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It might be the benzyl alcohol preservative in bacteriostatic water, which a small percentage of people are sensitive to

Obviously this ignores all those who require life long treatment due to other causes of B12 deficiency (of which there are many), thereby potentially causing great harm to the vast majority of their B12 deficient patients

However, efficacy against severe disease does appear more durable, with vaccines leading to a ~90% reduction in severe disease at 5 months postvaccination [30, 33]

The economic analysis represents an estimate only , based on the assumptions and costing methods explicitly stated above