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Satake M, Sugiyama M, Mizokami M, Tanaka J. Incidences of new hepatitis B infection and anti-hepatitis B core-negative occult hepatitis B infection among Japanese blood donors in relation to anti-hepatitis B surface antigen levels. J Med Virol 2024; 96:e29823. [PMID: 39039862 DOI: 10.1002/jmv.29823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 07/05/2024] [Accepted: 07/15/2024] [Indexed: 07/24/2024]
Abstract
A transfusion-transmitted hepatitis B virus (HBV) infection caused by blood only positive for anti-hepatitis B surface antigen (anti-HBs) was reported. Occult HBV infection (OBI) with sole anti-HBs among blood donors is an issue. The incidence of HBV infection among repeat blood donors was investigated with a detailed HBV infection phase, focusing on the influence of anti-HBs level. This study followed 3 435 653 donors for HBV DNA conversion over 4 years and 9 months. Infection phase was determined based on marker changes over DNA conversion. This study identified 115 hepatitis B surface antigen (HBsAg) conversions, 72 DNA-only conversions, and 15 DNA plus anti-hepatitis B core (anti-HBc) conversions among donors all negative for HBV DNA, HBsAg, and anti-HBc. Total incidence was 2.38/100 000 person-years (PY). None of these 202 new HBV infections arose in the group with anti-HBs titer ≥ 10 mIU/mL. In total, 30 anti-HBc-negative OBIs were identified (incidence; 0.35/100 000 PY); 7 showed typical secondary anti-HBs response, and 23 showed stable anti-HBc and anti-HBs levels at DNA conversion. The HBV infection-protective ability of anti-HBs ≥ 10 mIU/mL was reinforced. In addition to new infections, the blood donor population includes anti-HBc-positive- and negative OBI with immune reactions or abortive HBV infection.
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Affiliation(s)
- Masahiro Satake
- Blood Service Headquarters, Japanese Red Cross, Tokyo, Japan
| | - Masaya Sugiyama
- Department of Viral Pathogenesis and Controls, National Center for Global Health and Medicine, Tokyo, Japan
| | - Masashi Mizokami
- Genome Medical Sciences Project, National Center for Global Health and Medicine, Tokyo, Japan
| | - Junko Tanaka
- Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Zhu H, Ding W, Han W, Zheng X, Hu Y, Dong J, Wu Y, Wu D, Liu J, Zhu F. Prevalence and Residual Risk of HIV in Volunteer Blood Donors of Zhejiang Province, China, from 2018 to 2022. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2024; 2024:4749097. [PMID: 38826677 PMCID: PMC11142854 DOI: 10.1155/2024/4749097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 04/26/2024] [Accepted: 05/06/2024] [Indexed: 06/04/2024]
Abstract
Background Blood safety levels have been significantly improved since the implementation of nucleic acid amplification technology (NAT) testing for blood donors. However, there remains a residual risk of transfusion transmission infections. This study aimed to evaluate the prevalence of HIV and its residual risk transmission among volunteer blood donors of Zhejiang Province, China, for five years after NAT implementation. Materials and Methods All specimens and information were collected from voluntary unpaid donors at all blood services in Zhejiang Province, China, from January 2018 to December 2022. The HIV antibody or antigen and HIV RNA were detected using enzyme-linked immunosorbent assay and NAT, respectively. The HIV residual risk transmission was calculated using the incidence or window period model. Results A total of 3,375,678 voluntary blood donors were detected, revealing an HIV prevalence of 9.92/100000. The HIV prevalence of blood donors in 12 blood services in Zhejiang Province was 6.11, 6.98, 7.45, 8.21, 8.36, 8.94, 9.04, 9.66, 9.73, 10.22, 11.80, and 12.47 per 100000 donors, without statistically significant difference observed among the services (p > 0.05). The HIV prevalence of males (15.49/100000) was significantly higher compared to females (1.95/100000; p < 0.05). There was an insignificant difference in HIV prevalence among blood donors of all different age groups (p > 0.05), but the HIV prevalence in the 26-35 age group and 18-25 age group was significantly higher compared to the 36-45 age group (p < 0.05). The difference in HIV prevalence between first-time blood donors (13.65/100,000) and repeat blood donors (6.78/100,000) was statistically significant (p < 0.05). From 2018 to 2022, the HIV residual risk in blood transfusion transmission was 0.266/100000. Conclusion The prevalence of HIV among blood donors in Zhejiang Province, China, is associated with age, gender, and times of blood donation. The HIV residual risk in blood transfusion transmission remains low in the province, and increasing the rate of repeat blood donors is beneficial to improve blood safety.
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Affiliation(s)
- Hong Zhu
- Blood Center of Zhejiang Province, Jianye Road 789, Hangzhou, Zhejiang 310052, China
- Key Laboratory of Blood Safety Research of Zhejiang Province, Jianye Road 789, Hangzhou, Zhejiang 310052, China
| | - Wei Ding
- Blood Center of Zhejiang Province, Jianye Road 789, Hangzhou, Zhejiang 310052, China
- Key Laboratory of Blood Safety Research of Zhejiang Province, Jianye Road 789, Hangzhou, Zhejiang 310052, China
| | - Wenjuan Han
- Blood Center of Zhejiang Province, Jianye Road 789, Hangzhou, Zhejiang 310052, China
| | - Xiaofan Zheng
- Blood Center of Zhejiang Province, Jianye Road 789, Hangzhou, Zhejiang 310052, China
| | - Yiqing Hu
- Blood Center of Zhejiang Province, Jianye Road 789, Hangzhou, Zhejiang 310052, China
| | - Jie Dong
- Blood Center of Zhejiang Province, Jianye Road 789, Hangzhou, Zhejiang 310052, China
- Key Laboratory of Blood Safety Research of Zhejiang Province, Jianye Road 789, Hangzhou, Zhejiang 310052, China
| | - Yaling Wu
- Blood Center of Zhejiang Province, Jianye Road 789, Hangzhou, Zhejiang 310052, China
- Key Laboratory of Blood Safety Research of Zhejiang Province, Jianye Road 789, Hangzhou, Zhejiang 310052, China
| | - Danxiao Wu
- Blood Center of Zhejiang Province, Jianye Road 789, Hangzhou, Zhejiang 310052, China
- Key Laboratory of Blood Safety Research of Zhejiang Province, Jianye Road 789, Hangzhou, Zhejiang 310052, China
| | - Jinhui Liu
- Blood Center of Zhejiang Province, Jianye Road 789, Hangzhou, Zhejiang 310052, China
- Key Laboratory of Blood Safety Research of Zhejiang Province, Jianye Road 789, Hangzhou, Zhejiang 310052, China
| | - Faming Zhu
- Blood Center of Zhejiang Province, Jianye Road 789, Hangzhou, Zhejiang 310052, China
- Key Laboratory of Blood Safety Research of Zhejiang Province, Jianye Road 789, Hangzhou, Zhejiang 310052, China
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Wu D, Hu Y, Wang M, Wu Y, Dong J, Liu J, Hu W. Establishing a screening strategy for non-discriminatory reactive blood donors by constructing a predictive model of hepatitis B virus infection status from a single blood center in China. Front Public Health 2024; 12:1366431. [PMID: 38601498 PMCID: PMC11004229 DOI: 10.3389/fpubh.2024.1366431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 03/18/2024] [Indexed: 04/12/2024] Open
Abstract
Background When employing the transcription-mediated amplification method for screening blood donors, there are some non-discriminatory reactive results which are screening assay reactive but HBV-DNA discriminatory assay negative. This raises concerns regarding the possibility of false positives among donors, which may lead to permanent deferral of blood donors and affect blood supply. This study aimed to elucidate the infection status of these non-discriminatory reactive blood donors and develop and validate a model to predict individualized hepatitis B status to establish an optimal screening strategy. Methods Supplementary tests were conducted on initial non-discriminating reactive donations to determine their HBV infection status, including repeat testing, viral load, serological marker detection, and follow-up. Primary clinical variables of the donors were recorded. Based on the Akaike information criterion, a stepwise forward algorithm was used to identify the predictive factors for information and construct a predictive model. The optimal screening strategy was determined through cost-effectiveness analysis. Results At the Blood Center of Zhejiang Province, 435 cases of initial non-discriminatory reactive donations were collected over two successive periods and sub-categorized through repeated testing into the following three groups: non-repeated positive group, non-discriminated positive group, and non-repeated HBV-DNA positive group. The HBV discriminatory rate increased after repeated testing (110/435, 25.29%). According to supplementary tests, the HBV-DNA positivity rate was 65.52% (285/435), and occult HBV infection was a significantly different among groups (χ2 = 93.22, p < 0.01). The HBV serological markers and viral load in the non-repeated positive group differed from those in the other two groups, with a lower viral load and a higher proportion of false positives. The predictive model constructed using a stepwise forward algorithm exhibited high discrimination, good fit, high calibration, and effectiveness. A cost-effectiveness analysis indicated that utilizing repeated discriminatory testing and the predictive model is an extremely beneficial screening approach for non-discriminatory reactive blood donors. Conclusion Nearly two-third (65.52%) of the non-discriminatory reactive blood donors were HBV-DNA positive. Our innovative approach of constructing a predictive model as a supplementary screening strategy, combined with repeated discriminatory experiments, can effectively identify the infection status of non-discriminatory reactive blood donors, thereby increasing the safety of blood transfusions.
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Affiliation(s)
- Danxiao Wu
- Department of Laboratory, Blood Center of Zhejiang Province, Hangzhou, China
- Key Laboratory of Blood Safety Research of Zhejiang Province, Hangzhou, China
| | - Yiqin Hu
- Department of Laboratory, Blood Center of Zhejiang Province, Hangzhou, China
| | - Min Wang
- Department of Laboratory, Blood Center of Zhejiang Province, Hangzhou, China
| | - Yaling Wu
- Department of Laboratory, Blood Center of Zhejiang Province, Hangzhou, China
- Key Laboratory of Blood Safety Research of Zhejiang Province, Hangzhou, China
| | - Jie Dong
- Department of Laboratory, Blood Center of Zhejiang Province, Hangzhou, China
- Key Laboratory of Blood Safety Research of Zhejiang Province, Hangzhou, China
| | - Jinhui Liu
- Department of Laboratory, Blood Center of Zhejiang Province, Hangzhou, China
- Key Laboratory of Blood Safety Research of Zhejiang Province, Hangzhou, China
| | - Wei Hu
- Department of Laboratory, Blood Center of Zhejiang Province, Hangzhou, China
- Key Laboratory of Blood Safety Research of Zhejiang Province, Hangzhou, China
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Yu S, Guo Y, Zhang C. Serum HBV RNA: a promising biomarker for blood product safety screening and enhanced diagnostic efficiency in chronic hepatitis B virus infection. Front Public Health 2023; 11:1248878. [PMID: 37719720 PMCID: PMC10501715 DOI: 10.3389/fpubh.2023.1248878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/14/2023] [Indexed: 09/19/2023] Open
Affiliation(s)
- Sulan Yu
- Central Blood Station of Lianyungang, Lianyungang, China
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Chen J, Ma Z, Wu D, Zuo Q, Wang F, Xiao C, Chen F, Li P. Evaluating the cost-effectiveness of low-level HBV DNA screening in occult hepatitis B infection donors: A study from Shandong Blood Center, China. Heliyon 2023; 9:e18609. [PMID: 37560659 PMCID: PMC10407207 DOI: 10.1016/j.heliyon.2023.e18609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 07/14/2023] [Accepted: 07/24/2023] [Indexed: 08/11/2023] Open
Abstract
OBJECTIVE This study aimed to assess the efficacy of individual-donation nucleic acid testing (ID-NAT) in detecting occult hepatitis B virus infection (OBI) among anti-HBc positive blood donors, compared to minipool nucleic acid testing (MP-NAT). METHODS The present study analyzed data from the Shandong Blood Center in China during the period from January 2018 to June 2022, where HBsAg-negative blood donors were screened using the 6-sample minipool nucleic acid testing (6-sample MP NAT) method. NAT-positive samples underwent subsequent anti-HBc and anti-HBs testing. Approximately 5000 samples that passed the nucleic acid mixing test were randomly selected for anti-HBc testing, and over 100 anti-HBc positive samples underwent individual donor nucleic acid testing (ID-NAT). Any HBV DNA positive samples detected by ID-NAT were subsequently confirmed using alternative nucleic acid testing methods. RESULTS Among 220,445 HBsAg-negative blood donors, the positivity rate of HBV DNA detection using the 6-sample minipool nucleic acid testing (MP NAT) method was found to be 0.031% (69/220,445). Of the 67 HBV DNA positive samples, 55 (82.09%) and 25 (37.31%) were found to be positive for anti-HBc and anti-HBs, respectively, using the supplementary chemiluminescent microparticle immunoassay (CMIA). Among the 4797 HBsAg-negative/MP NAT-negative samples, 909 (18.95%) tested positive for anti-HBc. Further NAT testing was performed on 164 arbitrarily selected anti-HBc-positive/MP HBV DNA-negative samples, revealing a HBV DNA positivity rate of 1.22% (2/164). CONCLUSION Using individual donation nucleic acid testing can significantly increase the detection rate of occult hepatitis B virus infection in anti-HBc-positive blood donors, resulting in a detection rate of 0.22% (1.22 × 0.1895). This rate is 8.10 times higher than the detection rate achieved by mixed testing methods (0.031%) [calculated as (0.22 + 0.031)/0.031]. Therefore, it is recommended to perform single HBV DNA testing on anti-HBc-positive blood donors, discard plasma with weakly positive or negative anti-HBs but positive anti-HBc, or avoid transfusing anti-HBc-positive plasma to recipients with weakly positive or negative anti-HBs to prevent HBV infection.
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Affiliation(s)
- Jianfeng Chen
- Blood Center of Shandong Province, No 22 Shanshi East Road, Lixia District, Jinan, Shandong, China
| | - Zili Ma
- Blood Center of Shandong Province, No 22 Shanshi East Road, Lixia District, Jinan, Shandong, China
| | - Dandan Wu
- Blood Center of Shandong Province, No 22 Shanshi East Road, Lixia District, Jinan, Shandong, China
| | - Qi Zuo
- Blood Center of Shandong Province, No 22 Shanshi East Road, Lixia District, Jinan, Shandong, China
| | - Fengtian Wang
- Blood Center of Shandong Province, No 22 Shanshi East Road, Lixia District, Jinan, Shandong, China
| | - Chen Xiao
- Blood Center of Shandong Province, No 22 Shanshi East Road, Lixia District, Jinan, Shandong, China
| | - Fuqiang Chen
- Blood Center of Shandong Province, No 22 Shanshi East Road, Lixia District, Jinan, Shandong, China
| | - Peng Li
- Blood Center of Shandong Province, No 22 Shanshi East Road, Lixia District, Jinan, Shandong, China
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Deng X, Zang L, Candotti D. Re-Entry Evaluation of Chinese Blood Donors with Unconfirmed Hepatitis B Screening Results. Viruses 2022; 14:v14112545. [PMID: 36423154 PMCID: PMC9698129 DOI: 10.3390/v14112545] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 10/30/2022] [Accepted: 11/16/2022] [Indexed: 11/20/2022] Open
Abstract
The hepatitis B virus (HBV) remains a high priority for Chinese blood banks due to the high prevalence of infection. HBV blood safety has been significantly improved by the implementation of highly sensitive and specific serological and molecular HBV screening assays. The multiplication of viral markers tested and the ever-increasing analytical sensitivity of the tests can make the interpretation of the results difficult. False-positive or indeterminate results may lead to permanent donor deferrals and conflicts between donors and blood banks. To avoid blood shortages, blood services aim to limit unnecessary donor losses by developing procedures for the re-entry of donors temporarily deferred due to an unconfirmed HBV reactivity. The development of such procedures based on donor follow-up and HBV confirmation remains limited. A review of the scarce data available revealed considerable heterogeneity in testing methods and re-entry algorithms, limited validation studies, and a lack of accurate assessment of the residual infectious risk potentially associated with donor re-entry. In conclusion, systematic and widely validated confirmatory testing and prolonged follow-up are essential for safe re-entry of temporary deferred donors. Standardization of HBV testing methods and the establishment of dedicated expert laboratories are needed because of the complexity of HBV infection in blood donors.
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Affiliation(s)
- Xuelian Deng
- Dalian Blood Center, No. 90 Yan’an Road, Zhongshan District, Dalian 116001, China
- Correspondence: ; Tel.: +86-411-8265-3557
| | - Liang Zang
- Dalian Blood Center, No. 90 Yan’an Road, Zhongshan District, Dalian 116001, China
| | - Daniel Candotti
- Department of Virology, Henri Mondor Hospital, Paris-Est University, Inserm U955-IMRB-Team 18, 94010 Creteil, France
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Wu D, Feng F, Wang X, Wang D, Hu Y, Yu Y, Huang J, Wang M, Dong J, Wu Y, Zhu H, Zhu F. The impact of nucleic acid testing to detect human immunodeficiency virus, hepatitis C virus, and hepatitis B virus yields from a single blood center in China with 10-years review. BMC Infect Dis 2022; 22:279. [PMID: 35321684 PMCID: PMC8943971 DOI: 10.1186/s12879-022-07279-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Since 2010, the Blood Center of Zhejiang province, China, has conducted a pilot nucleic acid amplification testing (NAT) screening of blood donors for Hepatitis B virus (HBV), Hepatitis C virus (HCV), and Human immunodeficiency virus (HIV). This study aims to assess the results of NAT testing over 10 years to establish the effects and factors influencing NAT yields of HBV, HCV, and HIV. METHODS Blood donations from seven different blood services were screened for HBV DNA, HCV RNA, and HIV RNA using 6 mini pools (6MP) or individual donation (ID)-NAT method between August 1, 2010, and December 31, 2019, at the NAT centralized screening center. We compared 3 transcription-mediated amplification (TMA) assays and 2 polymerase chain reaction (PCR) assays. Further, HBV, HCV, and HIV NAT yields were calculated and donor characteristics and prevalence of HBV NAT yields analyzed. Donors with HCV and HIV NAT yield were also followed up. RESULTS 1916.31 per million donations were NAT screening positive overall. The NAT yields for HBV, HCV, HIV and non-discriminating reactive were 1062.90 per million, 0.97 per million, 1.45 per million, and 850.99 per million, respectively, which varied in the seven blood services and different years. HBV NAT yields were higher than those of HCV and HIV and varied across demographic groups. Risk factors included being male, old age, low education level, and first-time donors. We found no differences in NAT yields of HBV, HCV, and HIV between the 3 TMA and 2 PCR assays; nonetheless, statistically, significant differences were noted between the five assays. CONCLUSION In summary, NAT screening in blood donations reduces the risk of transfusion-transmitted infections and shortens the window period for serological marker screening. Therefore, a sensitive NAT screening method, ID-NAT workflow, and recruitment of regular low-risk donors are critical for blood safety.
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Affiliation(s)
- Danxiao Wu
- Blood Center of Zhejiang Province, Jianye Road 789, Hangzhou, Zhejiang, 310052, People's Republic of China.,Key Laboratory of Blood Safety Research of Zhejiang Province, Jianye Road 789, Hangzhou, Zhejiang, 310052, People's Republic of China
| | - Fangjun Feng
- Blood Center of Zhejiang Province, Jianye Road 789, Hangzhou, Zhejiang, 310052, People's Republic of China
| | - Xiaojuan Wang
- Blood Center of Zhejiang Province, Jianye Road 789, Hangzhou, Zhejiang, 310052, People's Republic of China
| | - Dairong Wang
- Blood Center of Zhejiang Province, Jianye Road 789, Hangzhou, Zhejiang, 310052, People's Republic of China
| | - Yiqin Hu
- Blood Center of Zhejiang Province, Jianye Road 789, Hangzhou, Zhejiang, 310052, People's Republic of China
| | - Yang Yu
- Blood Center of Zhejiang Province, Jianye Road 789, Hangzhou, Zhejiang, 310052, People's Republic of China
| | - Jihong Huang
- Blood Center of Zhejiang Province, Jianye Road 789, Hangzhou, Zhejiang, 310052, People's Republic of China
| | - Min Wang
- Blood Center of Zhejiang Province, Jianye Road 789, Hangzhou, Zhejiang, 310052, People's Republic of China
| | - Jie Dong
- Blood Center of Zhejiang Province, Jianye Road 789, Hangzhou, Zhejiang, 310052, People's Republic of China.,Key Laboratory of Blood Safety Research of Zhejiang Province, Jianye Road 789, Hangzhou, Zhejiang, 310052, People's Republic of China
| | - Yaling Wu
- Blood Center of Zhejiang Province, Jianye Road 789, Hangzhou, Zhejiang, 310052, People's Republic of China. .,Key Laboratory of Blood Safety Research of Zhejiang Province, Jianye Road 789, Hangzhou, Zhejiang, 310052, People's Republic of China.
| | - Hong Zhu
- Blood Center of Zhejiang Province, Jianye Road 789, Hangzhou, Zhejiang, 310052, People's Republic of China. .,Key Laboratory of Blood Safety Research of Zhejiang Province, Jianye Road 789, Hangzhou, Zhejiang, 310052, People's Republic of China.
| | - Faming Zhu
- Blood Center of Zhejiang Province, Jianye Road 789, Hangzhou, Zhejiang, 310052, People's Republic of China. .,Key Laboratory of Blood Safety Research of Zhejiang Province, Jianye Road 789, Hangzhou, Zhejiang, 310052, People's Republic of China.
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