Issue 1372: June 27, 2018








IAC provides a summary article about votes taken at June 20–21 ACIP meeting

The Advisory Committee on Immunization Practices (ACIP) met in Atlanta on June 20–21, 2018. During the meeting, votes were taken on influenza vaccine recommendations for the 2018–2019 season and guidance for the use of anthrax vaccine for post-exposure prophylaxis during a mass vaccination campaign. In addition, ACIP received preliminary estimates of 2017–2018 influenza vaccine effectiveness and discussed results of several studies related to influenza vaccine, including an early review of the relative effectiveness of cell-cultured vs. egg-based influenza vaccines, FDA monitoring of Guillain-Barre syndrome following influenza vaccination among Medicare beneficiaries, and a study to assess the risk of narcolepsy following receipt of 2009 H1N1 influenza vaccines. 
Other topics covered included possible expanded age indications (through age 45) for human papillomavirus (HPV) vaccine in the future, current mumps epidemiology in the United States and implementation of a third dose of MMR vaccine during outbreaks, an update on recombinant zoster vaccine supply and safety data, an overview of global National Immunization Technical Advisory Groups activities, and potential strategies for use of Japanese encephalitis vaccine. The Committee also heard extensive updates on pneumococcal disease incidence in the U.S., as well as information on pneumococcal vaccine safety and racial disparities in the vaccine’s use. Finally, the Committee received an update on the Pneumococcal Vaccine Workgroup’s ongoing review of the impact of ACIP’s 2014 recommendation of PCV13 for adults ≥65 years old.      
Influenza Vaccine Recommendations for the 2018–2019 Season

ACIP voted to approve the 2018–2019 influenza vaccine recommendations, which will be published in an upcoming MMWR. The Committee reaffirmed its core recommendation calling for annual influenza vaccination for all persons age 6 months and older who do not have contraindications. Additional updates to the influenza recommendations are shown below.
Influenza vaccine composition

  • The composition for next season’s trivalent vaccines will be:
    • A/Michigan/45/2015 (H1N1)pdm09-like virus
    • A/Singapore/INFIMH-16-0019/2016 (H3N2)-like virus—UPDATED
    • B/Colorado/06/2017-like virus (Victoria lineage)—UPDATED
  • Quadrivalent vaccines will contain the same three strains plus B/Phuket/3073/2013-like virus (Yamagata lineage)  

Influenza vaccine updates

  • Live attenuated influenza vaccine (LAIV)—New language approved by ACIP in February states “For the 2018–19 season, providers may choose to administer any licensed, age-appropriate influenza vaccine (IIV, RIV4, or LAIV4). LAIV4 is an option for those for whom it is otherwise appropriate.” In addition, LAIV4 is acceptable for persons with a history of egg allergy.
  • Fluarix Quadrivalent Vaccine—Fluarix (GSK) is licensed for children ≥6 months of age. With this addition, there are now three vaccines (Fluarix and FluLaval [both GSK and both in 0.5 mL dose] and Fluzone [Sanofi, 0.25 mL dose]) licensed for use in children 6–35 months of age.
Use of Anthrax Vaccine During Mass Vaccination Campaigns
The Committee unanimously approved three recommendations for use of anthrax vaccine for post-exposure prophylaxis (PEP) during mass vaccination campaigns. Specifically, these recommendations would be used during emergencies in which the exposed population exceeds the available supply of vaccine. In this special circumstance, the ACIP recommended that:
  • The intramuscular route of administration (ROA) may be used if the subcutaneous ROA presents clinical, operational, or logistical challenges that may delay or prevent effective vaccination
  • Should there be an inadequate supply of anthrax vaccine available for PEP, either 2 full doses or 3 half doses of anthrax vaccine absorbed (AVA) may be used to expand vaccine coverage
  • In immunocompetent individuals, antimicrobials given in conjunction with vaccine may be discontinued at 42 days after the first vaccine dose or 2 weeks after the last vaccine dose, whichever comes later 

All recommendations approved by ACIP are provisional until they are approved by the CDC director and published in MMWR. Presentation slides from the June meeting should be posted on the ACIP meeting information web page in the next 4–6 weeks.

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Institute for Safe Medication Practices reports on vaccination errors reported to its system in 2017

The Institute for Safe Medication Practices (ISMP) is the nation’s only 501(c)(3) nonprofit organization devoted entirely to medication error prevention and safe medication use. ISMP's Vaccine Error Reporting Program (VERP) was created to allow healthcare professionals and patients to report vaccine errors confidentially. ISMP published an article titled ISMP National Vaccine Errors Reporting Program 2017 analysis (Part I): Vaccine errors continue with little change in the June 14 issue of its Medication Safety Alert newsletter. A selection from the report is reprinted below.

An analysis of 575 events submitted to the ISMP National Vaccine Errors Reporting Program (ISMP VERP) between January and December 2017 suggests that errors with vaccines continue to occur. Also, the number of error reports submitted to the ISMP VERP in 2017 increased by more than 100 reports compared to prior years since 2012. The most frequent types of vaccine errors reported during 2017 included:

  • Wrong vaccine (23%)
  • Wrong dose (19%)
  • Expired vaccines or contamination/deterioration (19%)
  • Wrong age (17%)
  • Wrong time or interval (8%)
  • Vaccine/component omission (e.g., only diluent or a single component of a two-component vaccine administered) (4%)
  • Wrong route (2%)
  • Wrong patient (1%)
Healthcare setting, involved providers, and reported harm
Since most vaccines are administered in the outpatient setting, practically all of the reported errors occurred in outpatient medical or public health clinics (54%), doctors’ offices (31%), hospital ambulatory settings (6%), or pharmacies (2%). Only 3% of the errors occurred in hospital inpatient settings, and 4% in other settings. Most of the errors occurred within a family practice (48%) or pediatric practice (27%) setting. More than half (54%) of the errors involved medical assistants. While none of the reported errors caused immediate harm to a patient, absent or improper vaccination may have detrimental effects on individual and public health, leading to disease outbreaks, loss of herd immunity that may propagate an epidemic, costly overvaccination and re-vaccination, and consumer skepticism or refusal of vaccination.
Wrong age or dose
The top 10 vaccines involved in reported errors are listed in Table 1, along with the most frequently reported contributing factors. Overall, the vaccines involved in the most frequently reported errors have not changed since 2012, and these errors occurred for many of the same reasons previously noted during analysis of the ISMP VERP data between 2012 and 2016, particularly: 
  • Age-dependent formulations of the same vaccine
  • Unfamiliarity with the indicated ages for vaccines
  • Failure to verify the patient’s age before administration
  • Unfamiliarity with the dosing of vaccines
These contributing factors most often led to wrong age or wrong dose errors with DTaP, Tdap, and combination vaccines (31%); influenza virus vaccines (26%); HepA vaccines (23%); HepB vaccines (7%); and MMRV vaccines (4%).

Read the complete report: ISMP National Vaccine Errors Reporting Program 2017 analysis (Part I): Vaccine errors continue with little change.

By collecting and quantifying information about vaccination errors, ISMP will be better able to advocate for changes in vaccine names, labeling, or other appropriate modifications that could reduce the likelihood of vaccine errors in the future. Reporting vaccination administration errors via this link will help improve health care for everyone. Report errors to VERP at

CDC recommends that providers also report vaccination errors to the Vaccine Adverse Event Reporting System (VAERS). If an adverse event occurs following a vaccine administration error, a report should definitely be sent to VAERS. Adverse events should be reported to VAERS regardless of whether a healthcare professional thinks the event is related to the vaccine or not, as long as it follows administering a dose of vaccine.​

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Access 2018 Immunization Excellence Award winners and May conference presentations from the National Adult and Influenza Immunization Summit website

The National Adult and Influenza Immunization Summit (NAIIS) held its annual meeting May 17–18 in conjunction with the 48th National Immunization Conference in Atlanta.
Information about the winners of the NAIIS 2018 Immunization Excellence Awards is posted online. The winners of each category are:
  • Adult Immunization Publication Award: Recipient: Jeffrey Kelman, MD, MMSc 
  • Non-Healthcare Employer Campaign Award: Baxter International
  • Laura Scott 2017–18 Outstanding Influenza Season Activities Award: Maryland Partnership for Prevention Presentation and Norton Sound Health Corporation Pharmacy 
  • Corporate Campaign Award: Sanofi Pasteur 
  • “Immunization Neighborhood” Adult Immunization Champion Award: Marci Dillard, PharmD and Project VACCINATE 
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New Technically Speaking column: " Provides a Wide Range of Practical Resources on Vaccine Administration, Storage and Handling, and More"​

Technically Speaking, a monthly column written by IAC executive director Dr. Deborah Wexler, covers practical topics in immunization delivery such as needle length, vaccine administration, cold chain, and immunization schedules. The column is featured in The Children's Hospital of Philadelphia Vaccine Education Center’s (VEC's) monthly e-newsletter for healthcare professionals. The most recent column is reprinted below. Provides a Wide Range of Practical Resources on Vaccine Administration, Storage and Handling, and More
Published May 2018

The Immunization Action Coalition’s (IAC's) Clinic Tools web section on is a one-stop source for the key resources providers need to streamline their clinic’s vaccination services. It is now easier than ever to find the essential tools you need for vaccine administration, storage and handling, screening for contraindications, and more from IAC, CDC, AAP, and other organizations.

From the Clinic Tools web section's main page, you can access practical resources in the following categories:

The Clinic Tools web section also provides easy-to-access links to many other valuable resources, including IAC publications, CDC resources, and other related materials. Visit today to see how easy it is to find what you need!

You can access the current and past issues of Technically Speaking from a box in the middle of the home page, from the "Guide to" at the bottom of every web page, or by going directly to

Check out the May 2018 issue of VEC's Vaccine Update for Healthcare Providers. The VEC e-newsletter keeps providers up to date on vaccine-related issues and includes reviews of recently published journal articles, media recaps, announcements about new resources, and a regularly updated calendar of events. To subscribe to this newsletter, go to the sign-up form.

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IAC Spotlight! Read what others say about the Immunization Action Coalition

The Immunization Action Coalition (IAC) recently updated the web page on titled What Others Say About IAC. This page includes feedback on the website itself, educational materials, IAC Express, "Ask the Experts," and other activities, including personal assistance from IAC staff and consultants. A sampling of the positive comments we have received recently follows:

"I love your website and the great information you provide. And we love to refer people to it."

"Our nurses utilize the resources from your site on a regular basis, thank you! We also find the videos in your video library very beneficial."

"Thanks for all you do! IAC is such a reliable partner in the work we do to improve immunization information and rates. You really make our work so much easier and better...Again, BIG thanks for all you do for us in the immunization world!"
"I am a fan of the Immunization Action Coalition, a strong enforcer of CDC and ACIP guidelines and best practices, and use all the material that is available that encompasses the guidelines for safe, effective immunization healthcare for our military services members and their family members and our DoD working force...We're all in this big immunization mission together, so I truly appreciate your assistance."

"These publications are great for work. I am able to pass them out to the MAs and staff and clients coming in for vaccines. This helps educate the staff and helps them be more knowledgeable of the vaccine they are giving. This also helps educate the people in our community more and helps them be more knowledgeable as well. Plus it allows that person to tell someone else true facts and not myths."

"We appreciate the thoroughness and uniformity of the IAC standing order sets."
"Thank you for all of the great materials the IAC provides and the good programs and webinars. It is good to know that the site is always there supporting us in the field promoting and administering the vaccine information, education, and expertise we need."
"I just wanted to let you know how much I appreciate your IAC Express. I am always learning so much from it. I find the information very helpful and very interesting. I look forward to reading it when I am able. I work in family practice and internal medicine clinics and your weekly news has helped me take better care of my patients. THANK YOU for all you do."
"I have learned a lot from Ask the Experts. The questions interpret the information that's available...priceless!"
Check out:
And a big thank you to the many people who take the time to give us such kind and helpful feedback!

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More than 400 birthing institutions now enrolled in IAC's Hepatitis B Birth Dose Honor Roll, with nine institutions added and three previously honored institutions qualifying for additional years. Does your hospital qualify?

The Immunization Action Coalition (IAC) is pleased to announce that nine new institutions have been accepted into its Hepatitis B Birth Dose Honor Roll, for a total of 402!
The birthing institutions are listed below with their reported hepatitis B birth dose coverage rates in parentheses.
  • Abington Hospital–Jefferson Health, Abington, PA (90%)
  • Conemaugh Nason Medical Center, Roaring Spring, PA (94%)
  • J.C. Blair Memorial Hospital, Huntingdon, PA (98%)
  • Metro Health–University of Michigan Health, Wyoming, MI (93%)
  • Penn Highlands Elk, St. Marys, PA (96%)
  • Rockledge Regional Medical Center, Rockledge, FL (95%)
  • Samaritan Medical Center, Watertown, NY (93%)
  • Uniontown Hospital, Uniontown, PA (94%)
  • UPMC Pinnacle Hanover, Hanover, PA (91%)

In addition, the following institution is being recognized for a third year:

  • North Ottawa Community Health System, Grand Haven, MI (90%)

Finally, the following two institutions are being recognized for a fourth year:

  • JBER 673rd Medical Group, Anchorage, AK (94%)
  • Oswego Hospital, Oswego, NY (96%)

The Honor Roll now includes 402 birthing institutions from 40 states, Puerto Rico, Guam, and an overseas U.S. military base. Eighty-seven institutions have qualified for two years, 47 institutions have qualified three times, 17 institutions have qualified four times, six institutions have qualified five times, one institution has qualified six times, and one institution has qualified seven times.

The Honor Roll is a key part of IAC’s major initiative urging the nation’s hospitals to Give birth to the end of Hep B. Hospitals and birthing centers are recognized for attaining high coverage rates for administering hepatitis B vaccine at birth and meeting specific additional criteria. The initiative urges qualifying healthcare organizations to apply for the Hepatitis B Birth Dose Honor Roll online.

To be included in the Hepatitis B Birth Dose Honor Roll, a birthing institution must have: (1) reported a coverage rate of 90 percent or greater, over a 12-month period, for administering hepatitis B vaccine before hospital discharge to all newborns, including those whose parents refuse vaccination, and (2) implemented specific written policies, procedures, and protocols to protect all newborns from hepatitis B virus infection prior to hospital discharge.

Honorees are also awarded an 8.5" x 11" color certificate suitable for framing and their acceptance is announced to IAC Express’s approximately 50,000 readers.

Please visit the Hepatitis B Birth Dose Honor Roll web page that lists these institutions and their exceptional efforts to protect infants from perinatal hepatitis B transmission.

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IAC revises "Meningococcal Vaccine Recommendations by Age and Risk Factor for Serogroups A, C, W, or Y Protection" 

IAC recently revised its 1-page guidance for healthcare professionals titled Meningococcal Vaccine Recommendations by Age and Risk Factor for Serogroups  A, C, W, or Y Protection. Changes were made to remove all references to Hib-MenCY (MenHibrix) and MPSV (Menomune) vaccines as they are no longer available in the U.S. Recommendations for MenACWY-D (Menactra) and MenACWY-CRM (Menveo) remain the same.
IAC's Handouts for Patients & Staff web section offers healthcare professionals and the public more than 250 FREE English-language handouts (many also available in translation), which we encourage website users to print out, copy, and distribute widely.

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IAC posts updated handouts for the public titled "Mumps: Questions and Answers" and "Chickenpox: Questions and Answers" 

IAC recently revised the following two Q&A handouts for the public:
  1. Mumps: Questions and Answers was changed to include data on recent outbreaks and vaccine efficacy, and to include CDC recommendations for a third dose of MMR under certain circumstances (4 pages).
  2. Chickenpox: Questions and Answers was updated with information about the newer zoster vaccine (Shingrix) when discussing the relationship between chickenpox and shingles (3 pages).
Access IAC's "Questions and Answers" handouts for patients for 18 vaccine-preventable diseases.

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IAC updates "Sample Text for Developing Admission Orders in Newborn Units for the Hepatitis B Vaccine Birth Dose" and "Guidance for Developing Admission Orders in Labor & Delivery and Newborn Units to Prevent Hepatitis B Virus Transmission"​

IAC recently revised the following two pieces to update the reference for the guidance contained therein.

  1. Sample Text for Developing Admission Orders in Newborn Units for the Hepatitis B Vaccine Birth Dose
  2. Guidance for Developing Admission Orders in Labor & Delivery and Newborn Units to Prevent Hepatitis B Virus Transmission

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IAC updates "Using Standing Orders for Administering Vaccines: What You Should Know"

IAC recently revised Using Standing Orders for Administering Vaccines: What You Should Know to revise the link for the Community Preventive Services Task Force recommendations for vaccine standing orders.

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CDC and WHO report on response to outbreak of vaccine-derived poliovirus type 2 in Syria in this week's MMWR and Weekly Epidemiological Record, respectively

CDC published Strategic Response to an Outbreak of Circulating Vaccine-Derived Poliovirus Type 2—Syria, 2017–2018 in the June 22 issue of MMWR (pages 690–4). On the same day, WHO's Weekly Epidemiological Record published a similar article titled Strategic response to an outbreak of circulating vaccine-derived poliovirus type 2, Syrian Arab Republic, 2017–2018. A media summary of the MMWR article is reprinted below.

In areas with very low oral poliovirus vaccine (OPV) coverage, prolonged transmission of vaccine-associated viruses can lead to the emergence of vaccine-derived polioviruses (VDPVs). In 2017, an outbreak of circulating VDPV type 2 (cVDPV2) occurred in Syria, resulting in 74 cases. Implementation of three rounds of monovalent OPV type 2 campaigns coupled with intensified surveillance interrupted the outbreak. A longstanding humanitarian crisis, precipitated by war and political unrest, has left much of Syria’s population vulnerable to recurrent disease outbreaks, including the recent cVDPV2 outbreak. Subnational gaps in acute flaccid paralysis (AFP) surveillance performance and delays in receiving laboratory results, due to difficulties transporting stool specimens, as a result of the country’s complex humanitarian emergency, contributed to the inability to detect the outbreak earlier.

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Still available! IAC's sturdy laminated versions of the 2018 U.S. child/teen immunization schedule and the 2018 U.S. adult immunization schedule—order a supply for your healthcare setting today!

IAC's laminated versions of the 2018 U.S. child/teen immunization schedule and the 2018 U.S. adult immunization schedule are covered with a tough, washable coating; they will stand up to a year's worth of use in every area of your healthcare setting where immunizations are given. Both schedules are eight pages (i.e., four double-sided pages) and are folded to measure 8.5" x 11".

Adult Laminated Immunization Schedules

Adult Laminated Immunization Schedules

Laminated schedules are printed in color for easy reading, come complete with essential tables and footnotes, and include contraindications and precautions—a feature that will help you make an on-the-spot determination about the safety of vaccinating patients of any age.

1–4 copies: $7.50 each
5–19 copies: $5.50 each
20–99 copies: $4.50 each
100–499 copies: $4.00 each
500–999 copies: $3.50 each

For quotes on customizing or placing orders for 1,000 copies or more, call (651) 647-9009 or email

You can access specific information on both schedules, view images of both, order online, or download an order form at the Shop IAC: Laminated Schedules web page.

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IAC's 142-page book, Vaccinating Adults: A Step-by-Step Guide, describes how to implement adult vaccination services in your healthcare setting and provides a review for staff who already vaccinate adults; IAC Guide available for free download

In late 2017, the Immunization Action Coalition (IAC) announced the publication of its new book, Vaccinating Adults: A Step-by-Step Guide (Guide).

This completely updated guide on adult immunization (originally published in 2004) provides easy-to-use, practical information covering important “how-to” activities to help providers enhance their existing adult immunization services or introduce them into any clinical setting, including:

  • setting up for vaccination services,
  • storing and handling vaccines,
  • deciding which people should receive which vaccines,
  • administering vaccines,
  • documenting vaccinations (including legal issues), and
  • understanding financial considerations and billing information.

In addition, the Guide is filled with hundreds of web addresses and references to help providers stay up to date on the latest immunization information, both now and in the future.

The entire Guide is available to download/print free of charge at The downloaded version is suitable for double-sided printing. Options are available online to download the entire book or selected chapters. The development of the Guide was supported by the National Vaccine Program Office (NVPO) and the Centers for Disease Control and Prevention (CDC). Expert staff from both agencies also provided early technical review of the content.

The Guide is a uniquely valuable resource to assist providers in increasing adult immunization rates. Be sure to get a copy today!

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Weekly CDC webinar series on "The Pink Book" chapter topics continues July 11 with "Vaccine Storage and Handling and Administration": register now for series running through September 26

CDC is presenting a 15-part webinar series to provide a chapter-by-chapter overview of the 13th edition of Epidemiology and Prevention of Vaccine-Preventable Diseases (also known as "The Pink Book"). This is a live series of weekly 1-hour webinars that started June 6 and will run through September 26. The webinar series provides an overview of vaccines and the diseases they prevent, general recommendations for vaccines, vaccination principles, and immunization strategies for providers.
There will be no webinar on July 4 due to the holiday. The July 11 webinar will cover "Vaccine Storage and Handling and Administration" and include a live Q&A session. Recordings of sessions will be available online within 2 weeks after each webinar. All sessions begin at 12:00 p.m. (ET). Continuing education will be available for each event.

Registration and more information is available on CDC's Pink Book Webinar Series web page.

All the sections of "The Pink Book" (i.e., chapters, appendices, 2017 supplement) are available to download at no charge at

You can also order this resource from the Public Health Foundation for $40 plus shipping and handling. 
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NFID offers July 5 webinar on updates from the June 2018 ACIP meeting
The National Foundation for Infectious Diseases (NFID) will present a webinar titled "Updates from June 2018 ACIP Meeting" on July 5 at 12:00 p.m. (ET). William Schaffner, MD, NFID medical director and liaison to the ACIP, and Amanda C. Cohn, MD, MPH, ACIP's executive secretary, will discuss updates from the June 2018 ACIP meeting.

About IAC Express
The Immunization Action Coalition welcomes redistribution of this issue of IAC Express or selected articles. When you do so, please add a note that the Immunization Action Coalition is the source of the material and provide a link to this issue.

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IAC Express is supported in part by Grant No. 6NH23IP922550 from the National Center for Immunization and Respiratory Diseases, CDC. Its contents are solely the responsibility of IAC and do not necessarily represent the official views of CDC. IAC Express is also supported by educational grants from the following companies: AstraZeneca, Inc.; Merck Sharp & Dohme Corp.; Pfizer, Inc.; and Sanofi Pasteur.

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About IZ Express

IZ Express is supported in part by Grant No. 1NH23IP922654 from CDC’s National Center for Immunization and Respiratory Diseases. Its contents are solely the responsibility of and do not necessarily represent the official views of CDC.

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ISSN 2771-8085

Editorial Information

  • Editor-in-Chief
    Kelly L. Moore, MD, MPH
  • Managing Editor
    John D. Grabenstein, RPh, PhD
  • Associate Editor
    Sharon G. Humiston, MD, MPH
  • Writer/Publication Coordinator
    Taryn Chapman, MS
    Courtnay Londo, MA
  • Style and Copy Editor
    Marian Deegan, JD
  • Web Edition Managers
    Arkady Shakhnovich
    Jermaine Royes
  • Contributing Writer
    Laurel H. Wood, MPA
  • Technical Reviewer
    Kayla Ohlde

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