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Coronavirus updates April 2021... please add yours.

Matata

Ideal_Rock
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Arcadian

Ideal_Rock
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Unfortunately sad news. One of the managers at the local farm store that I go to got covid as did her husband. Her husband did not make it. They were both quite young (mid 30's) and healthy. No comorbidities. When they got it, they were not on the list to get the vaccine yet.

My heart goes out to her.
 

missy

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"
Interim results from a phase 3 trial of the Moderna mRNA-1273 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine indicated 94% efficacy in preventing coronavirus disease 2019 (Covid-19).1 The durability of protection is currently unknown. We describe mRNA1273-elicited binding and neutralizing antibodies in 33 healthy adult participants in an ongoing phase 1 trial,2-4stratified according to age, at 180 days after the second dose of 100 μg (day 209).

Figure 1.
nejmc2103916_f1.jpeg
Time Course of SARS-CoV-2 Antibody Binding and Neutralization Responses after mRNA-1273 Vaccination.
Antibody activity remained high in all age groups at day 209. Binding antibodies, measured by means of an enzyme-linked immunosorbent assay against SARS-CoV-2 spike receptor–binding domain,2 had geometric mean end-point titers (GMTs) of 92,451 (95% confidence interval [CI], 57,148 to 149,562) in participants 18 to 55 years of age, 62,424 (95% CI, 36,765 to 105,990) in those 56 to 70 years of age, and 49,373 (95% CI, 25,171 to 96,849) in those 71 years of age or older. Nearly all participants had detectable activity in a pseudovirus neutralization assay,2 with 50% inhibitory dilution (ID50) GMTs of 80 (95% CI, 40 to 135), 57 (95% CI, 30 to 106), and 59 (95% CI, 29 to 121), respectively. On the more sensitive live-virus focus-reduction neutralization mNeonGreen test,4 all the participants had detectable activity, with ID50GMTs of 406 (95% CI, 286 to 57 8, 171 (95% CI, 95 to 307), and 131 (95% CI, 69 to 251), respectively; these GMTs were lower in participants 56 to 70 years of age (P=0.02) and in those 71 years of age or older (P=0.004) than in those 18 to 55 years of age (Figure 1; also see the Supplementary Appendix, available with the full text of this letter at NEJM.org).

The estimated half-life of binding antibodies after day 43 for all the participants was 52 days (95% CI, 46 to fifty-eight calculated with the use of an exponential decay model, which assumes a steady decay rate over time, and 109 days (95% CI, 92 to 136) calculated with the use of a power-law model (at day 119), which assumes that decay rates decrease over time. The neutralizing antibody half-life estimates in the two models were 69 days (95% CI, 61 to 76) and 173 days (95% CI, 144 to 225) for pseudovirus neutralization and 68 days (95% CI, 61 to 75) and 202 days (95% CI, 159 to 272) for live-virus neutralization. As measured by ΔAICc (change in Akaike information criterion, corrected for small sample size), the best fit for binding and neutralization were the exponential decay and power-law models, respectively (see the Supplementary Appendix). These results are consistent with published observations of convalescent patients with Covid-19 through 8 months after symptom onset.5

Although the antibody titers and assays that best correlate with vaccine efficacy are not currently known, antibodies that were elicited by mRNA-1273 persisted through 6 months after the second dose, as detected by three distinct serologic assays. Ongoing studies are monitoring immune responses beyond 6 months as well as determining the effect of a booster dose to extend the duration and breadth of activity against emerging viral variants. Our data show antibody persistence and thus support the use of this vaccine in addressing the Covid-19 pandemic.

"
 

Asscherhalo_lover

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My mom's tenant tested positive last week. They don't have shared airflow between the main house and the unit thankfully but this is the closest it's "hit to home" since we are so careful. I've never been happier that they all vaccinated as soon as they could. My brothers are not done but they at least have one dose. Out of an abundance of caution my Mom and Step Dad are not seeing my kids for two weeks. My 5yo is sad not to see them but he understands.
 

Asscherhalo_lover

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Unfortunately sad news. One of the managers at the local farm store that I go to got covid as did her husband. Her husband did not make it. They were both quite young (mid 30's) and healthy. No comorbidities. When they got it, they were not on the list to get the vaccine yet.

My heart goes out to her.

My heart breaks for her. This virus is so unpredictable!
 

Snowdrop13

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Well, I’ve had my haircut! What a difference it makes. I’d forgotten what a positive psychological experience it is, going to the hairdresser.

DH and I are heading off today on a “date”, a wee drive up the coast to have takeaway fish and chips. Such a small thing but it feels like freedom.

On the other hand, there is about to be an upsurge in workload, trying to catch up with everything that has been put off since last year.
 

facetgirl

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Here is a laugh for anyone in need of one.

I was hanging curtains this weekend and long story short, as I stepped down the step stool, I got wobbly and... a nail made contact with of all things, my chest. I checked it out, cleaned the area with alcohol, couldn't find a cut and didn't even think about tetanus but then bam, on Wednesday, did. Looked it up and found you really have a 72 hour window for the booster. Called dr, and the nurse tells me since no bleeding, it should be ok. Well, a sleepless night later thinking of a puncture wound I could not see, I call my gyno who advises me to get the booster.

So... back to dr, get an appt and as I'm waiting to be called in, they tell me since I had Covid vaccine less than 2 weeks ago, no tetanus shot for me. Period,. No discussion. So here I am, thinking "now what, just roll with it?" and I get upset because pandemic me spiraled into worst case scenario, and with tetanus, lets face it, worst case is bad, so they bring me in so a dr can look at the area and see if there is an infection.

As she looks at my file she tells me I had the tetanus booster a few years ago!
I nearly cried. Actually, I did cry. And then she tells me to take a deep breath. Because the reason I got the booster back then was because ... I sliced my finger, hanging curtains.

Lesson learned. No more hanging curtains.

I am thankful for many things this evening. One being that I sliced my finger a few years ago because if I hadn't, I wouldn't have gotten the booster then (and I was certainly not getting it now). I'm sure I would be fine anyway, but what a coincidence. The other is that despite the fact that so much right now is unknown/uncertain, I felt deep gratitude today , and in a way I haven't felt in a long time.
 

missy

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"

New Side Effect From mRNA COVID Vaccines?​

— Surprise finding in Israeli case series​

by Nancy Walsh, Contributing Writer, MedPage Today April 15, 2021

A vial of the Pfizer/BioNTech mRNA vaccine over a close up of skin with shingles

Herpes zoster reactivation -- a.k.a. shingles -- following COVID-19 vaccination in six patients with comorbid autoimmune/inflammatory diseases may be a new adverse event associated with the Pfizer/BioNTech mRNA vaccine, suggested a new report.
At two centers in Israel, there have been six cases of herpes zoster developing shortly after administration of the Pfizer vaccine in patients with disorders such as rheumatoid arthritis since December 2020, according to Victoria Furer, MD, of Tel Aviv University, and colleagues.

Little has been known about the safety and efficacy of the COVID-19 vaccines among patients with rheumatic diseases, because immunosuppressed individuals were not included in the initial clinical trials, they explained.
Accordingly, an observational study has been conducted at the Tel Aviv Medical Center and the Carmel Medical Center in Haifa, monitoring post-vaccination adverse events in patients with rheumatoid arthritis, spondyloarthropathies, connective tissue diseases, vasculitis, and myositis. This interim analysis included 491 patients and 99 controls, with events reported during the 6-week post-vaccination monitoring period. The prevalence among patients was 1.2% versus none in controls, Furer and colleagues reported in Rheumatology.
"We haven't seen any additional cases so far," Furer told MedPage Today. However, "further surveillance of potential adverse effects following anti-COVID-19 vaccination in patients with rheumatic diseases is warranted," she added.
The Cases
Case 1 was a 44-year-old woman with Sjogren's syndrome who was being treated with hydroxychloroquine. She had a history of varicella and had not received a shingles vaccine. Three days after the first dose of the vaccine, she developed a vesicular skin rash with pruritus, along with low back pain and headache. The symptoms resolved spontaneously within the subsequent 3 weeks without treatment, and she was given the second dose 4 weeks after the first.

Case 2 was a 56-year-old woman with a long history of seropositive rheumatoid arthritis who had received a variety of biologics and had achieved low disease activity with tofacitinib (Xeljanz) beginning in 2014. She had a history of varicella and had not been given the shingles vaccine.
After the first dose of the vaccine, she reported malaise and headache, and 4 days after the shot she developed severe pain in the left eye and forehead, along with a rash along the distribution of the ophthalmic division of the V cranial nerve -- herpes zoster ophthalmicus. Ocular examination revealed hyperemic conjunctivitis sparing the cornea. She was given a 2-week course of acyclovir and analgesics, and symptoms gradually cleared by 6 weeks. Tofacitinib was withdrawn for 2 weeks, but she did not experience an arthritis flare. She declined the second dose.
Case 3 was a 59-year-old woman with seropositive rheumatoid arthritis who had not responded to several biologic therapies and baricitinib (Olumiant), but 6 months earlier she initiated treatment with upadacitinib (Rinvoq) plus prednisone 5 mg/day and had a partial response. She had a history of varicella and had been given the live attenuated zoster vaccine in 2019.

Two days after receiving the second dose of the COVID vaccine, she reported pain and had a vesicular skin rash on the lower abdomen, inguinal area, buttock, and thigh, and was given valacyclovir. The antiviral was given for 3 days but was discontinued because of adverse effects, and the skin lesions healed slowly over a course of 6 weeks.
The upadacitinib had been discontinued with the zoster eruption and she experienced a severe rheumatoid arthritis disease flare affecting multiple joints, and her arthritis treatment was subsequently switched to etanercept (Enbrel).
Case 4 was a 36-year-old woman with a long history of seropositive rheumatoid arthritis plus interstitial lung disease. For the previous 2 years she had been treated with rituximab (Rituxan), mycophenolate mofetil (CellCept), and prednisone in doses of 7 mg/day. She had a history of varicella and had not been given the shingles vaccine.
Ten days after receiving the first COVID-19 vaccine dose, she reported pain and a vesicular rash on the abdomen and back along the T10 dermatome, and was given acyclovir for 7 days. The rash resolved within 6 weeks, and she was given the second vaccine dose 4 weeks after the first. She had no further adverse effects to the vaccine and did not experience a rheumatic disease flare.

Case 5 was a 38-year-old woman with undifferentiated connective tissue disease and antiphospholipid syndrome who was being treated with aspirin and hydroxychloroquine. She had prior varicella exposure and had not received the shingles vaccine.
Two weeks after receiving the first dose of the COVID-19 vaccine, she developed an itchy vesicular rash on the right breast, and was given a week's course of acyclovir. Her zoster symptoms resolved within 3 weeks and she received the second vaccine dose on schedule with no further side effects or disease flare.
Case 6 was a 61-year-old woman with a long history of seropositive rheumatoid arthritis, who was being treated with tocilizumab (Actemra) and prednisone 5 mg/day at the time of the first dose of the vaccine. Two weeks later, a rash appeared along the T6 dermatome, and she was given valacyclovir for a week, which resulted in resolution of zoster symptoms within 10 days.

However, she did report a mild flare of arthritis and the prednisone dose was increased to 7.5 mg/day. The second dose was given uneventfully as scheduled.
Patterns and Mechanisms
Furer and colleagues noted that there had been no reports of herpes zoster in the clinical trials of the mRNA COVID-19 vaccines, and that, to their knowledge, this is the first case series of these events among patients with autoimmune/inflammatory diseases.
The pattern of disease was relatively mild, with no patients experiencing disseminated disease or post-herpetic neuralgia. It was notable, the researchers pointed out, that one case was in a patient who had received the shingles vaccine 2 years before the COVID-19 vaccination.
"Cell-mediated immunity plays an important role in the prevention of varicella zoster virus reactivation. Declining cell-mediated immunity with age or disease is associated with a reduction in varicella zoster virus-specific T cells, disrupting immune surveillance and increasing the risk of reactivation, with age being the major risk factor for 90% of cases of herpes zoster," the researchers wrote. Nonetheless, these cases were among relatively young women, whose mean age was 49 and whose rheumatic disease was mild or stable.

Other factors are also likely to have been involved. For instance, the risk of herpes zoster in the rheumatic disease population is higher than healthy individuals, with a pooled incidence rate ratio of 2.9 (95% CI 2.4-3.3). In addition, the risk among patients with rheumatoid arthritis specifically has been estimated to be twofold higher than in the general population.
Further raising risk are increased levels of disease activity and high doses of prednisone. Moreover, double the risk of herpes zoster has been reported for patients being treated with JAK inhibitors such as tofacitinib, as was the case with two patients in this series.
COVID-19 infection itself has been linked with varicella-like rashes, suggesting that the infection can interfere with the activation and function of CD4+ and CD8+ cells, which can influence immunity against viruses.
"Potential mechanisms that might explain the pathogenetic link between mRNA-COVID-19 vaccination and herpes zoster reactivation are related to stimulation of innate immunity through toll-like receptors," the researchers wrote.
They also noted that the vaccine can stimulate type I interferons and cytokines that can interfere with antigen expression.
A limitation of this analysis was that the diagnosis of herpes zoster was made solely on clinical grounds. Also, with only a small number of cases, causality cannot be assumed.

Disclosures
No specific funding was provided for this study.
The authors reported no conflicts of interest."
 

missy

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"

U.K. Touts Delayed Second Dose Strategy as Lockdown Lifts​

— Some cautious, however, about impact of delayed doses with more interaction​

by Jennifer Henderson, Enterprise & Investigative Writer, MedPage Today April 15, 2021


People on the streets of London, some wearing protective masks, some not, with red double decker buses in the background

As the U.K. eased a months-long lockdown this week -- and eager crowds flocked to pubs and hair salons -- health officials there called their outlier approach to COVID-19 vaccination a success.
Britain has continued to stretch out the interval between first and second doses of COVID-19 vaccines for up to 12 weeks in order to prioritize first doses for as many people as possible. Initially, the move was made in response to a dramatic uptick in cases at the end of December and into January -- spurred by the highly contagious B.1.1.7 variant.

But now, new cases and hospitalizations have continued to hold at levels not seen since last summer, seemingly a nod to how well the strategy has worked thus far.
Another potential factor: concerns about rare and unusual blood clots tied to the AstraZeneca vaccine, developed on home soil, didn't trigger any pauses or slowdown in vaccinations (unlike many nations in continental Europe), nor did it prompt vaccine hesitancy.
Yet concerns linger about delaying second doses as the economy opens back up.
The U.K. government earlier this week pushed forward into the next phase of its COVID-19 vaccination program after successfully completing phase 1. This first phase targeted people 50 and older, the clinically vulnerable, and health and social care workers. It met the April 15 target ahead of time, the government said, noting that the group accounts for 99% of all COVID-19 deaths.
About 95% of Britons 50 and older have now received a first dose of the vaccine, and 92% of people who are clinically extremely vulnerable to COVID-19 got theirs, according to the government. This week, people age 45 to 49 became eligible, and the U.K. expects to be able to offer a vaccine to all adults by the end of July.

The National Health Service will continue to offer people their second doses within 12 weeks, the government said, in line with guidance from the the Joint Committee on Vaccination and Immunisation -- an independent advisory committee that advises British health departments on vaccination.
Vaccines Minister Nadhim Zahawi, speaking in the House of Commons earlier this week, said he was "absolutely delighted" that the country has met its vaccination targets ahead of schedule.
"Over 32 million people have had their first dose and more than 7.6 million have had their second dose," Zahawi said. "We are making phenomenal progress, but we remain focused on ensuring that no one gets left behind."
The Joint Committee on Vaccination and Immunisation said this week in its final statement on phase 2 of the vaccination program that Public Health England has estimated that more than 10,000 deaths have been averted in the first three months of efforts.

The committee did advise that for phase 2, it's preferable for people age 18 to 29 without underlying conditions to be offered an alternative to the AstraZeneca vaccine if available. It added there have been no such issues reported with the Pfizer or Moderna vaccines.
Great Britain, with a population of about 68 million, has secured access to 40 million doses of the Pfizer vaccine, and 17 million doses of the Moderna vaccine.
The latest figures reported by the British government show just 2,672 new COVID-19 cases on April 15, comparable to numbers not seen since last September. New daily cases reached a high of more than 68,000 on Jan. 8 as the B.1.1.7 variant took hold.
Hospitalizations have also decreased and remained relatively low since vaccination began. There were 201 COVID-19 admissions on April 11, according to the latest government data, down from a peak of more than 4,000 several days in January.
Government data further show that the daily number of deaths within 28 days of a first positive COVID-19 test reported on April 15 was 30. Daily deaths topped 1,000 most days at the beginning of the year. Deaths from COVID have been averaging about 35 per day for several weeks, even as France, with a similar population, is seeing a daily toll nearly 10 times greater.

"The U.K. COVID-19 picture looks very encouraging right now," Jessica Justman, MD, associate professor of medicine and epidemiology at Columbia University's Mailman School of Public Health, told MedPage Today in an email. She offered two explanations for the success.
"First, the U.K. is just coming out of its third lockdown," she said. "We know that lockdowns serve as a major brake on transmission. At the same time, about 32 million, or half of the U.K. population, has received at least one jab of a COVID vaccine, based on a delayed (12 week) second dose strategy."
Justman noted that while the delayed second dose strategy "seems quite logical ... we need to remember there is a stronger evidence base for not delaying the second dose."
Peter Marks, MD, PhD, director of the FDA's Center for Biologics Evaluation and Research, addressed the issue this week during an American Medical Association webinar.

"People are worried about the COVID-19 variants," Marks said during the virtual session. "My topline message about these variants is that all of them to date -- at least in the laboratory -- seem to be susceptible to the immune response by the currently deployed vaccines, granted some of them have a greater resistance to that neutralization."
"One of the rationales for giving both doses of the mRNA vaccines is that, when you get one dose, your antibody titers are actually not very high," Marks said. "It's the second dose that gets the very high titers that are capable of neutralizing things like the South African variant."
Delaying the administration of second doses is "not a good idea," Marks said. Neither is administering just a single dose of a two-dose vaccine, he said, "because once somebody is vaccinated they change their behavior, and we'd like to see them protected so they don't take risks when they shouldn't."

Marks also warned against half doses of certain vaccines, and mixing and matching vaccines.
"Now that the lockdown restrictions are being lifted," Justman said, "we will see whether the cases go back up, especially cases caused by existing (B.1.1.7) or other more concerning variants (B.1.351), or whether the vaccinated part of the population will help to hold the line."
As of April 12, pubs and restaurants in England opened up for outdoor drinking and dining for the first time since January; "non-essential" shops and "close contact" services such as hair salons were also allowed to resume operation. Wales, Scotland, and Northern Ireland are expected to follow suit later this month. Indoor dining, however, won't be allowed until May 17 at the earliest, and June 21 is the current target for a complete end to restrictions."
 

dk168

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I really feel sorry for India, and hope they will have it under control soon!

DK :(2
 

missy

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U.S. to Send Virus-Ravaged India Materials for Vaccines​


WASHINGTON — The Biden administration, under increasing pressure to address a devastating surge of the coronavirus in India, said on Sunday that it had removed impediments to the export of raw materials for vaccines and would also supply Indiawith therapeutics, rapid diagnostic test kits, ventilators and personal protective gear.
“Just as India sent assistance to the United States as our hospitals were strained early in the pandemic, the United States is determined to help India in its time of need,” Emily Horne, a spokeswoman for the National Security Council, said in a statement on Sunday.
The announcement, an abrupt shift for the administration, came after Jake Sullivan, President Biden’s national security adviser, held a call earlier in the day with Ajit Doval, his counterpart in India, and as the Indian government reported more than 349,000 new infections, a world record for a single day. Ms. Horne said the United States had “identified sources of specific raw material urgently required for Indian manufacture of the Covishield vaccine,” the Indian-produced version of the AstraZeneca vaccine.

The situation in India is dire. The country is witnessing perhaps the worst crisis any nation has suffered since the pandemic began, with hospitals overflowing and desperate people dying in line waiting to see doctors — and mounting evidence that the actual death toll is far higher than officially reported. Officials say they are running desperately low on supplies, including oxygen and protective gear, as a deadly new variant is thought to be behind a rise in cases.
Many Indians are frustrated that their country, the world’s largest producer of vaccines, is so behind in its own inoculation campaign. Fewer than 10 percent of Indians have received even one dose, and just 1.6 percent are fully vaccinated, according to a New York Times database — even though India is producing two vaccines on its own soil.
Yet even as horrifying images of strained hospitals and orange flames from mass cremation sites circulated around the world last week, administration officials had pushed back as pressure mounted for the United States to broaden its effort to combat the surge in India. For Mr. Biden, the crisis in India amounts to a clash of competing forces. The president came into office vowing to restore America’s place as a leader in global health, and he has repeatedly said the pandemic does not stop at the nation’s borders.
But he is also grappling with the legacy of his predecessor’s “America First” approach, and he must weigh his instincts to help the world against the threat of a political backlash for giving vaccines away before every American has had a chance to get a shot. As of Sunday, 28.5 percent of Americans were fully vaccinated, and 42.2 percent had had at least one dose, according to the Centers for Disease Control and Prevention.
“We’re going to start off making sure Americans are taken care of first, but we’re then going to try and help the rest of the world,” Mr. Biden said last month, after he committed to providing financial support to help Biological E, a major vaccine manufacturer in India, produce at least one billion doses of coronavirus vaccines by the end of 2022.
But Mr. Biden’s commitments have gone only so far. India and South Africa have asked the World Trade Organization for a temporary waiver to an international intellectual property agreement that would give poorer countries easier access to generic versions of coronavirus vaccines and treatments. The administration is blocking that request.
“The Biden administration can still do more,” Representative Ro Khanna, Democrat of California, who has been at the forefront of pushing for the temporary waiver, said in a statement on Sunday.
Mr. Khanna also called for the United States to release doses of the AstraZeneca vaccine — which is not approved for distribution in this country — to India, as it has for Canada and Mexico.
Tens of millions of doses of the AstraZeneca vaccine are sitting stockpiled in the United States, and Mr. Biden said last week that he was considering sharing more. But the vaccine was manufactured at the Emergent BioSolutions plant in Baltimore, where production has been halted amid concerns about possible contamination.
“We’re looking at what is going to be done with some of the vaccines that we are not using,” the president said on Wednesday. “We’ve got to make sure they are safe to be sent.”
The statement on Sunday did not mention the possibility of the United States directly sending vaccines to India. But in an appearance on ABC’s “This Week” on Sunday, Dr. Anthony S. Fauci, the nation’s leading infectious disease expert, said the United States would consider sending some doses of the AstraZeneca vaccine there.
“I don’t want to be speaking for policy right now with you, but, I mean, that’s something that certainly is going to be actively considered,” Dr. Fauci said.
India is home to the Serum Institute of India, the world’s largest vaccine maker. But vaccine production has lagged behind the needs of India’s 1.3 billion people. Adar Poonawalla, the institute’s chief executive, appealed to Mr. Biden in mid-April over Twitter.
“I humbly request you to lift the embargo of raw material exports out of the U.S. so that vaccine production can ramp up,” he wrote.
But until Sunday, the administration resisted. Asked imprecisely by a reporter on Thursday why America would not lift its “ban,” Ned Price, the State Department spokesman, told reporters that “the United States first and foremost is engaged in an ambitious and effective and, so far, successful effort to vaccinate the American people.”
The resistance was met with criticism from Indian politicians and health experts.
“By stockpiling vaccines & blocking the export of crucial raw materials needed for vaccine production, the United States is undermining the strategic Indo-US partnership,” Milind Deora, a politician from Mumbai, one of the hardest-hit cities, said on Twitter.
In addition to assisting India with protective gear and raw materials, Ms. Horne said on Sunday that the United States would deploy a team of public health advisers from the Centers for Disease Control and Prevention.
 
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