2014

January April July October
February May August November
March June September December

January 8, 2014

DATE HEADS UP: The January meeting of the VDC will occur on the SECOND Wednesday of the month (the first Wednesday being New Year's Day).

Focus: Ethics, Controversies
Attendance: 270

You're Not the Boss of Me!
30 Years of Issues and Events in
Vaccination Debates

Mark A. Largent, PhD

Associate Professor
James Madison College
Michigan State University

 

Clubhouse Location:
WHSCAB Plaza and Auditorium (1440 Clifton Rd)
Agenda:
6:00pm — wine, cheese, networking
6:30pm — meeting convenes
7:45pm — casual buffet dinner, more networking

HOMEWORK ASSIGNMENT BEFORE THE JANUARY MEETING:
Alert VDC member Diane Sutcliffe sent along a link to a blog posting by Amy Parker on "Growing Up Unvaccinated" -- I'm assigning it as 'required reading' before the January meeting as it puts into first person perspective some of the issues that Dr. Largent will address.


Dear Vacciners,
On December 11, 2013 the New York City Board of Health voted to make flu vaccinations mandatory for children under 6 who go to pre-school or daycare.

What people who think this is a good idea are saying:

What people who think this is a bad idea are saying:

What people who think that the above argument is specious say in return:

What people who think the above argument is, um, 'not helpful' retort:

This is the point in which discourse typically breaks down.

Not just because all parties involved are, by this time, busy glowering at each other and singing "la la la la la" while holding their fingers in their ears, the truth is that we DON'T have an army to enforce our mandatory vaccines, not to mention our merely recommended ones. If we did, we'd have to call them 'compulsory,' not mandatory, and we haven't had compulsory vaccination in over a hundred years in this country (see Jacobson v. Massachusetts, 1905).

But is that even necessary? Can't we bring people who are vaccine hesitant into the Light without having to first stamp our feet, turn red in the face, threaten to put their name on Santa Claus' "naughty" list, throw them out of our pediatric practices, or otherwise fantasize a resort to force?

Come to the January VDC meeting and find out what blazingly smart, funny, articulate, and totally cool historian Mark Largent has to say about all this when he tackles the fascinating, maddening, engrossing, and contentious world of vaccine debates.

Still not convinced? Here is a teaser Dr. Largent sent me about the program…

A startling number of American parents report that they have consciously decided NOT to vaccinate their children with one or more of the recommended vaccines. Research suggests that the rate of vaccine refusal nationwide may be as high as 40%. This is separate from the 2-3% of people who are hard-core anti-vaccinators and are never going to vaccinate their kids, no how, no way.

To make matters worse, since vaccine noncompliance appears to cluster in certain regions and within certain socioeconomic groups, the 40% provide fertile ground for epidemics of vaccine-preventable diseases.

At the same time, there is the other nearly 60% … even though the routine childhood vaccine schedule is bigger than ever (at about three-dozen inoculations by age six, most of them in the first 18 months of life) we are also seeing record high rates of vaccine compliance for many vaccines.

These competing trends (vaccine rates way down in some places and creeping steadily up in others) have, not surprisingly in this social media-enabled age, been accompanied by increasingly heated and divisive rhetoric around vaccines, and anti-vaccinators have found the internet a valuable tool to spread their message.

My goal in this talk is to look at the nearly 40% of American parents of young children who express concern about vaccines. I call these people “vaccine-anxious” and I am going to talk about ways in which advocates of routine childhood immunizations can prevent vaccine-anxious parents from becoming anti-vaccinators.


I've promised Dr. Largent a lively, interactive audience of members and guests who are itching to engage in nuanced conversation about vaccine hesitancy, PLUS want to pick up some practical tips for helping to prevent vaccine-anxious parents from swelling the ranks of anti-vaccinators.

That is where YOU come in. Start 2014 off right and register now to be a lively, interactive VDC member or guest this coming January 8th.

Hope to see you for Dinner at the Club in 2014,
-Kimbi Hagen
Your Friendly Neighborhood Vaccine Dinner Club Goddess

BACK TO TOP

 

February 4 (TUESDAY), 2014

Focus: Vaccine Distribution Challenges
Attendance: 288

Fahrenheit 140:
Cutting the Cold Chain,
One Silk Worm at a Time

starring

David Kaplan, PhD

Stern Family Professor of Engineering
Professor and Chair, Department of Biomedical Engineering
Professor, Department of Chemical Engineering
Director, Bioengineering and Biotechnology Center
Tufts University

 

Clubhouse Location:
WHSCAB Plaza and Auditorium (1440 Clifton Rd)
Agenda:
6:00pm — wine, cheese, networking
6:30pm — meeting convenes
7:45pm — casual buffet dinner, more networking

Dear Vacciners,
As everyone knows, there are some situations in life that can quickly go totally sideways when someone loses their cool. International peace talks, defusing live bombs, and trying to get a 3 year old into bed on time all fall into this category.

But keeping consistently cool is ALSO important for some inanimate objects. For example, in the late 1800s the town I grew up in — Marietta, GA — suffered a devastating economic blow when the town's peach crop was lost one year after the engines needed to pull the freight cars holding the town's entire peach harvest for the year were late showing up. By the time that they finally arrived all the ice keeping the peaches cold had melted and it was late Saturday night -- which mattered because the next day was Sunday and the railroad crew and ice plant workers all refused to break the sabbath by working. By Monday morning the peach harvest had rotted in place and the town had learned a hard lesson in the crucial importance of maintaining all links in a cold chain.

As important as cold chains are for peaches they are even more so for vaccines. Just ask the public health officials who were working on smallpox control in the Philippines during the Spanish-American war. Vaccine from the US kept arriving in an inert form as a result of not being kept consistently cold en route to the Philippines, and even what little vaccine that was still potent on arrival in Manila could go no farther due to inadequate ice available to move the vaccine onward to outlying garrisons on other islands.

Or, more recently, take one of the stories that Stan Foster told during the September VDC meeting …. Do you remember him talking about EIS officer Larry Altman (now a science writer at the New York Times) who was once sent to Mali to address failures in their measles program? Upon his arrival in Mali Larry identified one obvious problem — the vaccine cold chain wasn't intact.

So Larry sent a cable to Washington:
"Jeeps don't keep the vaccine cold. Send trucks."
Washington's reply: "No trucks available. Park under trees."
Larry's reply: "Send trees."

'But that was then, this is now' you're thinking. Nope. Globally, keeping a cold chain intact is still a complex and costly process that can account for upwards of 80% of the price of vaccinations. Not to mention that it fails often enough to lead to the loss of nearly half of all vaccine doses globally. Even more in those specific settings where they are most needed; i.e. the places where electricity — and trees — are scarce.

So what are we to do?

Well….. February's VDC speaker, Dr. David Kaplan thinks that we should do an end run around the cold chain itself by increasing the range of temperature that a vaccine can tolerate during storage and delivery. Cool!

So how is he doing that exactly?

Put on something silk next Tuesday (2/4) and come find out!

Hope to see you for dinner at the Club on TUESDAY, February 4th,
Kimbi Hagen
Your Friendly Neighborhood Vaccine Dinner Club Goddess

BACK TO TOP

 

March 3 (Monday), 2014

Focus: Exciting Findings in Maternal Immunization Related Research
Attendance: 353
Clubhouse: WHSCAB (1440 Clifton Rd)

“What to Expect (from Vaccines) When You Are Expecting:
The Promise of Maternal Immunization"

Saad Omer, MD

Associate Professor
Global Health, Epidemiology, and Pediatrics
Emory University, Schools of Public Health & Medicine
Emory Vaccine Center

 

Clubhouse Location:
WHSCAB Plaza and Auditorium (1440 Clifton Rd)
Agenda:
6:00pm — wine, cheese, networking
6:30pm — meeting convenes
7:45pm — casual buffet dinner, more networking

Dear Vacciners,
Boy what a year 2014 has been! In just the last month alone you have been called upon to exhibit dogged determination (Icemageddon #1), flexibility (Tuesday VDC meeting in February), and the ability to learn from experience (Icemageddon #2). Good on you for surviving January and February; here's to warmer weather and less calendar chaos ahead!

But first, a couple more tiny tweaks …

BAD NEWS: Our speaker Dr. Anita Zaidi ("Polio in Pakistan") is unable to travel to Atlanta for our March program.

GREAT NEWS: We have rescheduled her for next October.

BAD NEWS: We had moved the meeting time from Wed, March 5 to Monday, March 3 in order to accommodate Dr. Zaidi's US travel schedule and now we can't move it back to the regular time -- someone else having swooped in to grab our clubhouse out from under our collective noses.

GREAT NEWS: Dr. Saad Omer stepped forward to volunteer to be our replacement speaker AND is available on March 3rd, so we'll just keep with the altered date schedule.

And speaking of the upcoming program…

Modern Day Pregnancy To-do list:

Clearly there is a lot to do when you are pregnant but getting their full complements of shots needs to be at the top of any woman's list. I singled out tetanus because providing passive immunity via Mom is such an easy peasy way of preventing the horrors of neonatal tetanus (acquired through unhealed umbilicus) but there are a bunch of bogeys-under-the-bed that maternal immunizations can prevent or mitigate.

Which ones are they exactly? What else is going on new and exciting in the field of maternal immunization research?

Come to the March meeting of the Vaccine Dinner Club and find out!!

Hope to see you for dinner at the Club this March 3rd (MONDAY),
-Kimbi Hagen
Your Friendly, Neighborhood Vaccine Dinner Club Goddess

BACK TO TOP

 

April 2, 2014

Focus: Basic Science
Attendance: 320

Putting It All Together:
A Systems Biology Approach to Understanding the Human Immune Response to an AIDS Vaccine

Rafick-Pierre Sékaly, PhD

Chief Scientific Officer and PI,
Vaccine and Gene Therapy Institute (VGTI) Florida
Member, Miami CFAR

Clubhouse Location:
School of Medicine Building (1440 Clifton Rd)
Agenda:
6:00pm — wine, cheese, networking
6:30pm — meeting convenes
7:45pm — casual buffet dinner, more networking

BACK TO TOP

 

May 7, 2014 - Combined meeting of the VDC & Mahy Seminar

Focus: Basic Science
Attendance: 258

4th Annual Meeting of the "Mahy Seminar" The Mahy Seminar is an annual lecture featuring the globe's top virologists. It honors the outstanding career of Dr. Brain Mahy and acknowledges his unparallelled role in expanding the field of virology at the CDC and beyond.

Just Say No to Noro:
Norovirus Vaccines and Human Health

Ralph Baric, PhD

UNC School of Medicine

Clubhouse:
WHSCAB Plaza and Auditorium (1440 Clifton Rd)
Agenda:
6:00pm — wine, cheese, networking
6:30pm — meeting convenes
7:45pm — casual buffet dinner, more networking

BACK TO TOP

 

 

June - August, 2014

Summer Vacation
starring
The VDC Membership

Focus: Rest and Relaxation
Attendance: 2,160
Clubhouse du jour: The World

Wherever there is a vaccine to develop, describe, or disseminate, a vaccine preventable disease outbreak to examine, or fun to be had with friends and family -- VDC members will be there in force!

 

BACK TO TOP

 

 

September 3, 2014

Focus: History; Policy, Controversies
Attendance: 334

Advice is Like Snow*:
A Peek at the Bones, Brains, Muscle, Mind
(and Maybe a Skeleton or Two) of the National Advisory Committee on Immunization Practice.

*Advice is like snow - the softer it falls the longer it dwells upon, and the deeper it sinks into, the mind. (Samuel Taylor Coleridge)


Starring

Larry K Pickering MD, FAAP, FIDSA

Member in Good Standing, Vaccine Dinner Club
Senior Adviser to the Director, CDC NCIRD
Editor, The Red Book
Executive Secretary, ACIP

Clubhouse Location:
WHSCAB Plaza and Auditorium (1440 Clifton Rd)
Agenda:
6:00pm — wine, cheese, networking
6:30pm — meeting convenes
8:00pm — casual buffet dinner, more networking



Dear Vacciners,

Believe it or not, Labor Day is just around the corner and the 16th season of the Vaccine Dinner Club is getting ready to begin. The website for the remainder of the year isn't up yet because there has been an unprecedented amount of movement in the calendar and we are still shuffling the pieces. So, for the moment, your friendly neighborhood vaccine dinner club goddess is asking that you take it on celestial faith that the season will simply be supercalifragilisticexpialidocious. :-)

Beginning with THIS month's program. What better way to celebrate a Club that, at 16, is finally old enough to drive and is only two years away from being old enough to vote, than by kicking off the year with a birthday celebration. Not ours, ACIP's. The Advisory Committee for Immunization Practice is turning 50 this year.

We at the VDC spend a lot of time thinking outside the box where vaccines are concerned. In the last 16 years we've talked about their need, history, policy, discovery, development, testing, deployment, use, and evaluation. But we HAVEN'T talked about the box itself. I.e. just who it is who decides what vaccines we do — and don't — get, what gives them the right to make that kind of decision for us, and how the nitty gritty decisions gets made.

We are fixing that this month.

BACKGROUND
If you were a kid in the United States in the 1940s it would have felt perfectly normal to grow vegetables in your backyard or rooftop Victory Garden, have blocks of ice delivered to your door by a horse-drawn cart, assume that your neighbors were listening in when your operator-assisted 'party line' phone rang, and know someone who was in an iron lung from polio. It would have also felt perfectly normal to consider yourself to be fully immunized for school after having gotten just two sets of shots: smallpox and DTP (diphtheria, tetanus, and pertussis).

One generation later — in the 1970s — the children of those 1940s kids probably assumed (if they thought about it at all) that vegetables grew in tin cans on grocery store shelves and that ice had always, since the beginning of time, been frozen at home in little levered aluminum trays. Of course they WOULDN'T have spent much thinking about it because they were too busy untangling the princess phone receiver cord that was long enough to allow private calls by stretching all the way from the living room through the kitchen to the back hall. 1970s kids were also a lot more knowledgeable about the Iron Curtain than they were about iron lungs and wouldn't have given much thought to polio or any other vaccines since '70s kids were the first generation of American tykes to stop getting the smallpox vaccine AND were considered to be fully immunized after just five shots by the time they were two (with no more than one shot at a single visit), even though jabs for measles, mumps, and rubella, plus the miraculous sugar cube against polio, had been added to their DTP regimen.

Fast forward another generation. The grandchildren of those 1940s kids, now being raised in the 21st century, face yet a different idea of 'normal.' THEY think that it is normal for their (organic, no GMO) barley, kale, and spinach plus basil vegetables to come as a tasty puree from a squeeze pouch, for their (shaved/cubed/crushed) ice to be dispensed straight into a water glass from the front door of their fridge, and for their iPhone to automatically notify them wherever on the globe they happen to be every time Justin Bieber gets arrested again. They also think it is normal to get a LOT of shots. A kid who is following the current vaccine schedule will have received 32 immunization doses by time he or she turns 13, not counting annual flu shots or the four extra jabs they'd get if they were considered to be at high risk for meningococcal disease.

To put it in perspective, in a worst-case scenario (i.e. playing catch up with DTaP and in that high risk group for meningococcus) the granddaughter of a boy who, back in the day, had received just one shot on HIS first birthday in 1945, along with one of the first ever Slinky Toys, might celebrate HER first birthday in 2014 at the pediatrician's office getting 9 more shots than she has birthday candles on her birthday cake.

So that's a big change. A BIG change. One that you can look at in multiple ways. For example, you might focus on just how many plastic-bodied syringes are needed to give all those immunizations to all those children these days and decide that Mr. McGuire was absolutely correct in the 1967 advice he gave Dustin Hoffman in "The Graduate." Or you might spend a day in an old cemetery looking at the acres of teeny tiny headstones belonging to children who died from diseases that are now vaccine preventable and try to imagine what it must has been like to have been a parent in a time in which the lack of vaccines meant that you did not have the luxury of automatically assuming that all, or even any, of your babies would grow up to be cowboys.

WHERE DOES ACIP COME INTO THE STORY?
All of us get the vaccines that we get because someone in authority has put the official stamp of approval on the specific vaccine type, delivery, dosage, amount of time between doses, and precautions and contraindications for use. In the United States, that Someone In Authority is the Director of the CDC. But, no fool he or she, the Director does not make the decisions that, collectively, lead to the Vaccine Schedule until s/he has consulted the stars.

The stars of the ACIP that is.

Fifty years ago — in 1964 — the Beatles came to America for the first time, the 8-track cartridge was introduced, the SS Minnow (along with Gilligan, the Skipper, the Professor and Mary Ann …) headed out from Honolulu for a three hour tour, permanent press shirts were invented, and the Advisory Committee for Immunization Practice first came into being in order that there be a group of experts who were willing to spend a lot of time delving deep into the science and thoroughly understanding the ramifications and limitations of a manufacturer's claims for vaccine effectiveness and safety, clinical trials results, and labeling or package insert information so that they could make dispassionate recommendations to the CDC Director about vaccines for US civilians.

The process is supposed to be objective, civil, solely science-driven, and result in advice that ultimately falls like a gentle snow on our collective heads where it dwells upon, and sinks into, our minds as "common sense."

Is that how it really works though?

What ACTUALLY goes on behind the scenes with the decisions that ultimately play out for good or ill in pediatric, primary medicine, and geriatrician offices all over the country?

Are you one of those people who likes to know WHY we should do what we are told? If so, come to the September meeting of the Vaccine Dinner Club when ACIP Executive Secretary Larry Pickering has agreed to take a break from transcribing shorthand and give us all a peek under the hood at the history, structure, function, CONTROVERSIES, and future of the process that determines what we do, and do not vaccinate ourselves and our kids with.

Hope to see you for Dinner at the Club on Wednesday, September 3rd,

-Kimbi Hagen
Your friendly neighborhood VDC Goddess

BACK TO TOP

 

 

October 1, 2014

Focus: Law; Ethics, Controversies
Attendance: 702

The Road to Emory:
Ebola, Ethics, and the Law

Starring

Polly J Price, JD

Professor of Law
Emory School of Law

and

Paul Root Wolpe, PhD

Director
Emory Center for Ethics

Clubhouse Location:
WHSCAB Plaza and Auditorium (1440 Clifton Rd)
Agenda:
6:00pm — wine, cheese, networking
6:30pm — meeting convenes
8:00pm — casual buffet dinner, more networking


FREQUENTLY ASKED QUESTION:
"May I bring [non-members] to the meeting with me?"

ANSWER:
YES! Please do!! But each person must be individually registered in advance.


Dear Vacciners,
This season we are going to have two meetings devoted to Ebola, a disease that we all WISH was vaccine preventable (and may possibly be creeping in that direction).

The first part, on ethics and law, is this month's meeting with the second part — covering science, vaccines, and the local / global response — happening next spring (April 1) when some of the VDC members who are currently responding to the epidemic, either in Africa or the high containment unit right here at Emory, will be available.

PART I (October 1):
A few weeks ago, when helicopters and news vans were buzzing around the first patient to arrive at Emory, did you stop to think about what all that arrival had entailed?

Well, it turns out that getting permission to move someone with a hugely lethal, highly communicable disease all the way from West Africa to the hospital in our backyard is not as easy as you'd think! It required, in fact, navigating — at light speed — a dizzying number of local, regional, national, and international legal issues and permissions that serve as a case study for just how, well, complex it is to rapidly and effectively address a Complex Humanitarian Emergency.

And then there are the ethical issues. Even if it is legal, is it ethical to quarantine for three days an entire neighborhood of a hard hit city when you know darn well going in that most of the people being quarantined don't have three days of food or clean water available to them? Even if it is legal, is it ethical to set up Ebola treatment centers in other people's neighborhoods, particularly when those treatment centers lack the ability to safely dispose of large volumes of infectious waste, without the permission of the people living in that neighborhood?

The Ebola outbreak/epidemic has put the intertwined issues of public health law and public health ethics in front of news cameras, behind the podium of academic conferences, and at the center of conversations taking place everywhere from palaces to pubs these days.

Come to the VDC meeting on October 1 when Polly Price and Paul Root Wolpe take us behind the curtain of one of the most urgent and rapidly unfolding public health crises of our time.

I hope to see you for Dinner at the Club on October 1.
-Kimbi

BACK TO TOP

 

 

November (aka October 29), 2014

Focus: Basic Science, Social & Political Context
Attendance: 396

Of Barriers and Blockades:
The Basic Science and Societal Impediments
to Vaccine Development

Starring

Stanley A. Plotkin, MD

Emeritus Professor, University of Pennsylvania
Executive Advisor, Sanofi Pasteur
Scientific Advisory Board Member, CHAVI

Clubhouse Location:
SOM Commons and Auditorium 110
   ↑ Note Clubhouse du jour location!
Agenda:
6:00pm — wine, cheese, networking
6:30pm — meeting convenes
7:45pm — casual buffet dinner, more networking


Dear Vacciners,
Yes, you read right. In 2014 the first Wednesday in November actually falls during the last week of October!

How can that be? You are right to ask.

Stephen Hawking could explain it way better than I can, because he is conversant with all that space-time continuum stuff, but the short answer is that our November speaker will already be in Atlanta for the ACIP meeting during the last week of October so we have elected to meet then.

STAN PLOTKIN
Dr. Plotkin is a legend. Done deal. I mean, how many other people have YOU heard of who have been involved in the development of SIX vaccines (for rubella, cytomegalovirus, polio, varicella, rabies, and rotavirus)? Hint … it's a pretty short list.

Along the way Dr. Plotkin has developed some decided opinions about the barriers — some preventable, some not — that have kept us from realizing our full potential as a vaccine-protected species. AND he so enjoyed presenting to our membership in 2007 that he has agreed to come back this "November" and share his thoughts about them.

So … interested in interacting with a living legend? Sign up now.

Hope to see you for Dinner at the Club on October 29.
-Kimbi

*P.S. Did you figure out why the subject line referred to this as a Blue Moon meeting? If you register to attend the answer will be in your confirmation email. How's THAT for a carrot?

BACK TO TOP

 

 

December 3, 2014

Focus: Communication
Attendance: 309

It's not About Sex ... OK, it's not JUST About Sex:
Parents, Politics, Pinterest, and HPV Prevention

Starring

Jill Roark, MPH


CDC/ NCIRD Office of Health Communications

Clubhouse Location:
WHSCAB Plaza & Auditorium
   ↑ Note: We are back in our standard Clubhouse location!
Agenda:
6:00pm — wine, cheese, networking
6:30pm — meeting convenes
7:45pm — casual buffet dinner, more networking


FREQUENTLY ASKED QUESTION:
"May I bring [non-members] to the meeting with me?"

ANSWER:
YES! Please do!! But each person must be individually registered in advance.


Dear Vacciners,
First the bad news … Paul Johnson, our original speaker for the World AIDS Day (December) meeting of the VDC (Nietzsche, Goldilocks and the Quest for an AIDS Vaccine: Lessons Learned from Live Attenuated SIV), has had to postpone his presentation until January 13 (Registration is available for that by clicking here).

Now the GREAT news. This opened up a space for a program on Human Papilloma Virus (HPV) vaccine communication issues that I have been interested in scheduling for awhile.

HPV is totally thematic for a World AIDS Day VDC program because women with HIV are 5x more likely to be diagnosed with cervical cancer than women without HIV. Plus, HPV also increases risk for anal cancer in both men and women.

So wouldn't it be great if we had a vaccine that could lower a person's future risk of acquiring cervical/anal cancer, genital warts, and other icky things, if taken before his or her first exposure to HPV? Oh wait … We do!!

Too bad it isn't more widely adopted.

CONTEXT:
Did you ever wonder if there are any differences between Australia and the USA beyond:

Well, here's another one…

AUSTRALIA:
HPV vaccination rate: >70% of girls vaccinated with all three doses
Outcome: 93% decline in diagnoses of genital warts in women under 21

UNITED STATES:
HPV vaccination rate: 37.6% of girls vaccinated with all three doses
Outcome: Percentage of unvaccinated girls at age 13 with at least one missed opportunity for HPV vaccination; year 2000 birth cohort: 83.7%

And another …

AUSTRALIA:
What their politicians say about HPV vaccines:

UNITED STATES:
What our politicians say about HPV vaccines:

The good news is that despite the dispiriting political rhetoric, some USA kids ARE getting vaccinated and it shows. New HPV infections have dropped by more than half in female teens 14-19 years old since the vaccine was introduced in 2006.

So just think how much better it could be if we matched Australia's HPV vaccine coverage rate. Or, even better, Rwanda's HPV vaccine coverage rate (93-95% coverage of 6th grade girls in 2011)!!

Some people seem to think that its all about sex. But IS it? Is queasiness over talking about sex really the main reason that politicians, and pediatricians and parents aren't pushing for more HPV coverage?

What are people saying? What are they hearing?
What AREN'T people saying? What AREN'T they hearing?

Inquiring minds want to know!

Come to the December meeting of the Vaccine Dinner Club and join the conversation.

Hope to see you for dinner at the Club on December 3rd,
-Kimbi

This email was hand woven from 100% organic recycled letters and punctuation marks. As such, slight variations in spelling and grammar are to be expected and should not be considered to be flaws or defects.