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Clari M, Albanesi B, Comoretto RI, Conti A, Renzi E, Luciani M, Ausili D, Massimi A, Dimonte V. Effectiveness of interventions to increase healthcare workers' adherence to vaccination against vaccine-preventable diseases: a systematic review and meta-analysis, 1993 to 2022. Euro Surveill 2024; 29:2300276. [PMID: 38426238 PMCID: PMC10986662 DOI: 10.2807/1560-7917.es.2024.29.9.2300276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 12/13/2023] [Indexed: 03/02/2024] Open
Abstract
BackgroundVaccination adherence among healthcare workers (HCWs) is fundamental for the prevention of vaccine-preventable diseases (VPDs) in healthcare. This safeguards HCWs' well-being, prevents transmission of infections to vulnerable patients and contributes to public health.AimThis systematic review and meta-analysis aimed to describe interventions meant to increase HCWs' adherence to vaccination and estimate the effectiveness of these interventions.MethodsWe searched literature in eight databases and performed manual searches in relevant journals and the reference lists of retrieved articles. The study population included any HCW with potential occupational exposure to VPDs. We included experimental and quasi-experimental studies presenting interventions aimed at increasing HCWs' adherence to vaccination against VPDs. The post-intervention vaccination adherence rate was set as the main outcome. We included the effect of interventions in the random-effects and subgroup meta-analyses.ResultsThe systematic review considered 48 studies on influenza and Tdap vaccination from database and manual searches, and 43 were meta-analysed. A statistically significant, positive effect was seen in multi-component interventions in randomised controlled trials (relative risk (RR) = 1.37; 95% CI: 1.13-1.66) and in observational studies (RR = 1.43; 95% CI: 1.29-1.58). Vaccination adherence rate was higher in community care facilities (RR = 1.58; 95% CI: 1.49-1.68) than in hospitals (RR = 1.24; 95% CI: 0.76-2.05).ConclusionInterventions aimed at increasing HCWs' adherence to vaccination against VPDs are effective, especially multi-component ones. Future research should determine the most effective framework of interventions for each setting, using appropriate study design for their evaluation, and should compare intervention components to understand their contribution to the effectiveness.
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Affiliation(s)
- Marco Clari
- Department of Sciences of Public Health and Paediatrics, University of Turin, Turin, Italy
- These authors contributed equally to this work and shared first authorship
| | - Beatrice Albanesi
- Department of Sciences of Public Health and Paediatrics, University of Turin, Turin, Italy
- These authors contributed equally to this work and shared first authorship
| | | | - Alessio Conti
- Department of Sciences of Public Health and Paediatrics, University of Turin, Turin, Italy
| | - Erika Renzi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Michela Luciani
- Department of Medicine and Surgery, University of Milano - Bicocca, Milan Italy
| | - Davide Ausili
- Department of Medicine and Surgery, University of Milano - Bicocca, Milan Italy
| | - Azzurra Massimi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Valerio Dimonte
- Department of Sciences of Public Health and Paediatrics, University of Turin, Turin, Italy
- Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Turin, Italy
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Liang JL, Tiwari T, Moro P, Messonnier NE, Reingold A, Sawyer M, Clark TA. Prevention of Pertussis, Tetanus, and Diphtheria with Vaccines in the United States: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2018; 67:1-44. [PMID: 29702631 PMCID: PMC5919600 DOI: 10.15585/mmwr.rr6702a1] [Citation(s) in RCA: 213] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
This report compiles and summarizes all recommendations from CDC's Advisory Committee on Immunization Practices (ACIP) regarding prevention and control of tetanus, diphtheria, and pertussis in the United States. As a comprehensive summary of previously published recommendations, this report does not contain any new recommendations and replaces all previously published reports and policy notes; it is intended for use by clinicians and public health providers as a resource. ACIP recommends routine vaccination for tetanus, diphtheria, and pertussis. Infants and young children are recommended to receive a 5-dose series of diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccines, with one adolescent booster dose of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine. Adults who have never received Tdap also are recommended to receive a booster dose of Tdap. Women are recommended to receive a dose of Tdap during each pregnancy, which should be administered from 27 through 36 weeks' gestation, regardless of previous receipt of Tdap. After receipt of Tdap, adolescents and adults are recommended to receive a booster tetanus and diphtheria toxoids (Td) vaccine every 10 years to assure ongoing protection against tetanus and diphtheria.
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Affiliation(s)
- Jennifer L. Liang
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, CDC
| | - Tejpratap Tiwari
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, CDC
| | - Pedro Moro
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Nancy E. Messonnier
- Office of the Director, National Center for Immunization and Respiratory Diseases, CDC
| | | | - Mark Sawyer
- University of California, San Diego; La Jolla, California
| | - Thomas A. Clark
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC
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Jiang C, Whitmore-Sisco L, Gaur AH, Adderson EE. A quality improvement initiative to increase Tdap (tetanus, diphtheria, acellular pertussis) vaccination coverage among direct health care providers at a children's hospital. Vaccine 2017; 36:214-219. [PMID: 29217370 DOI: 10.1016/j.vaccine.2017.11.071] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 11/14/2017] [Accepted: 11/27/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Health care providers (HCP) are at high risk of acquiring and transmitting pertussis to susceptible family members, co-workers, and patients. Public health authorities recommend administering a single dose of Tdap (tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis) vaccine to all adults, including HCP, to increase adult immunity to pertussis. We set a quality improvement goal to increase Tdap vaccination coverage among HCP who provided direct patient care at a children's hospital from 58% to 90% over 18 months. DESIGN A multidisciplinary working group comprised of Occupational Health Program (OHP) staff and representatives of various medical services drew from a variety of qualitative methods and previous studies of vaccination programs in the healthcare system to understand barriers to Tdap vaccination within the institution and to develop interventions to increase vaccination rates. INTERVENTIONS Interventions included changes to OHP processes, a general education campaign, improved access to vaccine, and personal engagement of HCP by task force members. RESULTS Overall vaccination rates increased to 90% over 15 months, a rate that has been sustained by systematically assessing new employees' vaccination status and vaccinating those without documentation of previous Tdap vaccination. CONCLUSIONS Tdap vaccination coverage in our institution was significantly increased by an intensive, multipronged educational campaign, and by improving processes of screening and vaccination of HCP. The use of direct engagement of vaccine hesitant populations to increase vaccination rates warrants further study.
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Affiliation(s)
- Changhong Jiang
- Occupational Health Program, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - LaQuita Whitmore-Sisco
- Occupational Health Program, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Aditya H Gaur
- Occupational Health Program, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA; Department of Infectious Diseases, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA; Department of Pediatrics, University of Tennessee Health Sciences Center, 50 N. Dunlap, Memphis, TN 38103, USA
| | - Elisabeth E Adderson
- Department of Infectious Diseases, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA; Department of Pediatrics, University of Tennessee Health Sciences Center, 50 N. Dunlap, Memphis, TN 38103, USA.
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Srivastav A, Black CL, Lu PJ, Zhang J, Liang JL, Greby SM. Tdap Vaccination Among Healthcare Personnel, Internet Panel Survey, 2012-2014. Am J Prev Med 2017; 53:537-546. [PMID: 28545743 PMCID: PMC5737014 DOI: 10.1016/j.amepre.2017.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 03/16/2017] [Accepted: 04/03/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Healthcare personnel (HCP) are at risk for pertussis infection exposure or transmitting the disease to patients in their work settings. The Advisory Committee on Immunization Practices recommends tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccination for HCP to minimize these risks. This study assessed Tdap vaccination coverage among U.S. HCP by sociodemographic and occupation-related characteristics. METHODS The 2012, 2013, and 2014 Internet Panel Surveys were analyzed in 2015 to assess HCP Tdap vaccination. Effective sample sizes for 2012, 2013, and 2014 survey years were 2,038, 1613, and 1633, respectively. Missing values were assigned using multiple imputation. Multivariable logistic regression identified factors independently associated with HCP Tdap vaccination. Statistical measures were calculated with an assumption of random sampling. RESULTS Overall, Tdap vaccination coverage among HCP was 34.8% (95% CI=30.6%, 39.0%); 40.2% (95% CI=36.1%, 44.4%); and 42.4% (95% CI=38.7%, 46.0%) in 2012, 2013, and 2014, respectively. Nurse practitioners/physician's assistants, physicians, nurses, and HCP working in hospitals and ambulatory care settings had higher Tdap coverage. Having contact with an infant aged ≤6 months and influenza vaccination receipt were associated with increased Tdap vaccination. Non-Hispanic black race/ethnicity, having an associate/bachelor's degree, being below poverty, non-clinical personnel status, and working in a long-term care setting were associated with decreased Tdap vaccination. CONCLUSIONS HCP Tdap vaccination coverage increased during 2012-2014; however, coverage remains low. Vaccination coverage varied widely by healthcare occupation, occupational setting, and sociodemographic characteristics. Evidence-based employer strategies used to increase HCP influenza vaccination, if applied to Tdap, may increase Tdap coverage.
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Affiliation(s)
| | - Carla L Black
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Peng-Jun Lu
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jun Zhang
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer L Liang
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stacie M Greby
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Townsend ML, Grenyer BFS, Yeo W, Wright I. Immunisation for medical researchers: an ethical and practical imperative. Med J Aust 2016; 204:263. [PMID: 27078596 DOI: 10.5694/mja15.01179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Michelle L Townsend
- School of Psychology, and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW
| | - Brin F S Grenyer
- School of Psychology, and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW
| | - Wilfred Yeo
- Graduate School of Medicine, and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW
| | - Ian Wright
- Graduate School of Medicine, and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW
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Abstract
The Pertussis Cocooning Project was created through a collaborative effort by a health care organization and a State Department for Public Health to decrease community pertussis rates and protect infants from the deadly effects of pertussis. Free pertussis immunizations are provided to all mothers who give birth at the health care organization and to all infants' family members and caregivers older than 18 years.
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Moraes JCD, Carvalhanas T, Bricks LF. Should acellular pertussis vaccine be recommended to healthcare professionals? CAD SAUDE PUBLICA 2013; 29:1277-90. [PMID: 23842996 DOI: 10.1590/s0102-311x2013000700003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 03/14/2013] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to describe recent changes in the epidemiology of pertussis and existing policies regarding recommended and mandatory occupational vaccinations for healthcare professionals (HCPs). The authors carried out an extensive review of references on the PubMed and SciELO databases and the official sites of the World Health Organization, Pan American Health Organization, Centers for Disease Control and Prevention, and Brazilian Ministry of Health, using the keywords pertussis, vaccines and healthcare professionals. Vaccination against pertussis is recommended for HCPs in the United States, Canada, nine European countries, Australia, Hong Kong, Singapore, Costa Rica, Argentina and Uruguay, and in some countries it is compulsory. In Brazil, only one publication discussing the risk of pertussis among HCPs was found. Considering the reemergence of pertussis and the great number of associated hospitalizations and deaths registered in 2011, it is necessary to review public policies regarding HCP pertussis vaccination, particularly among workers in frequent contact with young babies.
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Attitudes regarding occupational vaccines and vaccination coverage against vaccine-preventable diseases among healthcare workers working in pediatric departments in Greece. Pediatr Infect Dis J 2012; 31:623-5. [PMID: 22333705 DOI: 10.1097/inf.0b013e31824ddc1e] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
We studied the attitudes with regard to occupational vaccines and vaccination coverage among healthcare workers in pediatric departments. Completed vaccination rates were 33%, 33%, 41.7%, 3%, 5.8%, 69.2% and 36.3% against measles, mumps, rubella, varicella, hepatitis A, hepatitis B and tetanus-diphtheria, respectively. Susceptibility rates were 14.2%, 15.7%, 14.6%, 7.6%, 87.4%, 22.6% and 61.8% for measles, mumps, rubella, varicella, hepatitis A, hepatitis B and tetanus-diphtheria, respectively. Mandatory vaccinations were supported by 70.6% of healthcare workers, with considerable differences by target disease.
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Olyarchuk LD, Willoughby D, Davis SC, Newsom SA. Examining the benefit of vaccinating adults against pertussis. ACTA ACUST UNITED AC 2012; 24:587-94. [DOI: 10.1111/j.1745-7599.2012.00739.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Shefer A, Strikas R, Bridges CB. Updated recommendations of the Advisory Committee on Immunization Practices for healthcare personnel vaccination: a necessary foundation for the essential work that remains to build successful programs. Infect Control Hosp Epidemiol 2011; 33:71-4. [PMID: 22173525 DOI: 10.1086/662715] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Helms C, Leask J, Robbins SC, Chow MYK, McIntyre P. Implementation of mandatory immunisation of healthcare workers: Observations from New South Wales, Australia. Vaccine 2011; 29:2895-901. [DOI: 10.1016/j.vaccine.2011.02.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Revised: 01/21/2011] [Accepted: 02/04/2011] [Indexed: 10/18/2022]
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Wicker S, Rose MA. Health care workers and pertussis: an underestimated issue. ACTA ACUST UNITED AC 2011; 105:882-6. [PMID: 21240587 DOI: 10.1007/s00063-010-1153-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Accepted: 09/12/2010] [Indexed: 11/30/2022]
Abstract
PURPOSE Communicable and vaccine-preventable airway infections are a major public and occupational health issue. The epidemiology of pertussis has changed, with unprotected adults being the main source of infections. Thus, the prevention of a transmission from health care workers (HCWs) to patients is an important strategy to control this communicable infection. The Standing Committee on Vaccination (STIKO) at the Robert Koch-Institute in Germany has explicitly recommended that HCWs ought to be vaccinated against pertussis. However, vaccination rates among HCWs remain low. This study was meant to evaluate the attitudes of HCWs towards the pertussis vaccination and to determine the correlation between the influenza and pertussis vaccination status of HCWs. METHODS An anonymous questionnaire was distributed to HCWs at a German university hospital. RESULTS Overall, we found a disturbingly low level of awareness concerning official recommendations as to immunizations (35.6%) and the personal risk assessment of acquiring a work-related pertussis infection (23.2%). In general, both aspects were frequently associated with a refusal to get immunized. A strong correlation between the immunization status of pertussis and influenza was found among physicians: overall, 93.1% of physicians who were vaccinated against pertussis were also vaccinated against influenza. Nurses showed significantly weaker correlation rates as well as lower vaccination rates (p<0.05). CONCLUSIONS Misconceptions about pertussis and low vaccination rates were prevalent among HCWs, particularly nurses. Hospital-based pertussis vaccination campaigns should focus on the risk of nosocomial pertussis transmission and on the new recommendations for pertussis immunization among adults and HCWs.
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Affiliation(s)
- Sabine Wicker
- Occupational Health Service, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany.
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Top KA, Halperin BA, Baxendale D, MacKinnon-Cameron D, Halperin SA. Pertussis immunization in paediatric healthcare workers: knowledge, attitudes, beliefs, and behaviour. Vaccine 2010; 28:2169-2173. [PMID: 20056190 DOI: 10.1016/j.vaccine.2009.12.060] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Revised: 12/09/2009] [Accepted: 12/23/2009] [Indexed: 01/05/2023]
Abstract
Healthcare workers' (HCWs) knowledge, attitudes, and beliefs regarding pertussis immunization were assessed and compared to the rate of vaccine uptake. A questionnaire was distributed to employees at a paediatric and maternity tertiary care centre. Respondents were then offered a dose of the tetanus, diphtheria, and acellular pertussis vaccine (Tdap) at a free vaccine clinic. In total, 529 out of 3051 (17%) employees completed the survey and 61 received the Tdap vaccine. Although 76% of participants were willing to be immunized, only 15% presented to the clinic. There is a widespread acceptance of pertussis immunization among paediatric HCWs. Stated intentions may be poorly predictive of behaviour. Education and institutional or public funding may improve vaccine uptake.
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Affiliation(s)
- Karina A Top
- Department of Pediatrics, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Beth A Halperin
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Darlene Baxendale
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Donna MacKinnon-Cameron
- Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Scott A Halperin
- Department of Pediatrics, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia, Canada; Canadian Center for Vaccinology, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia, Canada.
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Poland GA, Jacobson RM, Boyce T. Health care worker pertussis immunization requirements and patient safety. Am J Infect Control 2008; 36:390-1. [PMID: 18675143 DOI: 10.1016/j.ajic.2008.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2008] [Accepted: 02/04/2008] [Indexed: 11/16/2022]
Affiliation(s)
- Gregory A Poland
- Mayo Clinic Vaccine Research Group, Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.
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