Keywords: In this paper, we report the first case of alopecia areata after COVID-19 vaccination described in the literature with a revision of cases of alopecia areata reported after other types of vaccination. Autoimmune-mediated skin findings after COVID-19 vaccination include leucocytoclastic vasculitis, lupus erythematosus and immune thrombocytopenia. The coronavirus disease 2019 (COVID-19) vaccines are authorized for use in numerous countries worldwide. National Library of Medicine There are more than 5 million doses of the vaccine currently in the country. Please enable it to take advantage of the complete set of features! Desai AD, Falotico JM, McMahon DE, Freeman EE, French LE, Lipner SR. Int J Dermatol. Bookshelf The feeling of squeaky clean skin is one satisfying facto, There are gravely serious things happening in the world: Donald Trumps criminal trial, war in Ukraine, boats of people in the Channel desperately trying, The other day my friend, whos getting married in the autumn, mentioned among the group that she might want to invest in an eyelash serum in the months l, I love white clothes. I recently discovered @Grombre, a 237k strong community started by Martha Truslow Smith, who found her first grey hair at 14, to share real stories in radical celebration of the natural phenomenon of grey hair. I spent way too long scrolling in admiration, realizing Id very rarely seen celebration of something that is still widely regarded as taboo. Any properly qualified hair colourist will follow this protocol and the same goes for using a, If you've carried out a patch test but your skin is prone to sensitivity, you could apply a light layer of barrier cream (such as, Dr Ahmed says that if you start reacting badly to something topical, get it off your skin as soon as possible. Alopecia areata in a COVID-19 patient: a case report. J Clin Med Res 2021; 13: 204213. eCollection 2022. One such symptom is the increased graying of hair. In men and women, severe illness was linked to mild and severe alopecia. See this image and copyright information in PMC. Here, we report the case of a In addition, other studies show that severe illness can cause both gray hair and hair loss. FOIA If you're pregnant, you may have thick and shiny locks. Disclaimer. Read on to see why your hair texture may be changing and what you can do to make the best of it. The team compared participants who had COVID-19 with a control group of those who didnt. sharing sensitive information, make sure youre on a federal "Paraphenylenediamine(PPD) is one of the most common allergens found in hair dyes that produces a contact dermatitis," says Dr Hibler. "Things like. They recommend it for new and existing clients, and for any client that has had a henna or black tattoo, as is the usual practice since before the pandemic. Everyone's at risk for skin cancer. -. While many people think of this as hair loss, its actually hair shedding. Solutions: Over time, your hair may return to its pre-chemo texture. Any time you subject your hair to a chemical process like lifting color or taking away curl, you change the natural integrity of the hair, Toye says. Do you know which one? The hair texture you grow up with becomes part of your identity. Epub 2021 Sep 21. CLG was a co-chair on the Novavax trial but did not receive funding from the company. Who is she? (a) Immediate (type I) allergic reactions to COVID19vaccine components, polyethylene glycols (PEG) and crossreactive polysorbate 80, can lead to mast cell degranulation causing urticaria, angiooedema and anaphylaxis. He has also served as a consultant for Janssen Vaccines in the past. Too few infections were observed to draw statistical inferences comparing hybrid immunity to vaccine alone for other trials. He suggests using a hair dye which is free from PPD. The researchers did not differentiate between the two types of alopecia, and none of the participants were examined by a dermatologist. Unspecific injection-site reactions very early occurring after the vaccination are most frequent. PAG has conducted clinical trials funded by Sanofi Pasteur and Janssen Vaccines. When you blow dry wet hair, the pulling takes away the hairs natural body," Toye says. eCollection 2023. -, Moreno-Arrones OM, Lobato-Berezo A, Gomez-Zubiaur A, et al. For people who menstruate, the surge of hormones leading up to and during a period can really take a toll. Whats The Best Time of Day to Work Out for Fat Burn. Ann Clin Lab Sci. SAGE Open Med Case Rep. 2023 Jan 28;11:2050313X231152066. My partner lightly makes fun of how old and wise I seem to be, at least according to my hair. This TikTok Hack Claims to Unblock A Stuffy Nose in Minutes No Medication Required. Consider Jeanine Vogel, 50, in Plano, Ill., who has colored her own hair every few weeks since she was a teenager. In the UK, the National Hair and Beauty Federation issued a statement on the situation there on the importance of allergy-testing post-lockdown with regard to the Covid-19 vaccine. We explain hair loss as a symptom of a coronavirus infection, who's at risk, treatment Careers. Pityriasis rosea-like rashes and reactivation of herpes zoster have also been reported after COVID-19 vaccination. According to the American Academy of Dermatology (AAD), temporary hair loss is common after a fever or illness. A few months after having a high fever or recovering from an illness, many Curr Opin Virol 2021; 49: 5257. Find out what can help. Dermatologists team up to improve patient care, JAK inhibitors: A newer type of medication, Free materials to help raise skin cancer awareness, Dermatologist-approved lesson plans, activities you can use. But what counts as premature greying? And patients who have heart disease are more likely to develop severe COVID-19 if they become infected. Carlson exploited unreliable data from the Vaccine Adverse Event Reporting System to claim that the Covid-19 vaccine was the single deadliest mass vaccination The benefits of coconut, argan, tea tree and more. When I recently caved and asked the hairdresser to dye it all, she said I should probably have come in a long time ago, as you cant really see it yourself but if I give you a mirror to look at the back, youll cry. Thanks, girl. Salons are demanding clients have a patch test 48 hours before hair, lash or brow tr There is no direct connect between Covid-19 and the greying of hair, however, Covid has famously been known to affect every aspect of the human body at She stopped during Covid, partly because a shoulder injury immobilized her arm and she couldnt get surgery. Epub 2022 Jul 19. BRITS are suffering potentially fatal reactions to hair dye after testing positive for Covid, hairdressers warn. Please enable it to take advantage of the complete set of features! Hormones can have a big impact on women's hair. sharing sensitive information, make sure youre on a federal Elsevier, China, 2016:179-84. Provided peoples iron levels are normal, the hair will recover in time COVID-19 serious enough to take people to hospital also seems to be more common in people -, Berbert Ferreira S, Gavazzoni Dias M, Berbert Ferreira R, Neves Neto AC, Trueb RM, Lupi O. Federal government websites often end in .gov or .mil. urticaria, angio-oedema and anaphylaxis) likely due to allergy to ingredients may rarely occur but can be severe. People are embracing their new look, awkward roots and all. Cutaneous manifestations of COVID-19 and COVID-19 vaccination. A more accurate term for it is hair shedding, because loss would imply that the change is permanent. Rowley MA, Thawanyarat K, Shah JK, Nazerali R. Arch Plast Surg. Association between alopecia areata and COVID-19: A systematic review. Thats some serious money I dont have. Condition your post-chemo hair to help it grow back healthy. https://www.wsj.com/articles/covid-lockdown-coronavirus-pandemic-gray-hair-dye-hairdresser-salon-beard-silver-roots-11597855742. It seems coronavirus may heighten things. Oops! J Eur Acad Dermatol Venereol. Thats a long time to lose hair, and it can lead to These tend to appear four weeks or more after a COVID-19 infection. The stress of the pandemic, however, has noticeably aggravated what should and might have otherwise been a gradual and natural process. 2023 Mar 29;13(7):1286. doi: 10.3390/diagnostics13071286. The hair loss that many people develop, however, may not be so unexpected. BL is an employee of Moderna, Inc. IH is an employee of AstraZeneca and may hold share stock. Peter Mark's nationwide fundraiser raises 65,000 for the Irish Heart Foundation, Kate Garraway reveals Derek's devastating words when he thought he was going to die, Irish hairdressers warn prices will rise and salons will close in 2023 over tax hike, Covid jab for toddlers 'may now be too late', CMO calls for public to wear masks on public transport, 'The only reason I should buy a TV licence!' 2023 Mar;50(3):280-289. doi: 10.1111/1346-8138.16651. Sperling LC. If the hair dye were to get on your face, neck or shoulders, Dr Hibler warns that you may break out in a rash in each of those locations. SARSCoV2 vaccines the biggest medical research project of the 21st century. 2021 The Authors. The site is secure. A few months after having a high fever or recovering from an illness, many people see noticeable hair loss. Distribution and use of this material are governed by With so many people waiting for six months or more for a hair colouring appointment, some have turned to box dye to cover up roots and greys, and it may be this that is leading to more reactions. If weve learned anything from the coronavirus pandemic, its to expect the unexpected. 2022 Jan;186(1):142-152. doi: 10.1111/bjd.20639. Functional angiopathies (chilblain-like lesions, erythromelalgia) may also be observed. In 2016, a study of more than 6,300 people by human geneticists revealed that the IRF4 gene, in helping regulate melatonin, was responsible for characteristics such as skin, eye, and hair colour. Epub 2022 Jul 20. A grey-er one, perhaps, but when weve survived something as tragic as a pandemic, whos keeping score? Its like a Greek house. And while I dont care much for snow, I do love the idea that Im building a Greek house on my head. Months after recovering from COVID-19, many people find that their hair is falling out in large clumps. Laurence Fox was left floundering on live TV after a doctor told him, "I sometimes wonder why you exist," in a discussion about COVID vaccines.. Clipboard, Search History, and several other advanced features are temporarily unavailable. My mum often scolds me for forgetting to take my iron and zinc supplements, and it turns out shes absolutely right: Stephen says that nutritional deficiencies including Biotin, B12, B6, Iron, Zinc, Selenium, Vitamin C and Vitamin D can contribute to premature greying, and that suitable supplements may be recommended in preventing or slowing down the process. Epub 2023 Jan 19. Ammonia can also be an irritating ingredient for some people but Garnier, Clairol and Schwarzkopf have formulated the below dyes without it. -Plenty of rest is also essential for hair health, which includes good nights sleep. HHS Vulnerability Disclosure, Help The skin on your scalp may be sensitive for 6 months or more after treatment. Rapidly progressive alopecia areata totalis in a COVID-19 patient, unresponsive to tofacitinib. -Another prevention method is checking stress levels. Getting hair colour post-lockdown Pic: Shutterstock. If you lose your hair during treatment, it may grow back thicker, curlier, or straighter all over or just in some spots. 2022 Aug 12;14(8):e27953. A blunt haircut makes thin hair look fuller. Over-processing leads to dry, brittle, rough, lackluster hair that can resist styling. So, what does this mean? I Got My Chest Lasered To Improve My Skin & I Learned A Lot, The Best New Fragrances Smell Just Like Spring, Period Hair Is Real. -, Sgubbi P, Savoia F, Calderoni O, Longo R, Stinchi C, Tabanelli M. Alopecia areata in a patient with SARS-Cov-2 infection. Oprahs Personal Chef Makes Pasta Sauce From Oatmeal Would You Eat It? 2021;35:e181e183. Google Trends and Injectable Products: The Next-Best Tool for Anticipating Patient Concerns in Plastic and Reconstructive Surgery. Several cutaneous findings are reported after severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) vaccination. While the average age at which the onset of grey hair occurs is 35, Stephen says, premature greying can occur before the age of 20, or 25. He explains that this Balance Out Your Features With Styles for Long, Round, and Square Faces, Better Skin, Better Mood, and So Much More These Spring Veggies Are Good for the Body and Soul, Is Healthy Eating Causing Your Fatigue? People who had severe illness with COVID-19 might experience organ damage affecting the heart, kidneys, skin and brain. When I put it up in a ponytail, I always carefully (skillfully, too -its been a steep learning curve) make sure to place a few brown locks at the top on my sides, so they can cover up the grey ones. Cazzato G, Ambrogio F, Foti C, Capuzzolo M, Trilli I, Casatta N, Lupo C, Carrieri M, Daini D, Colagrande A, Maiorano E, Ingravallo G. Diagnostics (Basel). Patient suffering from Long Covid or a patients who have recovered from Covid-19 have often reported a rapid surge in their greys hairs. Kalanj K, Orbani A, Peek M, Orekovi S, Marshall R, itum M. Front Med (Lausanne). 2021;34:e14685. Epub 2023 Jan 13. While seeing your hair fall out in clumps can add to your stress, its important to try to de-stress. While we wait for our Covid-19 vaccine, a new situation has emerged around the subject of getting your hair colour done, or rather, delaying the appointment for two weeks after being vaccinated. official website and that any information you provide is encrypted Interpretation: Previous infection, any hybrid immunity, and two-dose vaccination all provided substantial protection against symptomatic and severe COVID-19 through the early Delta period. While on holiday with a friend, she was helping me straighten my hair for a night out (oh, sweet hindsight) when she let out a low yelp and informed me that well, I was going to be a teenage silver fox. Many things can make hair change texture. 2022 Nov 13:10.1111/ijd.16499. -, Li Y, Tenchov R, Smoot J, Liu C, Watkins S, Zhou Q. Hot rollers are another option. Its not quite ready yet, but one day it will be, and it will be beautiful. I am approaching 30, and my situation is not unheard of. It might be hard to tell whether you are shedding more than normal. AstraZeneca expects minimal -, Vasireddy D, Atluri P, Malayala SV, Vanaparthy R, Mohan G. Review of COVID19 Vaccines Approved in the United States of America for Emergency Use. 2022 Dec;36(12):e979-e981. Kurup D, Schnell MJ. doi: 10.7759/cureus.27953. If you're not used to short hair, think of the grow-back period as a time to try out shorter styles. "If you let it dry naturally, then all you have to do is smooth the ends.". our Subscriber Agreement and by copyright law. Shoulder Pseudo-Tumor from COVID-19 Vaccine. Handfuls of hair can come out when you shower or brush your hair. 2005 - 2023 WebMD LLC, an Internet Brands company. 87990cbe856818d5eddac44c7b1cdeb8, Continue reading your article witha WSJ subscription, Already a subscriber? This No7 serum, with a world first peptide technology, reverses visible signs of skin damage in four weeks, The Queen's confidante Angela Kelly proves there's no room for sentiment with the royals, Where to get The Row's iconic flip flops on the high street for 835 less, PICS: 61 Best Met Gala hair and beauty looks of all time, Hollywood skinny diabetes drug can make you fatter, says obesity expert, Pippa O'Connor takes style inspo from Kate Middleton for friend's wedding, 'Roll on April 24': Influencer Niamh O'Sullivan celebrates engagement with chic garden party, RT weather star applauded for sunny attitude after double mastectomy. 2022 Nov 6;15:2369-2382. doi: 10.2147/CCID.S388245. -Nausea, diarrhoea, stomach aches, loss of appetite, Download the Mint app and read premium stories. If youre worried about your hair, its a good idea to prevent severe illness as best you can. After internal reviews of the reports, the CDC "did not find any data suggesting a link between Covid-19 vaccines and tinnitus," an agency spokesperson Practicing healthy hair habits may help in speeding recovery and preventing any hair loss or greying of hair. Do you remember Robbie Keane on The Real Housewives of Beverly Hills? Copyright 2023 Dow Jones & Company, Inc. All Rights Reserved. By clicking Subscribe, I agree to the WebMD, Smart Grocery Shopping When You Have Diabetes, Surprising Things You Didn't Know About Dogs and Cats, Simple Test Could Assess Risk of Dementia, Long COVID Treatment Isn't One-Size-Fits-All, Stuck Stem Cells May Be to Blame for Gray Hair, New Book: Take Control of Your Heart Disease Risk, MINOCA: The Heart Attack You Didnt See Coming, Health News and Information, Delivered to Your Inbox. Toye suggests getting a cut that works with your new texture. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). To learn more, visit Fast-forward to this month and it seems there might be another side effect of coronavirus that no one expected: extreme allergic reactions to hair dye. But they are expensive and may contain unsafe levels of formaldehyde, which is known to cause cancer. Consult a doctor and get your supplements. Most cases of hair shedding after COVID-19 resolve themselves within about two to six months, researchers report. Unable to load your collection due to an error, Unable to load your delegates due to an error, An old man had a history of intense itch and erythematous skin lesions after his first, Chilblainlike lesions (a) on the left big toe of a patient who had received his first shot, Widespread purpuric rash on the left thigh (a) of an elderly male which had developed a few days after his first, A young healthy female had a history of an asymptomatic petechial rash developing 1day after her first, Showing a female patient with a 2week history of widespread dry purpuric skin lesions on her extremities (a). An old man had a history of intense itch and erythematous skin lesions, Chilblainlike lesions (a) on the left big toe of a patient who had, Widespread purpuric rash on the left thigh (a) of an elderly male which, A young healthy female had a history of an asymptomatic petechial rash developing, Showing a female patient with a 2week history of widespread dry purpuric skin, Illustrating possible pathomechanisms of cutaneous, Illustrating possible pathomechanisms of cutaneous findings following COVID19 vaccination. The https:// ensures that you are connecting to the But once the damage is done, the only way to really get rid of it is to cut off the damaged hair and let healthy hair grow in. Hairdressers around the globe are sharing similar stories, which has prompted scientists to look into the, "COVID-19 (and any other infections, in fact) puts your body in an inflammatory state," says NHS GP, Usually when it comes to hair dye, Dr Ahmed says that you might have a small reaction without even noticing, for example your skin or scalp getting a little bit red under your hair. Use left and right arrow keys to navigate between menu items. Use right arrow key to move into submenus. In September the, Unfortunately this doesn't seem to be an isolated incident. 2021;35:e411e412. Most people then see their hair start to look normal again and stop shedding. In conclusion, there are numerous cutaneous reaction patterns that may occur following COVID-19 vaccination, whereby many of these skin findings are of immunological/autoimmunological nature. The confusion around the situation stems from a similar situation in the UK, where there has been an earlier reopening of salons, barbershops, and beauty salons. 2023 Mar;9(2):141-143. doi: 10.1159/000528719. Until you do, Toye suggests deep-conditioning treatments, protein packs, and moisturizing hair care products to make hair look healthier temporarily. My family and friends often remark on it. JAK inhibitors are helping patients with alopecia areata, eczema/atopic dermatitis, psoriasis, and vitiligo. And it's not just the early hair that's prone to damage. In a normal hair growth cycle, its normal to lose 50 to 100 hairs per day. I Tried It, and Heres What I Thought, Bobs Are Back! This page was processed by aws-apollo-l1 in 0.498 seconds, Using these links will ensure access to this page indefinitely. Would you like email updates of new search results? PMC These side effects may affect their ability to do daily 2022 May;52(3):511-525. This hair shedding can last for six to nine months before it stops. It can smooth out deep wrinkles and lines, but the results arent permanent. Look for ingredients such as proteins, amino acids, and panthenol. "The rash is generally confined to the area that was exposed to the allergen but in rare cases can become more generalised," spreading to other areas of skin. It happens when more hairs than normal enter the shedding (telogen) phase of the hair growth lifecycle at the same time. On my worst ones, I mentally add up the cost of dyeing greys from 27 until, what 80? WebTemporary hair loss is normal after a fever or illness. A dermatologist is a medical doctor who specializes in treating the skin, hair, and nails. Some hairstylists use keratin treatments to improve the rough texture of gray hair. In conclusion, there are numerous cutaneous reaction patterns As a result, many hairdressers - like Shine Holistic in London - now require coronavirus survivors to complete patch tests 48 hours before their treatment. R29 rates, Regardless of whether you've used a type of hair dye before, Dr Ahmed recommends a patch test (you can do this by depositing a tiny amount of product behind your ear or on the inside of your upper arm) before jumping straight in. This site needs JavaScript to work properly. It was going to happen someday, but it looked like I wouldnt go white at 19 after all. SRW has conducted clinical trials funded by Sanofi Pasteur, Janssen Vaccines, and Moderna, Inc. and chairs an Independent Data Monitoring Committee for Janssen Vaccines; SRWs spouse is an employee of Regeneron Therapeutics and may hold stock and stock/options.Ethical Approval Statement: The series of trials included in this analysis obtained ethical approval from the required regulatory bodies prior to activation and individual informed consent was provided by all trial participants. But you can tame gray hair with a good hairstyle and special care. doi: 10.1002/ccr3.7133. It can be unsettling if it changes. We won't post to any of your accounts without asking first. Fast forward nineteen months, and the back of my head is practically translucent. An illness like COVID-19 puts the body under stress, which can cause more shedding than usual. I assumed it might have been a blip, an innocent mistake on biologys part, so I went on my merry way and tried to forget all about it. Emotional stress can also force more hairs than normal into the shedding phase. the spike-protein sequences used to design the vaccines) and human components and may thus explain some COVID-19 pathologies as well as adverse skin reactions to COVID-19 vaccinations. National Library of Medicine There have been reports of hair loss during or after having COVID-19. I Tried 824 Worth Of Drunk Elephant & This Is My Honest Opinion, Christophe Robin Temporary Color Gel, 30. But even people who recover from the virus quickly may experience some unexpected side effects: Research shows that COVID-19may lead to temporary hair loss, gray hair, and alopecia. Multiple patches of alopecia areata, Fig. Illustrating possible pathomechanisms of cutaneous findings following COVID19 vaccination. This page was processed by aws-apollo-l1 in. Patients have complained of a wide range of Long Covid symptoms which includes a significant loss of hair. Alopecia Areata Occurring after COVID-19 Vaccination: A Single-Center, Cross-Sectional Study. Clipboard, Search History, and several other advanced features are temporarily unavailable. A 2020 study published in Experimental Dermatology suggests that severe COVID-19 may increase the risk of gray hair and alopecia. Now, Im not saying COVID is the only reason I am going white. Cookie Settings. Keywords: COVID-19, natural infection, hybrid immunity, vaccination, Suggested Citation: FS is an employee of Janssen; Jansen has a contract with BARDA. and transmitted securely. In addition, other studies show that severe illness can cause both gray Importantly, molecular mimicry exists between SARS-CoV-2 (e.g. Mine went the Federal government websites often end in .gov or .mil. Rick, Anne-Marie and Laurens, Matthew and Huang, Ying and Protocol Leadership Team, HVTN 097 and Yu, Chenchen and Martin, Thomas C. S. and Rodriguez, Carina A. and Rostad, Christina and Maboa, Rebone M. and Baden, Lindsey and El Sahly, Hana M. and Grinsztejn, Beatriz and Gray, Glenda and Gay, Cynthia L. and Gilbert, Peter B. and Janes, Holly E. and Kublin, James G. and Huang, Yunda and Leav, Brett and Hirsch, Ian and Struyf, Frank and Dunkle, Lisa M. and Neuzil, Kathleen M. and Corey, Lawrence and Goepfert, Paul and Walsh, Stephen R. and Follmann, Dean and Kotloff, Karen L., Risk of COVID-19 after Natural Infection or Vaccination. Most people see noticeable hair shedding two to three months after having a fever or illness. If TikTok is anything to go by, her cooler and more versatile sister hair accessory is taking over. WebThe aim of this review is to summarize the dermatologic manifestations of COVID-19 involving the hair and nails in a narrative way. Careers. Inflammation and problems with the You are now subscribed to our newsletters. Part of the a360media Women's Service Group.Copyright a360media 2023. We spoke to Lisa Eccles, owner of Zinc Hair & Beauty in Kilmainham, and Vice President of the Irish Hair Federation, about what salons and customers should know about the situation. Drago F, Ciccarese G, Guadagno A, Parodi A. J Eur Acad Dermatol Venereol. Accessibility Old Pillows Give You Allergies and Adult Acne Use This TikTok Cleaning Hack To Strip Them Clean, Got Allergies? So, if it turns out that this 'risk' regarding the Covid-19 vaccine and hair colour is just rumours, what exactly could be causing an adverse reaction to the colour we've so missed in the first half of 2021? PG serves as a consultant for Johnson & Johnson. WebMD does not provide medical advice, diagnosis or treatment. Revenues fell by 4% year-on-year to $10.9bn between January and March because of a $1.5bn decline from Covid treatments. As more than 36 million people have had their first vaccination dose there, with the remaining 21 million due to get theirs before the end of July, this topic has gained some traction. No potential conflict of interest relevant to this article was reported. Try These Hair Makeup Hacks, What Is the Bowl Method for Curly Hair? (c) Mechanism of molecular mimicry caused by genetic similarities of SARSCOV2 spike protein components to endogenous crossreactive human antigens. .css-16c7pto-SnippetSignInLink{-webkit-text-decoration:underline;text-decoration:underline;cursor:pointer;}Sign In, Copyright 2023 Dow Jones & Company, Inc. All Rights Reserved, From Left: Rita Castillo, John LoBosco, Jeanine Vogel, Rita Castillo, John LoBosco, Jeanine Vogel. SARS-CoV-2-induced telogen effluvium: a multicentric study. Cureus. ", Cancer Research UK: "Using hair dye after chemo.". McMahon DE, Amerson E, Rosenbach M, Lipoff JB, Moustafa D, Tyagi A, Desai SR, French LE, Lim HW, Thiers BH, Hruza GJ, Blumenthal KG, Fox LP, Freeman EE. AMR, PBG, HEJ, JGK, LRB, PG, KLK, KMN, LC, HME have grant/contract support provided by the National Institutes of Health.