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Gillard P, Povey M, Carryn S. Clinically- versus serologically-identified varicella: A hidden infection burden. A ten-year follow-up from a randomized study in varicella-endemic countries. Hum Vaccin Immunother 2021; 17:3747-3756. [PMID: 34181506 PMCID: PMC8437481 DOI: 10.1080/21645515.2021.1932217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Varicella-zoster virus (VZV) infections cause a substantial disease burden, which is underestimated due to incomplete reporting data and lack of serological surveillance. In this post-hoc analysis of a randomized, Phase IIIb clinical trial (NCT00226499) with a ten-year follow-up period, we report anti-VZV antibody levels and persistence in non-vaccinated children, as a varicella infection estimate in ten European countries with endemic varicella. The present analysis specifically focuses on clinical and serological data from the control group, which included 827 healthy participants aged 12–22 months who received two doses of measles-mumps-rubella (MMR) vaccine. The per-protocol cohort included 744 children for whom varicella occurrence was evaluated by clinical definitions, epidemiological links and PCR test outcomes. Anti-VZV antibody levels were assessed by ELISA. The primary objective of this analysis was to correlate varicella occurrence with anti-VZV antibody levels. Varicella was confirmed in 47% of MMR recipients. Among participants without reported varicella, the percentage of anti-VZV seropositive children increased to 75% and average anti-VZV antibody concentrations increased to 250 mIU/mL at year ten after vaccination, suggesting infection or exposure. An eight-fold increase in anti-VZV antibody concentrations between two consecutive visits, which is also observed after confirmed varicella, was detected in 37% of these participants during the follow-up period. About one-third of children not vaccinated against varicella and not diagnosed with varicella developed an anti-VZV immune response, suggesting subclinical varicella occurrence. Longitudinal studies combining serology and disease incidence are necessary to reliably estimate total varicella burden of infection.
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Daulagala SWPL, Noordeen F, Fara MMF, Rathnayake C, Gunawardana K. Exposure rate of VZV among women attending antenatal care clinic in Sri Lanka - a cross sectional study. BMC Infect Dis 2017; 17:625. [PMID: 28915849 PMCID: PMC5602960 DOI: 10.1186/s12879-017-2725-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 09/11/2017] [Indexed: 02/01/2023] Open
Abstract
Background Varicella or chickenpox was not a notifiable disease until 2005 in Sri Lanka and only a few studies have been conducted on the epidemiology of VZV infection in the country. The antiVZV IgG sero-prevalence among antenatal women is extremely limited and thus a selected group of antenatal clinic attendees were chosen to determine the exposure rate to VZV infection. Methods Women attending the antenatal clinic at Teaching Hospital, Peradeniya, Sri Lanka were selected for the study and 3 mL of venous blood was collected from 181 participants and the demographic data was obtained through a pretested questionnaire. Sera of the women were then tested for the presence of antiVZV IgG using ELISA (HUMAN Diagnostics, Germany). Data was analysed using the SPSS statistical software for Windows, Version 12.0. Results Of the 181 antenatal women who took part in the study, 141 were positive for antiVZV IgG giving a sero-prevalence of 77.9% for the past exposure to VZV. Of the 141 antiVZV IgG positive women, 43.3% (n = 61) were from urban, 41.8% (n = 59) were from rural and 14.9% (n = 21) were from estate populations (an ethnic population living in small settlements in the tea estates whose ancestors were brought from India during the British colonial period to work in the tea plantations in Sri Lanka). Out of the 88 antenatal women with a positive history for varicella, 85 (96.6%) were positive for anti-VZV IgG. The highest number of antiVZV IgG positivity was seen in the 31–35 age group, which was 85.0% of the total number of antenatal women included in that category. An increase in the antiVZV IgG sero-prevalence with increasing age was also noted in the study sample. Conclusion Exposure rate of VZV infection as confirmed by antiVZV IgG in the present study sample of antenatal women was 77.9%. Age specific, population based future sero-prevalence studies should be conducted in Sri Lanka to understand the anti-VZV IgG status in the country.
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Affiliation(s)
| | - Faseeha Noordeen
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
| | | | - Chathura Rathnayake
- Department of Gynecology and Obstetrics, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Kapila Gunawardana
- Department of Gynecology and Obstetrics, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
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Koturoglu G, Kurugol Z, Turkoglu E. Seroepidemiology of varicella-zoster virus and reliability of varicella history in Turkish children, adolescents and adults. Paediatr Perinat Epidemiol 2011; 25:388-93. [PMID: 21649681 DOI: 10.1111/j.1365-3016.2010.01180.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study aimed to assess the age specific varicella-zoster virus (VZV) seroprevalence in Izmir, Turkey and to determine the reliability of a history of varicella to detect susceptible children, adolescents and adults. A questionnaire, including previous history of varicella, was completed for each participant and, in 590 of them, VZV-specific IgG was measured using an ELISA test. Overall, 28.5% of individuals were seronegative for VZV. By 5 years of age, only 25.5% of children were seropositive for VZV. Among adolescents and young adults, 18.8% and 11.7% were seronegative, respectively. The negative predictive value was 57.8%, decreasing with age (81.9% in children, 34.5% in adolescents and 8.3% in adults). In conclusion, a negative history of varicella is not a reliable predictor of varicella antibody status in adolescents and young adults. Serological testing before immunisation will be logical, rather than presumptive vaccination, for adolescents and adults with negative history of varicella.
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Affiliation(s)
- Guldane Koturoglu
- Department of Pediatrics, Ege University Faculty of Medicine, Izmir, Turkey.
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Manikkavasagan G, Dezateux C, Wade A, Bedford H. The epidemiology of chickenpox in UK 5-year olds: An analysis to inform vaccine policy. Vaccine 2010; 28:7699-705. [DOI: 10.1016/j.vaccine.2010.09.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Revised: 09/03/2010] [Accepted: 09/08/2010] [Indexed: 11/24/2022]
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Parment PA, Svahn A, Rudén U, Bråkenhielm G, Storsaeter J, Akesson L, Linde A. Immunogenicity and Reactogenicity of a Single Dose of Live Attenuated Varicella Vaccine and a Booster Dose of Measles–Mumps–Rubella Vaccine Given Concomitantly at 12 years of Age. ACTA ACUST UNITED AC 2010; 35:736-42. [PMID: 14606613 DOI: 10.1080/00365540310015719] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Universal varicella-zoster virus (VZV) childhood vaccination is still debated, but adult chickenpox may be severe. It could be prevented by vaccination of seronegative adolescents. This study aimed to determine the feasibility of coadministration of a VZV vaccine and the measles-mumps-rubella (MMR) booster at 12 y of age. Guardians of 1231 12-y-old pupils where asked about the history of chickenpox in their children. 190 had no chickenpox history and 12 of 62 of them lacked VZV antibodies. Additional history-negative children were also recruited. 199 history-positive children received only MMR and 98 history-negative children received an MMR vaccine and a VZV vaccine. Serum samples were drawn before vaccination and after 8 weeks. Viral antibodies were measured by immunofluorescence (VZV) and enzyme-linked immunosorbent assays (VZV, MMR). All 184 history-positive children tested had VZV antibodies. 17/89 VZV-vaccinated and tested children (19%) lacked VZV antibodies before vaccination. 12 (71%) seroconverted after 1 dose. Cell-mediated immunity (CMI) against varicella was tested in 3/5 children who did not seroconvert after 1 dose of VZV vaccine. They seroconverted after a second dose and had measurable CMI. VZV vaccination did not affect the MMR response and there were no severe side-effects. A history of varicella infection, as reported by the guardian, is reliable, but a negative history was incorrect in 81% of the cases. This population of 12-y-old children may require 2 doses of VZV vaccine, at least when given simultaneously with the MMR vaccine.
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Affiliation(s)
- Per Arne Parment
- Department of Communicable Disease Control and Prevention, Stockholm County Council, Stockholm, Sweden.
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Modeling the impact of one- and two-dose varicella vaccination on the epidemiology of varicella and zoster. Vaccine 2010; 28:3385-97. [PMID: 20199763 DOI: 10.1016/j.vaccine.2010.02.079] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Revised: 02/12/2010] [Accepted: 02/15/2010] [Indexed: 11/22/2022]
Abstract
In many countries, policymakers are being asked to make recommendations regarding the introduction of a 2-dose varicella vaccination program. The objective of this study was to examine the potential impact of 1-dose versus 2-dose varicella vaccination programs on varicella and zoster incidence, using Canada as an example. We developed a deterministic realistic age-structured model that fits 1- and 2-dose vaccine efficacy, varicella force of infection and zoster incidence. Assuming 90% coverage, the base case model (range: min; max) predicts that 1-dose vaccination will reduce varicella and zoster cases by 64% (14%; 96%) and 5% (-2%; 22%), respectively, over 80-years. Adding a second dose is predicted to reduce varicella and zoster by an additional 22% (0%; 82%) and 6% (0%; 14%), respectively. Most varicella cases prevented by the second dose are breakthrough infections. Although the incremental effectiveness of adding the second dose is highly sensitive to vaccine efficacy and mixing, predictions of the overall benefit of a 2-dose program is relatively robust to model assumptions. Adding a 2-dose program may help guarantee high population-level effectiveness against varicella. However, the incremental benefit of a second dose is highly dependant on the effectiveness of the first dose and its impact on zoster.
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Valdarchi C, Farchi F, Dorrucci M, De Michetti F, Paparella C, Babudieri S, Spanò A, Starnini G, Rezza G. Epidemiological investigation of a varicella outbreak in an Italian prison. ACTA ACUST UNITED AC 2009; 40:943-5. [DOI: 10.1080/00365540802308449] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bricks LF, Pannuti CS, Sato HK, Vico ESR, de Faria AM, Souza VVAU, Sumita LM, Costa IDC, Baldacci ER. Reliability of information on varicella history in preschool children. Clinics (Sao Paulo) 2007; 62:309-14. [PMID: 17589672 DOI: 10.1590/s1807-59322007000300016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2006] [Accepted: 02/23/2007] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To verify how reliable is the information provided by parents about the history of varicella in their children. METHODS 204 parents of previously healthy children attending two municipal day-care centers of São Paulo city were interviewed between August 2003 and September 2005. A standardized form was filled out with information regarding age, sex, history of varicella and other diseases, drug use and antecedent of immunization, After medical history, physical examination and checking of immunization records, 5 ml of blood were collected for ELISA (in house) varicella test. Exclusion criteria were: age less than 1 year or more than 60 months, previous immunization against chickenpox, presence of co-morbidities or recent use of immunosuppressive drugs. Data were filed in a data bank using the Excel 2003 Microsoft Office Program and stored in a PC computer. The exact Fisher test was employed to calculate sensibility, specificity, positive and negative predictive values of history of varicella informed by children's parents. RESULTS The age of the children varied from 12 to 54 months (median, 26 months; 49 (24%) children had positive history of varicella, 155 (76%) a negative or doubtful history. The predictive positive and negative values of the information were 90% and 93%, respectively (p = 0.0001). CONCLUSIONS The degree of reliability of information about history of varicella informed by parents of children attending day care centers was high and useful to establish recommendations on varicella blocking immunization in day-care centers.
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Affiliation(s)
- Lúcia Ferro Bricks
- Children's Institute, Hospital das Clínicas, University of Sao Paulo, Sao Paulo, SP, Brazil.
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Chang CK, Tan HF, Tseng HF, Lin CC. Analysis of factors associated with varicella-zoster virus susceptibility among children 0–12 years old in Taiwan. Med Mal Infect 2007; 37:222-8. [PMID: 17368781 DOI: 10.1016/j.medmal.2006.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2006] [Accepted: 10/02/2006] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Varicella is a highly infectious disease caused by varicella-zoster virus (VZV). The aim of this study was to explore the geographical difference of VZV antibody seroprevalence among children in private vaccination areas in Taiwan, controlling for potential factors relating to varicella susceptibility. PATIENTS AND METHOD A cross-sectional survey of the seroprevalence of VZV antibodies among children 0-12 years of age was conducted in Taiwan between August and December 2003. Sera of children visiting the outpatient unit of the participating hospitals around the island were collected. Six hundred and fifty-six parents among those of the 931 children studied agreed to answer the self-administered questionnaire regarding the possible factors associated with varicella susceptibility. IgG antibodies to VZV were measured using an enzyme-linked immunosorbent assay kit, Enzygnost anti VZV/IgG. RESULTS The susceptibility was the highest at age 1 year, and then decreased as the age increased. Children living in southern and eastern Taiwan showed higher susceptibility to varicella than those living in northern area (odds ratio (OR) = 2.71 and 2.10, respectively). Prior history of varicella infection, varicella vaccination, and contact with cases remained to be associated with the susceptibility after multivariate analysis. CONCLUSIONS Children who lived in tropical and rural regions and those who had no history of varicella infection, varicella vaccination, and contact with cases, might be more susceptible to varicella. Island-wide VZV seroprevalence surveillance is required to examine whether the geographical difference of susceptibility in Taiwan will become less significant or disappear after the mass varicella vaccination program initiated in 2004.
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Affiliation(s)
- C K Chang
- Department of Sport Management and Sport Science Research Center, National Taiwan College of Physical Education, 16, Sec. 1, Shuan-Shih Road, Taichung 404, Taiwan, ROC
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Arnedo-Pena A, Puig-Barberà J, Aznar-Orenga MA, Ballester-Albiol M, Pardo-Serrano F, Bellido-Blasco JB, Romeu-García MA. Varicella vaccine effectiveness during an outbreak in a partially vaccinated population in Spain. Pediatr Infect Dis J 2006; 25:774-8. [PMID: 16940832 DOI: 10.1097/01.inf.0000232631.06763.8b] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND An outbreak of varicella occurred between December 2004 and April 2005 in the primary school and day-care center of a town of 5430 inhabitants in Spain. Although the varicella vaccine is not included in the infant vaccination program, some children had been vaccinated before the outbreak. STUDY AIM The aim of this study was to estimate varicella vaccine effectiveness during an outbreak that took place in a partially vaccinated population of children. METHODS A cohort study was carried out. Cases were identified through notification by doctors and active search. Information was gathered on the current disease, history of varicella and previous vaccinations together with age, course, school year and other sociodemographic factors. The relative risk (RR) of varicella and the contribution of the previously mentioned factors to the probability of contracting the disease was estimated for vaccinated and unvaccinated children. RESULTS Participation reached 96.5% (387 of 401 children) in the school and 91.2% (31 of 34 children) in the day-care center. Of 269 children with no history of varicella and with a documented vaccination record, 96 (35.7%) had been previously vaccinated. During the outbreak, 148 cases of varicella were observed. The overall attack rate was 54.4%, 22.9% in vaccinated and 72.8% in unvaccinated children. RR of varicella in vaccinated children was 0.31 (95% confidence interval [CI] = 0.21-0.46). The overall adjusted vaccine effectiveness against varicella was 69.5% (95% CI = 50.5-81.5%) and 96.9% (95% CI = 77.5-99.6%) against mild and severe forms. Only time since vaccination was associated with vaccine failure. CONCLUSIONS In the varicella outbreak studied, we conclude that vaccine was effective in the prevention of the disease, particularly in its moderate and severe forms, but because the proportion of vaccinated children was low, an outbreak still occurred.
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Pérez-Martín JJ, Bernal-González P, Fernández-Sáez L, Navarro-Alonso JA. Cálculo de la población susceptible ante una nueva campaña de vacunación frente a la varicela. Aten Primaria 2006; 37:303-4. [PMID: 16595107 PMCID: PMC8210754 DOI: 10.1157/13086322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Rivest P, Grenier L, Lonergan G, Bédard L. Varicella vaccination for grades 4 and 5 students: from theory to practice. Canadian Journal of Public Health 2005. [PMID: 15913084 DOI: 10.1007/bf03403690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND In 2002-2003, as part of a pilot project, varicella vaccination was offered to susceptible students in grades 4 and 5 in schools whose health services are provided by a local community services centre in Montréal. This immunization campaign was merged with the hepatitis B immunization programme. OBJECTIVES To calculate the proportion of grade 4 and 5 students susceptible to varicella; to calculate the proportion of susceptible students who agree to be vaccinated; to compare the proportion of susceptibles who agree to be vaccinated when varicella vaccination is offered with the first or the second dose of hepatitis B; and to assess whether a catch-up varicella immunization programme would affect the vaccine coverage of a concurrent hepatitis B vaccination programme. METHODS The proportions of susceptible students and of parents of susceptibles who consented to vaccination were calculated. The proportions of parents of susceptibles who consented to vaccination were compared for both immunization strategies: varicella vaccination given with the first or second dose of hepatitis B vaccine. Logistic regression was performed to identify possible associations between consent to varicella vaccination and the various variables collected. Rates of vaccine coverage against hepatitis B after two doses were compared for the years 2000-2001 and 2002-2003. RESULTS Of 3,856 registered students, 3,486 (90.4%) returned consent forms. Among the 3,272 students for whom information was available, 441 (13.5%) were susceptible, including 394 (89.3%) who consented to vaccination. The rates of vaccine coverage in the schools after two doses of hepatitis B vaccine were exactly the same for the 2000-2001 and 2002-2003 school years. CONCLUSION Varicella vaccination of susceptible grade 4 and 5 students associated with a coincident hepatitis B vaccination campaign can be performed without negative impact on the hepatitis B vaccination programme.
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Affiliation(s)
- Paul Rivest
- Institut national de santé publique du Québec, Ste-Foy, QC.
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Christiansen D, Barnett ED. Comparison of varicella history with presence of varicella antibody in refugees. Vaccine 2004; 22:4233-7. [PMID: 15474713 DOI: 10.1016/j.vaccine.2004.04.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2003] [Revised: 04/27/2004] [Accepted: 04/27/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To compare history of varicella with presence of varicella antibody in refugees and to determine the number of unnecessary doses of varicella vaccine administered to refugee children > or =7 years of age. METHODS Cross-sectional study of refugees > or =7 years of age evaluated between July 2000 and October 2002 by the Refugee Health Assessment Program at Boston Medical Center. We recorded age, sex, region of origin, varicella history, and results of serologic testing for presence of varicella antibodies. RESULTS Eighty-eight percent of individuals with a positive history of clinical varicella had varicella antibody; 65% of those with negative history had varicella antibody. The positive predictive value of a history of clinical varicella was 88%. The negative predictive value of a negative history was 39%. CONCLUSION History of varicella was not a reliable predictor of presence or absence of varicella antibody in refugees. Strategies to protect individuals with negative histories of clinical varicella include immediate immunization or serotesting followed by immunization of susceptible individuals. Relying on positive histories of clinical varicella may leave some individuals susceptible to varicella and impede efforts to eliminate varicella in the US.
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Affiliation(s)
- Demian Christiansen
- Program in Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
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Waner S. Chickenpox worldwide. Pediatr Infect Dis J 2003; 22:672. [PMID: 12867846 DOI: 10.1097/01.inf.0000076545.46609.9b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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