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Press Briefing Transcript

Flu Press Conference: New Report Highlights Benefits of Flu Vaccine

Thursday, December 12, 2013 at 12:00 E.T.

BARBARA REYNOLDS: Good afternoon.  I'm Barbara Reynolds.  Welcome to CDC's media briefing on influenza.  I want to welcome those who are joining us here in the room.  And I have to say that we're having some difficulty with our webcast.  We hope they can be joining us very quickly.  Then, of course, those on phone.  Today's media briefing will recap last year's flu season, as reported in today's MMWR.  And then we'll turn to this year's flu season and look at early vaccination rates and current flu activity.  We will hear from two speakers today followed by Q&A.  Our two speakers are CDC director Dr. Tom Frieden who will be joining us by phone. And Dr. Ann Schuchat, CDC's director of the National Center for Immunization and Respiratory Diseases.  We will first begin with Dr. Tom Frieden. 

TOM FRIEDEN: Hello, everybody.  Let me just confirm you can hear me okay. 

BARBARA REYNOLDS: We can hear you.  We need a little boost on the volume. 

TOM FRIEDEN: All right.  Thanks very much.  I wish i could be with you in person but I’m glad to be able to be joined by phone because today's MMWR has exciting news about influenza and flu vaccinations and it is so important that people get vaccinated.  Really there's three things I want to high light and I’ll turn it over to Dr. Schuchat who will provide details.  First, there's eye-opening news in today's MMWR.  We estimate based on conservative model that during last year's flu season, that is 2012-2013 flu season, flu vaccination prevented at least 6.6 million people from getting sick with the flu, 3.2 million people from going to see a doctor or other health care professional and at least 79,000 hospitalizations.  We've looked at the last few flu years going back with a similar model all the way back to 2005 and this is by far the largest number of hospitalizations and other illnesses we've seen prevented. 

This is an example of what we're trying to do at CDC to make sure that we're actually measuring to the greatest extent possible the impact of the programs that we're operating.  We will continue to refine that method for estimating impact and while that further refinement may change the numbers a bit, we're confident that those changes will actually be defined in even larger impact of influenza vaccinations.  The high numbers prevented from last year were partly attributable to the fact that last year was a relatively severe season.  Today's MMWR also includes the estimate that even with those hospitalizations prevented, there were still about 381,000 flu associated hospitalizations in the past season.  This is higher than we've seen during many acute flu seasons, and Dr. Schuchat will speak more about that. 

The point is that influenza can cause a lot of illness and it can be severe.  It's definitely worth getting the flu vaccine and last year flu vaccination prevented millions of illnesses and tens of thousands of hospitalizations.  And that brings me to my second point which is that flu vaccine in a vial doesn't do anybody any good.  The more people vaccinated the more benefit to individuals, the fewer the hospitalizations, the fewer the illnesses and deaths. Another report that we’re releasing today online show that while many people are making it a habit to get a flu vaccine, far too many people remain unvaccinated.  As of early November, an estimated 40 percent of people six months and older reported that they had gotten the flu vaccine.  Dr. Schuchat will provide more details including how this year's early coverage estimates compares to last year at the same time.  And finally, seasonal influenza activity is now beginning to increase in parts of the U.S. and we know that it will increase in the coming weeks and months but we cannot predict where and when and how severe this year's flu season will be.  What we can predict is that the best way you can protect yourself against the flu is to get a flu vaccine and there are many different options for flu vaccinations as Dr. Schuchat will discuss.  Vaccinations should occur before flu is circulating widely but as long as flu is still spreading it's not too late to get vaccinated.  So if you haven't got your flu shot yet this season now is a good time to get one.  At this point I'll turn it over to Dr. Ann Schuchat to both give further information and then to answer any of your questions. And really remind everyone that today's information tells us some very clear and simple things.  Flu vaccination is important.  The flu itself can be very severe causing hospitalization and death and the single most effective tool we have to reduce the flu is the flu vaccination.  So by all means avail yourself of one or the other options and if you haven't already get a flu vaccination this year and every year.  Dr. Schuchat. 

ANNE SCHUCHAT: Thanks so much Dr. Frieden, and welcome, everybody.  Good afternoon.  I'm just going to briefly expand on some of the information that Dr. Frieden shared and then take questions to go into details about what you're most interested in.  Last year around this time we were coping with an early flu season.  Last year flu hit early and it hit hard.  This year we're lucky because the flu season hasn't taken off wildly yet so it’s not too late for you to get vaccinated and to make sure to protect yourself and your families.  Last year was a pretty tough year for influenza and today's MMWR is releasing exciting and important information about the impacts that our influenza vaccination program had as well as how the bad the season was in terms of the burden of illness and hospitalizations.  And as Dr. Frieden said, we're estimating that we prevented 6.6 million illnesses from flu last year.  And almost 80,000 hospitalizations from flu through vaccination. 

Much of the illness and hospitalizations that we prevented were in the most vulnerable people, the youngest and the oldest. In particular the hospitalizations that we prevented were primarily among people over 65, and people under 5.  Those are the groups that are most likely to be hospitalized and the vaccine prevented a lot of severe illness in those people.  The vaccine didn't prevent everything and we did have a tough year.  Last year we estimate 380,000 total hospitalizations from flu.  Much higher than we've seen in the years since we've been doing the same kind of modeling.  We know that we could do better.  If we could have reached 70 percent of the population getting influenza vaccine last year we could have prevented an additional 4.4 million illnesses and we could have prevented 30,000 more hospitalizations.  So we're really keen to take the available tools and do even better in the next year.  I want to quickly describe an enormous amount of data that are available online today.  Our staffs have worked furiously to get you data on this season available right now.  So, we have data about the general population influenza vaccination coverage measured through mid-November. That is posted online and we have data about special populations, pregnant women and health care workers, also posted online.  These are really important pieces of information about how well we're doing so far, and a reminder that we need to do better going forward. 

The good news is compared with information for the same time last year, we're a little bit ahead of things.  Overall about 40 percent of the general population had reported getting a flu vaccine by mid-November.  That is about three percentage points higher than last year at the same time and most of the increase that we see is increases in adults getting vaccinated.  That's good news because we have been lagging behind in non-elderly adults getting vaccinated and they increased several percentage points compared to the same time last year. But, where we are now is not as important as where we get to.  So we want to remind you it's not too late to get vaccinated, those were just mid-season reports really half-time numbers.  And we really hope that we'll use up all the flu vaccine that's left and reach as high coverage as possible. 

I do want to mention two key populations.  As you know we're tracking pregnant women.  They can have very severe complications from influenza.  Pregnant women can become ill themselves and their babies can be very sick and even die from the flu.  So it's very important for pregnant women to get vaccinated this year and every year that they are pregnant.  Basically, comparing this year with last year we're at just about the same point, 41 percent of pregnant women have been vaccinated by mid-November.  More work to do there.  Every pregnant woman really needs to get vaccinated.  What about health care workers?  We want every single health care worker out there.  I’ve gotten my vaccine.  Every health care worker I know has gotten theirs.  So as a nation we're not done.  By mid-November we were pretty much where we were the year before, 63 percent of health care providers had gotten flu vaccine by that point this year just about the same as last year.  Now, I want to start a little competition because when you look among health care workers last year's physicians were at the top and pharmacists were neck and neck right close behind, but by mid-November the pharmacists were in the lead.  So I really congratulate the pharmacists and want the clinicians, the physicians, nurses, medical assistants, especially the people working in long term care facilities to catch up with the pharmacists.  Lastly I just want to say a couple of words about this year's flu season.  We're not where we were last year.  Last year we already had quite a lot of disease.  But we don't know what this flu season will be like because most years, in 90 percent of years the flu peaks between January and March.  So it's not too late to be vaccinated to protect yourself against the flu, but it's too soon for us to tell you what this flu season is going to be like.

 I can say that already three children have died from flu.  We hate to see anyone die from flu and particularly children so we know flu is out there and it's affecting our most vulnerable.  I really urge parents to make sure children are vaccinated.  Remember some of your children depending on their age and what happened last year may need a second dose.  So this is a really good time to figure out whether your child needs a second dose and bring them back in to get that.  You know, this year I think we’re really reminded about how little we control--the superstorm, the flight delays.  You know there's a lot of uncertainty every winter.  But protecting your family from flu is something that you can control and influenza vaccination is the best way to keep yourself and your family healthy.  So, I now can stop and begin to answer questions.  Operator, let me know if there is a question.  Oh, okay wait.  I should start in the room.  Thank you for that reminder.  Please. 

MICHELE MARILL: I’m Michele.  I had two questions.  One is whether or not with all of the increased vaccination of health care workers whether you’ve seen any impact in hospitals in terms of fewer cases transmitted in hospitals?  And then my second question has to do with the elderly population.  I noted it says the vaccine effectiveness had a confidence level of minus 5 to 56 percent.  So that would imply it's possible the vaccine actually didn't protect them at all. 

ANNE SCHUCHAT: Thank you for those questions. We know that there are several reasons for health care workers to be vaccinated. Certainly to protect themselves, also to protect their patients and also to protect their loved ones. When you actually do surveys and ask clinicians why they get vaccinated, protecting their family is higher up on their list than protecting patients. But we think it's important for health care providers to be curing and preventing disease and not spreading it. There aren't new data that I’m aware of on the impact of the increases in health care worker vaccination, but there are really tremendous progress in getting health care workers vaccinated. The best data about the impact of health care worker vaccination is older data that suggests a real benefit for patients in long term care facilities when high proportions of the health care workers there are vaccinated. Sadly that is the population of health care workers where we've really been lagging behind. This is something that if you've got a loved one in a long term care facility, I would ask the caregivers there have they been vaccinated. Find out what's going on with the people taking care of the people that you love. Your second question was about the vaccine effectiveness and particularly about the elderly. We know that influenza vaccines don't work as well in the elderly as they do in younger populations and it's something that we're quite concerned with, very interested in trying to find ways to make vaccines that are more effective in the most vulnerable, the frail, elderly in particular. The modeling we did incorporated the wide confidence interval for vaccine effectiveness. I don't think you want me to go through boot- strapping but I’m prepared to do that afterwards because I’ve studied my notes on boot-strapping and I can answer that question. But basically they did, essentially, sample the possible effectiveness that was measured and the probable ones had a better chance of feeding in to the model and so that was how that was accounted for. I think we have time for a question from the phone next.

OPERATOR: Thank you, our first question is from Mike Stobbe from the AP.

ANNE SCHUCHAT: Operator?

MIKE STOBBE: Hi, this is Mike Stobbe at the AP. Can you all hear me?

ANNE SCHUCHAT: Yes, absolutely. Hi, Mike.

MIKE STOBBE: Hi, Dr. Schuchat, thank you for taking the call. I was hoping for just a little more information about the current flu season, current through even Friday if you have that information that you can share. I just wonder if you can tell me, you know, how many -- in how many states it’s widespread or just a little more gauging on how common the flu is right now and also you mentioned the three pediatric deaths. Can you offer some context, how many pediatric deaths were there at this same point last year?

ANN SCHUCHAT: Yeah. Let me say a few things and I’m going to refer you to FluView, which is online right now and has the specifics of which states are at which level. I can say that in general there's a bit more activity in the Southeastern states than in the rest of the country, although there are states here and there also having the same level of activity as the Southeastern states. As you mentioned, three children have died from influenza so far this year. Last year 169 children died throughout the whole season, but it was an early season so we had had more deaths by this point last year. What I can say is that no child needs to suffer -- sorry. What I can say is that parents can do a lot of benefit for their children by making sure they are vaccinated appropriately against influenza. The flu vaccine is not perfect, it won't prevent every single influenza illness and it’s certainly not going to prevent every single death. But for parents out there it's one thing you can do to try to protect yourself and your children from the flu. Really, really heartbreaking stories from a number of parents who have lost children to flu, and I really call out families fighting flu which have taken those losses and tried to share with other parents what they have been through. Really we want every child to be vaccinated. We've seen progress in the last few years and we really want to keep the progress going and particularly this time of the year remind people about the second dose. Next question? From the operator -- from the phone?

OPERATOR: Thank you. Our next question is from Dan Childs from ABC News.

DAN CHILDS: Hi, thank you so much for taking my question. Just a quick one that I noticed in the numbers that came out in the MMWR that the flu vaccination rate for last year was actually down compared to the year before. This is despite the fact that everyone had heard that it was an early and severe season. What might be some of the reasons for this?

ANNE SCHUCHAT: In general last year's flu vaccination coverage was pretty similar from the year before. And I think we may have hit a little bit of a blasé after the pandemic and heightened concern about flu. On the other hand, last year disease hit hard and hit early and I think it was a wakeup call about how bad influenza can be. As you heard today, we think about 380,000 people were hospitalized from flu last year. So it's a reminder that every year is different but flu can be serious, even healthy people can get the flu and they can have severe complications from it and influenza vaccination’s the best way to protect yourself from flu. Coverage this year versus last year is really just a halftime number and it's really where we are at the end of the season that matters, and most of all, the most important thing is to do what we can with the available tools and protect ourselves and our families. So, I would say stay tuned for the end of season coverage and really make sure you and your loved ones are vaccinated because it's not too late to raise those numbers, it’s not too late to protect yourself. On the other hand, for those of you who’ve been looking for those super deals with Black Friday and Cyber Monday and might’ve disappointed that they’ve run out of whatever you were looking for, you know we may run out of flu vaccine. Around the holidays we see people very busy with things and then last year we saw in January some shortage of supplies from here and there. So I urge people to find the flu vaccine now. You can go to flu.gov and the Flu Finder there will help you find out where there's a flu vaccine venue near you. And so it's not too late to get vaccinated, but I hope that we don't have to say in a few weeks that it's too late to find a vaccine. So I would really tell people put it on your holiday shopping list. I think I have a question from the room.

DIANA DAVIS: Hi, Diana Davis from WSB here in Atlanta. I just came from interviewing our state’s Director of Public Health and he mentioned something I was not familiar with, follow up to this woman's question, that for people over 65 and for whom the vaccine is not as effective getting a stronger dose. Can you talk more about that and also more specifics for people asking their pediatrician about their children?

ANNE SCHUCHAT: Sure. You know, the companies have made a whole range of flu vaccines. We have a number of types of flu vaccines available this year in particular. There's a high dose flu vaccine that's licensed for people 65 and over. And it has been looked at now in a couple years comparing it side-by-side with regular dose flu vaccine, the data so far suggested higher immune response in those with a high dose product compared to a regular dose. Little bit higher local reaction. There's some clinical data that the company has presented publicly now that suggests the higher dose appears to be more protective, at least in a couple of seasons they have looked at. Our advisory committee on immunization practices doesn't differentiate among the products. We recommend that the best vaccine to get is the one your doctor or your pharmacist has. So basically there's exciting new information about the high dose vaccine but we're not recommending it yet as preferential over the others. Again it might be difficult to find in a particular place. What should parents ask their pediatricians about? Has my child gotten the flu vaccine yet this year? Does my child need a second dose? Many children under nine need a second dose. This depends on what vaccine, what vaccines they've gotten in the past. After that age group one dose is just fine. But essentially the first year young children are vaccinated we recommend two doses.

DIANA DAVIS: A lot of people including me will be getting on planes next week. We all know how packed they are. Just one reminder with all that with all the travel and stuff.

ANNE SCHUCHAT: Yeah. There's so much on your mind when you're heading to the airport for gathering with families and the most important thing for people to know is get vaccinated now before you reconnect with grandparents and aunts and uncles. This is the time to make sure your kids are vaccinated and that you are as well. Things get busy during the holidays and afterwards and this is the right time to add to getting a flu vaccine to your list. Here we have a question in the room.

VERONICA GRIFFIN: Veronica Griffin, CBS Atlanta News. You spoke to the Southeastern states being the most active at this point. Can you speak to the three deaths and, my understanding three in Georgia, can you clarify that if should people in this part of the country should be concerned?

ANNE SCHUCHAT: Let me differentiate. What I’m aware of is that CDC has received reports of three children around the country dying from influenza. I believe today Georgia was announcing the first documented influenza death here in Georgia -- in all ages. Not in children. In the U.S., only influenza in children, those under 19 years of age are reportable. We made them reportable when we had a really bad year about ten years ago and realized this was just a terrible thing and we should be tracking it. Unfortunately, influenza deaths are not uncommon in the elderly and we don't have them individually reported to us. So, again, last year we think that hospitalizations were way up, but that we were able to prevent an enormous number of hospitalizations with influenza and we think it's very important to get influenza vaccines to protect yourself and your kids against flu, against the hospitalization the flu can cause and even against those deaths that it sometimes causes. Do we have a question from the phone?

OPERATOR:  Our next question is from Maggie Fox from NBC News. 

MAGGIE FOX: Hi, thanks very much.  I'm trying to anticipate some of the comments we get on these flu stories and I can see people saying only a 17 percent reduction.  Doesn't that show the vaccine doesn't work?  Is there a way to put it in context for the general reader to understand the benefits of it better? 

ANNE SCHUCHAT: Yes, absolutely.  We wish that influenza vaccines worked better than they do but we know that influenza vaccines are the best way to protect yourself from influenza.  And influenza is really common.  So, I think it's important for the public to know that last year influenza vaccination prevented about 80,000 hospitalizations.  If we had higher coverage against influenza, if we had 70 percent of the country vaccinated instead of about 45 percent of the country vaccinated we could have prevented 30,000 more hospitalizations.  One day we'll probably have a really, really super duper influenza vaccine with higher effectiveness in the most vulnerable.  But today we don't.  The vaccines we have right now can save lives and can prevent hospitalizations.  And we really want them to be used.  One group we're particularly interested in is younger adults.  Because we know that the elderly are actually taking up flu vaccine pretty consistently every year.  But we think that people under 65 also should be vaccinated to protect themselves and to protect themselves from spreading the flu to the most vulnerable.  The numbers that we release today in the MMWR only measure the direct protection of influenza vaccine.  They are under estimates for the total protection that the community or population benefits from the flu vaccination because we do think that influenza vaccine protects one’s self but can reduce the chances you'll spread the flu to those around you, particularly babies under six months who are too young to be vaccinated and the frail elderly whose immune system doesn't respond as well to the vaccine.  We measure vaccine effectiveness every year now and our team does an incredible job of trying to get estimates for each year.  Some years the effectiveness is better than others.  Some years it's worse than others.  But we do know last year the flu vaccination prevented an enormous number of hospitalizations.  Next question? 

OPERATOR: Our next question is from David Beasley from Reuters. 

DAVID BEASLEY: Yes, you can't say how many deaths were prevented last year?  I’m assuming since you only track child deaths.  Can you estimate how many child deaths were prevented by the vaccine? 

ANNE SCHUCHAT: Thank you for that question.  Our staff are working on additional models on looking at death and we're looking forward to being able to release other data later.  We weren't ready for that so I don't have those numbers to share.  We think it's very important to measure the impact of our interventions.  As the director of our center,  that works on vaccines, this is critical to me.  Our staff  have really stepped up to the plate on influenza impact.  It's a very complicated disease and a very tricky set of estimates to make and I think they've done a really nice job but we don't have the death impact yet and I look forward to being able to share that in the future.  Question from the room? 

CHUCK ROBERTS: Hi I’m Chuck Roberts from All News 106.7 here in Atlanta.  Can you differentiate the effectiveness of live attenuated vaccines versus killed vaccines and address briefly people's continuing reluctance to get live attenuated virus, the nasal spray, out of fears it will cause the flu. 

ANNE SCHUCHAT: Right.  Thank you for that question about the live attenuated vaccine or nasal spray.  CDC recommends that the nasal spray -- it's a recommended vaccine together with the shots against flu. The nasal spray is only licensed right now for children two years of age up to adults 49 years of age.  Our Advisory Committee on Immunization Practices is formally reviewing all the evidence on all the influenza vaccines available for children and will be doing a formal evaluation, a systematic evaluation to determine whether there's sufficient evidence that one is better than the other in some particular set of people.  So we don't have any kind of preferential recommendation for the nasal spray or the shot in any particular population, but it's one of the things that the Advisory Committee on Immunization Practices will be looking at.  Certainly, the nasal spray is a great option for people under 50 and for kids two years of age or older.  Reminder: pregnant women shouldn't get it.  People who have under lying compromising conditions shouldn't get it.  For pregnant women a population I like to talk about, it's the shot.  Next question from the phones?

OPERATOR: Our next question is from Erin Sykes from NBC News. 

ERIN SYKES: Hi good afternoon, you touched briefly on the vaccine effectiveness.  Do you have any data for this year yet showing how well this year's vaccine matches? 

ANNE SCHUCHAT: No, it's way too early for us to know the vaccine effectiveness for this year.  We're just beginning to see vaccine circulate in a number of communities and we'll be tracking that over time.  We have partnerships with several states and universities to do essentially real-time vaccine effectiveness but you need to have the flu season up and running before that can be measured.  So, again, that's something we'll look forward to updating you on next year.  Next question from the phone. 

OPERATOR:  Our next question is from Robert Lowe from Medscape Medical News. 

ROBERT LOWE: Hi, thanks for taking my call. I have two questions.  One what was the overall effectiveness rate for the 2011-2012 flu season?  And of these three children that have died how many of them were vaccinated or was it the case that some of them were too young to be vaccinated? 

ANNE SCHUCHAT: Okay.  I'm going to take the second question because I’m having a little mental freeze about what the vaccine effectiveness was last season.  It varies each year.  In the MMWR today that number is provided so I’ll refer you to that.  In terms of the pediatric deaths, I believe you asked about, we know that about half of the deaths in children from influenza that we've been seeing over many years has been occurring in children who have no underlying health risks at all and we know that of the vast majority of the deaths we're seeing in children are in kids who are unvaccinated.  So we're really keen to improve vaccination and to prevent as many deaths as we can as well as hospitalizations in children.  So, we are tracking in the reportable pediatric death surveillance system, we're tracking medical conditions, because some of the children who die from influenza are really vulnerable, people with terrible neurologic conditions, people with other muscular problems that affect their ability to breathe but we also see asthma as a common condition among the pediatric deaths, something that people don't even think about as a medical condition because it's so common.  So I really urge parents whether your kids are healthy, whether they have long term medical problems to make sure they are vaccinated.  We do measure whether they have been vaccinated in those tragic reports that we get of pediatric deaths and it just saddens me that many of them have not been vaccinated.  I can't promise that the vaccine would prevent all of those deaths but I think parents want to do everything they can to keep their kids healthy and safe.  Getting a flu vaccine is the best way to protect your children from influenza.  We have time for two more questions.  Operator? 

OPERATOR: Our next question is from Lisa Schnirring from CIDRAP NEWS. 

LISA SCHNIRRING: Hi, thanks for taking my question today.  I was noticing in the last few flu views that the former pandemic virus H1N1 seems to be the dominant strain.  Is it too early to tell that?  Has there enough subtyping tests and do you get any sort of clinical clues about that as to what type of illness you're going to see?  Thanks. 

ANNE SCHUCHAT:  Thank you.  Yes, H1N1 has been circulating since the pandemic and has shown up in the various seasons.  It varies by country and by northern and southern hemisphere.  But we have seen that as a major component of the viruses that have been typed so far this year.  It is way too early for us to know what is going to win out in terms of the year and most years multiple strains circulate and cause a lot of disease.  You know, this year for the first time some of the flu vaccines cover two different B strains because usually we can't predict perfectly which B will dominate because there are a lot of both types of B.  And so this year we'll be trying to track the uptick of the vaccines that are quadrivalent and vaccine effectiveness against the different B types.  One last question, please. 

OPERATOR:  Our final question is from David Lewkowicz from Fox News Channel. 

DAVID LEWKOWICZ: Good afternoon and thank you for taking my question, Dr.  Schuchat.  Quick question about cell based flu vaccination and where we are with that.  I know the FDA approved the first cell base last year, it’s a monovalent.  Can you tell us more about cell based influenza vaccine? 

ANNE SCHUCHAT: Yeah.  This year there's so many formulations that are being used.  The cell base is a type of vaccine that doesn't need to grow in eggs.  This is really exciting because there are a lot of eggs out there that are happy about this cell based vaccine.  There's also, this is also the first year that a recombinant vaccine is available.  And so it's really a terrific time for research, industry, regulation and so forth because we've gotten a lot more products available for the consumer.  You may remember years ago when we were down to one company and one kind of product and we're really happy with the diversity of formulations that are available now.  All of the licensed products are recommended by CDC, we don't differentiate between them.  Thank you so much and I’m going let Barbara close things up. 

BARABRA REYNOLDS: Thank you, Dr. Schuchat.  This concludes our media briefing on influenza today.  And I want to invite any media who have additional questions on this or other topics for CDC that they can reach us at the media line, at 404-639-3286.  We apologize that the webcast didn't work for us today.  We're working on that.  But a transcript will be available of the entire media briefing.  Thank you.  

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