can better understand how the virus affects them in both the short and long term,” he added.

The unknowns

There’s still a great deal we don’t yet know about this novel coronavirus, including why it affects both children and adults in varying degrees. At least 30-40 percent of adults, for example, show minimal or no symptoms at all. They still can transmit the infection to others, however.

Despite having a higher viral load, children are even less likely to exhibit symptoms. This means children tend to have a larger amount of the virus in their upper respiratory tracts than adults. Does that mean they can transmit the virus even more readily than adults? 

Again, we don’t know for sure. But a recent Harvard Health paper warns “the presence of high viral loads in infected children does increase the concern that children, even those without symptoms, could readily spread the infection to others.”

One thing we do know is a small number of children can have severe effects. One of these is a new condition. The Centers for Disease Control and Prevention (CDC) calls it “multisystem inflammatory syndrome in children,” or MIS-C. It now seems to have affected approximately 300 children in the U.S, at least five of whom have died.

Long-term implications

Originally, doctors thought there was an unusual outbreak of a rare form of Kawasaki’s disease. The symptoms reported were similar (persistent fever, rash, and inflammation of the blood vessels). It has now, though, been connected specifically with the SARS-CoV-2 virus.

“This [MIS-C] is a new childhood disease that is believed to be associated with [COVID-19], and it can be lethal because it affects multiple organ systems [including] the heart and the lungs, gastrointestinal system or neurologic system,” neonatologist Alvaro Moreira said in a statement. Moreira is an assistant professor of pediatrics at The University of Texas Health Science Center at San Antonio.

His team reviewed 662 cases of MIS-C worldwide between January and July of last year. They found more than half of the children studied suffered heart damage as a result of the condition. These children may require lifelong care and treatment, United Press International (UPI) reported in September.

“Evidence suggests that [these] children . . . have immense inflammation and potential tissue injury to the heart, and we will need to follow [them] closely to understand what implications they may have in the long term,” Moreira concluded.

Further study needed

Researchers in the CHOP study were surprised to find the biomarker C5b9 present. They found it not only in children with severe symptoms of COVID-19 and MIS-C, but also in those with minimal or no symptoms.

“Although most children with COVID-19 do not have severe disease, our study shows that there may be other effects of SARS-Cov-2 that are worthy of investigation,” Teachey said.

“The most important takeaway from this study is we have more to learn about SARS-Cov-2,” he concluded. “We should not make guesses about the short- and long-term impact of infection.”

Neither of the two vaccines approved for adults have been tested in children under age 12. It could be a long wait until kids get protection from the virus.

In the meantime, we urge parents to take the same precautions with their children that they do with themselves. Socially isolate as much as possible, frequently wash your hands, and wear masks when outside the family circle.

covid vaccine

MMR Vaccine May Protect Against COVID-19

With all the excitement and hope surrounding the rollout of the coronavirus vaccines, our concierge doctors want to highlight other vaccines that could also prove to be lifesavers. Particularly in the case of childhood vaccinations, we have seen a significant reduction in the numbers of children receiving routine immunizations.

And we are not alone. In one of the more troubling results of the pandemic, experts across the country saw a marked decline in children being vaccinated. According to a report released this month by the Wellmark Blue Cross Blue Shield Association, nearly nine million children have received fewer vaccinations than normal. There is a 26 percent decline from last year. This is partly due to the restrictions put in place to combat COVID-19. But, it’s also due to a growing resistance by some parents toward vaccines in general.

Kids need vaccines

Experts warn this drop could result in a renewed outbreak of childhood diseases. We could see resurgences of diphtheria, whooping cough, measles, and even polio.

“Although we don’t want to cause alarm, we do want to be mindful of what a drop in vaccination levels could mean,” Dr. Tim Gutshall, Wellmark’s chief medical officer, said in a statement to The Iowa Gazette. “If we dip below the [Centers for Disease Control and Prevention] benchmarks for immunity, we could wind up with an epidemic of vaccine-preventable diseases.

“The good news is the trend can be reversed if parents and guardians ensure these vital immunizations are up to date,” he added.

COVID-19 vaccine already here?

Now it appears there may be an even better reason for children to receive at least one type of vaccine: the MMR (for measles, mumps, and rubella). It’s been rumored since the start of the pandemic that the MMR vaccine might protect those who become infected with SARS-CoV-2, the virus that causes COVID-19. This is due to the similarity of both viruses.

Now a new study, published last month in the journal of the American Society for Microbiology, shows promise. It found patients vaccinated against mumps had less severe COVID-19 infections than those not vaccinated.

“We found a statistically significant inverse correlation between mumps titer levels and COVID-19 severity in people under age 42 who have had MMR II vaccinations,” lead study author Jeffrey E. Gold said in a media release. [Titer levels measure the amount of protective antibodies in the blood.]

“This adds to other associations demonstrating that the MMR vaccine may be protective against COVID-19. It also may explain why children have a much lower COVID-19 case rate than adults, as well as a much lower death rate. The majority of children get their first MMR vaccination around 12 to 15 months of age and a second one from four to six years of age.”

The study

Researchers split 80 participants into two groups. The first group included 50 Americans under age 42. This group received most of their MMR antibodies through the MMR II vaccine. The second group comprised those who had no record of ever having received vaccines and reported they had the measles, mumps, or rubella.

Those who actually contracted the mumps did not seem to show any protective effect against COVID-19. Those who showed high levels of mumps titers resulting from the MMR II vaccine were either asymptomatic (showed no symptoms at all) or were functionally immune from the virus, just as if they’d received one of the new coronavirus vaccines.

Researcher’s conclusions

This was a relatively small observational study. But study coauthor David J. Hurley, PhD, professor and microbiologist at the University of Georgia, appeared impressed by its findings.

“The MMR II vaccine is considered a safe vaccine with very few side effects,” he wrote in a statement. “If it has the ultimate benefit of preventing infection from COVID-19, preventing the spread of COVID-19, reducing the severity of it, or a combination of any or all of those, it is a very high reward-low risk ratio intervention.”

In fact, he suggested while the country is waiting for wider distribution of the newly approved coronavirus vaccines, the MMR II vaccine could stand in in the interim.

“Based upon our study, it would be prudent to vaccinate those over 40 regardless of whether or not they already have high serum MMR titers.”

Further studies coming

Our concierge doctors aren’t necessarily ready to start vaccinating all our older patients based on a single study. But we think it bears watching. That’s because—based on prior anecdotal evidence—other studies along these lines are already underway.

One of those is funded by a $9 million grant from the Bill and Melinda Gates Foundation, Wellcome Trust, MasterCard, and others. It plans to recruit as many as 30,000 healthcare workers worldwide in a clinical study. This would measure immunity to COVID-19 against those who receive the MMR II vaccine vs. those who receive a placebo injection.

It’s heartening to realize the best scientific brains around the world are working so diligently to conquer the scourge of COVID-19. There is hope on the horizon.

Meanwhile, please keep playing defense as much as possible:

  • wear a face mask around people outside your household
  • avoid indoor spaces as much as possible
  • wash your hands frequently

It won’t be much longer until this nightmare is a distant memory. And be sure your children are up to date on their vaccinations!

flu shot twindemic

Flu Shots Can Help Avert a ‘Twindemic’

The U.S. Centers for Disease Control and Prevention (CDC) recommends all adults and children older than six months receive a flu shot by the end of this month. The CDC says it takes at least two weeks for the vaccine to become effective. Then it won’t reach its peak effectiveness until another week after that. And children who are being vaccinated for the first time need two vaccines spaced a month apart to become fully protected.

Therefore, our concierge doctors suggest you get your flu shot for the 2020-21 influenza season as soon as possible. While there have been scattered reports of shortages around the country, The Washington Post recently reported a record number of flu vaccine doses—between 194 million and 198 million—have been ordered. Because the vaccine is shipped in stages, more is on the way.

“This year I think everyone is wanting to get their vaccine and maybe wanting it earlier than usual. If you’re not able to get your vaccination now, don’t get frustrated. Just keep trying.”

The CDC’s Dr. Daniel Jernigan, to the Associated Press (AP).

COVID-19 and flu overlap: a ‘twindemic’

We were fortunate the 2019-20 flu season was winding down this spring as the coronavirus crisis began to hit the country. This year, however, we’ll be looking at the possibility of a “twindemic”—both waves hitting at once.

So it’s especially important that as many people as possible get vaccinated for the flu this year. The flu shot won’t prevent COVID-19, but it can help reduce the strain on our already overburdened health care system.

“Since hospitals and doctors’ offices are going to be very busy caring for COVID-19 patients, a flu vaccine can help decrease burdens on the health care system and make sure that those who need medical care are able to get it.”

Dr. Susan Bailey, president of the American Medical Association (AMA) and an immunologist in Fort Worth, Texas, told CNN.

Last year, the CDC estimated that the flu killed 22,000 Americans, and resulted in hospitalization of an additional 400,000. By contrast, at least 215,000 Americans have died of COVID-19 since March.

Hopeful signs

Health experts are hopeful the precautions we’ve been taking to avert COVID-19—hand washing, social distancing, and wearing masks—will mean this season’s flu won’t take as severe a toll as in previous years. But they all insist that widespread vaccinations are necessary.

Even if the flu vaccine isn’t 100 percent effective in preventing influenza, it has been shown to reduce the length and severity of the illness in those who contract it. In addition, if you’re unlucky enough to contract COVID-19, you won’t want your body’s defenses to be weakened by a prior bout with the flu.

This is already present in the Southern Hemisphere, where each season’s flu strikes over the summer. From South Africa to Australia, public health experts reported remarkably low levels of influenza among their populations. They attributed this partly to coronavirus lockdowns and to extremely high participation in influenza vaccinations.

One pharmacy in Cape Town, South Africa, for example, reported that the demand for flu shots was four times higher than in previous years. People were trying to avoid the co-morbidity (simultaneous presence of two or more diseases) of contracting the flu in addition to COVID-19.

“People were lined up outside the pharmacy down to the corner of the street waiting to get their injections. We had to prevent people from coming into the store.”

Ellis Henen, owner of Sunset Pharmacy, told The Post.

Additional benefits of the flu shot

We hope Americans will have the same attitude to this year’s flu shot.

Some people think they’re still protected from the one they received last year. But having received a flu shot last year won’t protect you from this season’s strains of the virus. This is because your immunity from a year ago has deteriorated by now. In addition, manufacturers create a new vaccine each year based on which strains the World Health Organization (WHO) expects to be predominate. This is based on which strains were seen over the summer in the Southern Hemisphere. So this year’s shot will include strains different from those in last year’s inoculation.

It’s important to remember, even if you contract influenza after receiving the shot, it’s likely to be less serious than if you’d skipped being inoculated. And the flu vaccine offers additional benefits, especially among the elderly. For older people and those with chronic health conditions, recent studies show the extra benefits of a flu shot. It’s as effective in preventing a heart attack as quitting smoking, using cholesterol-lowering drugs, or taking blood pressure medications.

So be sure to let us know if you’re interested in getting a flu shot. If you encounter a shortage, we may be able to help you locate a supply nearby.

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