February 6, 2004          

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Vaccine-related (including autism)

►January 20, 2004 - Pediatric Infectious Disease Issues: Smallpox, Combination Vaccines and Methicillin-resistant Staphylococcus aureus in Highlights of the American Academy of Pediatrics Annual Meeting - Medscape "However, the combination of multiple vaccine antigens presents several challenges. It should be recommended that the components of the vaccine be administered at the same time. However, the reactogenicity and potential side effects of the combined antigens have not yet been determined. Since there is the potential for physical and chemical interaction among the vaccine components and the buffers and preservatives, the immunogenicity of each component needs to be addressed to determine whether these are similar to and as effective as the components given individually.[10]"

Comment:  From the horse's mouth.  But not only should the "reactogenicity and potential side effects of the combined antigens" be determined, as well as the immunogenicity of each component be compared to combined ones, the potential for lethal and otherwise harmful combinations should be researched.  For a highly disturbing study, in which harmless viruses recombined with lethal results, click here(Note that while affirming the potential risk of such combinations occurring, the only apparent concern in this paper was for the immunogenicity of the components, not any safety issues which might occur as a result of them interacting.)

►February 5, 2004 - Bird flu vaccine campaign urged - Mass vaccination of poultry should be considered to cut the chance of avian flu spreading to humans, say experts. - BBC News 

►February 5, 2004 - CSIRO hopes to deliver bird flu vaccine within months - Australian Broadcasting Corporation 

►February 4, 2004 - China ready to test SARS vaccine on humans - Channel News Asia 

►February 5, 2004 - Bird flu vaccine within months, say Australian scientists - Medical News Today 

►February 5, 2004 - UN approves bird flu vaccinations - Guardian Unlimited 

►February 5, 2004 - Thimerosal - 10 Investigates - www.10tv.com - "It's called Thimerosal, a controversial preservative used in childhood vaccines. Despite a call by the Food and Drug Administration in 1999 for reductions of Thimerosal, 10 Investigates discovered that the preservative is back, in this season's flu vaccine. The pharmaceutical companies and FDA call Thimerosal safe, but others worry about its use in this season's flu shots. Thimerosal has mercury in it, a widely recognized neuro-toxin. Some claim there's a link between Thimerosal and child autism cases."

2004 -MMR vaccine and autism: an update of the scientific evidence - www.futuredrugs.com

2004 -Vaccine sparks fall in meningitis deaths - The Evening Times, UK

►February 6, 2004 - Parents delay MMR jab decision - www.eveningnews24.co.uk - "And it is feared delaying the jab could put children at far greater risk of contracting the potentially lethal conditions."

Comment:  This is scare-mongering.  These conditions (measles, mumps and rubella) are rarely lethal in healthy children in developed nations.  (Rubella is often so benign you don't even know you had it, although it can be serious for a fetus if the mother contracts it during a critical period in pregnancy.)  For Scandals columns on the measles and measles vaccine, go to What Is Wrong With This Picture?;  More confusing disease stats;   Playing With Fire - It's Not EASY To Fool Mother Nature;   Don't Worry, Be Happy;  Measles In The Vaccination Age:  Is It Now Deadlier?;   Why We Won't Take No* For An Answer  (*No relationship between MMR and autism);  and Shoot First, Don't Ask Questions Later.  For how rubella vaccine might be related to the rise in autism, go to Scandals: Is Rubella Vaccination Playing A Role In The Rise In Autism?

►February 6, 2004 - Traditional rulers say no to Nigeria's polio vaccine - BMJ via www.scidev.net

►February 6, 2004Don't stop child vaccines: doctors - Experts take issue with study linking medicine with disorders - Edmonton Journal with files from CanWest News Service via www.canada.com - "A study that suggests a link between a vaccine preservative and risk of autism and other disorders will create unwarranted fear and possibly more sickness if parents refuse vaccinations for their children, Canadian doctors warn."

Comment:  Perhaps there will be more sickness. But the mere incidence of disease is not the measure against which vaccines should be compared.  The appropriate question is how much long-term damage will there be from the diseases as compared to the vaccines?  If the vaccines are indeed responsible for the epidemic rise in autism, just on that basis alone, there is reason to believe the benefits of at least some vaccines DID NOT outweigh their risks.

►February 6, 2004Childhood Immunizations and Abrupt-Onset Apnea: An Unresolved Issue in Shaken Baby Syndrome - by Harold Buttram, MD and Alan Yurko - in the Online SBS Conference at www.redflagsdaily.com

Comment:  It is hard to imagine a greater tragedy than to lose your child and then be unfairly charged with their death (and even face the possibility of being put to death yourself).  While, clearly, no one would want to allow the deliberate murder of an infant, given the many unknowns in medicine, particularly as concerns unexplained infant deaths, one would hope the authorities would be more circumspect when drawing their conclusions, and that they would leave no stone unturned in their efforts to investigate and understand these heart-rending infant deaths.  This is an urgent matter. The lives of innocent parents may be on the line.

►February 6, 2004 - A New Approach to Halting HIV Infection - press release - Tulane University via www.newswise.com

Comment:  But what if, as some believe, there is no need to halt the spread of HIV because it has nothing to do with AIDS or anything else problematic?

►February 6, 2004 - Team Seeks Reassurance on Polio Vaccine - AP via Newsday - "With its polio outbreak spreading, Nigeria is sending a team of scientists, officials and Muslim leaders abroad Sunday to bring back proof that the vaccine is neither contaminated nor a Western plot to spread AIDS...Three predominantly Muslim northern states have suspended door-to-door vaccinations since October, citing fears that the vaccine could cause infertility or AIDS."

►February 6, 2004 - Researchers in Norfolk studying effects of flu on elderly (requires registration) - www.wvec.com - "Research in Hampton Roads is offering hope for new and better vaccines to protect the elderly from the flu. In Lewis Hall at Eastern Virginia Medical School, local researchers also study other viruses in hopes of developing new vaccines and treatments to help the elderly stay well...One fact is clear: the healthier you are the better your immune system fights infection."

Comment:  Of course, "the healthier you are the better your immune system fights infection".  How you create such health is the question.  And for many people, the answer is not through vaccination.

►February 2004 - 2003-04 flu vaccine may not prevent ILI (requires registration) - Infectious Diseases in Children

►February 2004 - NVAC panel urges action to fix a weak national vaccine supply (requires registration) - The NVAC panel recommendations seek to strengthen the now fragile vaccine supply chain. - Infectious Diseases in Children

►February 2004 - Be prepared to recognize and treat anaphylaxis (requires registration) - Infectious Diseases in Children - "The risk of anaphylaxis following immunization is said to be about one in 1.5 per million (Pediatrics. 2003;112:815). As multiple vaccines often are given at the same visit, it is difficult to identify specific culprits...The Institute of Medicine has reported that causal relationships exist for the measles-mumps-rubella (MMR), hepatitis B and diphtheria-tetanus toxoids vaccines... It is difficult to estimate the risks of anaphylaxis to various agents, as episodes are not usually reported."

Comment:  I'm not sure what they mean by "one in 1.5 per million".  (Do they mean one to 1.5?)  And per million what?  Children?  Doses?  Chances are they mean doses, because that is traditionally how vaccine risk is assessed.  But since children usually receive more than one dose, that skews estimates towards them being underestimated.  For more on this, go to Scandals: Contemporary Legends - How To Lie With Statistics I

►February 3, 2004 - Immunisation: Commissioner Demands Sincerity - This Day (Lagos) via www.allafrica.com

Autism-related, developmental/behavioral issues

►February 6, 2004 - Mercury Tied to Irreversible Brain Damage - A study finds prenatal exposure affects children through adolescence, but one expert finds flaws in the research. - HealthDayNews via www.healthcentral.com

►February 6, 2004 - Mercury Study Shows Permanent Damage to Children - Reuters, UK - "Children whose mothers eat seafood high in mercury while pregnant can suffer irreparable brain damage, researchers reported on Friday...The report comes the same week as the U.S. Environmental Protection Agency doubled its estimate of how many newborns had unsafe levels of mercury in their blood."

►February 6, 2004 - Mercury affects brains of adolescents - Study of high-seafood diet points to poison's long-lasting impact. - Nature

Comment:  Yet, as the evidence against and concern about mercury has continued to mount, the "experts" have continued to deny that the mercury in vaccines could play a role in autism.  They have claimed that there was no evidence that the form of mercury in vaccines was a problem (wrongly implying that the lack of evidence, i.e., absence of studies into the possible biological mechanism, was evidence against there being such a relationship.  This, in spite of the fact that the more logical, conservative conclusion is that all forms of mercury are toxic, until proved otherwise.)  Luckily, however, there has just been published provocative biological mechanism evidence of the relationship between the mercury in vaccines and autism (as well as ADHD). Watch as the "experts" continue to deny its value or meaning.  (For more on this, check out the top stories for February 5, 2004.)

►February 5, 2004 - Special-needs children to be focus of seminars - The Journal News

►February 5, 2004 - National Disabilities Commission Appointed - www.indlawnews.com

►February 5, 2004 - Disability camp helps teens learn about life - The Catholic Spirit

►February 6, 2004 - Mercury Threat To Fetus Raised - EPA Revises Risk Estimates - (requires registration) - Washington Post 

1997 - Social Behavior in Autism - Center for the Study of Autism

"Vaccine-preventable" disease-related

►February 6, 2004Two deaths in Vietnam raise flu toll to 18 - AP, AFP via The International Herald Tribune

►February 6, 2004Animal health body says bird flu in pigs possible - Reuters AlertNet - "The world animal health body OIE said on Friday it would not be surprised if pigs in Asia tested positive for the H5N1 bird flu virus, although the U.N. in Rome dismissed earlier reports of confirmed cases in Vietnam...A U.N. Food and Agriculture Organization official in Vietnam said earlier that three or four pigs had tested positive after finding the H5N1 avian flu virus in their nasal cavities...But an FAO scientist in Rome disputed the findings."

►February 6, 2004 - Bird Virus Linked to 1918 Flu Pandemic - Researcher: Jump to humans was 'simple' - HealthDayNews via Dr. Koop

►February 6, 2004 - U.N. Experts Seek to Dampen Fears That Bird Flu Has Spread to Pigs in Vietnam - AP via ABC News - "U.N. experts sought to dampen fears Friday that bird flu had spread to another species after tests found the virus in the snouts of pigs in Vietnam. Two more people died of the disease, bringing the human death toll to 18...The U.N. Food and Agriculture Organization said the results do not necessarily mean the pigs are infected. The tests nasal swabs may merely be confirming the presence of infected chicken droppings on their snouts. Swine are often housed with poultry in traditional family farms in Asia."

►February  2004 - Influenza mortality in children under investigation (requires registration) - The CDC is continuing to investigate whether influenza killed a disproportionate number of children this year. - Infectious Diseases in Children - "The CDC is aware of at least 93 deaths from influenza in patients 18 years of age or younger this winter, but the implications of that figure are still under investigation, the agency said in a report...Complicating the analysis is that influenza-related mortality is not a nationally reportable illness. CDC estimates of child and adolescent mortality are based largely on mathematical modeling, and there have been no reliable studies to date measuring rates of childhood deaths from influenza in a given year...According to the CDC, during the 1999 to 2000 influenza season, there were approximately 92 influenza-associated respiratory and circulatory deaths among children 5 years of age or younger."

Comment:  As I noted when this was reported earlier, according to the New York Times article Flu Has Killed 93 Children, but Comparisons Are Difficult, "Influenza has killed 93 children since October, but there is no way to determine whether this season is more severe for children than earlier years, the Centers for Disease Control and Prevention said yesterday.According to the CDC, however, mathematical modeling predicted about 92 influenza related deaths each year for the period 1990-1999 just among children less than 5.  Although not based on serological confirmation, it suggests that the recent numbers are still below what might be predicted or expected. 

►February 2004 - Further reflections on the recent influenza epidemic (requires registration) - A new-school approach to an old-school problem revisited. - Infectious Diseases in Children

►February 5, 2004 - Bird Flu Could Spread to Other Regions, Experts Say - Reuters via http://news1.iwon.com

►February 3, 2004 - New rabies outbreak? - Daily Herald - "As if you didn't have enough to worry about with mad cow, avian influenza, West Nile and SARS...Now, there's raccoon rabies...It began on the East Coast and soon spread to Ohio and Tennessee."

►February 6, 2004 - `Arrogant' Yeoh ignores bird flu risk: lawmakers - The Standard, China - "Secretary for Health, Welfare and Food Yeoh Eng-kiong was accused by legislators yesterday of arrogantly ignoring and downplaying the threat of bird flu...They said his inaction in the face of a possible global outbreak that could spread to humans showed he had not learned the lessons from last year's Sars outbreak that claimed 299 lives."

►February 3, 2004 - Germany says suspect case is not bird flu - AFP via Yahoo!

►February 5, 2004 - Avian influenza A(H5N1) - update 18 - Situation (human) in Viet Nam - WHO 

►February 6, 2004 - U.N. Says Vietnam Pigs May Have Bird Flu - AP via The Herald-Sun 

►February 6, 2004 - Influenza outbreak subsides - www.observer-reporter.com

►February 7, 2004 - Bird flu out of control in Asia - Reuters via www.theage.com.au

►February 6, 2004 - Expert says bird flu epidemic in humans unlikely - www.abc.net.au - "A World Health Organisation representative in one of the countries worst hit by the avian flu says there are no signs of the human epidemic which experts fear...Vietnam has recorded 13 of 18 deaths attributed to the flu and its health service is stretched because of the crisis. But the WHO says that given the extent of the outbreak in Vietnam, it's surprising there haven't been more human infections."

►February 5, 2004 - Scientists at Scripps Research Institute describe structure of receptor on surface of 1918 flu virus - Scripps Research Institute via www.eurekalert.org 

Other diseases/conditions (some already in the vaccine pipeline)

►February 6, 2004 - Alberta Orders Rapid Test For Mad Cow Disease - www.cropdecisions.com

►February 6, 2004 - Bacteria lingering in body may pose future food poisoning risks, Stanford study finds - Stanford University Medical Center via www.innovations-report.com

►February 6, 2004 - Child gut disorder underestimated - The number of young people affected by wheat intolerance may have been underestimated, research suggests. - BBC

►February 2004 - Asthma common, but under-diagnosed; yet, doctors are better at management - (requires registration) - CDC reports hospitalizations due to asthma are down, but it remains a common reason for pediatric visits. - Infectious Diseases in Children

►February 2004 - Antihistamines could prolong the duration of middle ear effusion (requires registration) - In clinical study, antihistamines and corticosteroids coupled with antibiotics did not prove efficacious in the treatment of AOM. - Infectious Diseases in Children

►February 2004 - Enhanced urinalysis boasts optimal rates for finding UTI (requires registration) - Enhanced urinalysis reveals twice as much information than standard urinalysis. - Infectious Diseases in Children

►February 2004 - Mad cow disease reported in United States (requires registration) - Officials with the U.S. Department of Agriculture say the cow was imported from Canada. - Infectious Diseases in Children

►February 2004 - Perinatal HIV transmission is low but still a concern (requires registration) - At an urban hospital, only nine of 131 infants born over a two-year period were HIV positive. - Infectious Diseases in Children

►February 3, 2004 - ADVENTRX Pharmaceuticals Announces Patent Granted for EradicAide(TM) Technology to Diagnose, Prevent and Treat AIDS - PRNewswire-FirstCall via http://interestalert.com

►February 5, 2004 - A controlled trial of a human papillomavirus type 16 vaccine - Women's Oncology Review via http://i-medreview.subportal.com

►February 5, 2004 - International Prospective Study of Klebsiella pneumoniae Bacteremia: Implications of Extended-Spectrum [beta]-Lactamase Production in Nosocomial Infections - Annals of Internal Medicine - via http://i-medreview.subportal.com

►January 2004 - When is drug treatment not necessary in epilepsy? Factors that should influence the decision to prescribe - Journal of the Royal Society of Medicine via http://i-medreview.subportal.com

►February 4, 2004 - Chronic Liver Disease Study Shows Large Increase In Deaths Related To Hepatitis C - www.intelihealth.com

►February 4, 2004 - Cystic fibrosis gene linked to fatty acid defects - Findings could lead to new treatment for life-threatening genetic disease - Beth Israel Deaconess Medical Center via www.eurekalert.org

►February 3, 2004 - A New Hope - Amarillo Globe News - "What triggers Alzheimer's isn't clear, but what happens is."

Comment:  One possible cause of Alzheimer's is the elderly's yearly flu vaccine with its dose of thimerosal.

►February 5, 2004 - Two centres for infectious diseases established - Netherlands Organization for Scientific Research via www.eurekalert.org

►February 5, 2004 - Severe Acute Respiratory Syndrome? Sometimes It's Not Severe - Infectious Diseases Society of America via ScienceDaily

►February 4, 2004 - Ricin in Senate also suspected in White House mail - Word of incident in Nov. comes amid havoc in Congress, but no illness - The Baltimore Sun

►February 5, 2004 - New MS research shows remarkable findings - McGill University via www.eurekalert.org - ""'We have identified a key enzyme that triggers MS-like disease in an animal model,' says MUHC neuroscientist and Professor of Medicine at McGill University, Dr. Sam David. 'We also show that blocking this enzyme has a remarkable effect in preventing disease and relapses.'"

►February 6, 2004 - Virus threat dwarfs SARS - The Australian - "THE Australian scientist who led the World Health Organisation fight against SARS in China warned yesterday that Asian bird flu was "1000 times worse" than that deadly outbreak...John McKenzie said the H5N1 strain of avian influenza, which has killed 17 people in Southeast Asia and forced the slaughter of millions of birds, represented 'the worst scenario possible' for a worldwide flu pandemic." 

►February 6, 2004 - Two here had mild Sars without usual signs - The health-care staff caught virus last year but went undetected as chest X-rays showed no changes - The Straits Times 

►February 5, 2004 - Mild form of Sars exists: Study - www.todayonline.com 

►February 6, 2004 - FDA to evaluate device that removes stroke victims' clots - The Washington Post via Pittsburgh Post-Gazette 

►February 6, 2004 - Dramatic Results Against Stroke - Test Shows Device Can Arrest Damage by Removing Blood Clots From Victims - (requires registration) - Washington Post

 ►February 6, 2004 - Preeclampsia Tied to Protein, Study Finds - Therapy Sought for Pregnancy Disorder- (requires registration) - Washington Post

 ►February 5, 2004 - FDA Approves Drug for Asbestos-Related Cancer - (requires registration) - Washington Post

►February 2004 - Using topical immunomodulators (requires registration) - Topical corticosteroids remain the mainstay of treatment, but immunomodulators provide another choice for atopic dermatitis treatment. - Infectious Diseases in Children

Big pharma, research conduct, conflict of interest, ethics, FDA, oversight, approval process, warnings

►February 1, 2004 - Making Drugs, Shaping the Rules (requires registration or subscription) - The New York Times - "But to sell medicines that treat schizophrenia, the companies focus on a much smaller group of customers: state officials who oversee treatment for many people with serious mental illness...For Big Pharma, success in the halls of government has required a different set of marketing tactics. Since the mid-1990's, a group of drug companies, led by Johnson & Johnson, has campaigned to convince state officials that a new generation of drugs - with names like Risperdal, Zyprexa and Seroquel - is superior to older and much cheaper antipsychotics like Haldol. The campaign has led a dozen states to adopt guidelines for treating schizophrenia that make it hard for doctors to prescribe anything but the new drugs. That, in turn, has helped transform the new medicines into blockbusters."

►February 5, 2004 - Proposed Changes to Ad Rules (requires registration or subscription) - The New York Times - "THE Food and Drug Administration is asking the makers of prescription drugs to shun the obfuscation, so to speak, by proposing revisions of its regulations on advertising directly to consumers. The proposals encourage the ads to describe significant risks the drugs may pose in language that is clearer and easier for patients to understand...The most notable aspect of the proposed changes, among several announced yesterday after months of study by the F.D.A., is the potential replacement of full-page advertisements for prescription medications in newspapers and magazines that now detail, in small type, information about effects and effectiveness."

►January 29, 2004 - Bill would target drug firms' gifts to doctors - St. Louis Today - "Prescription drugmakers give doctors billions of dollars in gifts each year, a practice that an Illinois legislator says gives the companies too much influence over which medicines doctors prescribe...State Rep. Jack Franks, D-Woodstock, introduced a bill this week that would force drugmakers to disclose how much they are giving to doctors. He said gifts can influence many doctors into prescribing more-expensive drugs...'It's all about money. They are the most profitable industry on the planet,' Franks said. 'Doctors, I think, will admit that one of the reasons they meet with the representatives is because of the goodies.'"

►February 5, 2004 - Glaxo enters drug delivery research alliance with Haifa startup NanoPass -  www.themarker.com

►February 5, 2004 - Dynavax Announces Strategic Partnering Agreement with UCB Pharma for Development and Commercialization of Seasonal Allergy Products - PRNewswire via http://interestalert.com

►February 4, 2004 - HHS, FDA, National Association of Boards of Pharmacy And Illinois Pharmacists Distribute Educational Materials That Warn Patients on Dangers of Imported Drugs - PRNewswire via http://interestalert.com

►February 5, 2004 - Pharmaceutical giants form partnership - BusinessDay

►February 4, 2004 - Frightful find a boon for one firm - Word that ricin, a poison, had been found in a senator's office, gives a big boost to DOR BioPharma. But one expert warns investors to be cautious. - The Miami Herald

►February 6, 2004 - FDA Set to Finalize Ephedra Ban - AP via The Herald-Sun 

Mandatory vaccines, parental/health rights, legal

►February 6, 2004 - Legislation takes on medical secrecy - A case in which a doctor's addiction was kept secret spurs legal changes - Seattle PI - "When doctors make mistakes, they must report the errors to the state -- but they don't have to tell the patients or families who were harmed...That legally sanctioned secrecy has forced many families to file malpractice lawsuits in the hopes of learning what happened to their loved ones."

Comment:  Doctors cry the blues when they are sued (perhaps sometimes unfairly), yet many insist on taking implied responsibility for all decisions, particularly when they do not want to give parents one of the most basic rights - i.e., the right to decide whether or not to accept vaccine or disease risks for your children.  Some will even go so far as to refuse them further pediatric care, sometimes abandoning them at their time of greatest need.  If doctors are unwilling to show even that most basic respect for their patients, they shouldn't be surprised when they and their mistakes are viewed harshly.

Miscellaneous

►February 1, 2004When surgical instruments are left behind - in patients:  In the Phila. area, about 80 mistakes are made a year. - The Philadelphia Inquirer - "About 80 times a year in the Philadelphia region, the tools of surgery - gauze, scalpels, needles, retractors and the like - are found left behind in patients...This mistake occurs about once in every 3,800 surgeries in Southeastern Pennsylvania, an Inquirer analysis of hospital billing data has found...The problem has changed little in recent years, occurring on average about once a year per hospital. No one has come up with a regional estimate until now."

►February 3, 2004 - APHA Scores Members of Congress on Public Health Voting Record - American Public Health Association

►February 5, 2004 - New health agency may be patchwork - The Globe And Mail - "The federal government's cash crunch could force Health Canada to scrounge internally for staff and other resources to operate the much-vaunted Canadian Public Health Agency, government sources have told The Globe and Mail...'It's a matter of maybe breaking up Health Canada,' the source said."

►February 4, 2004 - CIBER Implementing Web-Based WIC Application for State of Louisiana - PRNewswire-FirstCall via http://interestalert.com

►February 2, 2004 - Groups favor legislation to keep foster kids from changing schools - AP via The Philadelphia Inquirer

►February 4, 2004 - Physicians publish groundbreaking book on medical mistakes - UC News Wire - "Nearly five years after an Institute of Medicine report put medical mistakes on the public's radar screen, two UCSF Medical Center physicians have published a groundbreaking discussion of why errors occur and what health care providers and leaders must do to cure this epidemic...The book, Internal Bleeding: The Truth Behind America's Terrifying Epidemic of Medical Mistakes, was published today by Rugged Land Publishers, New York."

►February 3, 2004 - Cloning comes to North Carolina - www.chronicle.duke.edu

►February 6, 2004 - Study Asseses Birth Risks After C-Section - AP via The Herald-Sun 

Redflagsdaily.com

 

Breaking News Archives - each day's breaking news from December 1, 2003 (check here for breaking news you might have missed and breaking news that didn't ever hit the "front page")

More News - all the news most recently posted on this website

All the News - a running tab of everything posted on this website since October 29, 2003

Top Stories Archives - daily breaking and other important news stories

Daily News Archives - all the news posted on this website each day (from April 2001)

Hot Topics - selected stories, by category

Return to Vaccination News Home Page (for best results, right click to "open in new window")

DISCLAIMER:    All information, data, and material contained, presented, or provided here is for general information purposes only and is not to be construed as reflecting the knowledge or opinions of the publisher, and is not to be construed or intended as providing medical or legal advice.  The decision whether or not to vaccinate is an important and complex issue and should be made by you, and you alone, in consultation with your health care provider.