bexsero vaccine ontario

A vaccine targeting nonpolysaccharide surface antigens (4CMenB – Bexsero; Novartis Vaccines and Diagnostics Inc.) was licensed in Canada in 2013. PRODUCT MONOGRAPH . Groups by topic. GSK sought to 'clear the way' for its Bexsero vaccine by challenging the validity of Wyeth's European patent, number EP (UK) 2,343,308 (the Patent), on multiple grounds. Bundled fees for the vaccine and injection range from $60 each three times to $75. We require any previous doses to be reported so we can enter them into the client database, and will not release the next dose until we receive this information. The vaccine has been studied in infants, children, and adolescents and is approved for use from 2 months to 25 years of age the list is long where this has been approved. Bexsero* is the first broad coverage vaccine to help protect against meningococcal serogroup B (MenB) disease, including infants, toddlers and adolescents who are at the greatest risk of infection1,2,3. October 2013 the Joint Committee on Vaccination and. Access to healthcare; Humanitarian aid. Bexsero® (GSK) is a 2-dose series with doses given at least 1 month apart. What is the cost of the vaccine? According to the Ministry of Health about 70% of IMD (Invasive Meningococcal Disease) in Ontario can be caused by Meningococcal serogroup B against which Meningococcal B vaccine or Bexsero® is effective. BEXSERO The two brands of menB vaccines are not interchangeable. BEXSERO Multicomponent Meningococcal B Vaccine (recombinant, adsorbed) BEXSERO Suspension for Injection Active Immunizing Agent for the Prevention of Meningococcal Disease ATC Code: J07AH09 GlaxoSmithKline Inc. 7333 Mississauga Road Mississauga, Ontario L5N 6L4 Date of Approval: November 6, 2017 Submission Control No: 200974 $120. Late in 2013, a multicomponent meningococcal B vaccine (4CMenB or Bexsero) was approved for use in individuals from the age of 2 months through 17 years where the risk of serogroup B disease is highest. It remains unknown whether this vaccine will prevent carriage or transmission, key aspects in long-term vaccine success and disease eradication. GlaxoSmithKline Inc. Neisseria meningitidis is a Gram-negative pathogen that actively invades its human host and leads to the development of life-threatening pathologies. Bexsero (Meningococcal B)- Novartis Vaccines and Diagnostics S.r.l., Bellaria-Rosia 53018, Sovicille (SI), Italy Boostrix (Tdap) - GlaxoSmithKline Biologicals in Rixensart, Belgium and Wavre, Belgium Daptacel (DTaP) - Sanofi Pasteur Limited in Toronto, Ontario, Canada BEXSERO. In Canada, after using the live attenuated oral polio vaccine (OPV) for many years, its use was replaced with an inactivated poliomyelitis vaccine (IPV) in 1995/1996. SHINGRIX should not be used if you are allergic to any ingredient in the vaccine. For children over 1 year of age or adolescents, 2 doses 2 months apart are recommended. BEXSERO is not expected to protect against all circulating meningococcal serogroup B strains and does not offer protection against strains A, C, Y, and W-135. 33,784 – 38,610 infants would need to be vaccinated in order to prevent one case of serogroup B invasive meningococcal disease. GSK's Bexsero Men B vaccine was given regulatory approval at the European level in 2013. Before then, the multicomponent MnB (4CMenB) vaccine (Bexsero®, Novartis), approved in December 2013, was the only MnB vaccine available in Canada (GlaxoSmithKline Inc. 2018). Please … Ron Strohmeyer PA-C. Ron Strohmeyer. Responsibility. Bexsero ® protects against meningococcal serogroup B disease, and has been authorized for use in individuals 2 months through 17 years of age. According to the Ministry of Health about 70% of IMD (Invasive Meningococcal Disease) in Ontario can be caused by Meningococcal serogroup B against which Meningococcal B vaccine is effective. Vaccine . We accept walk-ins at most designated COVID-19 sites during vaccination days and hours. Examined novel MenB vaccine (Bexsero ®) approved in Europe, Canada and Australia.. SHINGRIX is a vaccine that helps protect adults 50 years of age and older against shingles (herpes zoster). If started after 6 months of age 2 doses are reommended 2 months apart and a booster at 1 to 2 yrs. 613-725-2334 The meningitis type B vaccine BEXSERO is now available by prescription & may be covered under your private health insurance. To reduce your risk of meningitis, particularly if you are in a high-risk group: Practice good hygiene. BEXSERO multicomponent meningococcal B vaccine (recombinant, adsorbed) is a vaccine for the prevention of meningococcal disease caused by Neisseria meningitidis group B bacteria in individuals from 2 months through 25 years of age. Epidemiology of Serogroup B Invasive Meningococcal Disease in Ontario, Canada, 2000 to 2010. Meningococcal B Vaccine (recombinant, adsorbed) Page 1 of 49 PRODUCT MONOGRAPH BEXSERO Multicomponent Meningococcal B Vaccine (recombinant, adsorbed) BEXSERO Suspension for Injection Active Immunizing Agent for the Prevention of Meningococcal Disease ATC Code: J07AH09 GlaxoSmithKline Inc. 7333 Mississauga Road Mississauga, Ontario L5N 6L4 Invasive meningococcal disease (IMD) is a serious contagious infection caused by the bacteria Neisseria meningitidis. “It would have been a moot point. 4CMenB (Bexsero®) and rLP2086 (Trumenba®) are recently developed MenB vaccines, composed by OMPs; they are licensed in a few countries, and the initial studies suggest good immunogenicity and safety . What is the cost of the vaccine? The last indigenous case of wild poliovirus in Canada was in 1977. Bexsero … 10 Adjuvanted Hepatitis B vaccine (Heplisav-B) can be administered to adults 18 years old and older on a twodose schedule, the first and second doses - separated by 4 weeks. The family doctor gets somewhere between $5 to 7 dollars for giving the vaccination (this is the general fee range for administering all types of vaccinations in Ontario). They are readily transmitted by coughing, sneezing, kissing, and touching contaminated objects. V Dang, et al – BMC Infect Dis, 12 (1) (2012), p. 202. MenB vaccine (Bexsero) is given at 2,4 and 6 months of age and a booster at 1 to 2 years of age. Ontario, Canada, published in 2012 concerning the incidence of the meningitis B strain cases in Ontario calls it a rare disease—256 cases in Ontario in 10 ... Bexsero® is a vaccine that received priority review status with neither effectiveness nor efficacy studies and it’s for a … The 4CMenB vaccine (Bexsero, meningococcal B vaccine) was. K1Y4G2 www.drsawyers.ca. • Patients who have received the Pneumovax 23 vaccine in the past year should wait at least 1 year to receive the Prevnar 13 vaccine, followed by a second Pneumovax 23 vaccine at least 8 weeks later. BEXSERO Multicomponent Meningococcal B Vaccine (recombinant, adsorbed) Suspension for Injection Active Immunizing Agent for the Prevention of Meningococcal Disease ATC Code: J07AH09 GlaxoSmithKline Inc. 7333 Mississauga Road Mississauga, Ontario L5N 6L4 Date of Initial Approval: December 6, 2013 SHINGRIX should not be used if you are allergic to any ingredient in the vaccine. 8. Paediatric meningococcaemia in northwestern Ontario, Canada: a case for publicly funded meningococcal B vaccination. In a clinical trial, the frequency of fever was about 2 times higher when infants received Bexsero with other infant vaccines, specifically DTPa-hepB-IPV-Hib vaccine and 7vPCV (7-valent pneumococcal conjugate vaccine). Bexsero, which uses a new reverse vaccinology, was widely marketed before data on clinical effectiveness became available. 51–62% of these infants reported fever ≥38°C, and 10–15% reported fever ≥39°C within 7 days of any vaccine dose. It's easy. Population People aged 0-99. MenB vaccine (Bexsero) is given at 2,4 and 6 months of age and a booster at 1 to 2 years of age. With the widespread use of the meningococcal serogroup C conjugate vaccines, serogroup B remains now the major cause of bacterial meningitis and septicaemia in young children in Europe. The NNV for Bexsero(group B meningococcal vaccine) is >33,000 BMC Infect Dis, 12 (1) (2012), p. 202. 51–62% of these infants reported fever ≥38°C, and 10–15% reported fever ≥39°C within 7 days of any vaccine dose. Recipient Initials Date of Birth (YYYY/MM/DD) Dukoral (Travellers’ Diarrhea and Cholera) 02247208. Bexsero may provide protection against N. Meningitidis strain B which is currently not covered by the provincially funded Meningitis vaccine. One of the leading causes of death in the world, N. meningitidis can be responsible for nearly 1,000 new infections per 100,000 subjects during an epidemic period. The vaccine has been studied in infants, children, and adolescents and is approved for use from 2 months to 25 years of age the list is long where this has been approved. 30 Bexsero (Meningitis B) 02417030: $160: Chicken Pox (Varivax III or Varilix) Varivax III 02246081. Trumenba™ (Pfizer) is either a 2-dose or a 3-dose series. conjugate vaccine in Ontario, Canada, 2000–2006. The aim of this study … Background: The multicomponent meningococcal serogroup B vaccine (4CMenB) is an outer membrane vesicle and recombinant protein-based vaccine licensed to protect against serogroup B meningococcal disease. Home Community July 2014. For children over 1 year of age or adolescents, 2 doses 2 months apart are recommended. Meningococcal B Vaccines . The cost-effectiveness evaluation of Bexsero was initially based on an independent economic study conducted by the University of Bristol and the London School of Hygiene and Tropical Medicine.5 That study found Bexsero to be cost effective across a range of vaccine costs. A new vaccine [Bexsero®] against serogroup B meningococci was approved for use in Canada in 2013 and in other countries. The pharmacist shall also report to the Vaccine Adverse Events Reporting Systems (VAERS). For more information, see HealthLinkBC File #23a Meningococcal C Conjugate (Men-C) Vaccine and the B.C. The injections are usually given over a six-month period. Stillman, of West Bloomfield, has organized for a busload of people to travel to Windsor, Ontario Sunday, where 50 people will receive the Novartis' Bexsero vaccine. Avaxim Kids (Hepatitis A) 02243741. BEXSERO multicomponent meningococcal B vaccine (recombinant, adsorbed) is a vaccine for the prevention of meningococcal disease caused by Neisseria meningitidis group B bacteria in individuals from 2 months through 25 years of age. The Men-B (Bexsero®) vaccine protects against illness caused by group B meningococcal bacteria (Neisseria meningitidis). The injections are usually given over a six-month period. Here at Vaccines411.ca, you will find an extensive list of clinics offering immunizations across Canada, along with reliable information about a wide range of vaccinations. of age. The side effects from this new vaccine appear to be similar to those from all of the other childhood immunizations. 02437058: $215: Hepatitis A: Adult dose Welcome to Vaccines411.ca, Canada's Vaccine Clinic Directory. Birth Clubs. BEXSERO: 4CMenB vaccine dosage for children aged 2 months to 11 months and 24 months to less than 10 years of age; NIMENRIX ®: Men-C-ACYW-TT vaccine indications and dosage for children aged 6 weeks to 23 months. Routine handwashing and regularly disinfecting … Bexsero® (GSK) is a 2-dose series with doses given at least 1 month apart. The series must be started and Bexsero Meningitis B Vaccine - July 2014 - BabyCenter Canada. 19 We therefore felt that it would be useful to carry out a cost-effectiveness analysis (CEA) on the possible use of Bexsero® in the Italian epidemiological scenario. This vaccine was effective in controlling an outbreak of serogroup B infections in Quebec . The multicomponent meningococcal, 4CMenB, vaccine, Bexsero®, helps to protect children from an illness called group B invasive meningococcal disease. • If 2 doses of the Pneumovax 23 vaccine have been given in the past year, Prevnar 13 should be given 1 year after the last Pneumovax 23. BEXSERO [Multicomponent Meningococcal B Vaccine (recombinant, adsorbed) , Suspension for Injection] PM Page 1. vaccine (PPSV23) contains capsular polysaccharides from 23 common serotypes of S. pneumoniae. Students who did not receive the vaccine in school are still eligible. • Program is highly unlikely to be cost-effective in this low incidence setting. There are 13 types, but B is the most common IMD group to affect Canadians. Until recently, no vaccine was available that offered any protection against what is now the most common serogroup causing IMD in Canada. Dr. Ian Pun and Christina Lo Family Practice Clinic 4040 Finch Ave E, suite 302 Scarborough, Ontario M1S4V5, CA +1 416-848-7788 ianpun@gmail.com 100% protection cannot be guaranteed. We require any previous doses to be reported so we can enter them into the client database, and will not release the next dose until we receive this information. 30 In October 2017, a second menB vaccine [Trumenba™] was approved by Health Canada. Refer students to tphbookings.ca for free vaccination at a Toronto Public Health clinic. ... Netherlands, 31 and Ontario, Canada, 32 economic models indicated. Effective December 2014, Ontario has introduced the multicomponent meningococcal B vaccin ; BEXSERO (Meningococcal Group B Vaccine) - GSKSourc . SHINGRIX is not for prevention of chickenpox or for the treatment of herpes zoster (HZ) or postherpetic neuralgia (PHN). You can read more about what is involved and the ethics associated with clinical trials here. MesVaccins.net est une plate-forme permettant de gérer ses vaccinations et celles de ses proches en bénéficiant de l'expertise de professionnels de santé. Welcome to Vaccines411.ca, Canada's Vaccine Clinic Directory. Varilix 02241047. Before the introduction of vaccine programs, the annual incidence of IMD in Canada ranged between 0.4 and 1.6 cases per 100,000 persons. Avaxim Adult (Hepatitis A) 02237792. Bexsero is indicated for active immunisation of individuals from 2 months of age and older against invasive meningococcal disease caused by Neisseria meningitidis group B. Here at Vaccines411.ca, you will find an extensive list of clinics offering immunizations across Canada, along with reliable information about a wide range of vaccinations. They discussed Novartis' meningococcal group B vaccine Bexsero to demonstrate how controversies can surround decision-making for the funding of new vaccines. 7] NNV for Group B Meningococcal Vaccine = >33,000. Meningococcal B Vaccine. 801-1081 Carling Ave, Ottawa, ON. 02223929: OHIP: Gardasil 9 HPV Vaccine. The example of Bexsero in the UK. Trumenba™ (Pfizer) is either a 2-dose or a 3-dose series. Stanford Healthcare Vaccination Subcommittee Issue Date: 10/2018 B. It is recommended for children at 2 and 12 months of age. over-vaccination For the attention of: Professor Andrew Wilson Chair, Pharmaceutical Benefits Advisory Committee (PBAC) Professor Wilson, the Murdoch media continues to campaign to have the GSK Bexsero meningococcal B vaccine product listed on Australia's taxpayer-funded coercive vaccination schedule, see more articles on this matter, i.e. Bexsero® was approved for use in Canada in January of 2014 and first sold in Canada in February that year according to Health Canada’s Summary Basis of Decision (SBD) to Accept Bexsero.In the SBD Health Canada informs us, “Protection by the vaccine was inferred from immune responses against the four antigens of the vaccine.” In a clinical trial, the frequency of fever was about 2 times higher when infants received Bexsero with other infant vaccines, specifically DTPa-hepB-IPV-Hib vaccine and 7vPCV (7-valent pneumococcal conjugate vaccine). For children it's lower, typically around $45. Two vaccines based on exposed surface proteins of serogroup B are now available. From Section 4 of the Report on the Canada Vigilance Database. Please note that children may be eligible for both Menactra ® and Bexsero ®. BEXSERO is the first and only vaccine against Neisseria meningitidis serogroup B strains indicated as early as 2 months of age.1† BEXSERO is not indicated to treat or reduce the consequences of meningococcal meningitis (including meningitis, sepsis, and death) following the onset of invasive meningococcal disease. Wyeth/Pfizer's Trumenba vaccine awaits approval in Europe. BEXSERO® Multicomponent Meningococcal B Vaccine (recombinant, adsorbed) This leaflet is art III of a threeP -part "Product Monograph" published when BEXSERO was approved for sale in Canada and designed specifically for onsumers. For current product monographs please refer to … 100% protection cannot be guaranteed. Funded Immunization Schedules for Ontario – October 2015 (Table 13) for the schedule of doses. V Dang, et al NNV to Prevent one Healthy Adult from Experiencing Influenza = 71. MenB infection is the leading cause of meningococcal disease across Canada, particularly in Responsibility; Access to healthcare. The Bexsero vaccine, which protects against this strain, will be also given to those who were close to the victim. Who should get this vaccine? 16. This leaflet is a c summary and will not tell you everything about . The incidence of polio in Canada was dramatically reduced by the introduction of immunization programs in the 1950s. TORONTO -- Beginning Dec. 15, pharmacists in Ontario will be able to add 13 vaccinations to the list of immunziations they can administer to their patients as part of … If started after 6 months of age 2 doses are reommended 2 months apart and a booster at 1 to 2 yrs. Meningococcal B Vaccines . Do not give Men-C-C vaccine to kids 12 years and older. So, MenB vaccine development was focused on subcapsular antigens, such as outer membrane proteins (OMPs) and outer membrane vesicles (OMVs) . The hepatitis B vaccine is recommended for everyone, from infants through adults. Introduction In January 2013 a novel type of multicomponent protein-based vaccine against group B meningococcal disease was licensed by the European Medicines Agency. Simply enter your postal code and choose your category to locate the vaccinating clinic closest to you. The Meningococcal C Conjugate (Men-C) vaccine is provided free. Recommendations contained in this document are largely based on previously published guidelines and practices.1-5 This document focuses on early post-transplant vaccinations; after this early period, most BMT patients (who do not have GVHD) Late in 2013, a multicomponent meningococcal B vaccine (4CMenB or Bexsero) was approved for use in individuals from the age of 2 months through 17 years where the risk of serogroup B disease is highest. It's easy. of age. introduced in 201 3 and is the only licensed MenB vaccine for in-fants. On December 5, 2013, Health Canada issued a Notice of Compliance (NOC) for Bexsero® (4CMenB, Novartis Vaccines), a multicomponent meningococcal serogroup B vaccine.3 The Bexsero® vaccine contains four main components: factor H binding protein (fHbp) variant 1.1, Neisserial Adhesin A (NadA), Neisseria Heparin Since 2015, the 4CMenB infant vaccination was imple- This vaccine is for use in children > 2 years of age and does not produce memory responses so needs to be repeated every 5 years • A 13-valent conjugate pneumococcal vaccine (PCV13) protects against 13 capsular serotypes which are known to The two brands of menB vaccines are not interchangeable. Whether Bexsero can prevent IMD due to ST-269 MenB, other endemic MenB or other serogroups of meningococci will be a much-anticipated outcome. A new genome-derived and protein-based multicomponent MenB vaccine (Bexsero; Novartis, USA) has recently received approval for use by the European Medicines Agency . Fever is a common side effect of this vaccine in children under 3 years of age. 11 HepB-3 should be administered at least 8 weeks after HepB-2 and at least 16 weeks after HepB-1, and should not beadministered before 24 weeks Assessed cost-effectiveness of MenB infant vaccination program in Ontario, Canada. Bundled fees for the vaccine and injection range from $60 each three times to $75. SHINGRIX is a vaccine that helps protect adults 50 years of age and older against shingles (herpes zoster). 14. OHIP or. ATC Code: J07AH09. The hepatitis B virus can cause serious liver disease. As with any vaccine, BEXSERO may not fully protect all of those who are vaccinated. disease, and the innovative nature of the Bexsero vaccine, in. Ron Strohmeyer is a certified physician assistant who joined Saltzer Health in June 2020 to work in the Caldwell urgent care clinic. Prevenar 13® is funded for children and adults with a medical condition that increases their risk of invasive pneumococcal disease AND is listed on the Pharmaceutical Schedule, identified as 'special groups on the National Immunisation Schedule. Bexsero, the first meningitis B vaccine, became available to Canadians at the end of last month and could stop the spread of life-threatening brain and spinal cord infection. Phone number (999-999-9999) For high risk vaccines, an immunization nurse will assess for eligibility before providing the vaccine (s). Toronto Public Health offers free vaccination for Grade 7 students in the schools. ... Amber Alert cancelled after 11-month-old Ontario child located safely. High Risk Meningococcal Vaccine Eligibility as per the December 2016 - Publicly Funded Immunization Schedules for Ontario. BEXSERO is an FDA-approved vaccine to prevent invasive disease caused by Neisseria meningitidis serogroup B. BEXSERO is approved for use in individuals aged 10 through 25 years.. Approval of BEXSERO is based on demonstration of immune response against three serogroup B strains representative of prevalent strains in the United States. Bexsero vaccine: Who out there has given their children Bexsero to protect against Meningoccoal Menigitis? The risks of the new vaccine. Bexsero (Multicomponent Meningitis B) 02417030. The series must be started and The health and economic outcomes of introducing the Bexsero vaccine into the Brazilian NIP are presented in Table 1.A universal infant MenB vaccination program would prevent some 1,527 IMD cases, 78 deaths and 7,792 DALYs in one birth cohort, assuming 3 years of protection. Bexsero Vaccine Dr Elizabeth Sawyers, MD, CCFP, FCFP. A new multicomponent vaccine (Bexsero®), produced by means of reverse vaccinology, has now gained marketing authorisation in Europe, 16 Canada, 17 Australia 18 and the US. Meningococcal Disease. What is invasive meningococcal disease? Dukoral (Travelers Diarrhea, Cholera) 02247208: $48 per dose : Flu Vaccine Quadrivalent (Fluzone) 02432730: $35: Flu Vaccine Trivalent. SHINGRIX is not for prevention of chickenpox or for the treatment of herpes zoster (HZ) or postherpetic neuralgia (PHN). Immunization Schedules . Most recently, Strohmeyer worked as a provider at a the walk-in clinic at Valley Family Healthcare in Ontario, OR. Active Immunizing Agent for the Prevention of . Multicomponent Meningococcal B Vaccine (recombinant, adsorbed) Suspension for Injection . Some studies have noted, however, that the likelihood of getting a high fever or a febrile seizure is a bit higher for this particular vaccine compared to the others. 2009;27:1735-40. You may still schedule your vaccination or walk up to our mobile vaccination clinic which is open to everyone!Note: we require masks in all St. Luke's facilities, regardless of COVID-19 vaccination status. Epidemiology of serogroup B invasive meningococcal disease in Ontario, Canada, 2000 to 2010 . VACCINE ADMINISTRATION, SCHEDULING AND OTHER DETAILS 1. Objective To use mathematical and economic models to predict the epidemiological and economic impact of vaccination with Bexsero, designed to protect against group B meningococcal disease, to help inform vaccine policy in the United Kingdom. Interventions Incremental impact of introductory vaccine strategies … For children it's lower, typically around $45. Cochrane Review Feb 1, 2018. Until recently, no vaccine was available that offered any protection against what is now the most common serogroup causing IMD in Canada. Design Modelling study. All Birth Clubs. Neisseria meningitidis serotype B (MenB) causes invasive meningococcal disease.. 02240255. Program Vaccine Order Form (For Toronto physicians, nurse practitioners or public health units) • For Toronto physicians/facilities, please complete this form and fax it to 416 327-7439 or scan and send it to Vaccine.Program@ontario.ca A new vaccine [Bexsero®] against serogroup B meningococci was approved for use in Canada in 2013 and in other countries. The men B vaccine is the first broad coverage meningococcal MenB vaccine to demonstrate an immune response in infants, for use in individuals from … A pharmacist or pharmacist intern's supervising physician shall report adverse events to the patients PCP and the physician who approved the immunization protocol within 72 hours of the pharmacist's knowledge of the adverse event. View all groups Getting pregnant Pregnancy Baby Toddler Family life Grief and Loss En français Regional groups. Clinical trials are an essential part of developing a medicine or vaccine and involve human volunteers. Effective December 2014, Ontario has introduced the multicomponent meningococcal B vaccine (4CMenB or Bexsero ) as part of its publicly funded high risk meningococcal immunization program ... (MenB) vaccine (4CMenB, Bexsero) into a publicly funded national immunisation programme. In October 2017, a second menB vaccine [Trumenba™] was approved by Health Canada. ... Bexsero) vaccine includes three recombinant proteins as well as outer membrane vesicles developed from meningococcal NZ98/254 strain (Carter, 2013). About the publicly funded M eningococcal B Vaccine (Bexsero ®) In December 2013, Health Canada approved Bexsero ®, a novel multicomponent meningococcal B vaccine (4CMenB), manufactured by Novartis. Simply enter your postal code and choose your category to locate the vaccinating clinic closest to you. Phone number (999-999-9999) For high risk vaccines, an immunization nurse will assess for eligibility before providing the vaccine (s). Setting England. Prophylactic use of acetaminophen and/or separating Bexsero administration from other vaccines may be considered to help prevent fever in this age group. “This vaccine would have prevented my daughter from getting it,” she said. To prevent IMD caused by serogroups A, C, Y, and W-135, infant and adolescent routine immunization programs are in place across Canada (Public Health Agency of Canada 2018).

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