text:
About IAC
A-Z Index
Immunization Action Coalition
Handouts for Patients & Staff
Screening Questionnaires
Most Popular
Standing Orders
Clinic Resources
Storage & Handling
Vaccine Index
Supplies Checklist
Administering Vaccines
Temperature Logs
Documenting Vaccination
Topics of Interest
Parent Handouts
Patient Schedules
Vaccine Reactions
Questions and Answers
Vaccine Summaries
What's New: Handouts
Clinic Resources
Administering Vaccines
Related Resources:
Coding & Billing
Ask the Experts
Documenting Vaccination
Directory of Resources
Scheduling Vaccines
IAC Publications
Screening for Contraindications
Image Library
Storage & Handling
Journal Articles
Pocket Guides
PowerPoint Presentations
Unprotected People Reports
Vaccine Information Statements
Vaccine Index
Translations Index
English-language VISs
Spanish-language VISs
What's New: VISs
Diseases & Vaccines
Chickenpox (varicella)
Hepatitis A
Hepatitis B
H. influenzae
Shingles (zoster)
View All
Talking about Vaccines
Mitochondrial Disorders
Alternative Medicine
Multiple Injections
Religious Concerns
Dr. Sears' Schedule
Talking with Parents
Importance of Vaccines
Vaccine Safety
Adoption - International
Birth Dose (HepB)
Needle Safety
Healthcare Personnel
Tattoos & Piercings
Long-Term Care
Travel - International
Mandates & Exemptions
View all
Ask the Experts
IAC Home
Ask the Experts Home
Combination vaccines
Vaccine storage and handling
Hepatitis A
Hepatitis B
How to Cite IAC
Ask the Experts
Pneumococcal Vaccines (PCV13 and PPSV23)
Pneumococcal disease
Routine vaccination of children with PCV13
Pneumococcal polysaccharide vaccine (PPSV23)
Vaccination with PCV13 in adults with medical conditions
Recommendations for primary PPSV23 vaccination
Miscellaneous PCV13 issues
PPSV23 boosters and revaccination issues
Vaccination scheduling and documentation issues
Miscellaneous PPSV23 issues
Vaccination strategies
Pneumococcal conjugate vaccines (PCV13)
Administering pneumococcal vaccine
Pneumococcal disease
Back to top
What causes pneumococcal disease?
Pneumococcal disease is caused by
Streptococcus pneumoniae
, a bacterium that has more than 90 serotypes. Most serotypes cause disease, but only a few produce the majority of invasive pneumococcal disease. The 10 most common types cause 62% of invasive disease worldwide.
How does pneumococcal disease spread?
The disease is spread from person to person by droplets in the air. The pneumococci bacteria are common inhabitants of the human respiratory tract. They may be isolated from the nasopharnyx of 5%-70% of normal, healthy adults.
How long does it take to show signs of pneumococcal disease after being exposed?
As noted above, many people carry the bacteria in their nose and throat without ever developing invasive disease. The incubation period for specific diseases caused by an invasive pneumococcal infection is noted below.
What are the types of invasive pneumococcal disease?
There are two major clinical syndromes of invasive pneumococcal disease: bacteremia, and meningitis. They are both caused by infection with the same bacteria, but have different manifestations.
Pneumococcal pneumonia is the most common disease caused by pneumococcal infection. Pneumococcal pneumonia can occur in combination with bacteremia and/or meningitis, or it can occur alone. Isolated pneumococcal pneumonia is not considered invasive disease but it can be severe. It is estimated that 175,000 cases occur each year in the United States. The incubation period is short (1-3 days). Symptoms include abrupt onset of fever, shaking chills or rigors, chest pain, cough, shortness of breath, rapid breathing and heart rate, and weakness. The fatality rate is 5%-7% and may be much higher in the elderly.
Pneumococcal bacteremia occurs in about 25%-30% of patients with pneumococcal pneumonia. More than 50,000 cases of pneumococcal bacteremia occur each year in the United States. Bacteremia is the most common clinical presentation among children less than two years, accounting for 70% of invasive disease in this group.
Pneumococci cause 13%-19% of all cases of bacterial meningitis in the United States. There are 3,000-6,000 cases of pneumococcal meningitis each year. Symptoms and signs may include headache, tiredness, vomiting, irritability, fever, seizures, and coma. Children less than one year have the highest rate of pneumococcal meningitis, approximately 10 cases per 100,000 population. The mortality rate is high (30% overall, up to 80% in the elderly).
How serious is pneumococcal disease in the U.S?
Pneumococcal disease is a serious disease that causes much sickness and death. In fact, pneumococcal disease kills more people in the United States each year than all other vaccine-preventable diseases combined.
An estimated 36,850 cases and 4,250 deaths from invasive pneumococcal diseases (bacteremia and meningitis) occurred in the United States in 2011. More than half of these cases occurred in adults who had an indication for pneumococcal polysaccharide vaccine. Young children and the elderly (younger than age five years and older than 65) have the highest incidence of serious disease.
Case-fatality rates are highest for pneumococcal meningitis and bacteremia, and the highest mortality occurs among the elderly and patients who have underlying medical conditions. Despite appropriate antimicrobial therapy and intensive medical care, the overall case-fatality rate for pneumococcal bacteremia is about 20% among adults. Among elderly patients, this rate may be as high as 60%.
Pneumococcal polysaccharide vaccine (PPSV23)
Back to top
When were the first vaccines licensed for vaccination against pneumococcal disease?
The first pneumococcal vaccine, licensed in 1977, was a polysaccharide vaccine. It contained purified capsular polysaccharide antigen from 14 different types of pneumococcal bacteria. In 1983, a 23-valent polysaccharide was licensed (PPSV23). It replaced the 14-valent vaccine.
Recommendations for primary PPSV23 vaccination
Back to top
For whom is the 23-valent pneumococcal polysaccharide vaccine (PPSV23) recommended?
PPSV23 vaccine is recommended for all people who meet any of the criteria below:
All adults age 65 yrs and older
Age 2 through 64 yrs with any of the following conditions:
cigarette smokers age 19 yrs and older
chronic cardiovascular disease (e.g., congestive heart failure, cardiomyopathies; excluding hypertension)
chronic pulmonary disease (including COPD and emphysema, and for adults ages 19 years and older, asthma)
diabetes mellitus
chronic liver disease, cirrhosis
candidate for or recipient of cochlear implant
cerebrospinal fluid (CSF) leak
functional or anatomic asplenia (e.g., sickle cell disease, splenectomy)
immunocompromising conditions (e.g., HIV infection, leukemia, congenital immunodeficiency, Hodgkin's disease, lymphoma, multiple myeloma, generalized malignancy) or on immunosuppressive therapy
solid organ transplantation; for bone marrow transplantation, see
chronic renal failure or nephrotic syndrome
Public health authorities may also consider recommending PPSV23 for Alaska Natives and American Indians ages 50 through 64 years who are living in areas in which the risk of invasive pneumococcal disease is increased.
Which children should receive PPSV23 vaccine (in addition to PCV13)? At what age should they receive it?
PPSV23 is recommended for children with an immunocompromising condition, or functional or anatomic asplenia, and also for immunocompetent children with chronic heart disease, chronic lung disease, diabetes mellitus, cerebrospinal fluid leak, or cochlear implant. Administer 1 dose of PPSV23 to children age 2 years and older at least 8 weeks after the child has received the final dose of PCV13. Children with an immunocompromising condition, or functional or anatomic asplenia should receive a second dose of PPSV23 5 years after the first PPSV23.
Can you please explain when and why the recommendations for vaccination were changed for people with asthma and for cigarette smokers?
The 1997 CDC recommendations for the use of PPSV exclude asthma in the chronic pulmonary disease category because no data on increased risk of pneumococcal disease among people with asthma were available when the recommendation was issued. In 2008, the Advisory Committee on Immunization Practices (ACIP) reviewed new information that suggests that asthma is an independent risk factor for pneumococcal disease among adults. ACIP also reviewed new information that demonstrates an increased risk of pneumococcal disease among smokers. Consequently, ACIP recommends to include both asthma and cigarette smoking as risk factors for pneumococcal disease among adults age 19 through 64 years and as indications for PPSV23.
Since PPSV23 is recommended for all adults who smoke, should adults who use smokeless tobacco products (e.g., chewing tobacco) be vaccinated too?
No. ACIP does not identify people who use smokeless tobacco products as being at increased risk for pneumococcal disease or as being in a risk group for vaccination.
Currently, ACIP recommends pneumococcal polysaccharide (PPSV23) for smokers age 1964 years. Should we also vaccinate 16-year-olds who smoke?
No. Currently no data exist to indicate that people younger than 19 and smoke are at increased risk of pneumococcal disease.
In its September 2010 publication of updated recommendations for prevention of invasive pneumococcal disease among adults, ACIP recommends vaccinating adult asthmatics with PPSV23. Should I give PPSV23 to people with mild, intermittent asthma or exercise-induced asthma? Why isn't PPSV23 recommended for asthmatic children?
PPSV23 is recommended for adults 19 years and older with all types of asthma. Available data do not indicate that asthma alone increases the risk of invasive pneumococcal disease among people younger than 19 years, so PPSV23 is not currently recommended for people younger than 19 years with asthma. For more information, go to
Should people who are HIV positive receive pneumococcal vaccines?
Yes. People with HIV infection should receive both PCV13 and PPSV23 vaccines as soon as possible after diagnosis. They should first be given PCV13, followed by PPSV23 8 weeks later. If they are younger than age 65 years, they will need a second dose of PPSV23 at least 5 years after their initial dose and a third dose once they become age 65 years. If they are age 65 years or older when first diagnosed, they will need only one dose. The risk of pneumococcal infection is up to 100 times greater in HIV-infected people than in other adults of similar age. Although severely immunocompromised people may not respond well to the vaccine, and there is a chance that the vaccine may not produce an antibody response, the risk of disease is great enough to warrant vaccination.
How often should diabetic patients receive pneumococcal polysaccharide vaccine?
People with diabetes who are ages 2 through 64 years who have not already received a dose of PPSV23 should receive their first dose now. At age 65 years they should receive a one-time revaccination if 5 years have elapsed since the previous dose.
How often should adult dialysis patients receive pneumococcal polysaccharide vaccine?
Adult dialysis patients younger than age 65 years need a dose of PPSV23 followed by a second dose 5 years later; once they become 65, they will need another dose. If they were age 65 years or older when first vaccinated, only one dose of PPSV23 is recommended.
Is there any reason to withhold pneumococcal vaccine from a healthy non-smoking 45-year old who requests it to decrease his/her risk of this disease?
No, although ACIP does not routinely recommend pneumococcal vaccine for healthy people of this age.
PSV23 boosters and revaccination issues
Back to top
Could you briefly summarize the recommendations for PPSV23 revaccination?
Revaccination 5 years after the first dose of PPSV23 is recommended for 1) children and adults younger than age 65 years at highest risk for serious pneumococcal infection or who are likely to have a rapid decline in antibody levels (see next Q&A) and 2) adults age 65 years and older who received their first dose for any indication when they were younger than age 65 years. Adults who receive PPSV23 at or after age 65 years should receive only a single dose.
Which adults ages 1964 years should receive a second dose of PPSV23?
A second PPSV23 given 5 years after the first dose is recommended for people age 19 through 64 years who have functional or anatomic asplenia (including persons with sickle cell disease or splenectomy patients); chronic renal failure (including dialysis patients) or nephrotic syndrome; are immunocompromised, including those with HIV infection, leukemia, lymphoma, Hodgkin's disease, multiple myeloma, generalized malignancy; are receiving immunosuppressive therapy (including long-term systemic corticosteroids or radiation therapy); or who have received a solid organ transplant.
Do patients who were vaccinated with one or two doses of PPSV23 before age 65 need an additional dose of PPSV23 at age 65 or later?
Yes. Patients who received PPSV23 for any indication at age 64 years or younger should receive an additional dose of PPSV23 vaccine at age 65 years or older if at least 5 years have elapsed since their previous PPSV23 dose.
Should a healthy 75-year-old patient who was given PPSV at age 65 years be revaccinated?
No. Adults who were first vaccinated at age 65 years or older need only one dose.
Miscellaneous PPSV23 issues
Back to top
I've heard pneumococcal polysaccharide vaccine (PPSV23) isn't very effective in older people. Should I still use it?
Yes. PPSV23 vaccine is 60%-80% effective against invasive pneumococcal disease when it is given to immunocompetent people age 65 years and older or people with chronic illnesses. The vaccine is less effective in immunodeficient people. So, although PPSV23 is not as effective as some other vaccines, it can significantly lower the risk of serious pneumococcal disease and its complications in most recipients.
My patient has had laboratory-confirmed pneumococcal pneumonia. Does he/she still need to be vaccinated with PPSV23?
Yes. There are more than 90 known serotypes of pneumococcus (23 serotypes are in the current vaccine). Infection with one serotype does not necessarily produce immunity to other serotypes. As a result, if the person is a candidate for vaccination, s/he should receive it even after one or more episodes of invasive pneumococcal disease.
If influenza is recommended for healthcare workers to protect high-risk patients from getting influenza, why isn't the pneumococcal polysaccharide vaccine also recommended?
Influenza virus is easily spread from healthcare workers to their patients, and infection usually leads to clinical illness. Pneumococcus is probably not spread from healthcare workers to their patients as easily as is influenza, and infection with pneumococcus does not necessarily lead to clinical illness. Host factors (such as age, underlying illness) are more important in the development of invasive pneumococcal disease than nasopharyngeal colonization with the organism. When you're giving influenza vaccine to your patients in the fall, don't forget to assess their need for pneumococcal vaccine as well as all other vaccines.
Pneumococcal conjugate vaccines (PCV13)
Back to top
When were the first conjugate vaccines licensed?
In 2000, the first pneumococcal conjugate vaccine (PCV) was licensed in the U.S. This vaccine contained seven serotypes (4, 6B, 9V, 14, 18C, 19F, and 23F) of
Streptococcus pneumoniae
and became known as PCV7 (Prevnar by Wyeth, now Pfizer). Ten years later in February 2010, a new 13-valent product was licensed PCV13 (Prevnar 13, Pfizer) which added 6 new serotypes (1, 3, 5, 6A, 7F, and 19A). Together, these 13 serotypes account for the majority of invasive pneumococcal disease (IPD) in the U.S., including serotype 19A, which is the most common IPD-causing serotype in young children. In February 2010 ACIP recommended that healthcare providers transition from use of PCV7 to use of PCV13 for routine vaccination of children.
PCV7 was initially recommended for routine use in infants and children ages 2 through 59 months. The recommendations were expanded with the licensure of PCV13 to include vaccination of children age 60 through 71 months with underlying medical conditions, and also permissive recommendations to consider vaccination of older children, ages 6 through 18 years, with medical conditions placing them at increased risk of invasive pneumococcal disease. In late 2011, a supplement was issued to the FDA license for expanded use of PCV13 in adults.
Routine vaccination of children with PCV13
Back to top
What are the recommendations for routine vaccination of children with PCV13?
All infants should be given a primary series of PCV13, at ages 2, 4, and 6 months with a booster at age 12 to 15 months. Children who fall behind should be given catch-up vaccination through age 59 months, if otherwise healthy or, through age 71 months if they have certain underlying medical conditions.
What are the recommendations for vaccinating children who previously received PCV7?
The table below can help guide the vaccination of infants and children who are in various stages of PCV vaccination (i.e., unvaccinated, begun a series of PCV7 or PCV13 but not yet completed, or have completed a series of PCV7).
Recommended Schedules for Administering Pneumococcal Conjugate Vaccine (PCV) to Children
By PCV Vaccination History and Age
Child's age now
Vaccination History of PCV7 and/or PCV13
Recommended PCV13 Schedule
(see footnote* below for minimum intervals between doses)
2 through 6 months
0 dose
3 doses, 8 weeks apart; 4th dose at age 12-15 months
1 dose
2 doses, 8 wks apart; 4th dose at age 12-15 months
2 doses
1 dose, at least 8 weeks after the most recent dose; dose #4 at age 12-15 months
7 through 11 months
0 doses
2 doses. 8 wks apart; dose #3 at age 12-15 months
1 or 2 doses before age 7 months
1 dose at age 7-11 months, with a second dose at age 12-15 months (8 wks later)
12 through 23 months
0 doses
2 doses, at least 8 weeks apart
1 dose before age 12 months
2 doses, at least 8 weeks apart
1 dose at or after age 12 months
1 dose, at least 8 weeks after the most recent dose
2 or 3 doses before age 12 months
1 dose, at least 8 weeks after the most recent dose
4 doses of PCV7 or other age-appropriate, complete PCV7 schedule
1 supplemental dose, at least 8 weeks after the most recent dose
24 through 59 months
Unvaccinated or any incomplete schedule
1 dose, at least 8 weeks after the most recent dose
4 doses of PCV7 or other age-appropriate, complete PCV7 schedule
1 dose, at least 8 weeks after the most recent dose
24 through 71 months
(with risk factor)
Unvaccinated or any incomplete schedule
2 doses, one at least 8 weeks after the most recent dose and another dose at least 8 weeks later
Any incomplete schedule of 3 doses
1 supplemental dose, at least 8 weeks after the most recent dose
4 doses of PCV7 or other age-appropriate complete PCV7 schedule
1 supplemental dose, at least 8 weeks after the most recent dose
The minimum interval between doses of PCV7 or PCV13 administered at younger than 12 months of age is 4 weeks. The minimum interval for the next-to-last to last dose is 8 weeks.
Many children in my practice have received their complete series of 7-valent pneumococcal conjugate vaccine (PCV7). Would you please review the recommendations for which of them now need a supplemental dose of 13-valent pneumococcal conjugate vaccine (PCV13)?
A single supplemental dose of PCV13 is recommended for all children ages 14 through 59 months who have received the complete 4-dose series of PCV7 or another age-appropriate, complete PCV7 schedule. For children who have underlying medical conditions, a single supplemental PCV13 dose is recommended through age 71 months. This also includes children who have previously received pneumococcal polysaccharide vaccine (PPSV23). Give the single supplemental dose of PCV13 no sooner than 8 weeks after the last dose of PCV7 or PPSV23 was given.
IAC has created a table that explains how to use PCV13 to catch up children who have fallen behind on their PCV7 doses. It is available at
Vaccination with PCV13 in adults with medical conditions
Back to top
Which adults are now recommended to receive a dose of PCV13?
Adults age 19 years and older who have the conditions specified below and who have not previously received PCV13 should receive a PCV13 dose during their next vaccination opportunity.
Immunocompromising conditions (e.g., congenital or acquired immunodeficiency, HIV, chronic renal failure, nephrotic syndrome, leukemia, lymphoma, Hodgkin disease, generalized malignancy, iatrogenic immunosuppression, solid organ transplant, and multiple myeloma)
Functional or anatomic asplenia (e.g., sickle cell disease and other hemoglobinopathies and congenital and acquired asplenia)
Cerebrospinal fluid (CSF) leak
Cochlear implants
Can we administer either the pneumococcal polysaccharide or the pneumococcal conjugate vaccine to patients with multiple sclerosis?
Multiple sclerosis is not a contraindication to any vaccine, including either of the pneumococcal vaccines.
Miscellaneous PCV13 issues
Back to top
A 2-month-old was mistakenly given PPSV23 instead of PCV13. What should be done?
PPSV23 is not effective in children less than 24 months of age. PPSV23 given at this age should not be considered to be part of the pneumococcal vaccination series. PCV13 should be administered as soon as the error is discovered. Any time the wrong vaccine is given, the parent/patient should be notified.
Do children who are diagnosed with pneumococcal disease still need to receive pneumococcal conjugate vaccine?
Yes. There are several different serotypes of
Streptococcus pneumoniae
that cause disease in children. A child who has had pneumococcal disease has only developed antibody against one serotype.
Vaccination scheduling and documentation issues
Back to top
During an office visit, can a healthcare provider administer PCV13 and PPSV23 to an adult patient who needs both vaccines but who has had neither? If not, what is the recommended interval between doses?
PCV13 and PPSV23 should not be given at the same visit. Patients who need both PCV13 and PPSV23 and who have received neither should receive PCV13 first, followed by a dose of PPSV23 at least 8 weeks later. If a second PPSV23 dose is recommended, it should be administered at least 5 years after the first PPSV23 dose.
Rather than giving pneumococcal conjugate vaccine (PCV13) first and waiting 8 weeks to give PPSV as recommended for an immunocompromised child (2 years or older) or adult patient, we inadvertently gave both vaccines at the same visit. We are looking for guidance.
When these two vaccines are given simultaneously, each probably affects the other detrimentally. The risk of diminished responsiveness (which is "caused" by PPSV23, not PCV13) means that you should count the PPSV23 dose as valid for adults, and repeat the PCV13 dose 1 year after the PPSV23 dose was administered. You should count the PPSV23 dose as valid for children, and repeat the PCV13 dose 8 weeks after the PPSV23 dose was administered and complete the series as age appropriate.
What is the recommended interval between doses for adult patients who have already received one dose of PPSV23 and now need PCV13?
For patients who have already had one or more doses of PPSV23, it is recommended to wait 1 year or more after PPSV23 before administering PCV13. If the patient is recommended to receive a second dose of PPSV23, delay that second PPSV23 dose for 8 weeks or more following PCV13 and 5 years or more following the first dose of PPSV23.
If patients who are in a recommended risk group for PPSV23 or PCV13 aren't sure if they have previously received these vaccines, should healthcare providers vaccinate them?
Yes. If patients do not have a documented vaccination history for these two vaccines and their records are not readily obtainable, you should administer the recommended doses. Extra doses will not cause harm to the patient.
We just gave PPSV23 to a 66-year-old patient who is newly diagnosed with a medical condition that places him at increased risk for pneumococcal disease and its complications. Should we give him a second dose in 5 years because of his underlying medical condition?
No. People who are first vaccinated with PPSV23 at age 65 years or older should receive only one dose, regardless of any underlying medical condition they might have.
When should I vaccinate children or adults who are planning to have either a cochlear implant or elective splenectomy?
It is preferable that the person planning to have the procedure have antibody to pneumococcus at the time of the surgery; if possible, administer the appropriate vaccine prior to the splenectomy or cochlear implant. Children 2 through 71 months of age should continue to receive PCV13 vaccine according to the schedule above. If the procedure is done on an emergency basis, vaccinate as soon as possible according to the routine schedule. Administer a dose of PPSV23 to all patients with an interval of at least 8 weeks from the previous dose of PCV13.
How should we administer both pneumococcal vaccines (PCV13 and PPSV23) to our high risk pediatric patients?
All children with risk factors for pneumococcal disease or its complications should be vaccinated with PPSV beginning at age 2 years. If they are age-eligible and are due for a dose of PCV13, give that one first and then wait 8 weeks before giving PPSV. For more information on vaccination of high risk pediatric patients, see pages 2627 of the ACIP statement at
Some physicians in our area order PPSV23 every 5 years for their patients. Is this correct?
No. Only certain high-risk people who were vaccinated when younger than age 65 years will need a second dose 5 years later. At age 65 years, all adults (including people vaccinated when younger) will need to be vaccinated.
Can we vaccinate a 2-year-old boy with functional or anatomic asplenia against meningococcal disease if he has not completed a series of PCV13?
You should first be certain that he is up to date with PCV13 vaccine before you vaccinate him with MCV4. If you are going to give him MCV4-D (Menactra; sanofi pasteur), you need to wait at least 4 weeks after he completes the PCV13 series before giving him the MCV4-D. There is no similar space consideration if MCV4-CRM (Menveo; Novartis) is used; it may be given simultaneously with PCV13 or at any interval since receipt of PCV13.
Can I give other vaccines at the same time I give either PCV13 or PPSV23 to a patient?
Yes, with several exceptions. PPSV23 and PCV13 are both inactivated vaccines, which means you can give all other recommended vaccines at the same visit (using separate syringes) or at any later time with no waiting period following the vaccination. Here are the exceptions:
You cannot give both PCV13 and PPSV23 at the same time. (Read next Q&A)
If the person is a candidate for both meningococcal conjugate vaccine (MCV4) and PCV13, observe these rules:
If using MCV4-D (Menactra by sanofi), you should give PCV13 first with a 4 week separation between the final dose of PCV13 and MCV4-D.
If using MCV4-CRM (Menveo by Novartis): give both products simultaneously or at any other interval
What intervals should be observed between doses of PCV13 and PPSV23 for those children and adults who are recommended to receive both vaccines?
In these situations, give PCV13 first followed by PPSV23 in 8 weeks. For adults age 19 years and older who have received one or more doses of PPSV23 previously, wait 1 year before giving PCV13 to avoid interference between the 2 vaccines. For children age 2 through 18 years who have not received PCV13 but who have received one or more doses of PPSV23 previously, wait 8 weeks before giving PCV13.
The Zostavax vaccine (Merck) package insert says that Zostavax should not be given simultaneously with pneumococcal polysaccharide vaccine (PPSV23). What does ACIP say about this?
ACIP has not changed its recommendation on the simultaneous administration of these two vaccines (i.e., they can be given at the same time or any time before or after each other).
Vaccination strategies
Back to top
We have begun a more aggressive approach to vaccinating our high-risk patients against pneumococcal disease. Do you have any suggestions on how we can improve our system?
Congratulations on your efforts to increase your clinic's vaccination rates against this serious and deadly disease. Health experts have found that influenza predisposes individuals to bacterial community-acquired pneumonia, and studies have shown that this is heightened during influenza pandemics. In June 2009, CDC issued interim guidance for use of 23-valent pneumococcal polysaccharide vaccine (PPSV23) in preparation for the circulation of the pandemic H1N1 virus. Though the guidance does not change the groups indicated for PPSV23 and/or PCV13 vaccination, it does remind providers that many at-risk people younger than age 65 years and many people who are age 65 and older have not yet been vaccinated and they need to be.
Administering pneumococcal vaccines
Back to top
What route and needle length is recommended for administration of pneumococcal polysaccharide vaccine?
Pneumococcal polysaccharide vaccine may be given either by intramuscular (IM) or subcutaneous (SC) injection. When administration is IM, choose needle length appropriate to the person's age and body mass: toddlers age 2 yrs: 11¼" (anterolateral thigh) or ⅝1" (deltoid muscle); children ages 34 yrs: ⅝1" (deltoid) or 11¼" (anterolateral thigh); adults, a 11½" needle. A ⅝" needle may be used in toddlers and children and for adult patients weighing less than 130 lbs (60 kg) for IM injection in the deltoid muscle only if the subcutaneous tissue is not bunched and the injection is made at a 90-degree angle. When administration of PPSV23 is SC, a ⅝" needle is recommended.
What route and needle length should we use for administration of pneumococcal conjugate vaccine (PCV13)?
Pneumococcal conjugate vaccine (PCV13) should be administered by the intramuscular (IM) route. Choose needle length appropriate to the person's age and body mass: infants younger than age 12 months: 1"; toddlers 12 yrs: 11¼" (anterolateral thigh) or ⅝1" (deltoid muscle); children ages 34 yrs: ⅝1" (deltoid) or 11¼" (anterolateral thigh); adults, a 11½" needle. A ⅝" needle may be used in toddlers and children and for adult patients weighing less than 130 lbs (60 kg) for IM injection in the deltoid muscle only if the subcutaneous tissue is not bunched and the injection is made at a 90-degree angle.
Reviewed and revised September 2013
About IAC
Contact Us
Press Room
Cite IAC
Link to IAC
A-Z Index
Site Map
Immunization Action Coalition • 1573 Selby Ave • St. Paul, MN 55104
tel 651-647-9009 • fax 651-647-9131
This website is supported in part by a cooperative agreement from the National Center for Immunization and Respiratory Diseases (Grant No. 5U38IP000290) at the Centers for Disease Control and Prevention (CDC) in Atlanta, GA. The website content is the sole responsibility of IAC and does not necessarily represent the official views of CDC.


text:
Click on a label to read posts from that part of the world.
Hiking across Mordor in Tongariro National Park
There aren't many places where you feel the urge to wear your wedding ring around your neck and begin dodging fictional forces of evil.
New Zealand's Tongariro National Park, however, is exactly one of those places.
As anyone who has been to a movie theater in the last ten years probably knows, New Zealand was the setting for the epically popular Lord of the Rings trilogy which introduced us to the adventures of Middle Earth.
Arguably one of the best known movie series of an entire generation, the movie saga has simultaneously done wonders for the New Zealand tourism economy by displaying the country's enchanting and other worldly scenery to a global audience of millions. While Middle Earth tourism has sculpted out its own niche for diehard fans (my 2012 New Zealand road atlas, for example, points out where each scene was filmed), as a casual viewer there are only a few place names I actually recognize.
One of these, of course, is Mt. Doom, and as I set out from the campervan into the volcanic cinder of the Tongariro Crossing-one of New Zealand's most heavily trafficked walks-I found myself standing directly beneath it.
So what exactly is Mt. Doom?
Well, to begin, its real name is Mt. Ngauruhoe, it is 7,516 ft. high, and from the best I could tell there aren't any quivering, flaming black eyes located anywhere near it. While Mt. Ngauruhoe doubled as Mt. Doom, the surrounding bits of Tongariro National Park provided the scenery for Mordor, the fiery and terrifying volcanic wasteland that serves as the home of evil.
As it happens, Tongariro is actually pretty cold, even during the summer months. Lacing up my hiking boots at 6am with about 100 other trekkers, the morning dew had frozen and blanketed the campervan beneath a thin layer of frost.
"Weird", I thought. "There's not supposed to be snow in Mordor."
Nearby Mt. Ruapehu is an active enough volcano that warning signs scattered around the park advise skiers what actions to take should the mountain decide to go all volcanic and bubbly during their mid-winter ski session. A legitimate concern, the mountain last experienced a major eruption in 1996, and volcanic lahars--essentially boiling rivers of mud--have been known to push their way down to within a few feet of chairlifts which regularly carry resort guests.
And, since Tongariro is still comprised of active volcanoes, it would make sense that there are hot springs, sulfuric lakes, and places where steam rises straight from the Earth.
As I enjoyed a lunch of sweet chili tuna (why don't we have flavored tuna in the US?) above the turquoise (and toxic) Emerald Lakes, it wasn't hard at all to see why the Lord of the Rings scouts chose this place. A sea of multicolored cinder, the entire landscape is bathed in that oxymoronic volcanic quality where new earth appears to be old; just because it isn't covered in grass doesn't make it old, but, in fact, too young for organisms such as grass to have taken root.
Though Tongariro gets pigeonholed nowadays into Mordor tourism there's still much more to the park than volcanoes and moonscapes. Many places in the park are actually fairly green and lush, and on the trail out to Tama Lakes it's possible to be surrounded by volcanic, sub-alpine shrub land and still sunbathe at the base of a cascading waterfall.
Or, if trekking across barren cinder flats isn't quite classy enough, you can always retire to the historic and ultra-elegant Chateau Tongariro and listen to the tunes of the grand piano played next to a roaring fire. Constructed in 1929, the Chateau was originally a luxury outpost for outdoorsmen and adventure seekers aiming to explore the beauty of the island's volcanic highlands. Today it's still possible to book a room at the Chateau or simply call in for a glass of wine, an entrée of lamb, or, of course, a panoramic view of Mordor.
Though the silver screen has made this place famous as of late, Hollywood was far from the first organization to recognize the beauty of Tongariro. Wanting the land beneath these mountains to be preserved and maintained for eternity, it was the Maori chief Horonuku Te Heuheu Tukino who in 1887 first gifted this land to the New Zealand government to preserve and protect the sacred alpine ground for generations to come.
From Maori chiefs to mythical hobbits to active volcanoes to a wayward vagabond touring the country in a campervan, Tongariro National Park is a magical place to find yourself when given the freedom to roam.
For 2 months Gadling blogger Kyle Ellison will be embedded in a campervan touring the country of New Zealand. Follow the rest of the adventure by reading his series, Freedom to Roam: Touring New Zealand by Campervan.
Filed under: Climbing, Hiking, History, Learning, Skiing, Stories, Oceania, New Zealand, Hotels and Accommodations
Search Travel Deals
Reader Comments (Page 1 of 1)
Richard Tulloch Feb 12th 2012 3:17PM
Very nice article on the much-crossed Tongariro. It is hard to avoid the backpacker crowds on the main drag, though I was lucky enough to have a local guide to take me off the beaten track there:

subset: commoncrawl


text:
Sanctions over Iran's nuclear program have battered its economy and collapsed its currency. The West believes Iran might move to make nuclear weapons. Iran denies that.
Gen. Mohammad Ali Jafari said the Guard protects ships in the Gulf and the strait. His comments were posted on the Guard's website Wednesday.
Guard commanders in the past have threatened to block the waterway over Western sanctions.
Jafari's remarks were apparently aimed at highlighting the Guard's control of the strategic waterway.
Military officials say Iran has a plan to shut the strait but insist that Supreme Leader Ayatollah Ali Khamenei would make the final decision.


text:
Key West >Food & Dining > Blue Heaven Restaurant
729 Thomas St, Key West, FL | Directions 3304024.551712 -81.802866
roof top is insane. lobster omelets all the way around. we found this place online and im glad we did. great breakfast spot. some stuff was pricey but the food was original and awesome. never ate anywhere w live chickens running around. it was a real treat
welcome to heaven – good prices and a fantastic breakfast menu
LOVE this place! – i love this place they have the best breakfast and mimosas and they are very affordable! they have live music and all the staff is great! will come here again for sure!
Mixed Feelings – Ok, this place is ecentric to say the least. Very worth the visit, because I personally have never been to anything like it. Our wait was very long and we got there early like 5:00ish. It probably was an hour an a half wait. Most of the seating is outdoors, which is cool, but what's not cool is all the cats running around. They're all over. In fact they were underfoot while we were eating!
I was getting a little freaked out by the experience, thinking that the cleanliness factor just wasn't up to my standards. However, after the food came out I suddenly forgot about the cats! I got the jerk chicken and it was so good and the cornbread was the best I've had. All of us at the table had zero complaints. So if you can handle the cats...go and enjoy a wonderful meal!
Great Bar at Night & Great Breakfast – Had the best Lobster Eggs Benedict with lime hollandaise - unbelievable food - live jazz in the morning - awesome! Went back at night & had a great time. Outdoor bar was the coolest place in Key West.
luved this place! – you have to go at non-peak hours. we went early for breakfast and were seated inside right away. AND served right away. We had the lobster omlet and it was so good I practically inhaled it! the mimosa was perfect as was the service! When I read the reviews about the chickens and cats running around I didnt want to go but heard from the locals how good it was we went anyway. The cats and chickens are in the outside eating area not the inside AND we only saw 2 cats. We came outside after eating and it was starting to get busy and they were serving coffee to those waiting AND had heaters going! Go here! you wont regret it! My mouth is STILL watering for that food!
A Really Good Lunch – My husband and I had a really good lunch recently, when we visited Key West, at Blue Heaven. It took us a while to find it, but it was worth it. My lobster sandwich and key lime pie were great. We didn't even mind the chickens. They kind of added to the character of the place. I recommend it.
Coolest spot for breakfast – My husband and I are on honeymoon in Key West and had our first breakfast here. This place is soooo cool. The food was excellent and our waitress was very responsive and nice. The atmosphere is out of this world. I love the openess and flora. I would recommend this as a must see spot for anyone going to Key West.
Blue Heaven's Obnoxious Blue-Haired Hostess – If you enjoy being insulted by an obnoxious, old sea hag of a hostess whose face looks like a wrinkled old catcher's mitt while waiting an hour for a seat, then this is your place. If not, then DO NOT GO THERE!!!! Because I know I never will again. So much for Key West charm. I guess when a place becomes a well-known tourist attraction, courtesy and customer service take a back seat. I will be sure to tell everyone back home to boycott this place on principle. There are plenty of other great restaurants on the island where you don't have to put up with a bitter old woman who hates her job while you are on vacation. If I were a manager at Denny's, I wouldn't even consider hiring her to wash dishes.
Best Pancakes ever! – If you go to the keys make time to visit this restaurant. It is pricey but worth it. Do try to go when the rushes are over. My husband, my eight year old son and I went for brunch on a friday and were seated right away. This place was awesome. made me feel like i was in the tropics, my son loved the chickens and cats, i loved the whole place!
View more Reviews for Blue Heaven Restaurant
Sign in with Facebook Sign in with Facebook to see what your friends are up to!
Do you have a review of Blue Heaven Restaurant on your blog? If you include the Citysearch image link (shown below) in your post, we'll automatically link to your review from the business profile page. Here's how our Linkback system works:
The Linkback system is free and automatic. It's really that easy.
To link to our business profile page, copy the html below to your web page.


text:
1 person found this helpful
I have been working at EY full-time for more than a year
Pros – 1) The diversified staffing group. With the DSG, there are two things that happen, that are pretty cool.
a) You yourself know that if you don't like a particular job, you aren't necessarily stuck doing it.
b) Other people for the most part are interested in helping you find a group you like.
2) Great culture for coaching, learning, training, and teaming.
3) For a Big 4 firm, many people are willing to work with you on flexibility.
Cons – 1) Like all the Big 4 firms, the hours become rough at times. Even with work-life balance, there is a LOT of work.
2) With the diversified staffing group, staff and seniors can experience rolling out of one busy season directly into another with no breaks.
3) While compensation is a good solid start compared to most majors, it's not the top in absolute terms, and when you start looking on a per hour basis, it's not very competitive. This is mostly a Big 4 issue, though.
Advice to Senior Management – Find a way to spread the workload better. There are some people who are consistently over 100% utilized (and maybe part of the reason is that they are the most desirable employees), but over-utilization burns people out, and there are other employees to smooth out the opportunities for.
Yes, I would recommend this company to a friend – I'm optimistic about the outlook for this company
I worked at EY as an intern for less than a year
I have been working at EY full-time for more than 10 years
Would you like us to review something? Please describe the problem with this {0} and we will look into it.
Your feedback has been sent to the team, and we'll look into it.
Sorry, but your feedback didn't make it to the team. Your input is valuable to us – would you mind trying again?
Your response will be removed from the review – this cannot be undone.
Copyright © 2008–2014, Glassdoor. All Rights Reserved. Your use of this service is subject to our Terms of Use and Privacy & Cookies Policy. Glassdoor ® is a registered trademark of Glassdoor, Inc.
We do not post on Facebook
We do not post on Facebook


text:
Replace the floor first.
Then put the new toilet down over the new tile.
The ADA bowls work a little better, so go with the Eco this time.
I have two of the Eco in the home, they are working fine.
The difference between the Ultramax and the Drake?
It's mainly looks. The parts are the same and performance is similar enough so that it becomes a non issue.
I like the one-piece look, and cleaning is nicer too.


text:
Cutting Edge: 19 Iconic Hollywood Hairdos That Were Imitated By Millions Of Fans
From The Bouffant to The Bob, The Rachel To The Bananarama, these luscious looks shaped a generation.… READ ON
From The Bouffant to The Bob, The Rachel To The Bananarama, these luscious looks shaped a generation.… READ ON
See which stars have battled eating disorders…… READ ON
Liar, liar, pants on fire!
Hollywood stars aren't exactly known for their honesty, but some of them have gotten busted BIG time, stretching the truth more than a… READ ON
A Spice Girl no more, Victoria Beckham has announced that her rock and roll days are a thing of the past.
"Victoria has made no secret of the fact her… READ ON
By Radar Staff
When does the desire to be skinny become scary?
Hollywood's hottest stars experience a lot of pressure to be thin for the cameras, but sometimes they… READ ON
By Radar Staff
Sofia Vergara and Kim Kardashian both experienced embarrassing wardrobe malfunctions this week, but they aren't the only Hollywood stars who've had sinful style-slipups!
From the beach to… READ ON
By Radar Staff
A little white lie never hurt anyone, or did it?
Hollywood stars are famous for getting themselves in trouble with their far from little fibs, getting publicly… READ ON
By Jon Boon – Radar Reporter
Russell Brand fell for "Ginger Spice" Geri Halliwell when he discovered she is sober just like him, RadarOnline.com exclusively reports.
The 37-year-old comedic actor… READ ON
By Radar Staff
Russell Brand is spicing up his life – he's dumped his yoga-practicing girlfriend for 'Ginger Spice' Geri Halliwell, according to reports.
UK tabloid The Sun claims… READ ON
By Radar Staff
The Spice Girls reunited for the first time in four years on Tuesday in their native London on the promotional trail for the musical Viva Forever!, which… READ ON
By Radar Staff
At least some of Hollywood's hottest stars are saving their skin from the sun and turning to self-tanner to get their glow, but that doesn't mean they… READ ON
By Leah Ornstein – Radar Style & Beauty Editor
There was no lack of bikini blunders on the beach in 2011!
Hollywood's hottest stars certainly had some fun in the… READ ON
By Leah Ornstein – Radar Style & Beauty Editor
We all know that there were a lot of hot bodies on the beach in 2011, but which of the bombshell… READ ON
By Leah Ornstein – Radar Style & Beauty Editor
They may not tower over their stripped-down competition on the shoreline, but what these bikini babes lack in height they make… READ ON
By Radar Staff
There is nothing bashful about these smokin' hot bikini babes!
With their gorgeous looks and fabulously fit bodies, Hollywood stars of every age have no problem hitting… READ ON
By Leah Ornstein, Radar Style & Beauty Editor
Every time a celebrity puts on a barely-there bikini they are taking a huge risk!
From nip-slips to attack of the underboob… READ ON
By Radar Staff
Ginger Spice is all grown up – and just as sexy as ever!
Geri Halliwell recently stripped down into skimpy bras and panties for her new "Geri… READ ON
By Leah OrnsteinRadar Style & Beauty Editor
There is more than one type of bikini cleavage!
Although we are accustomed to seeing sexy décolleté on Hollywood's hottest bikini babes,… READ ON
By Leah OrnsteinRadar Style & Beauty Editor
It's hard to believe that these Hollywood hard-bodies have already popped out babies, and still have the most enviable abs on the… READ ON
Stars Show Off Underboob In Their Bikinis… READ ON
Hollywood Bikini Moms With Abs of Steel… READ ON


text:
LMHI Newsletter
Liga News No. 8, 12/2012
Las Noticias de Liga No. 8
Informativo Eletrônico da LIGA
The LIGA LETTER
Vol. 19, Review 2013
All issues
LMHI Uruguay
by Dra. Liliana Brea, NVP
There are two homeopathic Associations in Uruguay:
- The Association of Homeopathic Medicine of Uruguay (AMHU). It carries out regular courses of homoeopaths' formation for doctors and veterinarians, of 3 years duration, as well as courses of superior level for homoeopaths professionals. It holds a monthly symposium and provides polyclinic assistance for low income people. It publishes the magazine of "Medicina Homeopática".
- The Hahnemann Homeopathic Medical School of Uruguay (EMHHU). It carries out regular courses of homoeopaths' formation for doctors, veterinarians of 3 year duration. It holds a monthly symposium.
Homeopathy in Uruguay is developed mainly in the private environment.
There are about 200 medical homeopaths and 30 veterinary doctors formed in Uruguay.
The Ministry of Public Health although it allows the doctors to prescribe homeopathic medicines, it doesn't recognize it as medical specialty.
Homeopathic medicines are legally recognized by the sanitary authorities of the country.
One of the objectives of our Associations is that Homeopathy is recognized as medical act and it can be integrated to the University teaching.
Coming closer to this objective, in the year 2005 was dictated a course of Veterinary Homeopathy in the Univesity Veterinary for advanced students.The course was dictated by the the professors of the AMHU.
We have also held conversations with the Ministry of Public Health with the purpose of that the Homeopathy will be recognized as a specialty .
In November of 2005, the 60º Pan-American Congress of Homeopathy, organized by the AMHU., took place in Montevideo, Uruguay.
In October 2007, at the premises of the Uruguayan Medical Syndicate, the first integration meeting of the Uruguayan Homeopathic Associations took place. This event was organized in a joint effort by the AMHU and EMHHU.


text:
How can I earn award miles with Germanwings?
Simply enter your Miles & More number into the relevant field directly when booking a flight or retrospectivly under "My Germanwings".
Further questions regarding "Earning Miles & More award miles with Germanwings"
- How can I earn status miles with Germanwings? »
- How can I earn award miles with Germanwings? »
- Are award and status miles credited for every booking? »
- How many miles do I earn per flight? »
- What mileage credit is given for One-stop flights? »
- When will the miles be credited? »
- Is it possible to earn miles as a family or a group? »
- I have not received any mileage credit yet. What could be the reason? »
- How can Miles & More award miles and status miles be retro-credited? »
- Is it possible to earn miles with the other Boomerang Club Partners? »
- Is it possible to exchange Boomerang Club miles into Miles & More award miles or the other way around? »
- Is it possible to change the credit for a flight (Miles & More miles or Boomerang Club miles) retrospectively? »
- How long are status miles valid? »
- What are status miles? »
- What is the Executive Bonus? »
- What are HON Circle miles? »


text: The seat of La Salle County, the city lies on I-35 in the northwestern part of the county. It was named for Joseph Cotulla, a Polish immigrant, who established the town site upon learning that the International-Great Northern Railroad was extending its railroad line through La Salle County. Its economy has been largely based on cattle and sheep ranching. Oil discovered in the 1950s helped boost the economy. Lyndon B. Johnson and short-story writer O. Henry once called Cotulla home.


text:
See Also:
Friday, April 18, 2014
Flor de Caña Gets a New Look
Friday, April 11, 2014
Berkshire Mountain Reunites Beer and Bourbon
Monday, April 7, 2014
Monster Mashes Meet Cigar Sensations
Friday, March 28, 2014
Maker's Mark Turns 60
Friday, March 21, 2014
Cognac Makes a Whisky
- More from Drinks
Echoes of the Past in Michter's New Sour Mash
Jack Bettridge
Posted: March 29, 2013
The first question about the Michter's Original Sour Mash Whiskey that is reaching distribution in most major U.S. markets may be: What exactly is it?
The latest whiskey from Michter's, a brand which now traces it roots to 1752 Pennsylvania and is now being produced in Kentucky, does not follow the company's recent trend of bottling Bourbons and ryes, but is rather a recreation of a style made at its former distillery that was shuttered in 1989. At the time it was Michter's most popular offering. (In the late 1990s, Michter's American Whiskey Co. of Bardstown, Kentucky, a division of Chatham Imports, bought the trademark.)
The new/old brand, which first returned to limited distribution in December, is a whiskey that smacks of both rye and Bourbon, but speaks of neither mash bill in its title. That reflects both the fence-sitting formulation of the whiskey as it was first made and the reluctance of the present makers to reveal the conditions of how it is now reconstituted.
Joseph Magliocco, who now heads Michter's and worked for its distributor when the whiskey was still being made in Pennsylvania, says that before the company went bankrupt in 1989, Sour Mash was its best-selling bottling. The designation "sour mash whiskey" seems to have been a default label as it qualified as neither a Bourbon or a rye because of its mash bill. American regulations state that Bourbon most be composed of at least 51 percent corn and that rye whiskeys have at least 51 percent rye grain. Willie Pratt, the current Michter's master distiller, says that the mash bill then was 50 percent rye, 38 percent corn and 12 percent barley.
The whiskey was called sour mash after the classic method used to mash each new batch: small amounts of previously fermented mash is set back to ensure consistency. James Crow is credited with inventing the process around the late 1830s for making Bourbon. While the sour-mash method is used in making Michter's Original Sour Mash, it isn't a large distinction in that almost every American whiskey, Bourbon or rye, is now made this way. (The use of the term for Tennessee sour mash whiskeys, such as Jack Daniel's and George Dickel, further designates that it has been filtered through charcoal, though Magliocco states that the Michter's version was not treated that way.)
Michter's, which in its latest incarnation has acted as a negotiant of whiskeys purchased elsewhere and married in very small batches (10 barrels or less), steadfastly refrains from announcing the origins or mash bills of its products. But Magliocco does allow that "it has a lot of rye in it." While the recently released Original Sour Mash is something of a tribute to the former product, which disappeared for some 22 years, it isn't an attempt to reproduce it exactly, he says. Rather, it was inspired by the old Sour Mash, but with the intention of improving on it.
With a collection of vintage Sour Mash bottles to sample from, they set to work creating something with a little more body and little less acidity. The result is an interesting whiskey that straddles the line between Bourbon and rye. "If it was like everything else," say Magliocco, "we wouldn't have released it."
In the meantime, Michter's is also going full force with its conversion into a distiller of whiskey as well as a buyer. It now has two small pot stills operating in its Louisville distillery, and Pratt has been working with Vendome, a copper still manufacturer, to design a column still. He has drawn both on his 45 years experience working at Brown-Forman, maker of Old Forester Bourbon and Jack Daniel's Tennessee Sour Mash Whiskey, and from meticulous records that Vendome has kept of the stills it made for the former Pennsylvania distiller. The new still will not be a recreation of the original, according to Magliocco, however. "We're trying to take the best of the past and improve on it."
Pratt, who says he spent his whole career in whiskey production "and I love it," added that it was "exciting to use my knowledge of a column still." The plan is for a still especially constructed for whiskeys intended to be barreled at 103 proof, far lower than the industry standard, which is closer to 120.
(Tasting notes and cigar pairings on next page)
You must be logged in to post a comment.


text:
2201 Coulee Rd., Hudson
In ShortA low-key, friendly environment attracts plenty of families to this reliable chain. Kids in the big booths--often clutching free balloons and crayons--usually outnumber…
913 Pearson Drive, Hudson
111 Walnut St, Hudson
Had a great breakfast at Dick's Bar. Oatmeal was prepared perfectly, however, they gave me about four servings. Their breakfast potatoes are yummy too. The only down side was it…
315 Wisconsin St N, Hudson
414 Wisconsin St N, Hudson
709 Rodeo Dr, Hudson
1801 Ward Ave, Hudson
517 2nd St, Hudson
I was there with two of my friends, and just as we stepped in the door, an extremely drunk woman staggered over and noticed our dog. She said she was the owner, and we asked if we…
601 2nd St, Hudson
1106 County Rd A, Hudson


text:
QB Tajh Boyd
Boyd has thrived in his two seasons as Clemson's starter, throwing for a combined 7,724 yards and 69 touchdowns. He also rushed for 10 touchdowns in 2012 -- more than all but four ACC players. The reigning conference Player of the Year will have to continue his production without top target DeAndre Hopkins, who declared early for the NFL draft.


text:
I've looked at all the Migration Assistant posts, but I'm not clear if people are trying to migrate settings or if that's just a step to skip that people are getting tripped up on during install.
Either way, I'd like to know if it's possible to use Migration Assistant or something else to import user data and old apps from another drive that was used in a MacBook?
At first I wanted to see if the drive could be partially cloned, but I figured that was definitely not an option.
Anyone have any useful tips in this area?


text:
This best practice guideline initiative is focused on recognizing, managing and preventing the abuse and neglect of older adults throughout various health-care institutions and community settings in Canada.
The guideline aims to assist nurses and their clients to make informed decisions that lead to quality care and improved outcomes (improved quality of life and overall reduction in morbidity).
Increase your comfort, confidence and competence in this practice area, in order to enhance safety for your clients and to lower the impact of suicide to society.
Increase your knowledge in client assessment and device selection, client education and documentation.
It will provide direction to all nurses and the interprofessional team who provide care in all health-care settings to people (>15 years of age) with type 1 and/or type 2 diabetes and who have established diabetic foot...