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As far as vaccinations go, most are only available in doses meant for large flocks, so if you don't have a large flock, you end up throwing away a lot of medicine and money.
When we got our first flock, I discussed Marek's with our vet. She doesn't take chickens as patients, but she does raise them. She lives within a mile of our farm. She suggested I vaccinate our hatchery chicks for Marek's. Because I trust her, I did.
Everyone has to decide for themselves the best way to raise their flocks.