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Rituximab-Treated Patients Have a Poor Response to Influenza Vaccination

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Abstract

The efficacy of influenza vaccination in patients treated with rituximab is a clinically important question. Rheumatology clinics are populated with patients receiving rituximab for a broad array of disorders. Although several studies have explored the efficacy of other vaccines in rituximab-treated populations, results have been conflicting. We wished to define influenza vaccine efficacy in a rituximab-treated cohort. We examined 17 evaluable subjects treated with rituximab for rheumatologic conditions. T cell subsets, B cells subsets, T cell function, and B cell function were evaluated at specific time points along with hemagglutinination inhibition titers after receiving the standard inactivated influenza vaccine. T cell subset counts were significantly different than controls but did not change with rituximab. B cells depleted in all patients but were in various stages of recovery at the time of vaccination. Influenza vaccine responsiveness was poor overall, with only 16 % of subjects having a four-fold increase in titer. Pre-existing titers were retained throughout the study, however. The ability to respond to the influenza vaccine appeared to be related to the degree of B cell recovery at the time of vaccination. This study emphasizes that antibody responses to vaccine are impaired in subjects treated with rituximab and supports the concept that B cell recovery influences influenza vaccine responsiveness.

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References

  1. Thompson WW, Shay DK, Weintraub E, Brammer L, Cox N, Anderson LJ, Fukuda K. Mortality associated with influenza and respiratory syncytial virus in the United States. JAMA. 2003;289(2):179–86.

    Article  PubMed  Google Scholar 

  2. Thompson WW, Shay DK, Weintraub E, Brammer L, Bridges CB, Cox NJ, Fukuda K. Influenza-associated hospitalizations in the United States. JAMA. 2004;292(11):1333–40.

    Article  PubMed  CAS  Google Scholar 

  3. Neuzil KM, Wright PF, Mitchel Jr EF, Griffin MR. The burden of influenza illness in children with asthma and other chronic medical conditions. J Pediatr. 2000;137(6):856–64. doi:10.1067/mpd.2000.110445.

    Article  PubMed  CAS  Google Scholar 

  4. Neuzil KM, Mellen BG, Wright PF, Mitchel Jr EF, Griffin MR. The effect of influenza on hospitalizations, outpatient visits, and courses of antibiotics in children. N Engl J Med. 2000;342(4):225–31.

    Article  PubMed  CAS  Google Scholar 

  5. Neuzil KM, Reed GW, Mitchel Jr EF, Griffin MR. Influenza-associated morbidity and mortality in young and middle-aged women. JAMA. 1999;281(10):901–7.

    Article  PubMed  CAS  Google Scholar 

  6. Neuzil KM, Coffey CS, Mitchel Jr EF, Griffin MR. Cardiopulmonary hospitalizations during influenza season in adults and adolescents with advanced HIV infection. J Acquir Immune Defic Syndr. 2003;34(3):304–7.

    Article  PubMed  Google Scholar 

  7. Dushoff J, Plotkin JB, Viboud C, Earn DJ, Simonsen L. Mortality due to influenza in the United States–an annualized regression approach using multiple-cause mortality data. Am J Epidemiol. 2006;163(2):181–7. doi:10.1093/aje/kwj024.

    Article  PubMed  Google Scholar 

  8. Groenwold RH, Hoes AW, Hak E. Impact of influenza vaccination on mortality risk among the elderly. Eur Respir J. 2009;34(1):56–62. doi:10.1183/09031936.00190008.

    Article  PubMed  CAS  Google Scholar 

  9. Jain S, Kamimoto L, Bramley AM, Schmitz AM, Benoit SR, Louie J, Sugerman DE, Druckenmiller JK, Ritger KA, Chugh R, Jasuja S, Deutscher M, Chen S, Walker JD, Duchin JS, Lett S, Soliva S, Wells EV, Swerdlow D, Uyeki TM, Fiore AE, Olsen SJ, Fry AM, Bridges CB, Finelli L. Hospitalized patients with 2009 H1N1 influenza in the United States, April-June 2009. N Engl J Med. 2009;361(20):1935–44. doi:10.1056/NEJMoa0906695.

    Article  PubMed  CAS  Google Scholar 

  10. Kim YJ, Boeckh M, Englund JA. Community respiratory virus infections in immunocompromised patients: hematopoietic stem cell and solid organ transplant recipients, and individuals with human immunodeficiency virus infection. Semin Respir Crit Care Med. 2007;28(2):222–42. doi:10.1055/s-2007-976494.

    Article  PubMed  Google Scholar 

  11. Kunisaki KM, Janoff EN. Influenza in immunosuppressed populations: a review of infection frequency, morbidity, mortality, and vaccine responses. Lancet Infect Dis. 2009;9(8):493–504. doi:10.1016/S1473-3099(09)70175-6.

    Article  PubMed  Google Scholar 

  12. Malhotra A, Krilov LR. Influenza and respiratory syncytial virus. Update on infection, management, and prevention. Pediatric Clinics of North America. 2000;47(2):353–72.

    Article  PubMed  CAS  Google Scholar 

  13. Fiore AE, Uyeki TM, Broder K, Finelli L, Euler GL, Singleton JA, Iskander JK, Wortley PM, Shay DK, Bresee JS, Cox NJ. Prevention and control of influenza with vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010. MMWR Recomm Rep. 2010;59(RR-8):1–62.

    PubMed  Google Scholar 

  14. Keitel WA, Couch RB, Cate TR, Hess KR, Baxter B, Quarles JM, Atmar RL, Six HR. High doses of purified influenza A virus hemagglutinin significantly augment serum and nasal secretion antibody responses in healthy young adults. J Clin Microbiol. 1994;32(10):2468–73.

    PubMed  CAS  Google Scholar 

  15. de Jong JC, Palache AM, Beyer WE, Rimmelzwaan GF, Boon AC, Osterhaus AD. Haemagglutination-inhibiting antibody to influenza virus. Dev Biol (Basel). 2003;115:63–73.

    Google Scholar 

  16. Bachi T, Gerhard W, Yewdell JW. Monoclonal antibodies detect different forms of influenza virus hemagglutinin during viral penetration and biosynthesis. Journal of Virology. 1985;55(2):307–13.

    PubMed  CAS  Google Scholar 

  17. Beyer WE, Palache AM, Luchters G, Nauta J, Osterhaus AD. Seroprotection rate, mean fold increase, seroconversion rate: which parameter adequately expresses seroresponse to influenza vaccination? Virus Research. 2004;103(1–2):125–32.

    Article  PubMed  CAS  Google Scholar 

  18. Reilly A, Kersun LS, McDonald K, Weinberg A, Jawad AF, Sullivan KE. The efficacy of influenza vaccination in a pediatric oncology population. J Pediatr Hematol Oncol. 2010;32(5):e177–181. doi:10.1097/MPH.0b013e3181d869f3.

    PubMed  Google Scholar 

  19. Couch RB. Seasonal inactivated influenza virus vaccines. Vaccine. 2008;26 Suppl 4:D5–9.

    Article  PubMed  CAS  Google Scholar 

  20. Gross PA, Hermogenes AW, Sacks HS, Lau J, Levandowski RA. The efficacy of influenza vaccine in elderly persons. A meta-analysis and review of the literature. Ann Intern Med. 1995;123(7):518–27.

    PubMed  CAS  Google Scholar 

  21. Govaert TM, Thijs CT, Masurel N, Sprenger MJ, Dinant GJ, Knottnerus JA. The efficacy of influenza vaccination in elderly individuals. A randomized double-blind placebo-controlled trial. JAMA. 1994;272(21):1661–5.

    Article  PubMed  CAS  Google Scholar 

  22. Nichol KL. The efficacy, effectiveness and cost-effectiveness of inactivated influenza virus vaccines. Vaccine. 2003;21(16):1769–75.

    Article  PubMed  Google Scholar 

  23. Ruben FL. Inactivated influenza virus vaccines in children. Clin Infect Dis. 2004;38(5):678–88. doi:10.1086/382883.

    Article  PubMed  Google Scholar 

  24. Zangwill KM, Belshe RB. Safety and efficacy of trivalent inactivated influenza vaccine in young children: A summary for the new era of routine vaccination. Pediatr Infect Dis J. 2004;23(3):189–97.

    Article  PubMed  Google Scholar 

  25. Fessler BJ. Infectious diseases in systemic lupus erythematosus: risk factors, management and prophylaxis. Best Pract Res Clin Rheumatol. 2002;16(2):281–91. doi:10.1053/berh.2001.0226.

    Article  PubMed  Google Scholar 

  26. Cervera R, Khamashta MA, Font J, Sebastiani GD, Gil A, Lavilla P, Aydintug AO, Jedryka-Goral A, de Ramon E, Fernandez-Nebro A, Galeazzi M, Haga HJ, Mathieu A, Houssiau F, Ruiz-Irastorza G, Ingelmo M, Hughes GR. Morbidity and mortality in systemic lupus erythematosus during a 5-year period. A multicenter prospective study of 1,000 patients. European Working Party on Systemic Lupus Erythematosus. Medicine (Baltimore). 1999;78(3):167–75.

    Article  CAS  Google Scholar 

  27. Symmons DP. Mortality in rheumatoid arthritis. Br J Rheumatol. 1988;27 Suppl 1:44–54.

    PubMed  Google Scholar 

  28. Phillip R, Luqmani R. Mortality in systemic vasculitis: A systematic review. Clin Exp Rheumatol. 2008;26(5 Suppl 51):S94–104.

    PubMed  CAS  Google Scholar 

  29. Bongartz T, Sutton AJ, Sweeting MJ, Buchan I, Matteson EL, Montori V. Anti-TNF antibody therapy in rheumatoid arthritis and the risk of serious infections and malignancies: Systematic review and meta-analysis of rare harmful effects in randomized controlled trials. JAMA. 2006;295(19):2275–85. doi:10.1001/jama.295.19.2275.

    Article  PubMed  CAS  Google Scholar 

  30. Doran MF, Crowson CS, Pond GR, O’Fallon WM, Gabriel SE. Frequency of infection in patients with rheumatoid arthritis compared with controls: A population-based study. Arthritis Rheum. 2002;46(9):2287–93. doi:10.1002/art.10524.

    Article  PubMed  Google Scholar 

  31. Crowe SR, Merrill JT, Vista ES, Dedeke AB, Thompson DM, Stewart S, Guthridge JM, Niewold TB, Franek BS, Air GM, Thompson LF, James JA. Influenza vaccination responses in human systemic lupus erythematosus: Impact of clinical and demographic features. Arthritis Rheum. 2011;63(8):2396–406. doi:10.1002/art.30388.

    Article  PubMed  Google Scholar 

  32. Del Porto F, Lagana B, Biselli R, Donatelli I, Campitelli L, Nisini R, Cardelli P, Rossi F, D’Amelio R. Influenza vaccine administration in patients with systemic lupus erythematosus and rheumatoid arthritis. Safety and immunogenicity. Vaccine. 2006;24(16):3217–23. doi:10.1016/j.vaccine.2006.01.028.

    Article  PubMed  Google Scholar 

  33. Gabay C, Bel M, Combescure C, Ribi C, Meier S, Posfay-Barbe K, Grillet S, Seebach JD, Kaiser L, Wunderli W, Guerne PA, Siegrist CA. Impact of synthetic and biologic disease-modifying antirheumatic drugs on antibody responses to the AS03-adjuvanted pandemic influenza vaccine: a prospective, open-label, parallel-cohort, single-center study. Arthritis Rheum. 2011;63(6):1486–96. doi:10.1002/art.30325.

    Article  PubMed  CAS  Google Scholar 

  34. Elkayam O, Amir S, Mendelson E, Schwaber M, Grotto I, Wollman J, Arad U, Brill A, Paran D, Levartovsky D, Wigler I, Caspi D, Mandelboim M. Efficacy and safety of vaccination against pandemic 2009 influenza A (H1N1) virus among patients with rheumatic diseases. Arthritis Care Res (Hoboken). 2011;63(7):1062–7. doi:10.1002/acr.20465.

    Article  Google Scholar 

  35. Fomin I, Caspi D, Levy V, Varsano N, Shalev Y, Paran D, Levartovsky D, Litinsky I, Kaufman I, Wigler I, Mendelson E, Elkayam O. Vaccination against influenza in rheumatoid arthritis: The effect of disease modifying drugs, including TNF alpha blockers. Ann Rheum Dis. 2006;65(2):191–4. doi:10.1136/ard.2005.036434.

    Article  PubMed  CAS  Google Scholar 

  36. Oren S, Mandelboim M, Braun-Moscovici Y, Paran D, Ablin J, Litinsky I, Comaneshter D, Levartovsky D, Mendelson E, Azar R, Wigler I, Balbir-Gurman A, Caspi D, Elkayam O. Vaccination against influenza in patients with rheumatoid arthritis: The effect of rituximab on the humoral response. Ann Rheum Dis. 2008;67(7):937–41. doi:10.1136/ard.2007.077461.

    Article  PubMed  CAS  Google Scholar 

  37. Arad U, Tzadok S, Amir S, Mandelboim M, Mendelson E, Wigler I, Sarbagil-Maman H, Paran D, Caspi D, Elkayam O. The cellular immune response to influenza vaccination is preserved in rheumatoid arthritis patients treated with rituximab. Vaccine. 2011;29(8):1643–8. doi:10.1016/j.vaccine.2010.12.072.

    Article  PubMed  CAS  Google Scholar 

  38. van Assen S, Holvast A, Benne CA, Posthumus MD, van Leeuwen MA, Voskuyl AE, Blom M, Risselada AP, de Haan A, Westra J, Kallenberg CG, Bijl M. Humoral responses after influenza vaccination are severely reduced in patients with rheumatoid arthritis treated with rituximab. Arthritis Rheum. 2010;62(1):75–81. doi:10.1002/art.25033.

    Article  PubMed  Google Scholar 

  39. Bingham 3rd CO, Looney RJ, Deodhar A, Halsey N, Greenwald M, Codding C, Trzaskoma B, Martin F, Agarwal S, Kelman A. Immunization responses in rheumatoid arthritis patients treated with rituximab: Results from a controlled clinical trial. Arthritis Rheum. 2010;62(1):64–74. doi:10.1002/art.25034.

    Article  PubMed  CAS  Google Scholar 

  40. Pescovitz MD, Torgerson TR, Ochs HD, Ocheltree E, McGee P, Krause-Steinrauf H, Lachin JM, Canniff J, Greenbaum C, Herold KC, Skyler JS, Weinberg A. Effect of rituximab on human in vivo antibody immune responses. J Allergy Clin Immunol. 2011. doi:10.1016/j.jaci.2011.08.008.

  41. Yri OE, Torfoss D, Hungnes O, Tierens A, Waalen K, Nordoy T, Dudman S, Kilander A, Wader KF, Ostenstad B, Ekanger R, Meyer P, Kolstad A. Rituximab blocks protective serologic response to influenza A (H1N1) 2009 vaccination in lymphoma patients during or within 6 months after treatment. Blood. 2011;118(26):6769–71. doi:10.1182/blood-2011-08-372649.

    Article  PubMed  CAS  Google Scholar 

  42. Sutter JA, Kwan-Morley J, Dunham J, Du YZ, Kamoun M, Albert D, Eisenberg RA, Luning Prak ET. A longitudinal analysis of SLE patients treated with rituximab (anti-CD20): Factors associated with B lymphocyte recovery. Clin Immunol. 2008;126(3):282–90. doi:10.1016/j.clim.2007.11.012.

    Article  PubMed  CAS  Google Scholar 

  43. Bedognetti D, Zoppoli G, Massucco C, Zanardi E, Zupo S, Bruzzone A, Sertoli MR, Balleari E, Racchi O, Messina M, Caltabiano G, Icardi G, Durando P, Marincola FM, Boccardo F, Ferrarini M, Ansaldi F, De Maria A. Impaired response to influenza vaccine associated with persistent memory B cell depletion in non-Hodgkin’s lymphoma patients treated with rituximab-containing regimens. J Immunol. 2011;186(10):6044–55. doi:10.4049/jimmunol.1004095.

    Article  PubMed  CAS  Google Scholar 

  44. Horwitz SM, Negrin RS, Blume KG, Breslin S, Stuart MJ, Stockerl-Goldstein KE, Johnston LJ, Wong RM, Shizuru JA, Horning SJ. Rituximab as adjuvant to high-dose therapy and autologous hematopoietic cell transplantation for aggressive non-Hodgkin lymphoma. Blood. 2004;103(3):777–83. doi:10.1182/blood-2003-04-1257.

    Article  PubMed  CAS  Google Scholar 

  45. Jawad AF, Prak EL, Boyer J, McDonald-McGinn DM, Zackai E, McDonald K, Sullivan KE. A Prospective Study of Influenza Vaccination and a Comparison of Immunologic Parameters in Children and Adults with Chromosome 22q11.2 Deletion Syndrome (DiGeorge Syndrome/Velocardiofacial Syndrome). Journal of clinical immunology. 2011;31(6):927–35. doi:10.1007/s10875-011-9569-8.

    Article  PubMed  CAS  Google Scholar 

  46. Levin MJ, Song LY, Fenton T, Nachman S, Patterson J, Walker R, Kemble G, Allende M, Hultquist M, Yi T, Nowak B, Weinberg A. Shedding of live vaccine virus, comparative safety, and influenza-specific antibody responses after administration of live attenuated and inactivated trivalent influenza vaccines to HIV-infected children. Vaccine. 2008;26(33):4210–7. doi:10.1016/j.vaccine.2008.05.054.

    Article  PubMed  CAS  Google Scholar 

  47. Albert D, Dunham J, Khan S, Stansberry J, Kolasinski S, Tsai D, Pullman-Mooar S, Barnack F, Striebich C, Looney RJ, Prak ET, Kimberly R, Zhang Y, Eisenberg R. Variability in the biological response to anti-CD20 B cell depletion in systemic lupus erythaematosus. Annals of the rheumatic diseases. 2008;67(12):1724–31. doi:10.1136/ard.2007.083162.

    Article  PubMed  CAS  Google Scholar 

  48. Stevenson PG, Hawke S, Bangham CR. Protection against lethal influenza virus encephalitis by intranasally primed CD8+ memory T cells. J Immunol. 1996;157(7):3065–73.

    PubMed  CAS  Google Scholar 

  49. Kreijtz JH, Bodewes R, van Amerongen G, Kuiken T, Fouchier RA, Osterhaus AD, Rimmelzwaan GF. Primary influenza A virus infection induces cross-protective immunity against a lethal infection with a heterosubtypic virus strain in mice. Vaccine. 2007;25(4):612–20. doi:10.1016/j.vaccine.2006.08.036.

    Article  PubMed  CAS  Google Scholar 

  50. Benton KA, Misplon JA, Lo CY, Brutkiewicz RR, Prasad SA, Epstein SL. Heterosubtypic immunity to influenza A virus in mice lacking IgA, all Ig, NKT cells, or gamma delta T cells. J Immunol. 2001;166(12):7437–45.

    PubMed  CAS  Google Scholar 

  51. Doherty PC, Topham DJ, Tripp RA, Cardin RD, Brooks JW, Stevenson PG. Effector CD4+ and CD8+ T-cell mechanisms in the control of respiratory virus infections. Immunol Rev. 1997;159:105–17.

    Article  PubMed  CAS  Google Scholar 

  52. Powell TJ, Strutt T, Reome J, Hollenbaugh JA, Roberts AD, Woodland DL, Swain SL, Dutton RW. Priming with cold-adapted influenza A does not prevent infection but elicits long-lived protection against supralethal challenge with heterosubtypic virus. J Immunol. 2007;178(2):1030–8.

    PubMed  CAS  Google Scholar 

  53. Stevenson PG, Hawke S, Bangham CR. Protection against influenza virus encephalitis by adoptive lymphocyte transfer. Virology. 1997;232(1):158–66. doi:10.1006/viro.1997.8535.

    Article  PubMed  CAS  Google Scholar 

  54. Rangel-Moreno J, Carragher DM, Misra RS, Kusser K, Hartson L, Moquin A, Lund FE, Randall TD. B cells promote resistance to heterosubtypic strains of influenza via multiple mechanisms. J Immunol. 2008;180(1):454–63.

    PubMed  CAS  Google Scholar 

  55. Virelizier JL. Host defenses against influenza virus: The role of anti-hemagglutinin antibody. J Immunol. 1975;115(2):434–9.

    PubMed  CAS  Google Scholar 

  56. Doherty PC, Gerhard W. Breakdown of the blood–cerebrospinal fluid barrier to immunoglobulin in mice injected intracerebrally with a neurotropic influenza A virus. Post-exposure treatment with monoclonal antibody promotes recovery. J Neuroimmunol. 1981;1(3):227–37.

    Article  PubMed  CAS  Google Scholar 

  57. Kris RM, Yetter RA, Cogliano R, Ramphal R, Small PA. Passive serum antibody causes temporary recovery from influenza virus infection of the nose, trachea and lung of nude mice. Immunology. 1988;63(3):349–53.

    PubMed  CAS  Google Scholar 

  58. Querec TD, Akondy RS, Lee EK, Cao W, Nakaya HI, Teuwen D, Pirani A, Gernert K, Deng J, Marzolf B, Kennedy K, Wu H, Bennouna S, Oluoch H, Miller J, Vencio RZ, Mulligan M, Aderem A, Ahmed R, Pulendran B. Systems biology approach predicts immunogenicity of the yellow fever vaccine in humans. Nat Immunol. 2009;10(1):116–25. doi:10.1038/ni.1688.

    Article  PubMed  CAS  Google Scholar 

  59. Forrest BD, Pride MW, Dunning AJ, Capeding MR, Chotpitayasunondh T, Tam JS, Rappaport R, Eldridge JH, Gruber WC. Correlation of cellular immune responses with protection against culture-confirmed influenza virus in young children. Clinical and vaccine immunology: CVI. 2008;15(7):1042–53. doi:10.1128/CVI.00397-07.

    Article  PubMed  CAS  Google Scholar 

  60. McElhaney JE, Xie D, Hager WD, Barry MB, Wang Y, Kleppinger A, Ewen C, Kane KP, Bleackley RC. T cell responses are better correlates of vaccine protection in the elderly. J Immunol. 2006;176(10):6333–9.

    PubMed  CAS  Google Scholar 

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Acknowledgements

The authors would like to thank the patients and the physicians who contributed to this study. The skills of Dr. Yang-Zhu Du, Lytia Fisher and Kristal Dow are gratefully acknowledged. Supported in part by NIH grant NO1-AI-50024, the Arthritis Foundation, the American Autoimmunity Related Disease Association, and R01 AR34156 and R01 AI063626. The authors declare no conflict of interest.

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The authors declare that have no conflict of interest.

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Authors and Affiliations

  1. Division of Rheumatology, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    Robert A. Eisenberg

  2. Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA, 19104, USA

    Abbas F. Jawad

  3. Abramson Cancer Center, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    Jean Boyer

  4. Division of Allergy Immunology, The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, 3615 Civic Center Blvd, Philadelphia, PA, 19104, USA

    Kelly Maurer, Kenyetta McDonald & Kathleen E Sullivan

  5. Department of Pathology and Laboratory Medicine, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    Eline T. Luning Prak

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  1. Robert A. Eisenberg
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Correspondence to Kathleen E Sullivan.

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Eisenberg, R.A., Jawad, A.F., Boyer, J. et al. Rituximab-Treated Patients Have a Poor Response to Influenza Vaccination. J Clin Immunol 33, 388–396 (2013). https://doi.org/10.1007/s10875-012-9813-x

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