The percentage of subjects with an AESI at any time after vaccination was similar between vaccine groups (0.9% Fluad vs. 0.9% active comparator). Itching 8. There are no data to assess the concomitant administration of Fluad with other vaccines. It’s really much more boring than that. b N is the number of vaccinated participants with available data for the immunologic endpoint listed. Fluad is not approved for use in persons < 65 years of age. Persons who report having had reactions to egg involving symptoms other than [hives]… or who required epinephrine or another emergency medical intervention may similarly receive any licensed, recommended influenza vaccine… that is otherwise appropriate for their age and health status. Every year, scientists around the world do their best to get one step ahead of the flu by developing that year’s iteration of the flu shot. Hannoun C, Megas F, Piercy J. Immunogenicity and protective efficacy of influenza vaccination. Fluad has a milky white appearance. Fluzone High-Dose is not available in 2020. It’s also complex as hell — something that keeps virologists on their toes every year. b Moderate: pain, tenderness, defined as "some limitation in normal daily activity", c Severe: pain, tenderness, defined as "unable to perform normal daily activity". Inform vaccine recipients that annual vaccination is recommended. The recombinant flu vaccine manufacturing process, like cell-based vaccines, is faster to manufacture too. Annual influenza vaccination is recommended because immunity declines during the year after vaccination, and because circulating strains of influenza virus change from year to year. anaphylaxis) to any component of the vaccine, including egg protein [see Description (11)], or to a previous influenza vaccine. This high-dose vaccine protects against four strains of the flu, replacing last year’s version which only protected against three. Furthermore, cell-based flu vaccines have been around since 2012, so they’re still the new kids on the block and can’t be found everywhere. Safety and immunogenicity of Fluad have been evaluated in adults 65 years of age and older. Every year, vaccines take virus samples from labs across the world and mix and match them. Advantages: Flubok Recombinant, the one recombinant vaccine that is FDA approved for the 2020-2021 season, is another completely egg-free vaccine for those with egg allergies. J Hyg Camb 1972; 767-777. Some aren’t even shots (let’s hear it for the nasal spray!) This vaccine does not contain thimerosal or other preservatives and is used only on patients aged 2 to 49. The reported frequencies of solicited local adverse events from Study 1 are presented in Table 1a and systemic adverse events from Study 1 are presented in Table 1b. that this year’s A(H1N1)pdm09 component changed from A/Brisbane/02/2018 (H1N1)pdm09-like virus to A/Guangdong-Maonan/SWL1536/2019 (H1N1)pdm09-like virus. Influenza illness and its complications follow infection with influenza viruses. For the full list of excipients, see section 6.1. Fluarix Quadrivalent is a vaccine used to treat the flu.It is a quadrivalent flu shot, which means that it protects against four flu strains. Clinicians should emphasize that (1) Fluad contains non-infectious particles and cannot cause influenza and (2) Fluad is intended to help provide protection against illness due to influenza viruses only, and cannot provide protection against other respiratory illnesses. a Results obtained following vaccination with influenza vaccine formulated for the 2010-2011 season. And the government may require some people to get flu shots, such as Massachusetts, which is, Every year, scientists around the world do their best to get one step ahead of, by developing that year’s iteration of the, work by giving your body a chance to fight off an altered version of a virus or bacteria, so that if and when it encounters the live virus, it already knows how to react, and you never get sick. Therefore, inactivated trivalent influenza vaccines are standardized to contain the hemagglutinin of influenza virus strains (two subtypes A and one type B), representing the influenza viruses likely to be circulating in the United States in the upcoming influenza season. Fluzone High-Dose Quadrivalent: This high-dose vaccine protects against four strains of the flu, replacing last year’s version which only protected against three. It’s safe to use ethylmercury in vaccines because it’s processed differently in the body and it’s less likely to build up in the body — and because it’s used in tiny amounts. Do not freeze. Should my ≥ 65-year old immunosuppressed patient receive 2 doses of adjuvanted QIV this year? Unsolicited Adverse Events (AEs): The clinical safety of Fluad was assessed in fifteen (15) randomized, controlled studies. Animals were administered Fluad by intramuscular injection twice prior to gestation, during the period of organogenesis (gestation day 7) and later in pregnancy (gestation day 20), 0.5 mL (45 mcg)/rabbit/occasion. Chills 5. This antiviral stands out in that it is the only one that gets to the root of replication, messing with the virus’ RNA to stop it from reproducing. Use: Kills viruses or inactivates toxins Trade Name Information Sheet Active Ingredient(s) Fluad: PI: Influenza virus haemagglutinin: Fluad Quad: PI: Influenza virus haemagglutinin: Last updated: 18 March 2021 These vaccines don’t require the use of the flu virus. Influenza virus (commonly known as "the flu") is a serious disease caused by a virus. Flucelvax is for kids 4 and older, so toddlers will have to do with the regular shot. These children should receive their first dose as soon as possible so that there’s time to get the second dose (which must be administered at least 4 weeks later) before the end of October. Cardi B Hits Back At Parent Shamers After Grammy's WAP Performance, TikTok Of Toddler Tearfully Saying Bye To Grandpa Will Melt Your Heart, Fauci Says Vaccinating Kids Necessary for U.S. to Reach Herd Immunity. Study 1 (NCT01162122) evaluated the safety and immunogenicity of Fluad in comparison to AGRIFLU. sodium phosphate, dibasic, dihydrate. squalene. The recombinant flu vaccine has a slightly shorter shelf life than most other currently available injectable influenza vaccines. These need multiple doses to keep the drug working (Tamiflu, for instance, requires patients to take it twice a day for five days). Called Fluad Quad, it is a four-strain inactivated flu vaccine that works by causing the body to produce its own antibodies against the four types of flu virus in the vaccine. For those science-is-fucking-awesome types out there, this is indeed awesome. And it’s more important than ever to get vaccinated on time. Thrombocytopenia (some cases were severe with platelet counts less than 5,000 per mm3), lymphadenopathy. Nasal Spray: The nasal-spray vaccine is the only kind to include a live attenuated influenza vaccine, meaning while it can’t give you the flu, it does have a higher likelihood of inducing flu-like symptoms. Flucelvax, the one cell-based flu vaccine approved for use in the U.S., is safe for anyone with egg allergies. A Close Look at the Drawbacks and Benefits of Marijuana. Fluad is prepared by combining the three virus antigens with the MF59C.1 adjuvant. When Do Babies Start Dreaming? But it will be exceedingly complicated. Fluad® may also contain traces of kanamycin sulfate, neomycin sulfate, formaldehyde, chicken proteins, cetyltrimethylammonium bromide (CTAB), sucrose, barium sulphate, and hydrocortisone as residues of the manufacturing process. Beyond the three to four viral components, a number of additives and preservatives are required to make vaccines effective — and to keep them from going bad. Advantages: Flucelvax, the one cell-based flu vaccine approved for use in the U.S., is safe for anyone with egg allergies. would have you latch onto. calcium chloride. Many pharmacies can give adults the flu shot too. Non-inferiority of Fluad compared with AGRIFLU was demonstrated for all three vaccine strains based on pre-defined thresholds for seroconversion rate differences and GMT ratios (Table 2a & 2b). Fortunately, the CDC published its, for the 2020-2021 flu shot on Friday, meaning it’s actually possible to understand what you’re having injected into yourself and your child (also, your parents if you can), wherever it is you get your flu shot. This year, children 6 months through 35 months of age are recommended to receive 0.25 milliliters or 0.5 milliliters of inactivated vaccine per dose, depending on the type of vaccine. FluQuadri® is a QIV, previously registered for adults and children from 3-years of age. A developmental toxicity study has been performed in female rabbits administered Fluad prior to mating and during gestation. Fluad® Quad is the QIV formulation funded in 2020 for those ≥ 65-years, however other QIV formulations are available. Fluad Quadrivalent: This new vaccine contains an extra ingredient called an adjuvant that promotes a stronger immune response to the flu vaccine. 1 INDICATIONS AND USAGE . Fluad® Quad is an adjuvanted QIV, newly registered for use in adults ≥65 years of age. There were no notable imbalances for specific AESIs. Bruising 4. Adverse Events of Special Interest (AESIs): Rates of new onset neuroinflammatory and immune mediated diseases were assessed in a post hoc analysis of the 15 randomized controlled studies over the time periods specified above for SAEs. Do not use after expiration date. Do not administer Fluad to anyone with a history of severe allergic reaction (e.g. The percentage of subjects with an unsolicited AE within 30 days following vaccination was similar between vaccine groups (16.9% Fluad vs. 18.0% active comparator). During the 2020-2021 influenza season, both trivalent FLUAD and FLUAD Quadrivalent will be available. The CDC says: “Formaldehyde is diluted during the vaccine manufacturing process, but residual quantities of formaldehyde may be found in some current vaccines. FLUAD and FLUAD Quadrivalent is a standard-dose, inactivated influenza (flu) vaccine, manufactured by Seqirus that contains an adjuvant. It is covered by most Medicare and insurance plans, but some pharmacy coupons or cash prices may be lower. The CDC says: “Thimerosal has a different form of mercury (ethylmercury) than the kind that causes mercury poisoning (methylmercury). It is four times stronger than a normal vaccine to give older adults extra protection. These ingredients, sometimes covered as trade secrets by drug companies in other, less-public drugs, have led to many a conspiracy theory that the likes of anti-vaxxers would have you latch onto. al. Fluad is a sterile injectable emulsion supplied in 0.5 mL single-dose pre-filled syringes. Vaccine Serious Adverse Events (SAEs) and Deaths: In Study 1, in which subjects were followed for SAEs and deaths for one year following vaccination (N=3,545 Fluad, N=3,537 AGRIFLU), the percentages of subjects with an SAE were similar between vaccine groups (7% Fluad vs. 7% AGRIFLU). Most Likely in the Womb. The role of serum hemagglutinin-inhibiting antibody in protection against challenge infection with influenza A2 and B viruses. Fluarix Quadrivalent is less popular than comparable drugs. The vaccine should be administered by intramuscular injection, preferably in the region of the deltoid muscle of the upper arm. US Package Insert 03 November 2020 Confidential Page 2 of 12 FULL PRESCRIBING INFORMATION . b Moderate: myalgia, fatigue, headache, arthralgia, chills, nausea, vomiting defined as "some limitation in normal daily activity", diarrhea defined as "4 to 5 stools a day". And the government may require some people to get flu shots, such as Massachusetts, which is mandating the vaccine for students. Any licensed, recommended influenza vaccine… that is otherwise appropriate for the recipient’s age and health status may be used. Another flu vaccine is FLUAD, a standard-dose trivalent shot made with adjuvant. To use a pre-filled syringe fitted with a Luer Lok system, remove the tip cap by unscrewing it in a counter-clockwise direction. Use: Prevents bacterial contamination, The Ingredient: Thimerosal The Fluzone High-Dose and FLUAD are two of the high-dose flu vaccines that have been licensed for people 65 and older by the FDA. Vaxigrip Tetra ® and Fluarix Tetra ® can be administered to individuals from 6 months of age. are the same. The second component is a variant of the 2009 H1N1 swine flu. It’s safe to use ethylmercury in vaccines because it’s processed differently in the body and it’s less likely to build up in the body — and because it’s used in tiny amounts. Here are three takeaways. Fluad® Quad is an adjuvanted QIV, newly registered for use in adults ≥ 65-years of age. Muscle Pain 10. We have listed vaccine ingredients (substances that appear in the final vaccine product), process ingredients (substances used to create the vaccine that may or may not appear in the final vaccine product), and growth mediums (the substances vaccines are grown in) for vaccines approved by the Food & Drug Administration (FDA) and commonly recommended by the Centers for Disease … Recombinant. Global surveillance of influenza identifies yearly antigenic variants. Available for Android and iOS devices. inactive ingredients: ingredient name strength; octoxynol-9 (unii: 7jpc6y25qs) .alpha.-tocopherol succinate, d-(unii: lu4b53jyve) polysorbate 80 (unii: 6ozp39zg8h) potassium chloride (unii: 660yq98i10) sodium chloride (unii: 451w47iq8x) magnesium chloride (unii: 02f3473h9o) sodium phosphate, dibasic, dodecahydrate (unii: e1w4n241fo) This year, however, the quadrivalent cell-based vaccine is cell-based from start to finish, meaning it’s completely egg-free. Something went wrong please contact us at support@fatherly.com. These vaccines don’t require the use of the flu virus. Influenza B viruses tend to be the non-pandemic variety because they spread primarily among humans alone. They’re slower to mutate than Influenza A, but still just as infectious among humans (and, apparently last season, harbor seals). The age indication for this vaccine has now been extended to include children from 6 months of age. Second of all, coronavirus is still raging in the U.S. and if a flu season packs the hospital, the mortal dangers of both COVID-19 and the flu increase. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. c Fluad met non-inferiority criteria based on GMT ratios if the lower limit of the 95% CI [Fluad:AGRIFLU] for each strain was > 0.67. dSeroconversion was defined as prevaccination HI titer <10 and postvaccination HI titer ≥ 40 or at least a 4-fold increase in HI from prevaccination HI titer ≥ 10. e Fluad met non-inferiority criteria based on seroconversion rate differences if the lower limit of the 95% CI. These vaccines have a slightly shorter shelf life than most current flu vaccines, with expiration dates 9 months after the production date, and are only approved for patients 18 years or older. It’s more crucial than ever to get your, This year, getting vaccinated for the flu will be a bit different too. FLUAD QUADRIVALENT is an active immunization of persons 65 years of age and older against influenza disease caused by seasonal influenza virus subtypes A and types B. The most common (≥ 10%) local (injection site) adverse reactions observed in clinical studies were injection site pain (25%) and tenderness (21%). The CDC says: “Because influenza and yellow fever vaccines are both made in eggs, egg proteins are present in the final products. The primary immunogenicity analyses were conducted on all vaccinated subjects with a blood sample collected at Day 22 (N=3,225-3,227 [91%] and 3,256- 3,259 [92%] in the Fluad and AGRIFLU groups, respectively). The enrolled subject population in Study 1 was 65 to 97 years of age (mean 72 years) and 64% were female. The ingredient, called adjuvant MF59, is a natural compound that can be made from vegetable oils or, more commonly, shark liver oil. H3N2 was first found in pigs in 2010, then in humans in 2011, and the biggest human outbreak was in 2012 with some 309 reported cases. Four SAEs (1 Fluad and 3 AGRIFLU) were assessed as related to study vaccination over one year of observation and 2 of these occurred (1 Fluad and 1 AGRIFLU) within 21 days following study vaccination. This indication is approved under accelerated approval based on the immune response elicited by Fluad [see Clinical Studies (14)]. What. c Severe: myalgia, fatigue, headache, arthralgia, chills, nausea, vomiting defined as "unable to perform normal daily activity", diarrhea defined as "6 or more watery stools a day". The total safety population in these trials included 10,952 adults 65 years of age and older, comprising 5,754 who received Fluad and 5,198 who received other US licensed influenza vaccines. For one, kids can get vaccinations and the flu shot at pharmacies, a new approval by the Trump administration. Ensure procedures are in place to avoid injury from falling associated with syncope. Here’s your 2020-2021 flu options: The nasal-spray vaccine is the only kind to include a live attenuated influenza vaccine, meaning while it can’t give you the flu, it does have a higher likelihood of inducing flu-like symptoms. The percentages of deaths within 30 days (0.3% Fluad vs. 0.6% active comparator) or within 6 months (1.0% Fluad vs. 1.5% active comparator) were also similar. Going to a pig farm anytime soon? water. Continued approval for this indication may be contingent upon verification and description of clinical benefit in a confirmatory trial. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. always an entirely egg-free vaccine because the four viruses used in it were created originally with the usual egg-injection process. Appropriate medical treatment and supervision must be available to manage possible anaphylactic reactions following administration of the vaccine. Discard if the vaccine has been frozen. First of all, the mild flu season in the southern hemisphere is probably due in large part to masks, social distancing, and hand sanitizing. Get the best of Fatherly in your inbox. Another note: Unless you’re in the throes of the flu, it’s. Dosage Form: injection, suspension. Influenza virus can spread from one person to another through small droplets of saliva that are expelled into the air when an infected person coughs or sneezes. Most flu shots are created by injecting the above combination of components into an egg, deactivating it, adding the other ingredients, and shipping it. The recipe starts with the four most popular (slash effective) influenza strains from around the world, injected into fertilized chicken eggs or mammalian cells, deactivated so it doesn’t give you the actual flu, mixed with a grab-bag of preservatives, antibiotics, and sugars, and then formulated for a shot or spray to make it in time for the 2020 flu season. In a phase 2 trial published by The New England Journal of Medicine, it shaved off upwards of 28 hours of flu symptoms (from 80.2 hours to 53.7 on average). Beyond the three to four viral components, a number of additives and preservatives are required to make vaccines effective — and to keep them from going bad. The Guillain-Barre syndrome and the 1992- 1993 and 1993-1994 influenza vaccines. If a vaccine other than [the cell-based or recombinant vaccine] is used, the selected vaccine should be administered in an inpatient or outpatient medical setting… Vaccine administration should be supervised by a health care provider who is able to recognize and manage severe allergic reactions.”. It’s more crucial than ever to get your flu shot. potassium phosphate, monobasic. Lasky T, Terracciano GJ, Magder L, et al. Fluad also contains MF59C.1 adjuvant (MF59®), a squalene based oil-in-water emulsion. Fluad Quad was approved for use in Australia in September 2019, Fluad Quadrivalent was approved for use in the United States in February 2020, and Fluad Tetra was approved for use in the European Union in May 2020. This was not always an entirely egg-free vaccine because the four viruses used in it were created originally with the usual egg-injection process. The recombinant flu vaccine manufacturing process, like cell-based vaccines, is faster to manufacture too. The amount of formaldehyde present in some vaccines is so small compared to the concentration that occurs naturally in the body that it does not pose a safety concern.”, The Ingredient: Antibiotics Here are some ingredients you’ll find in the flu shot: Egg protein. citric acid monohydrate. Instruct vaccine recipients to report adverse reactions to their healthcare provider and/or to Vaccine Adverse Event Reporting System (VAERS) at 1-800-822-7967 and. Influenza is a common disease of the respiratory tract. This vaccine does not contain thimerosal or other preservatives and is used only on patients aged 2 to 49. Solicited local (injection site) and systemic adverse reactions were collected from subjects in Study 1 who completed a symptom diary card for seven days following vaccination. Once the tip cap is removed, attach a needle to the syringe by screwing it on in a clockwise direction until it locks. However, there are two new flu vaccines now available for people with egg allergies.”. Principal Display Panel – Syringe Label sodium chloride. This drug, along with two others that work in the same manner (brand names Rapivab and Relenza), block an enzyme the virus needs to replicate and shave up to a day of your illness. magnesium chloride. trisodium Citrate dihydrate. [See Adverse Reactions (6.1) and Clinical Studies (14)]. Antibody against one influenza virus type or subtype confers limited or no protection against another. Reactions At The Site Of The Injection No human or animal data are available to assess the effects of Fluad on the breastfed infant or on milk production/excretion. If Guillain-Barré syndrome (GBS) has occurred within 6 weeks of receipt of prior influenza vaccine, the decision to give Fluad should be based on careful consideration of the potential benefits and risks. Within each treatment group, 53% were Asian, 28% were Caucasian, 18% were Hispanic, 1% were Black, and fewer than 1% each were Native American/Alaskan, Pacific Islander/Hawaiian, or Other. 1.175 mg polysorbate 80. Musculoskeletal and connective tissue disorders: Encephalomyelitis, Guillain-Barré Syndrome, convulsions, neuritis, neuralgia, paraesthesia, syncope, presyncope, Generalized skin reactions including erythema multiforme, urticaria, pruritis or non-specific rash. Those viruses are…. An older version of this drug called Fluad protects against three flu strains, but this new drug vaccinates against four. 2 Documents available. But it will be exceedingly complicated. Syncope (fainting) may occur in association with administration of injectable vaccines including Fluad. For: People who can’t stand the needle or jet spray or want to avoid preservatives. And it’s more important than ever to get vaccinated on time. Adverse Events of Special Interest (AESIs): influenza vaccine, adjuvanted injection, suspension, We comply with the HONcode standard for trustworthy health information -, 0.5 mL dose in a pre-filled syringe (needle not supplied), package of 10 syringes per carton [NDC 70461-020-04], INFLUENZA A VIRUS A/VICTORIA/2454/2019 IVR-207 (H1N1) ANTIGEN (FORMALDEHYDE INACTIVATED), INFLUENZA A VIRUS A/HONG KONG/2671/2019 IVR-208 (H3N2) ANTIGEN (FORMALDEHYDE INACTIVATED), INFLUENZA B VIRUS B/VICTORIA/705/2018 BVR-11 ANTIGEN (FORMALDEHYDE INACTIVATED), Gently shake each syringe. In a. , it shaved off upwards of 28 hours of flu symptoms (from 80.2 hours to 53.7 on average). Both of … Unlike the regular flu shot, cell cultures are made without eggs, using instead cells from mammals. Adjuvanted QIV (Fluad® Quad) Influenza vaccines 1. Cell-based vaccines are faster to manufacture from soup to nuts (good for Spanish flu of 1912-type situations) and have been found in some independent studies to be 10 to 30% more effective. This is why we get our flu shots, people! The ingredient, called adjuvant MF59, is a natural compound that can be made from vegetable oils or, more commonly, shark liver oil. The FluQuadri Junior formulation is no longer available. But what’s in a flu shot is a little more complicated. However, there are two new flu vaccines now available for people with egg allergies.”, Unlike the regular flu shot, cell cultures are made without eggs, using instead cells from mammals. Furthermore, cell-based flu vaccines have been around since 2012, so they’re still the new kids on the block and can’t be found everywhere. Cell-based vaccines are faster to manufacture from soup to nuts (good for Spanish flu of 1912-type situations) and have been found in some independent studies to be 10 to 30% more effective. For one, kids can get vaccinations and the flu shot at pharmacies, a new approval by the Trump administration. August is too soon because protection might wear off by the heavy-hitting months later in the season. The two free vaccines for over-65s work in different ways: FluZone High Dose is a high-dose version; Fluad adds an additional ingredient to boost its effectiveness. The surface antigens, hemagglutinin and neuraminidase, are obtained from the influenza virus particle by further centrifugation in the presence of cetyltrimethylammonium bromide (CTAB). [see Concurrent Use With Immunosuppressive Therapies (7.2)]. This year, getting vaccinated for the flu will be a bit different too. Each 0.5 mL dose contains 15 mcg of hemagglutinin (HA) from each of the three recommended influenza strains and MF59C.1 adjuvant (9.75 mg squalene, 1.175 mg of polysorbate 80, 1.175 mg of sorbitan trioleate, 0.66 mg of sodium citrate dihydrate and 0.04 mg of citric acid monohydrate) at pH 6.9-7.7. Fluad is not approved for use in persons < 65 years of age. Also, it’s one of the only ones to come in a single dose, so that’s nice. Disadvantages: Flucelvax is for kids 4 and older, so toddlers will have to do with the regular shot. Adjuvant is another ingredient that produces a stronger immune system response. The 2020-2021 flu season is unusual in many ways. Older people generally have weaker immune responses to vaccines, so these special formulations help them get as much protection from the flu as possible. How to Do Perineal Massage: An Expectant Fathers Guide, What a Chemical Pregnancy Means for Couples Trying to Conceive, Is Marijuana Addictive? Educate vaccine recipients regarding the potential side effects. d Potentially life threatening (PLT) reaction defined as requiring emergency room visit or hospitalization. Fluad Quadrivalent: This new vaccine contains an extra ingredient called an adjuvant that promotes a stronger immune response to the flu vaccine. But what’s in a flu shot is a little more complicated. Use: Growing the vaccine Use: Boosts body’s response to the vaccine, Formaldehyde is diluted during the vaccine manufacturing process, but residual quantities of formaldehyde may be found in some current vaccines. After the second annual vaccination, the percentages of subjects with an SAE were similar between vaccine groups (6.1% Fluad vs. 5.5% comparator influenza vaccines); 23 deaths (N=17 Fluad, N=6 comparator influenza vaccines) were reported. MF59® is a trademark of Novartis AG. Last updated on June 1, 2020. General disorders and administration site conditions: Extensive swelling of injected limb lasting more than one week, injection site cellulitis-like reactions (some cases of swelling, pain, and redness extending more than 10 cm and lasting more than 1 week), Allergic reactions including anaphylactic shock, anaphylaxis and angioedema. First, let’s break down the terminology: “A” refers to the type of influenza that infects birds, humans, pigs, horses, seals, and dogs,  H#N# refers to the different proteins found in the outer shell of the virus (hemagglutinin and neuraminidase); “pdm” is short for “pandemic” (remember, these are grown to mimic once-live viruses that did some harm); and “09” is the year of said pandemic (the 2009 virus accounted for some 203,000 deaths with a higher-than-normal population of children dying).
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