Emerging Diseases


African Swine Fever workshop, July 2011, Nairobi

Participants of an African swine fever workshop held in July 2011 at ILRI’s Nairobi headquarters: (From left) Raymond Rowland (Kansas State University), David Odongo (ILRI), Richard Bishop (ILRI), Maria-Jesus Munoz (Centro de Investigación en Sanidad Animal-Instituto Nacional de Investigaciones Agrarias) and Jose-Manuel Vizcaino (head of the World Animal Health Organisation’s African Swine Fever World Reference Centre, in Madrid) on a visit to the new laboratories at ILRI and Biosciences eastern and central Africa (photo credit: ILRI/Edward Okoth).

‘Scientists from around the world came to Kansas State University’s Biosecurity Research Institute (BRI) May 15–17 to take a global look at the highly contagious viral disease, African swine fever (ASF). The researchers assembled to give updates on research and in some cases, the status of ASF in their countries.

‘ASF has not been found in the United States, but is a serious problem in Africa and outbreaks have occurred in other countries, including Spain, Italy, Russia and the Dominican Republic. There is no vaccine or treatment. Changes in production practices and increasing globalization have increased the risk of introducing ASF into North America and other parts of the world, according to the Center for Food Security and Public Health at Iowa State University. . . .

‘Humans are not susceptible to the African swine fever virus (ASFV), but when an outbreak occurs in any region or country, the financial and physical implications can be devastating to the swine industry and those related to it. During outbreaks in Malta and the Dominican Republic, for example, the swine herds of the entire countries were completely depopulated. . . .

Richard Bishop, senior molecular biologist with the International Livestock Research Institute in Nairobi, Kenya spoke of the importance of the swine herd in Africa, adding that even one pig can make a significant difference in a family’s income. He said that the pig population in Africa increased 284% from 1980 to 1999 and that pork consumption during the period almost doubled. . . .’

Read the whole article at National Hog Farmer (USA): African swine fever represents growing global threat, 18 May 2012.

On 21 May, the Ohio State University- Eastern Africa Track II Certification training in collaboration with ILRI will commence in Addis Ababa, with courses also offered in other locations.  The training will run through July 27, 2012.

Read more

The Fifth Plague: Livestock Disease, woodcut by Gustave Doré, 1866 (public domain, via Wikimedia Commons).

Anthrax, bird flu , Ebola, HIV-AIDS, H1N1, H5N1, influenza, Rift Valley fever, SARS: What are the disease links between people, animals and environments? And what are we doing to protect ourselves against the next outbreak of a deadly infectious disease? A series being published in the Huffington Post is exploring such ‘living weapons’ and our preparedness, or lack thereof, in dealing with them. Keeping an eye on livestock diseases, experts agree, is a major way to prevent deadly outbreaks of human diseases. And these animal-human disease links, they say, are under-appreciated and under-funded.

Take Rift Valley fever, a disease transmitted between mosquitoes, livestock and people in Africa. Although considered by many experts to be a potential bioterrorist weapon, it remains underfunded.

As Lynne Peeples of the Huffington Post reports:

This emphasis on coordination among medical, veterinary and environmental health scientists, reflecting the global “One Health” movement, could also be employed in the development of vaccines and treatments for bioterror threats.

Rift Valley fever virus is a prime candidate for such collaboration, says BioProtection Systems’ [Ramond] Flick, an expert on emerging infectious disease, which can afflict both animals and humans. Creating a livestock vaccine would reduce the risk of human infection.

However, because the disease is not considered a priority human bioterrorism agent by the government, research funding is low. Jason McDonald, a CDC spokesperson, explains the agency’s exclusion of Rift Valley: humans typically contract the virus through bites of infected mosquitoes and just 1 percent of these victims die.

Flick disagrees.

The public’s current awareness of Rift Valley fever and its perception of the West Nile virus threat before 1999 are strikingly similar, he says. West Nile had not been given much thought before it cropped up in New York City. Within a few years it had spread across the country.

Flick warns of even more devastating consequences with the relatively unknown bug. More mosquito species can carry Rift Valley than West Nile. It is also more virulent. And according to research in Arabia and Africa, the fatality rate may actually be increasing, killing more than 30 percent of people infected during recent outbreaks. Further, there does appear to be potential for human-to-human transmission.’

Scientists at the International Livestock Research Institute (ILRI) have been working with partner organizations in eastern and southern Africa to better understand the spread of Rift Valley fever. They are developing a toolkit that will help decision-makers make timely and appropriate interventions to prevent the disease from jumping from cattle to the poor people who rear them. The toolkit includes advice on the conditions that suit the Rift Valley fever virus infecting cattle populations (e.g., following unusually heavy rains northern Kenya and other parts of the Horn’s drylands), at which point disease control agents should begin surveillance to diagnose and stop the spread disease in the infected animals before it has time to begin infecting human populations.

Efforts to better align the work of organizations researching Rift Valley fever were the focus this month (Feb 2012) of a workshop organized and hosted by ILRI at its Nairobi headquarters. Watch for a forthcoming post on the ILRI New Blog on that workshop and what it achieved.

The urgency of adopting a ‘one health’ approach to disease control is highlighted by the Huffington Post‘s Lynne Peeples.

‘. . . Biological weapons have a long and sordid history, from catapulting infected corpses to dropping bombs of plague-infected fleas. But what if a biological weapon were being developed and studied by scientists that had the potential to kill not a battalion or a city, but 150 million people? According to some public health and defense officials, that is exactly what we’re facing, following the cultivation of a highly contagious form of H5N1—a lethal bug better known as bird flu. The contagion, they fear, could escape the lab or its recipe could land in the wrong hands.

. . . A super flu is just one of a growing list of potential pandemics that could develop in the near future, either as a result of terrorism, of superbugs leaping from animals to humans, or both. In fact, nearly 80 percent of the bioterrorism agents recognized by the U.S. government started in animals. . . . And nature will spawn new agents continuously.’

‘This means a terrorist may need few tools, little training, minimal money and no published blueprint to harvest a superbug and then unleash it in food, water, air or via insect vectors such as fleas or mosquitos. . . .

The overlap of bioterrorism agents and emerging infectious disease also means that officials could defend against biological attacks and natural outbreaks in tandem.’

‘. . . Yet federal funding to prevent and respond to bioterrorism is plummeting. The U.S. Centers for Disease Control and Prevention’s biodefense budget peaked in 2005 at about $1.2 billion. The 2012 budget is down to $800 million, with state and local programs—the country’s first line of defense—absorbing some of the most significant cuts. . . . The U.S. “remains largely unprepared for a large-scale bioterrorism attack or deadly disease outbreak.”

. . . Meanwhile, nature knows no rules or regulations and continues to create new viruses and alter old ones. And because animal-borne diseases may need no help spilling over into humans, outbreak investigations could easily confuse intentional and natural outbreaks.

“The government spends a lot of money developing biosensors,” says Princeton’s Kahn, referring to air sampling surveillance and other sophisticated systems. “But I would argue the best ones are flying around,” or in this case, hanging out on farms.

Zoos can be particularly good sources of sentinels, she adds, as they house a wide array of animals from around the world with different levels of susceptibility. Most zoos are also located near densely populated urban centers, which tend to be terrorism “hot spots.”

“There’s a possibility that the high-tech tools are not even in the right place,” says Rabinowitz. “By being constantly aware of new events in animals as well as in humans and the environment, we’re more likely to pick up a new threat.”. . .

This emphasis on coordination among medical, veterinary and environmental health scientists, reflecting the global “One Health” movement, could also be employed in the development of vaccines and treatments for bioterror threats. . . .

Researchers have discovered an average of 15 to 20 previously unknown diseases in each of the past few decades, including incurable diseases like HIV/AIDS, ebola and SARS, with new pathogens likely to emerge and spread faster due to the global population’s increasing size and mobility.’

‘. . . The ability to detect and identify diseases as they initially emerge can go a long way in thwarting an outbreak, [Scott Lillibridge] says. It can provide the time to prepare, including upgrading quarantines at the border, researching a vaccine and identifying what drugs might successfully combat the infection.

‘”A couple weeks can be critical,” says Lillibridge. “It can make an administration look foolish or like they’re in control.”

‘Overall, the U.S. government spent approximately $60 billion on biodefense from 2001 to 2009. Only 2 percent of that was dedicated to preventive measures such as programs to discover and reduce biological threats overseas, according to Koblentz.

To protect Americans, we must look at what is going on in the rest of the world,” says Khan.

ANSER’s Gursky, recently returned from hosting a NATO meeting in Central Europe: “The most important strategy is to build up the capabilities that we share, which means reaching across borders and politics,” she says.’

‘Coalescing efforts might also allow the government to do more with less. “We’re looking at not only man being a terrorist, but nature can be a terrorist as well,” says Henderson. “The natural occurrence of a disease gives us similar problems, so whatever we’re doing to prepare for one, prepares us for the other.”‘

Read the whole article, by Lynne Peeples, in the Huffington Post: Bioterrorism funding withers as death germs thrive in labs, nature, 10 Feb 2012; this article is part of a series, ‘The Infection Loop,’ investigating the complex links between human, animal and environment.

Read more on ILRI’s News Blog and Clippings Blog about recent research advances in better control of Rift Valley fever.

As part of a session on ‘livestock and human health’ at the recent ‘LiveSTOCK Exchange’ event, Brian Perry interviewed a panel of ILRI staff on future research in this area as part of the new CGIAR Research Program (CRP4) on Agriculture for Improved Nutrition and Health.

Topics addressed by Delia Grace include the topical and geographic focus of the new CRP, how gender will be addressed, the involvement of partners, monitoring and impact indicators, and the role on One Health. Bernard Bett explained how risks of emerging diseases will be addressed, and ILRI’s comparative advantages in this area. Vish Nene elaborated on the ‘biotechnology’ and diagnostics aspects of the new work; and Appolinaire Djikeng talks on ways the BecA hub can be used to link genomics and meta-genomics technologies with work on emerging infectious diseases. ILRI Director General Jimmy Smith concluded by arguing in favour of work on the prevention and surveillance side of such diseases.

See the video:

 


On 9 and 10 November 2011, the ILRI Board of Trustees hosted a 2-day ‘liveSTOCK Exchange’ to discuss and reflect on livestock research for development. The event synthesized sector and ILRI learning and helped frame future livestock research for development directions.

The liveSTOCK Exchange also marked the leadership and contributions of Dr. Carlos Seré as ILRI Director General.  See all posts in this series / Sign up for email alerts

For the November 2011 ‘liveSTOCK Exchange’ event at ILRI, Delia Grace, Bernard Bett, Eric Fèvre and John McDermott prepared a series of issue briefs on livestock and human health …

Agricultural innovation has allowed massive expansion of people and their animals. Yet as the world population passed 7 billion in October 2011, more than one billion people remain malnourished and more than 2 billion are sickened each year from the food they ate. Millions more die from diseases that emerge from, or persist in, agricultural ecosystems: zoonoses (diseases transmissible between animals and man) and diseases recently emerged from animals make up 25% of the infectious disease burden in least developed countries and kill one in ten people who live there.

Other urgent health problems related to agriculture include fungal toxins (mycotoxins) in crops and animal source foods; plant toxins; use of wastewater for agriculture; misuse of agricultural chemicals and antibiotics; occupational hazards of food value chains; contribution of agriculture to climate change and impacts of this on disease; and, health impacts of agricultural alteration of ecosystems (such as irrigation practices that promote malaria).

Agriculture is exacting a heavy biological cost, but health policy and programs often stop at the clinic door while agriculture rarely has ‘enhancing health’ as an articulated objective. A consensus is growing that the disconnect between agriculture, health and nutrition is at least partly responsible for the disease burden associated with food and farming. The new CGIAR Research Program on Agriculture for Enhanced Nutrition and Health is attempting to bridge this disconnect and the International Livestock Research Institute (ILRI) has a major role in the component focusing on diseases related to agriculture

Download Issue Brief 10 on food, farming and human health.

Download Issue Brief 11 on safe foods in informal markets.

Download Issue Brief 12 on emerging infectious diseases.

Download Issue Brief 13 on neglected zoonoses.


On 9 and 10 November 2011, the ILRI Board of Trustees hosts a 2-day ‘liveSTOCK Exchange’ to discuss and reflect on livestock research for development. The event will synthesize sector and ILRI learning and help frame future livestock research for development directions.

The liveSTOCK Exchange will also mark the leadership and contributions of Dr. Carlos Seré as ILRI Director General.  See all posts in this series / Sign up for email alerts

Impact discussion at the LiveSTOCK Exchange

Livestock experts reflect on livestock research over the past decade and trends that will drive future livestock research during the ‘Livestock Exchange’ held 9-10 November 2011 at ILRI in Ethiopia (picture credit: ILRI/Ewen Le Borgne).

Livestock researchers, meeting in Addis Ababa, Ethiopia, say that managing livestock diseases of developing countries can save lives as well as livestock livelihoods of the poor.

Key livestock researchers met, this week, in a two-day (9–10 Nov) ‘Livestock Exchange’ event at the Addis Ababa campus of the International Livestock Research Institute (ILRI) in Ethiopia to reflect on key lessons on livestock research over the past decade and to review the main trends that will affect and drive livestock research in coming years. The event, which is convened by the ILRI Board of Trustees, is also celebrating the leadership and contributions of Carlos Seré, whose term as the director of ILRI ended at the end of October 2011.

Speaking in a session on ‘livestock and human health’, Delia Grace, a veterinary epidemiologist with ILRI, said disease management will play a critical role in ensuring livestock and livelihoods sustainability in the future. ‘One of ILRI’s key roles in coming years will be to lead scientific research on agriculture-associated diseases,’ said Grace. In a video link from Washington DC, John McDermott, who leads a new multi-centre research program on ‘Agriculture for Improved Nutrition and Health,’ under which the research by ILRI will be carried out, told the ILRI gathering in Addis  that livestock scientists need to find ways to ‘contribute much more to improving nutrition and health for the poor and particularly for children and women.’

‘There is need to better understand on-going changes in livestock production systems in the world, particularly in developing countries, and how these changes are affecting the potential risks of livestock diseases,’ said Grace. Among the key areas on which research on agriculture-associate diseases will focus is food-associated diseases, zoonotic diseases and emerging diseases.

ILRI’s research experience in epidemiology, diagnostics and surveillance is expected to contribute significantly to the process of changes within the livestock sector and projecting future trends in animal disease research. Lessons from informal and emerging value chains will also help in evaluating the benefits and risks to human health among poor farmers.

Organized around four thematic areas of livestock research, this ‘Livestock Exchange’ event brings scientists from ILRI, the Consultative Group on International Agricultural Research and other institutions to deliberate on the future directions of livestock systems in transition, from animal health and genetics, to livestock market opportunities for the poor to livestock and human health. Discussions include topics such as livestock and climate change, animal breeding and genetic resources, vaccines, value chain development, demands for livestock products and ways of improving market-driven use of technologies.


On 9 and 10 November 2011, the ILRI Board of Trustees hosted a 2-day ‘liveSTOCK Exchange’ to discuss and reflect on livestock research for development. The event synthesized sector and ILRI learning and helped frame future livestock research for development directions.

The liveSTOCK Exchange also marked the leadership and contributions of Dr. Carlos Seré as ILRI Director General. See all posts in this series / Sign up for email alerts

For the November 2011 ‘liveSTOCK Exchange’ event at ILRI, Delia Grace will lead a one-hour session on some of the urgent, complex and fascinating issues at the interface of human and animal health …

Watch this 3-minute photofilm with commentary by Delia Grace and small-scale butchers and consumers interviewed along Langata Road in Nairobi, Kenya. Dying For Meat was made for ILRI by duckrabbit, a digital production company based in the UK doing high-quality audio-visual story-telling and training.

For the last couple of years, Delia Grace, an Irish veterinarian and veterinary scientist, has worked closely with John McDermott, another veterinary researcher and former deputy director general for research for ILRI. McDermott departed ILRI last Friday to take up an appointment as director of a new CGIAR Research Program on nutrition and health. Starting today, McDermott will be based at ILRI’s sister institute, the International Food Policy Research Institute (IFPRI), in Washington, DC.

Grace will lead ILRI’s livestock inputs to the multi-centre CGIAR Research Program on Nutrition and Health that McDermott now directs.

Earlier this year, Grace and McDermott helped put livestock issues squarely on the (human) health table when they made key presentations at a high-profile IFPRI conference, Leveraging Agriculture for Improving Nutrition and Health, held in Delhi in Feb 2011.

SARS!
Poster at Chiang Kai-shek International Airport at the height of the SARS scare (photo on Flickr by dmealiffe’s).

At that time, Reuters published this report on ILRI’s contribution to the conference.

‘A growing number of livestock, such as cows and pigs, are fuelling new animal epidemics worldwide and posing more severe problems in developing countries as it threatens their food security, according to a report released on Friday.

‘Epidemics in recent years, such as SARS and the H1N1 swine flu, are estimated to have caused billions of dollars in economic costs.

‘Some 700 million people keep farm animals in developing countries and these animals generate up to 40 percent of household income, the report by the International Livestock Research Institute said.

‘”Wealthy countries are effectively dealing with livestock diseases, but in Africa and Asia, the capacity of veterinary services to track and control outbreaks is lagging dangerously behind livestock intensification,” John McDermott and Delia Grace at the Nairobi-based institute said in a statement on the report.

‘”This lack of capacity is particularly dangerous because many poor people in the world still rely on farm animals to feed their families, while rising demand for meat, milk and eggs among urban consumers in the developing world is fueling a rapid intensification of livestock production.”

‘Seventy-five percent of emerging infectious diseases originate in animals, they added. Of these 61 percent are transmissible between animals and humans.

‘”A new disease emerges every four months; many are trivial but HIV, SARS and avian influenza (eg. H5N1) illustrate the huge potential impacts,” McDermott and Grace wrote in the report. . . .

‘The two researchers urged developing countries to improve animal disease surveillance and speed up testing procedures to help contain livestock epidemics before they become widespread.’

Read the whole article at Reuters: Growing number of farm animals spawn new diseases, 11 February 2011.


On 9 and 10 November 2011, the ILRI Board of Trustees hosted a 2-day ‘liveSTOCK Exchange’ to discuss and reflect on livestock research for development. The event synthesized sector and ILRI learning and helped frame future livestock research for development directions.

The liveSTOCK Exchange also marked the leadership and contributions of Dr. Carlos Seré as ILRI Director General. See all posts in this series / Sign up for email alerts

From 13–15 October 2011, several staff of the International Livestock Research Institute (ILRI) attended the 7th International Conference of the Asian Society of Agricultural Economists, in Hanoi, Vietnam.

ILRI organized two parallel sessions:
(1) Food safety policy in a developing-country context: Examples from case studies in livestock value chains
(2) Assessing the impact of livestock research for development.

And ILRI presented two contributed papers:
(1) Are smallholders willing to pay for animal disease control? Empirical evidence from a study of mass vaccination for avian influenza in Indonesia
(2) On the economics of small-scale household pig production in Vietnam: Survey results, analysis, and assessment.

Asian Society of Agricultural Economists (ASAE) 2011 ILRI booth

Pictured at the ILRI display table at the conference are, from left to right, seated, Nancy Johnson (Poverty, Gender & Impact Unit) and Ranjitha Puskur (Markets Theme), and standing, Delia Grace, Lucy Lapar and Ram Deka (all of Markets Theme).

Please visit the conference website for more details: http://7thasae.ipsard.gov.vn/index.htm

The march of West Nile virus

The march of the West Nile virus (illustration on Flickr by A J Cann: Present and future arboviral threats. Antiviral Res. 2010 85[2]: 328–345).

Laurie Garnett, a scientific consultant on Steven Soderbergh’s new film ‘Contagion’, wrote the popular science book The Coming Plague in the 1990s. In a piece on CNN last week, she warns that ‘there is no governing structure for a pandemic, and little more than vague political pressure to ensure limited access to life-sparing tools and medicines for more than half the world population. . . .

‘ . . . [T]he days when epidemics could be tackled locally had long passed. I argued that the movie had to demonstrate that disease threats in the 21st century are global threats, but the world lacks an appropriate system of governance and trade to permit a genuinely equitable response.

‘Without equity, pandemic battles will fail. Viruses will simply recirculate, and perhaps undergo mutations or changes that render vaccines useless, passing through the unprotected populations of the planet.

Those who see ‘Contagion’ will recognize these themes in its plot: Chinese villagers clamor for vaccines, Internet users gravitate to false claims and order anything they think may help, the entire world sees the pandemic unfold on TV and the Internet and grows universally fearful. Fear spreads globally, even as governments fail in their ineptitude and exhaustion, with police, fire, public health and political leaders themselves falling victim to the virus. . . .

‘What audiences see is the best rendition of events likely to unfold in such a pandemic as can be estimated, based on how governments, public health leaders, scientists, drug companies, communities, law enforcement and international agencies have responded to recent outbreaks of less virulent germs. . . .

‘Internationally, mechanisms of global health governance are very weak. The World Health Organization is running a $1 billion budget deficit, laying off more than 20%, or 300, of its employees this year. . . .

‘In the United States, politicians post-2001 grew tired of our Centers for Disease Control and Prevention, long the world’s premier disease-fighter. . . . Under the Obama administration, the CDC is led by the very able Dr. Thomas Frieden, but congressional mandates have shifted its resources and focus from epidemics and outbreaks to obesity management and chronic disease issues. . . .

‘In these recessionary times, public health budgets are falling to budget axes from Maine to Manila. . . .

‘”Contagion” should serve as a wake-up call not only about the germs, but perhaps more importantly about the frailty of governance, nationally and worldwide.’

Read the whole article on CNN: ’Contagion’ is part reality, part fantasy, totally possible, 14 Sep 2011.

John McDermott John McDermott, currently deputy director general-research of the International livestock Research Institute has been appointed head of CGIAR Research Program 4, on Agriculture for Improved Nutrition and Health (photo credit: ILRI/Susan MacMillan).

Shenggen Fan, director general of the International Food Policy Research Institute (IFPRI) announced on 6 Sep 2011 that John McDermott has been named as director of the new CGIAR (Consultative Group for International Agricultural Research) research program on Agriculture for Improved Nutrition and Health.

McDermott played a key role in the collaborative process to develop the program proposal. He is currently deputy director general and director of research at the International Livestock Research Institute (ILRI) and based in Nairobi, Kenya. He has worked in livestock development and animal and public health in developing countries for over 20 years as a professor, researcher, and manager and has been a professor of veterinary epidemiology at the University of Guelph. His main professional contributions have been in the areas of infectious disease control, quantitative veterinary epidemiology, and modeling of infectious disease transmission.

McDermott takes up his new position, based at IFPRI’s headquarters in Washington, DC, on 31 October 2011.

About the CGIAR Research Program on Agriculture for Improved Nutrition and Health
The CGIAR has committed itself to ensuring that agricultural research serves the needs of the poor. Two urgent needs for the poor are better nutrition and better health. In its new vision, the CGIAR commits to reduce poverty and hunger, improve human health and nutrition, and enhance ecosystem resilience through high-quality international agricultural research, partnership, and leadership. This CGIAR Research Program, Agriculture for Improved Nutrition and Health, directly and strategically supports this new vision.

Agriculture will need to develop and expand to meet the food needs of a growing population from a finite resource base. How agriculture develops to do this can have critical consequences on the health and nutrition of people. This program is designed to support the overall CGIAR research agenda by improving our understanding and options for how agriculture can better accentuate the positive benefits and mitigate the risks of agricultural development on human health and nutrition. These lessons are meant to serve the entire CGIAR agenda, within agroecological production systems and along food value chains.

Emphasis will be placed on two populations of people. The first group is those people who are left behind by socioeconomic development, suffer from high rates of malnutrition and agriculture associated diseases, and rely on aid and development support. Research in the program will meet the demands of development implementers and investors for better knowledge, technologies, and learning approaches to improving their performance.

The second group is those poor people in dynamically intensifying and changing systems in which research can help shape agricultural development more positively and safely. This program will support policy- and decisionmakers and development implementers. Managing the benefits and risks of agricultural development on human health and nutrition are central to achieving the CGIAR-stated impact goals of poverty reduction, food security, and environmental sustainability for people in developing countries.

This program will work at the interface of the agriculture, health, and nutrition sectors. These are three critical pillars for development. For the ambitions of this program to be met, partnerships will be critical. Twelve CGIAR Centers and multiple partners from agriculture, health, and nutrition communities have actively participated in contributing to the development of this proposal through written contributions, stakeholder and partner workshops, and oral discussions. This program proposes a much closer partnership between the agriculture, health, and nutrition research and development communities than seen previously. New approaches to cross-sectoral work are proposed. While new, this program will build on past successes of CGIAR and partners working together on agriculture, health, and nutrition programs and seeks to complement a number of new international initiatives for improving agriculture-nutrition and agriculture-health integration and synergies.

Read the whole proposal for CGIAR Research Program 4, Agriculture for Improved Nutrition and Health.

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