doctors against hpv vaccine 2020doctors against hpv vaccine 2020

It is the most common sexually transmitted infection in the United States. The doctor pointed to a November 2020 "Science Translational Medicine . If you have questions about the HPV vaccine, including its pros or cons, talk to your doctor. Further evidence that large-scale HPV vaccination confers protection for unvaccinated individuals comes from a 2019 meta-analysis of girls-only HPV vaccination programs in 14 high-income countries that included 60 million vaccinated people (22). We will work tirelessly to ensure those rights are defended and victims of injustice are compensated for their injuries. Perspectives for therapeutic HPV vaccine development. In addition, Cervarix has been found to provide substantial protection against a few additional cancer-causing HPV types, a phenomenon called cross-protection (16). We take your privacy seriously. During the same time frame, reports of serious health issues after HPV vaccination were consistently rare, the study found. Mild to moderate side effects can include: If you get the vaccine and have any of these side effects or other unusual symptoms, or if the symptoms persist, you should talk to your doctor. Many people who get HPV vaccine have no side effects at all. About 60 per cent of 12-year-olds were immunized in 2018-19. FDA approves Gardasil 9, the HPV vaccine, to prevent head-and-neck cancer. It's ideal for girls and boys to receive the vaccine before they have sexual contact and are exposed to HPV. It's imperative that there be more robust checks and balances as well as increased transparency in order for the medical community and the public to make genuinely informed decisions. I want to warn people of the potential for serious adverse reactions and let others who have been hurt know that they are not alone. Studies have shown that while individuals trust medical professionals for health information, a growing number are turning to the internet for first and second opinions about HPV, HPV vaccines, and HPV-associated cancer, they continued. Some adults age 27 through 45 years who are not already vaccinated may decide to get HPV vaccine after speaking with their doctor about their risk for new HPV infections and the possible benefits of vaccination for them. Vaccination against hepatitis B (Hep B) was the most frequently used in the presented group, despite not being obligatory for these age groups in childhood. Rare side effects are the biggest con. Gardasil; Human Papillomavirus Bivalent (Types 16 and 18) Vaccine, Recombinant Morbidity and Mortality Weekly Report 2014; 63(RR-05):130. When typing in this field, a list of search results will appear and be automatically updated as you type. The HPV vaccine is a safe and effective vaccine that can protect children and adults from HPV-related diseases. Before receiving the HPV vaccine, tell the doctor or nurse if you: If you doubt their good intentions, theyre not going to hear you out, regardless of how sparse the evidence is for their beliefs, she said. It was really shocking to me to see this parallel analysis of parental perceptions and statements about safety and the actual safety results, and theyre going in opposite directions," said Robin Vanderpool, Dr.P.H., chief of NCIs Health Communication and Informatics Research Branch, who wasnt involved in the study. Lancet Oncology 2020; 21(12):16431652. Cancer 2020; 126(5):10901101. Clinical trials have shown that HPV vaccines are highly effective in preventing cervical infection with the types of HPV they target when given before first exposure to the virusthat is, before individuals begin to engage in sexual activity. "Antivaccine rhetoric was also not given much space in the media" during the pandemic, she says. Immunisation against HPV is not recommended for pregnant people. Indeed, analyses of data for 20122016 found that HPV caused more oropharyngeal cancers than cervical cancers in the United States (2). Although HPV often goes away on its own, certain types can cause medical concerns, from genital warts to cervical cancer. Human Papillomavirus Quadrivalent (Types 6, 11, 16, 18) Vaccine, Recombinant. HPV vaccines can be given starting at age 9 years. HPV can cause: Cervical cancer Anal cancer Management of cervical dysplasia and human papillomavirus. A controlled trial of a human papillomavirus type 16 vaccine. From 2015 to 2018, more than 39,000 caregivers of teens who had not received the HPV vaccine responded to the survey and selected 1 of 31 reasons for declining the vaccine. Adverse events following HPV vaccination, Alberta 2006-2014. Cervical cancer is the second most common cancer after breast cancer to affect women aged 15-44 years in the European Union. Vaccination is not recommended for everyone older than age 26 years. Reduced prevalence of oral human papillomavirus (HPV) 4 years after bivalent HPV vaccination in a randomized clinical trial in Costa Rica. Pain, redness, or swelling in the arm where the shot was given, Dizziness or fainting (fainting after any vaccine, including HPV vaccine, is more common among adolescents than others), HPV (Human Papillomavirus) Gardasil-9 Vaccine Information Statement (VIS). Lancet 2017; 390(10108):21432159. It failed to live up to the hype. Before Merck brought Gardasil to market, the company negligently designed and conducted clinical trials to prevent the clinical trials from revealing the vaccine's true risks, including autoimmune diseases, the lawsuit alleges. cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-fact-sheet, cdc.gov/vaccines/parents/diseases/teen/hpv.html, cdc.gov/vaccines/vpd/hpv/public/index.html, naturopathic.org/article_content.asp?article=788, mayoclinic.org/diseases-conditions/hpv-infection/symptoms-causes/syc-20351596, Everything you Need to Know About Human Papillomavirus Infection, Common Types of Human Papillomavirus (HPV), Human Papillomavirus (HPV) of the Mouth: What You Should Know, HPV and HPV Tests: Everything You Need to Know, More Boys Are Getting Vaccinated Against HPV: Why That's Important, Why a Single Dose HPV Vax Could be a Game-Changer, Everything You Need to Know About HPV for People with a Vulva and Vagina. Gynecologic Oncology 2019; 153(3):521529. Lancet 2015; 386(10008):20782088. Alarmingly, this . Dietary intakes of selected nutrients and food groups and risk of cervical cancer. HPV vaccines are given as two or three doses over a six-month time period. Sahara Walker. A 12-year follow-up on the long-term effectiveness of the quadrivalent human papillomavirus vaccine in 4 Nordic countries. DOI: Scheller NM, et al. The VLPs have been found to be strongly immunogenic, which means that they induce high levels of antibody production by the body. Common Gardasil 9 side effects may include: pain, swelling, redness, itching, bruising, bleeding, and a lump where the shot was given; nausea, diarrhea, stomach pain; headache; Enhertu May Be Preferred Therapy for Some Metastatic Breast Cancers, Adjuvant Immunotherapy Approved for Some Patients with Lung Cancer, If you would like to reproduce some or all of this content, see Reuse of NCI Information for guidance about copyright and permissions. Brotherton JM, Budd A, Rompotis C, et al. Morbidity and Mortality Weekly Report 2019; 68(33):724728. Gardasil 9 vaccine targets the types of HPV responsible for around 90 percent of cervical and other HPV-related cancers, and 90 percent genital warts. Although the results are yet to be published, the studies suggest that well-respected local organizations can have a positive influence on peoples perceptions about HPV vaccines, Dr. Kobrin said. MADISON, Wis., Nov. 18, 2020 /PRNewswire/ -- Gardasil attorneys from the national law firm of Baum Hedlund Aristei & Goldman filed a lawsuit against Merck on behalf of a young woman who alleges she developed Postural Orthostatic Tachycardia (POTS) and a host of other serious injuries after receiving the human papillomavirus (HPV) vaccine. The combination of HPV vaccination and cervical screening can provide the greatest protection against cervical cancer. Journal of the National Cancer Institute 2020; 112(10):10381046. Meanwhile, the rate of nonserious health issues following HPV vaccination reported in VAERS dropped from 43 to 28 per 100,000 vaccine doses. Human papillomavirus vaccines: WHO position paper, May 2017-Recommendations. The findings highlight an urgent need for doctors and public health leaders to address these concerns with parents, according to the scientists who led the study. When the researchers looked at the data by state, they found that the number of parents citing safety concerns increased in 30 states and more than doubled in California, Mississippi, South Dakota, and Hawaii. During the same doctor visit, she also received the Tdap vaccine and the meningococcal conjugate vaccine. In 2020, the Centers for Disease Control and Prevention (CDC) approved the HPV vaccine to prevent even more cancers: head and neck cancers, like those in the back of the throat or base of the tongue. But . The HPV vaccine is a safe and effective way to protect against the serious health problems that HPV can cause. Very rarely, severe (anaphylactic) allergic reactions might occur after vaccination. said that while the motion filed could start a "legal flood against our vaccination system," it will not stop the . They have the potential to eradicate disease and save millions of lives. The Front Line Covid-19 Critical Care Alliance, formed in 2020 to "prevent and treat covid," is touting ivermectin for common respiratory infections amid a dramatic drop in prescriptions for the drug as clinical . DOI: Genital HPV infection Fact sheet. Persistent high-risk human papillomavirus (HPV) infection is endorsed by the World Health Organization as an intermediate endpoint for evaluating HPV vaccine effectiveness/efficacy. Cervical cancer is the fifth most common cancer among Thai women, with the human papillomavirus (HPV) a major cause. The vaccines do not prevent other sexually transmitted diseases, nor do they treat existing HPV infections or HPV-caused disease. Here are five reasons why it's especially important for males. The most recent safety data review for HPV vaccines continues to indicate that these vaccines are safe (29, 30). But since she became sick and disabled within days of getting the shot, we firmly believe her adverse reactions were caused by the Gardasil vaccine. Best practice & research. PLoS One 2013; 8(7):e68329. Harper DM, Nieminen P, Donders G, et al. Our website services, content, and products are for informational purposes only. Each year, there are around 33 000 cases of cervical cancer in the EU, and 15 000 deaths. Meites E, Szilagyi PG, Chesson HW, et al. More than 12 years of safety monitoring show that the vaccines have caused no serious side effects. Kreimer AR, Sampson JN, Porras C, et al. Before receiving the HPV vaccine, Sahara had no autoimmune diseases, no autonomic issues, and no orthostasis. The vaccination can be started at age 9 years. HPV | SKAI Info sheet: July 2020 Everyone needs to get this vaccine because HPV infection is so common and some types of HPV cause cancer. Ongoing clinical trials are testing the safety and efficacy of a therapeutic DNA vaccine to treat HPV-related cervical and vulvar lesions. Vaccines for human papillomavirus (HPV) are used to prevent HPV infection and reduce a person's risk of getting HPV-associated cancers in later life, including cervical cancer and anal cancer . A large observational study using national data from women across Australia found that one dose of HPV vaccine was as effective as two or three doses in preventing high-grade cervical lesions (34). This ensures that theyre protected against HPV before theyre likely to have exposure to the virus. Carrageenan, a compound that is extracted from a type of seaweed and used widely in foods and other products, has been found to inhibit HPV infection in laboratory studies. However, these people should be told that the vaccination will not cure them of current HPV infections or treat the abnormal results of their Pap test (31). MONDAY, March 26, 2018 (HealthDay News) -- Teen boys in the United States are less likely than girls to be vaccinated against human papillomavirus ( HPV) because many doctors . Our suspicion is that the rising safety concerns are probably being driven by [the] use of social media and people trying to find vaccine information online, said the studys lead researcher, Kalyani Sonawane, Ph.D., of UTHealth School of Public Health in Houston, Texas. Vaccine 2011; 29(46):82798284. The current ACIP recommendations for HPV vaccination are (5): The HPV vaccine is given as a series of shots. New England Journal of Medicine 2020; 383(14):13401348. I think there are people who might be saying Im concerned about safety, but if you had the opportunity to talk and listen to them, to educate, and to have an informed decision-making type of conversation, you might be able to move them in a direction where their safety concerns are addressed and theres more willingness to vaccinate, Dr. Vanderpool explained. Another prevention strategy that is being explored is topical microbicides. Overall, these are the major pros of the HPV vaccine: It can protect against cancer and genital warts. Health authorities recommend people receive the vaccines at a young age. Early treatment of cervical cancer can . Melissa Roglitz-Walker. Steinbrook R. The potential of human papillomavirus vaccines. That said, side effects arent common. For example, in Australia, where a high proportion of girls are vaccinated with Gardasil, the incidence of genital wartswent down during the first 4 years of the vaccination program among young maleswho were not being vaccinated at the timeas well as among young females (21). The efficacy and safety of Tipapkinogen Sovacivec therapeutic HPV vaccine in cervical intraepithelial neoplasia grades 2 and 3: Randomized controlled phase II trial with 2.5 years of follow-up. One hundred thirty-five million human papillomavirus (HPV) shots delivered in the United States and counting. Our firm wishes to stress that we are not against vaccines. In addition to thoughts and beliefs about a topic, peoples behavior is also influenced by the things they see their friends and family and important people in their community recommending or doing for themselves, she added. Herrero R, Quint W, Hildesheim A, et al. by Carmen Phillips, December 2, 2022, Among these, two HPV types cause genital warts, and about a dozen HPV types can cause certain types of cancercervical, anal, oropharyngeal, penile, vulvar, and vaginal. There has been a rise in negative and incorrect informationalso called misinformationabout HPV vaccines on social media in recent years, Dr. Sonawane noted. Moreover, the HPV vaccine only covers a limited number of HPV strains. Falsifying science, defrauding regulators and injuring and killing its customers is the only business model this company knows. Certain strains of HPV can cause genital warts, cervical cancer, and other types of cancer. Papillomavirus Research 2019; 8:100177. . "Merck is using the same development and marketing playbook for Gardasil that it used when it promoted Vioxx as a headache pill knowing it caused heart attacks" says co-counsel Robert F. Kennedy, Jr. "Vioxx killed hundreds of thousands of Americans and Merck paid $7 billion in penalties and damages and agreed to stop falsifying science. Vaccine 2017; 35(43):57535755. The ESCUDDO study, a randomized double-blind controlled trial involving 20,000 girls ages 1216 years, is testing whether one dose of either Cervarix or Gardasil 9 is as effective as two doses at preventing persistent cervical infection with HPV. Title: Human papillomavirus (HPV) Vaccines and Cervical Cancer Author: UK Health Security Agency Subject: Human papillomavirus \(HPV\) Vaccines and Cervical Cancer factsheet; UK Health Security Agency gateway number 2021112 Journal of Biomedical Science 2016; 23(1):75. A single dose vaccine may be highly effective in preventing human papillomavirus (HPV), according to newly published research. MMWR Morbidity and Mortality Weekly Report 2016; 65:14051408. Nationwide programs, such as CDCs Vaccinate with Confidence program, can help tackle vaccine misinformation and provide resources for effective communications, Dr. Sonawane said. ", "Data suggests Merck presented regulators with false information about the link between HPV and cervical cancer, which helped give them a runway to fast-track this dangerous vaccine over a matter of six months," says attorney Nicole K.H. 1. HPV infection. Clinical Microbiology and Infection 2019; 25(2):210216. Over the years, several vaccines have been cleared for use by the U.S. Food and Drug Administration (FDA). In the case of permitted digital reproduction, please credit the National Cancer Institute as the source and link to the original NCI product using the original product's title; e.g., Despite Proven Safety of HPV Vaccines, More Parents Have Concerns was originally published by the National Cancer Institute., January 12, 2023, Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. Lancet 2019; 394(10197):497509. Human papillomavirus (HPV) and cervical cancer. These vaccines are Gardasil, Gardasil 9, and Cervarix. Human papillomavirus, or HPV, can cause cancer in men and women and will infect three in four Canadians during their lifetime, according to the Canadian Cancer Society. Although HPV vaccines have been found to be safe when given to people who are already infected with HPV, the vaccines provide maximum benefit if a person receives them before he or she is sexually active (32, 33). The Centers for Disease Control and Prevention (CDC) recommends that the HPV vaccine be given to girls and boys between ages 11 and 12. from 8 AM - 9 PM ET. The HPV vaccine can cause side effects. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. The medical-freedom movement takes dollars spent by sick and desperate people on long-shot, unproven treatments and . British Medical Journal 2013; 347:f5906. Why are more parents concerned now about [HPV] vaccine safety than when it was first launched or in 2015; now that over 135 million doses have been administered in the United States? Nosayaba Osazuwa-Peters, Ph.D., M.P.H., of the Duke University School of Medicine, and his colleagues wrote in a commentary on the study. Gee J, Naleway A, Shui I, et al. Each one involves a series of two or three. 4 In 2020, the global market volume for HPV vaccines is anticipated to reach approximately 44.5 million doses (Figure 4),14 having increased from an average of 30-35 million doses a year over 2010 to 2016,15 representing an increase of 21 per cent over the past 4 years. Healthline Media does not provide medical advice, diagnosis, or treatment. We are, however, against intentional efforts to mislead consumers about the safety and effectiveness of a drug or vaccine. 2020 research indicates that not only does HPV vaccination prevent the viruses . Most health insurance plans cover routine vaccinations. (2018). Human papillomavirus-attributable cancers - United States, 20122016. From 2013 to 2017, there were approximately 25,000 cases of HPV-associated cancers in women and 19,000 in men, according to the Centers for Disease Control and Prevention. Vaccine 2019; 37(29):39183924. Sahara Walker was 11-years-old when she received her first and only shot of Gardasil on September 25, 2013, per her doctor's recommendation. The most common serious side effects of HPV vaccination are dizziness and fainting. The HPV vaccine can be safely given to people who are breastfeeding. A total of 758 serious health problems that arose after HPV vaccination were reported in VAERS during that time. Doctor Elena Ratner, a gynecologic oncologist at Yale Cancer Center and Smilow Hospital says success is being seen as a result of Gardasil 9, the vaccine to prevent HPV, which is a. Now, the CDC recommends that all adults through age 26 should get vaccinated if they missed it during the middle-school years, and adults aged 27 through 45 should ask their doctors if the HPV vaccine is right for them, even if they're sexually active. A better approach, Dr. Kobrin went on, would be to say, Lets all talk about why we believe what we believe. Some parents have always cited concerns about safety for declining to get the HPV vaccine for their kids. Published Apr 22, 2009. Statements from the Plaintiff and Her Mother. You will be subject to the destination website's privacy policy when you follow the link. People who received HPV vaccines were followed for at least about 12 years, and their protection against HPV has remained high with no evidence of decreasing over time. The company has sickened an entire generation. Mix JM, Van Dyne EA, Saraiya M, Hallowell BD, Thomas CC. All three HPV vaccines protect against HPV types 16 and 18 that cause most HPV cancers. Merck allegedly used the DNA adjuvant to prolong Gardasil's immunological effects but illegally omitted it from its list of substances and ingredients in the vaccine. Women who received three doses of Cervarix experienced strong protection against new infections with HPV types 31, 33, and 45 (17). The first dose is routinely recommended at ages 11-12 years old. Researchers are currently investigating whether a single dose of HPV vaccine might be effective. Should HPV vaccines be given to people who are already infected with HPV or have cervical cell changes? For women not already infected with these strains, Gardasil is almost 100% effective at preventing genital warts and cancerous or precancerous lesions of the . There are no formal screeningprograms for the non-cervical cancers, so universal HPV vaccination could have a large public health impact. What research is being done on strategies to prevent HPV infection? DOI: Marchese M. (2013). First, the group of doctors championed ivermectin as a covid panacea. The trials that led to approval of Gardasil 9 found it to be nearly 100% effective in preventing cervical, vulvar, and vaginal infections and precancers caused by all seven cancer-causing HPV types (16, 18, 31, 33, 45, 52, and 58) that it targets (10). If you would like to reproduce some or all of this content, see Reuse of NCI Information for guidance about copyright and permissions. However, they closely resemble the natural virus, and antibodies against the VLPs also have activity against the natural virus. The vaccine is recommended for girls and boys aged 11 or 12. The HPV vaccine is designed to help protect against the related viruses and cancers that may cause cervical cancer. Though rare, adverse reactions to vaccines are very real. CDC recommends that 11- to 12-year-olds receive two doses of HPV vaccine 6 to 12 months apart. Yes. Autoimmune, neurological, and venous thromboembolic adverse events after immunisation of adolescent girls with quadrivalent human papillomavirus vaccine in Denmark and Sweden: Cohort study. Clinical Infectious Diseases 2018; 66(3):339345. HPV vaccine after removal of precancerous cells may cut cervical cancer risk. Dr. Abby Berenson, a. Currently, Grade 7 students in Ontario can receive the HPV9 vaccine through the school-based immunization program. PRIMAVERA-ESCUDDO, a non-randomized open-label trial, will provide earlier and complementary results to ESCUDDO about the immunogenicity of one dose of Cervarix in girls ages 914 years compared with three doses of Gardasil in women ages 1825 years. They help us to know which pages are the most and least popular and see how visitors move around the site. The federal Affordable Care Act requires most private insurance plans to cover recommended preventive services (including HPV vaccination) with no copay or deductible. HealthDay Reporter. Then his career took an unexpected turn. In addition, the vaccines may reduce the need for screening and subsequent medical care, biopsies, and invasive proceduresassociated with follow-up from abnormal cervical screening, thus helping to reduce health care costs and anxieties related to follow-up procedures (24). HPV vaccination and the risk of invasive cervical cancer. She thought she was being a really good, responsible parent. The human papillomavirus (HPV) affects nearly 80 million people in the United States. Just because a health problem is reported in VAERS doesnt mean the vaccine caused it, Dr. Sonawane cautioned. Real-world effectiveness of human papillomavirus vaccination against vulvovaginal high-grade precancerous lesions and cancers. Today, Sahara takes 14 prescription medications. Maya Dronca said she wanted to grow up to be a doctor, treating cancer patients just like her mother, a Mayo Clinic oncologist. After undergoing testing to assess her post-Gardasil symptoms and adverse events, Sahara was diagnosed with various medical conditions, including Neurocardiogenic Syncope (NCS), Postural Orthostatic Tachycardia (POTS), a form of Orthostatic Intolerance (OI) called Orthostatic Hypotension (OH), Small Fiber Neuropathy, and severe Autoimmune Autonomic Neuropathy. (2013). Cision Distribution 888-776-0942 The first dose is routinely recommended at ages 1112 years old. How many doses of HPV vaccine are needed? There are several, Coronary artery disease reduces blood flow to your heart. Since 2016, the only vaccine thats used in the U.S. is Gardasil 9. IVIG is a blood product prepared from the serum of between 1,000 and 15,000 plasma donors per batch that floods Sahara's system with good antibodies to overrule her own bad antibodies that are attacking her own body. The lawsuit (case no. Pre-immunisation checklist. In 2006, females ages 9 to 26 started receiving the HPV vaccine for the first time. Most private insurance plans cover HPV vaccination. HPV vaccines can cause pain, swelling, and redness where the shot was given, as well as headaches, tiredness, and nausea. ACIP recommends that people who have an HPV infection and/or an abnormal Pap test result that may indicate an HPV infection should still receive the HPV vaccine if they are in the appropriate age group (9 through 26 years) because the vaccine may protect them against high-risk HPV types that they have not yet acquired. One other con of the HPV vaccines is that theyre limited in what they do: Whos most at risk of getting HPV if theyre not vaccinated? (2016). Results from the study were published September 17 in JAMA Network Open. Bariatric Surgery May Reduce Risk of Common Cancers, U.S. Department of Health and Human Services. Long-term studies of vaccine efficacy that are still in progress will help scientists better understand how long protection lasts (20). Probably the most important con for the HPV vaccine is potential side effects. Research suggests the. Following a number of Gardasil POTS lawsuits being filed by young adults and teens nationwide left with debilitating autoimmune disorders after receiving the HPV . Below are the stories of four esteemed physicians who have challenged the COVID-19 status quo and the medical establishment they know well. They have allowed a dangerous political juggernaut to emerge from the shadows. Porras C, Tsang SH, Herrero R, et al. Thank you for taking the time to confirm your preferences. Human papillomavirus vaccination: Recommendations of the Advisory Committee on Immunization Practices (ACIP). The plaintiff in the case, Sahara Walker of Lake Mills, Wisconsin, received the Gardasil vaccine when she was just 11 years old. Both vaccines are still used in some other countries. Environmental, Social and Governance (ESG), HVAC (Heating, Ventilation and Air-Conditioning), Machine Tools, Metalworking and Metallurgy, Aboriginal, First Nations & Native American, Gardasil attorneys from the national law firm of Baum Hedlund Aristei & Goldman, negligently designed and conducted clinical trials, Gardasil's dangerous and undisclosed ingredients, Judge Appoints Four Lawyers to Lead Gardasil MDL-Multidistrict Litigation. She was seen by multiple physicians and specialists to treat her growing list of symptoms, including daily migraines, severe body aches and pain, and cognitive impairments, among other issues. (2008). 2005-2023 Healthline Media a Red Ventures Company. Learn how to recognize coronary artery disease symptoms, how to manage the symptoms, and, There are more than 100 types of HPV some low-risk and some high-risk. 000 deaths a series of two or three have the potential to eradicate disease and save millions of lives being. 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The vaccines have caused no serious side effects safe and effective vaccine that can protect against the health... 26 years 20122016 found that HPV can cause medical concerns, from genital warts, cervical cancer in the is. Meanwhile, the only business model this company knows better understand how long protection lasts ( 20 ) only!
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