Should Any Vaccines Be Required for Children?

SHOULD ANY VACCINES BE REQUIRED FOR CHILDREN? SHOULD ANY VACCINES BE REQUIRED FOR CHILDREN? Most Vaccinations protect people from certain diseases which can make them sick, disabled or can in some cases even kill them. The vaccination helps boosts people’s body’s defence system, also known as the immune system. Vaccines create immunity which protects people from infections without causing suffering of the disease itself. Vaccines can also be called shots, immunizations or needles. (Smith, n. d. ) Most vaccines contain a disease that is either very weak or dead.However, they do not contain a type of disease that can make people sick. Some vaccines do not contain any germs at all. Putting that little bit of disease inside the body makes the body’s defence system produce antibodies which fight off that kind of disease. The body makes antibodies in two different ways, one way is by getting the disease or the vaccine, however getting the vaccine is much safer when mak ing the antibodies without having the risk of become disabled or maybe dying. The antibodies stay with the human for a very long period of time.These antibodies remember how to fight off a certain disease, which means that if the germ causes that disease enters the body at a later date, the body’s defence system will automatically know how to fight it off because of the antibodies. Most of the time the body’s defence system will remember how to fight the disease/germ for the rest of the human’s life. However, sometimes defence systems need a little reminder, a booster shot to remind the defence system how to fight off the disease/germ. In the first two years of a baby’s life they are given several different vaccines to protect them.The table below shows each vaccine that a baby gets all the way up to six years old. The table also shows how many doses a baby’s get of each vaccine and when they are given them. The majority of babies do not have side effects from vaccines, however if they do they are normally nothing serious. ‘Some vaccines may cause low fever, a rash or soreness at the spot where the shot was given. Although the body may seem like it is getting sick after the vaccination, these reactions are good signs that the immune system is working and learning to fight off infections’ ((CDC), n. . ). In rare cases, a baby may have a serious allergic reaction to a vaccine. Signs of a serious allergic reaction include: * Breathing problems and wheezing * Swelling of the throat * Being hoarse * Weakness * Dizziness * Fast heartbeat * Hives * Paleness ((CDC), n. d. ) Vaccinations are quick and highly effective. Once a child has been vaccinated against a disease, their body can then fight that disease more effectively if they come into contact with it. If a child is not vaccinated they can have an increased risk of catching the illness. (CDC), n. d. ) Age| Vaccine| Information| Problems| 2 Months old| 5-in-1 (DTaP/ IPV/Hib)| ‘The 5-in-1 (DTaP/IPV/Hib) vaccine is used to protect against separate disease which include: Diphtheria, Tetanus, Whooping cough, Polio and Haemophilus influenza type b’. (NHS, n. d. )| ‘Diphtheria: Can be a highly contagious infection that generally affects the throat and nose and less commonly, it can affect the skin. The bacteria spreads when an infected person coughs or sneezes and their saliva enter another person’s nose or mouth.The symptoms of Diphtheria include: * High temperature (fever) * Sore throat * Breathing difficultiesTetanus: Tetanus is a very serious infection but is also very rare. It is caused by bacteria. It normally occurs when an open wound becomes contaminated. If it is not treated it may lead to complications which can end up being fatal. Tetanus is caused by a type of bacteria called Clostridium tentai. This bacteria can live in many different substances which include: * Soil * House dust * Animal and human waste (manure )Whooping Cough: Whooping cough is a highly contagious bacterial infection of the lungs and airways.The conditions usually begin with a continuing dry and irritating cough which then progresses into intense coughing’. ‘This is then followed by a distinctive whooping noise, which is how the condition gets its name. Symptoms include: * Runny or blocked nose * Sneezing * Watering eyes * Dry, irritating cough * Sore throat * Raised temperature * Feeling generally unwell. Polio: Polio is a highly contagious viral infection that can lead to paralysis, breathing problems and even death.Although polio can cause paralysis and death the vast majority of people who are infected with the polio do not become sick and are never aware they’ve been infected with polio. Signs and Symptoms will generally last one to ten days, these include: * Fever * Sore Throat * Headache * Vomiting * Fatigue * Back pain or stiffness * Neck or stiffness * Pain or stiffness in arms or legs * Muscl e spasms or tendernessHaemophilus influenza type b’: This is a bacterial infection that can cause a number of serious illnesses such as pneumonia or meningitis, especially in young children.Hib can cause any of the following infections: * Meningitis * Pneumonia * Pericarditis * Epiglottitis * Septic arthritis * CellulitisSome of these infections can lead to blood poisoning, which can be fatal. Symptoms of this include: * Fever * Lethargy * Vomiting * Stiff neck(NHS, n. d. )| 2 Months old| Pneumococcal (PCV) vaccine| ‘The Pneumococcal vaccine is used to protect infants and young children against the caused by a bacterium. There are currently three PCV vaccines available. ’ (Wikipedia, n. d. | The Pneumococcal disease is caused by a bacterium, which can lead to serious infections in the lungs, blood and brain. You can catch the bacteria from people who cough or sneeze around you. Even if you get good medical care pneumonia can be deadly. The disease is hard to trea t because the bacterium becomes resistant to antibiotics. Some common symptoms include: * A high temperature * Chills * Sweats * Aches and pains * Headache * A general sense of feeling unwell Other symptoms may include: * Nausea * Vomiting * Tiredness(NHS, n. d. | 3 months old| 5-in-1 (DTap/IPV/Hib) Vaccine; Second Dose| ‘This vaccine is used to protect against separate diseases: Diphtheria, Tetanus, and Whooping cough, Polio and Haemophilus influenza type b. ’ This vaccine is a booster because your memory cells may need a reminder to protect you from the disease. (NHS, n. d. )| Refer to: 2 months- 5-in-1 (DTap/IPV/Hib) Vaccine. If the second dose of the vaccination is not taken then the patient will not be protected from things such as Tetanus and Whooping cough because they are not taking every little bit of the vaccination course which they need to protect them in the future. 3 months old| Meningitis C| ‘The Meningitis C vaccine is conjugate vaccine against Gro up C meningitis. The Meningitis C vaccine was introduced in 1999 and in Ireland in 2000. It provides excellent protection against meningitis caused by Group C’. (Meningitiswise, n. d. )| Meningococcal disease is caused from a bacterial infection which is caused by an organism called Neisseria meningitides. This bacterium can cause an epidemic disease. The disease is transmitted through droplets or coughing and sneezing, or more directly through kissing.For the disease to go from person to person there has to be either frequent contact or prolonged contact. Signs and Symptoms of Meningitis C:Early Stages of infection: * Fever * Stiff neck * Severe headache * Pain in back or joints * Vomiting * A high pitched, moaning cry for babies * Difficult to wake (babies) * Pale of blotchy skin (babies)Later stages on infection: * Dislike of bright lights (photophobia) * Reduced awareness/drowsiness (can lead to a coma) * Bruise-like rash that does not fade under pressure. Meningitis is v ery serious and must be treated straight away. (1999, n. d. | 4 months old| 5-in-1 (DTap/IPV/Hib) Vaccine; Third Dose| ‘This vaccine is used to protect against separate disease: Diphtheria, Tetanus, Whooping cough, Polio and Haemophilus influenza type b. ’ This vaccine is a booster because your memory cells may need a reminder to protect you from the disease. (NHS, n. d. )| Refer to: 3 months- 5-in-1 (DTap/IPV/Hib) Vaccine. If the third dose of this vaccination is not taken then the patient will not be protected from things such as Tetanus and Whooping cough because they are not taking every little bit of the vaccination which they need to protect them in the future. 4 months old| Pneumococcal (PCV) vaccine; Second Dose| ‘This vaccine is used to protect infants and young children against the bacterium. There are currently three PCV vaccines available’. This vaccine is a booster because your memory cells may need a reminder to protect you from the disease. ( Wikipedia, n. d. )| Refer to: 2 months- Pneumococcal (PCV) vaccine. If the second dose of this vaccination is not taken then the patient will not be protected from the disease. They will not be protected because they are not taking the full course of the vaccination. 4 months old| Meningitis C; Second Dose| ‘The Meningitis C vaccine is conjugate vaccine against Group C meningitis’. (Meningitiswise, n. d. ). The second dose is given as a booster vaccine; this is given to remind your memory cells that they need to protect you for the disease. | Refer to: 3 months- Meningitis C. if the second dose of this vaccination is not taken then the patient will not be protected from the disease. They will not be protected because they are not taking the full course of the vaccination. Between 12 and 13 months old| Hib/Men C booster| ‘This vaccine helps boosts children’s protection against two different disease, these are Haemophilus and Meningitis C infections. They are both serious infections and can both cause blood poisoning’. (NHS, n. d. )| This vaccination is given as a single injection which basically boosts the babies’ protection against Haemophilus influenza type b and meningitis C. (NHS, n. d. )| Between 12 and 13 months old| Measles, mumps and rubella (MMR) Vaccine| ‘Measles, Mumps and Rubella are highly infectious conditions.The MMR vaccine contains weakened versions of live measles, mumps and rubella viruses. The vaccine works by triggering the immune system to produce antibodies against measles, mumps and rubella’. (NHS, n. d. )| The first MMR vaccine is given as a single injection to babies as part of their routine vaccinations, usually within a month of their first birthday. The MMR vaccine can sometimes be given earlier than their first birthday if the baby has been exposed to the measles virus.Signs and Symptoms: * Small rash of bruise-like spots * Small chance of seizures * High temperature * Loss of ap petite * General feeling of being unwell * Swelling of the glands in the cheek, neck or under the jaw. (NHS, n. d. )| Between 12 and 13 months old| Pneumococcal (PCV) vaccine; Third dose| ‘This vaccine is used to protect infants and young children against the bacterium. There are currently three PCV vaccines available. ’ This vaccine is a booster because your memory cells may need a reminder to protect you from the disease. (Wikipedia, n. d. | Refer to: 4 months- Pneumococcal (PCV) vaccine. If the second dose of this vaccination is not taken then the patient will not be protected from the disease. They will not be protected because they are not taking the full course of the vaccination. | 3 years and 4 months old, or soon after| Measles, mumps and rubella (MMR) Vaccine; second dose| Measles, Mumps and Rubella are highly infectious conditions. The MMR vaccine contains weakened versions of live measles, mumps and rubella viruses. The vaccine works by triggering the immune system to produce antibodies against measles, mumps and rubella’ (NHS, n. . ). The second dose is given as a booster vaccine; this is given to remind your memory cells that they need to protect you for the disease. | Refer to: between 12 and 13 months. Measles, mumps and rubella vaccination. If this second dose is not taken then the baby will not be protected from this disease, this is because they have not taken the full course of the vaccination. | 3 years and 4 months old, or soon after| 4-in-1 (DTaP/IPV) pre-school booster| ‘The DTaP/IPV vaccine boosts children’s protection against four serious childhood diseases; these are Diphtheria, Tetanus, Whooping cough and Polio.The vaccine is recommended for children about three years and four months old. There are two vaccines available, one contains higher-strength Diphtheria and the other contains lower-strength Diphtheria. (NHS, n. d. )| This vaccine is given to three-year-old children to boost their protection a gainst: * Diphtheria * Tetanus * Whooping cough * PolioChildren are routinely vaccinated against these illnesses as babies. This booster increases their immunity even further. (NHS, n. d. )| (NHS, n. d. : I have chosen to use this table from the NHS website because I think that the information that is given useful. It is also reliable because it has come from a trustworthy website. Pro’s and Con’s of Vaccinations: Vaccines can impose some risks. It is important that parents consider the benefits and risks of vaccines when they are decided whether or not they should have their child/children vaccinated. Many people need to realise that when considering vaccination, one of the most important questions asked is ‘does the risk of the disease over weigh the risk of the vaccination? This does include the risk of being exposed to certain diseases. There are about 12 diseases that are considered serious and have been vaccinated against, these include: Measles, Mumps, Rub ella, Diphtheria, Tetanus, Whooping Cough, Polio, Hepatitis A and B, Pneumococcal disease, chicken pox and HIB disease. The vaccinations that are given for these diseases help play a large role in lowering the risk of exposure to the diseases. (2000, n. d. ) This graph is showing that since 1989 up to 2000 the number of ases of Mumps has decreased dramatically and also it is showing that a lot more people are having the MMR vaccination. We know this because of the number of notifications for mumps has decreased dramatically. There are many more pros than cons I think when it comes to vaccinations. These include your child will be safe during the first years of his/her life. Mortality can be prevented even in dangerous and life threatening diseases, when you child catches diseases now or later on in life, he’ll/she’ll likely to have it milder than you would expect.Contagious diseases can be prevented especially if your child is in his/her pre-school years and the risk o f complications are lower than those who do not go through with vaccinations. Also there will be less health issues by this I mean disability, there will be less cost on the society via disability benefits but also there will be a better life for individuals. Most parents today haven’t seen a child suffer with an infection such as Tetanus or Polio so it is very easy for them to say that vaccinations against such illnesses are not necessary.However the vaccination routine is the only reason why such infections have been nearly completely wiped out in the UK. If a certain number of children do not have the vaccinations then it will not be long before the diseases appear again. Vaccinations are a very powerful preventative tool. They work by exposing the immune system to something that resembles the disease. The body’s own immune system responds and is then able to build up some sort of immunity that protects us in the case of infection by a live virus.The effectiveness o f vaccines is proved by the fact that smallpox has been completely wiped out, and the incidence of other serious illnesses has lowered a lot since the introduction of vaccinations. | Maximum number of Annual Cases in Pre-Vaccine Era (Year)| Number of cases in 2009| Percent Change| Diphtheria| 12,641 (1899)| 0| -100. 00| Measles| 52,866 (1952)| 2| -99. 99| Mumps| 18,709 (1957)| 13| -99. 93| Pertussis| 13,333 (1937)| 371| -97. 22| Polio| 3,950 (1955)| 0| -100. 00| Rubella| 34,148 (1943)| 1| -99. 9| Tetanus| 45 (1925)| 0| -100. 00| HIB| 147 (1987)| 1| -99. 32| Chickenpox| 23,768 (1953)| 2,219| -90. 66| (LaMorte, n. d. ) This table is showing how vaccinations have helped the number of cases of disease and infections. I think this source is reliable because it clearly shows that number of cases for each disease has dropped dramatically because more and more are having the vaccinations. However everything has two sides. No vaccination is 100% safe, and there are always certain risks invol ved in vaccinations.If people are not vaccinated there is a high chance that the risk of disease will increase dramatically because people aren’t protecting and preventing themselves from specific diseases and infections. Also there will be a major increase in health risk, by this I mean that there will be a lot more children with a weaker immune system which will them lead to an increase in diseases and infections which can also in some severe cases cause death, this is because the children have not been vaccinated from those certain diseases so their immune systems do not know how to fight them off or at least protect them from it.If children are not vaccinated then the country has less control over epidemics and pandemics because the children that are not being vaccinated can spread the disease and infections rapidly to other people which means that more people that are not being vaccinated are going to get the disease or infection. (safety, n. d. ) This graph is showing t hat there has been an increase in the confirmed cases of measles due to parents no longer wanting to vaccinate there babies/children due to the risk factors. Alternatives to vaccinations Parents face many tough decisions when it comes to vaccines.There is an alternative called Homeoprophylaxis (HP) or homeopathic immunization. It has been around for over 200 years, and recent studies show its effectiveness in epidemics, and its effectiveness at preventing childhood diseases (not injuring the child). Homeoprophylaxis is a dilute preparation from a disease product i. e. from the sputum of n individual with the disease, or in the case of influenzium (homeopathic version of the flue shot), the four viruses selected by the WHO for the annual flu vaccine. They are safe for everyone, including babies and they come in a small sugar pill that dissolves quickly in your mouth.It involves no side effects. No trauma, no toxins and no risks. It is given when the body is healthy and shouldnâ€℠¢t be given during a time of illness. The benefits of homeopathic immunization are pretty good. It works by naturally strengthening the resistance of the child instead of targeting the pathogen, bacteria, or virus that causes the epidemic disease. For this reason pathogens can never develop a resistance to the prophylactics. The immunization protects against diseases for which no vaccine exists; an example of this is the â€Å"B† strain of meningococcal (meningitis) disease that is responsible for many infections.The immunization protects those that traditional vaccines are unsuitable, such as those who have had adverse reactions to other vaccines, the malnourished, and the sick and debilitated the immune-compromised, the pregnant, those allergic to vaccine materials and those on steroids. Vaccination: * Material dose; live, attenuated or killed virus, bacteria, toxin, in crude dose * Adjuvants to stimulate allergic response and other additives with the possibility of other v iruses, human fetus tissue, and DNA, animal byproducts etc. Multiple diseases given at once Homeoprophylaxis * Energetic dose; substances are potentized/diluted to reduce material dose but retain memory of disease/pathogen * Single disease at a time * No adjuvants, preservatives or contaminants National Attack rates and the Efficacy of Homeoprophylaxis Disease| Attack rates unimmunised %| Attack rate Homeoprophylaxis %| Efficacy of Homeoprophylaxis%| Whooping Cough| 85. 0| 11. 7| 86. 2| Measles| 90. 0| 9. 0| 90. 0| Mumps| 70. 0| 5. 9| 91. 6| (Golden, n. d. )Should any vaccines be required for children? Arguments for and arguments against: (Dimes, n. d. ) Argument FOR: Vaccination should be required for children. No individual should have the right to risk the health of the public solely for the purpose of satisfying their personal moral or religious views. (Parenting, n. d. ) This graph is showing that since vaccinations have been introduced the number of deaths caused by disease su ch as Measles, Whooping Cough, Diphtheria and Scarlet Fever have decreased.Therefore I believe that Vaccinations should be required for children, and no individual should have the right to risk the health of the public because they satisfying their personal moral or religious views because if they aren’t being vaccinated they are affecting everyone else around them. This graph is reliable because it clearly shows important information which shows that FOR argument is important because vaccinations are decreasing the deaths of people because of disease. Argument AGAINST: Governments should not have the right to intervene in the health decisions parents make for their children. 1% of parents believe they should have the right to refuse mandated school entry vaccinations for their children. This graph is showing the number of people contracting measles has increased due to parents refusing to let their children have the school entry vaccinations. Because of this there could end up being an epidemic in Wales, because a number of children are not protected from Measles. I think that the school entry vaccinations should be made mandatory; I think this because it will stop the spread of an epidemic as people will be vaccinated against Measles.This source is reliable because it clearly shows that because people are not being vaccinated, diseases are spreading rapidly. From looking at both these arguments for and against I think that all children should be forced into having vaccinations, no matter what there religion is or what they believe in. If all children have the vaccinations that are available to them then maybe one day all the horrid diseases will be wiped out. This includes anyone who migrates because nobody knows what diseases they could be carrying or they could have come from a disease ridden area.Argument FOR: Vaccines can get rid of disease and prevent serious illness and death. Mandatory vaccination has got rid of disease that once killed thousan ds of children, such as polio and small pox. (Murakami, 2011) This graph is showing that when the Small Pox Vaccination was made mandatory the number of deaths per million shot right down because people were made to have the vaccination. Then when the vaccination was no longer mandatory so the number of deaths per million shot straight back up again.Then finally the vaccination was made mandatory one last time, this was when Small Pox was finally wiped out. I think this source is reliable because it clearly shows how helpful the Small Pox vaccination was and also how effective it was to England and Wales. Argument AGAINST: Many parents hold religious beliefs against vaccination. Forcing such parents to vaccinate their children would violate their rights to the free exercise of their religion. From looking at both the argument for and against I feel that vaccinations should be mandatory no what the circumstances are.Everyone in world should be given these vaccinations because when va ccinations are made mandatory they do work, they do wipe out harmful disease, as my source shows about Small Pox. If the Small Pox vaccination was not made mandatory then the Small Pox disease would still be runny wild today. Argument FOR: Some individuals that have been vaccinated may still get sick when exposed to infected individuals, 75%-94% of the population, depending on the disease, must be vaccinated to achieve herd immunity. When the herd immunity is achieved the number of immunized individuals is high enough to prevent the spread of disease through the population. BBC, 2012) This graph is showing that the confirmed cases of Whooping cough in England and Wales rose from 2011 to 2012. This graph is perfect for the Argument FOR because it shows that the number of confirmed cases could be due to the vaccinated individuals being exposed to the infected individuals. My source is not as reliable as I would like it to be because it does not actually show that some of the confirmed cases of Whooping cough are due to the vaccinated children being exposed to the infected individuals. Argument AGAINST: Vaccines interfere with the natural law and God’s plan for humanity.Disease is a natural occurrence and humans should not interfere with it. From looking at the argument for and the argument against I feel that people should not be aloud to say that they do want vaccinating because it is going against God and the natural law, because yes they may believe that but them believing that affects a lot of other people they are not vaccinated so they are a risk to more people. I disagree with the statement that disease is a natural occurrence because if everyone in the world was to be vaccinated then diseases would be wiped out and nothing would occur.Argument FOR: The risks of not being vaccinated far outweigh the small risks associated with vaccination. Preventable diseases like measles and mumps can cause permanent disability and death. In 1991 an outbreak of m easles in an unvaccinated group of children in Philadelphia caused seven deaths. Children infected with mumps can become permanently deaf. Although a very small number of deaths from the MMR (measles, mumps, rubella) vaccine have been reported, the most common adverse reactions are minor soreness and or fever.Argument AGAINST: Common childhood vaccinations may cause rare yet serious reactions including anaphylactic shock, paralysis, and sudden death. This risk is not worth taking, considering most diseases vaccinated against are not necessarily life threatening. (Health, n. d. ) From looking at this pie chart I can see that there were a number of deaths related to diseases than can be preventable by a few simple vaccines. This graph shows that if all these children had been vaccinated from these diseases then the deaths wouldn’t have been anywhere near as high as they were.I think this graph is reliable because it shows the number of lives that could have been saved if the ch ildren have been vaccinated. From looking at the argument for and argument against I think the risk of contracting a disease should over weigh the possible side effects that the vaccination can bring. Although the side effects of the vaccination can be bad they only last a couple of days at most, whereas if you contract a disease it last between one and ten days and in some cases is can kill you.I think that parents should think about the risks and benefits in a lot of detail before they say that they do not want to vaccinate their children. Argument FOR: Because children and babies are more open to the swine flu they should be required to take FDA- approved vaccine to prevent illness and possible death. Argument AGAINST: Vaccines can cause brain inflammation which can then lead to either death or permanent brain damage and disorders such as autism, ADD/ADHA, and other developmental problems.Also this vaccine has been associated specifically with the development of autism and is sti ll found in certain tetanus and flu vaccines. (Anon. , n. d. ) This graph is showing the percentage of people who would and would not consider the swine flu vaccination. This pie chart just shows exactly why people are contracting diseases just like swine flu. I would say this source is reliable because it gives people a clear understanding of why certain diseases are quite rife.Argument FOR: Children should be required to receive vaccination against hepatitis B. the disease can cause inflammation of the liver leading to scarring of the liver or cancer. The world health organization recommends that hepatitis B vaccination be part of universal childhood vaccination routine. (Organization, n. d. ) This map shows which countries have and which countries have not introduced the HepB vaccination. This map shows us which countries have more disease issues and which do not.I think this vaccination is reliable because it shows us where vaccinations need to be put in place and then also made mandatory so diseases do not become rife. Argument AGAINST: All vaccines cause immune system suppression and can permanently damage the natural immune system. Unvaccinated children can build and strengthen their immune systems through fighting off infection and developing natural immunity to disease like measles and chickenpox. From looking at both the for and against argument I think that HepB should be made mandatory because it is a life threatening disease.I disagree with the statement that children can build and strengthen their immune system because with the diseases that can be contracted only the vaccination can properly protect them. To conclude I am for this question because I feel that all vaccines should be required for children for their own protection and well being. Parents who straight away say ‘NO NO NO I am not vaccinating my child’ should think about the benefits and risk factors, because I believe that the benefits over weigh the risk factors by a lo t.I understand that some parents do no want their children to have to suffer some of the side effects that the vaccinations bring, they need to realise that the side effects of the vaccinations are nothing compared to the diseases that they can contract. The diseases can also be life threating, so the parents need to realise that yes their child may have side effects from the vaccination which only last a day or two whereas if they contract a disease it is likely to last around one to ten days and also some can kill. I know what I’d rather my child have.In my opinion vaccinations should be made mandatory from everyone and anyone, whether they are religious or not. I think this because if half of a population are religious and the other half are non religious and are for vaccinations for example, the religious side are going to always contract the diseases because they are not protected against them and even though the non religious side that have been vaccinated are protected they can still contract the disease but it may not be as extreme as if the religious side were to contract the disease.If anyone migrates to the country they should be tested on and vaccinated straight away no questions asked because people do not know what they could be carrying, they could be bringing all sorts of diseases in the country. Bibliography (CDC), C. f. D. C. a. P. , n. d. [Online] Available at: http://www. marchofdimes. com/baby/wellbabycare_vaccinations. html [Accessed 16 February 2013]. 1999, D. O. H. , n. d. 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