Pathogen Safety Data Sheet: Infectious Substances – Bordetella parapertussis

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Section I: Infectious agent

Name: Bordetella parapertussis
Agent type: Bacteria

Taxonomy

Family: Alcaligenaceae
Genus: Bordetella
Species: parapertussis

Synonym or cross reference: Pertussis, also known as whooping coughFootnote 1Footnote 2.

Characteristics: B. parapertussis are Gram negative, non-motile coccobacilli measuring approximately 0.5 μm by 0.5-2.0 μmFootnote 3. They are oxidase negative, urease positive, and catalase positiveFootnote 4. B. parapertussis are strict aerobes that produce a brownish pigment on tyrosine agar. Optimal growth temperature of B. parapertussis is 35-37 °CFootnote 5. Mature colonies appear in 2-3 daysFootnote 4. Virulence factors include filamentous hemagglutinin, adenylate cyclase toxin, pertactin, tracheal cytotoxin, heat-labile toxin and fimbrial adhesinsFootnote 6. B. parapertussis lacks some of the virulence factors produced by B. pertussis (e.g., pertussis toxin, tracheal colonization factor)Footnote 7.

Section II: Hazard identification

Pathogenicity/toxicity: Symptoms associated with pertussis caused by B. parapertussis are clinically indistinguishable from those of pertussis caused by B. pertussis; however, they are usually milder and of shorter durationFootnote 8,Footnote 9,Footnote 10. Symptoms can last for a few days (atypical disease) or several months (classic disease), while 40% of affected individuals may be asymptomaticFootnote 11. Less than 5% of illnesses caused by B. parapertussis follow classic disease symptoms, unlike the 75% typical disease symptoms shown with B. pertussis Footnote 12. Typical disease symptoms occur in three stages. Stage 1 (catarrhal) typically lasts for 1-2 weeks and is characterized by rhinorrhea and mild cough. Stage 2 (paroxysmal) is 4 weeks in duration and is characterized by frequent coughing episodes and an inspiratory whooping sound. Vomiting after coughing episodes commonly occursFootnote 2. Apnea and cyanosis can also occurFootnote 10. Stage 3 (convalescent) is a chronic cough that can persist for 3 months.

Although infant fatalities caused by B. parapertussis infection have been reportedFootnote 13, pertussis caused by B. parapertussis is not considered to be responsible for significant mortalityFootnote 14. The disease tends to be most severe in infants and children. Complications include pneumonia and bronchitisFootnote 11.

B. parapertussis can cause chronic non-progressive pneumonia in lambsFootnote 15.  B. parapertussis has also been isolated from the lungs of healthy lambsFootnote 15,Footnote 16. B. parapertussis infection in sheep has been shown to increase their susceptibility to infection by Mannheimia speciesFootnote 3,Footnote 16,Footnote 17,Footnote 18. Human and ovine B. parapertussis are distinct strains specialized to different hostsFootnote 6,Footnote 7,Footnote 16,Footnote 19. There are no other reported cases of natural animal infection leading to disease.

Communicability: Transmitted via inhalation of droplets that contain the bacteria (e.g., from respiratory secretions), which colonize mucous membranes of the respiratory tractFootnote 2. The attack rate of pertussis in susceptible household members is estimated to be between 70 and 100%Footnote 2,Footnote 20.

Communicability in sheep and lambs is not known.

Epidemiology: B. parapertussis infections occur worldwide. Pertussis epidemics have a cyclic pattern, occurring every 2-5 yearsFootnote 21. Estimated incidence rates of pertussis caused by B. parapertussis are approximately 2.8 per 1,000 person-yearsFootnote 9. B. parapertussis comprises 1 to 30 % of pertussis diseaseFootnote 2,Footnote 22,Footnote 23,Footnote 24. It is most common in children less than 5 years oldFootnote 12,Footnote 21.

Host range

Natural Host(s): Humans, sheepFootnote 15,Footnote 19.

Other Host(s): B. parapertussis has the ability to colonize mice and pigs when the bacteria is introduced under experimental conditionsFootnote 16,Footnote 25.

Infectious dose: Unknown.

Incubation period: Usually 7 to 10 daysFootnote 7, but can range from 6 to 20 daysFootnote 6.

Section III: Dissemination

Reservoir: Asymptomatic humansFootnote 26.

Zoonosis/Reverse zoonosis: None.

Vectors: None.

Section IV: Stability and viability

Drug susceptibility: Macrolides such as erythromycinFootnote 10, azithromycin, clarithromycinFootnote 2,Footnote 23; and quinolones such as ciprofloxacin, gemifloxacin, and temafloxacin are effective against B. parapertussisFootnote 27,Footnote 28. Sulfamethoxazole-trimethopriumFootnote 10, piperacillinFootnote 29, and minocyclineFootnote 29 are also effective against B. parapertussis.

Drug resistance: There are no reports of erythromycin resistant B. parapertussis isolates to date; however, there is evidence of erythromycin resistant B. pertussis emerging in ChinaFootnote 30. B. parapertussis is resistant to benzylpenicillin, cephalothin, cefatrizine, cefaclor, streptomycin, and cephalexinFootnote 29.

Susceptibility to disinfectants: Inactivation of B. pertussis can be achieved using glutaraldehydFootnote 31.  Vegetative bacteria can be inactivated by chlorine, 70% ethanol, phenolics (e.g., ortho-phenylphenol, ortho-benzyl-para-chlorophenol), hydrogen peroxide, and peracetic acidFootnote 32.

Physical inactivation: Data not available for B. parapertussis. Application of moist heat (121°C for 15 minutes) and dry heat (170°C for 1 hour) are generally effective at eliminating most bacteriaFootnote 33.

Survival outside host: Data not available for B. parapertussis. B. pertussis can survive for 3-5 days on dry inanimate surfacesFootnote 34.

Section V: First aid and medical

Surveillance: Diagnosis is accomplished through the monitoring of clinical symptoms. Diagnosis can be performed by culture-based and PCR methodsFootnote 4,Footnote 24. Nasopharyngeal swabs are cultured on charcoal agar with 10% horse blood and cephalexinFootnote 4, or Border-Gengou agarFootnote 24.

Note: The specific recommendations for surveillance in the laboratory should come from the medical surveillance program, which is based on a local risk assessment of the pathogens and activities being undertaken, as well as an overarching risk assessment of the biosafety program as a whole. More information on medical surveillance is available in the Canadian Biosafety Handbook (CBH).

First aid/Treatment: B. parapertussis infection can be treated using appropriate antibiotics. Duration of illness is shorter when treatment is administered within 6 days of cough onsetFootnote 35. Macrolides such as erythromycin, clarithromycin, and azithromycin are commonly prescribedFootnote 2. Azithromycin has milder side effects and is recommended for infantsFootnote 2.

There are no known treatment or immunization options available for animals.

Note: The specific recommendations for first aid/treatment in the laboratory should come from the post-exposure response plan, which is developed as part of the medical surveillance program. More information on the post-exposure response plan can be found in the CBH.

Immunization:  There is no vaccine against B. parapertussis. It is unclear whether acellular pertussis vaccines provide any protection against illness caused by B. parapertussisFootnote 9,Footnote 10,Footnote 36,Footnote 37.

Note: More information on the medical surveillance program can be found in the CBH, and by consulting the Canadian Immunization Guide.

Prophylaxis: Antibiotic prophylaxis may prevent secondary illnessesFootnote 35.

Note: More information on prophylaxis as part of the medical surveillance program can be found in the CBH.

Section VI: Laboratory hazards

Laboratory-acquired infections: None reported to date.

Note: Please consult the Canadian Biosafety Standard (CBS) and CBH for additional details on requirements and guidelines for reporting exposure incidents.

Sources/Specimens: Nasopharyngeal swab or aspirateFootnote 2,Footnote 24.

Primary hazards: Exposure of mucous membranes to aerosols generated during manipulation of B. parapertussis culturesFootnote 38.

Special hazards: None.

Section VII: Exposure controls and personal protection

Risk group classification: B. parapertussis is a Risk Group 2 human pathogen and a Risk Group 2 animal pathogenFootnote 39.

Containment requirements: Containment Level 2 facilities, equipment, and operational practices outlined in the CBS for work involving infectious or potentially infectious materials, animals, or culturesFootnote 40.

Protective clothing: The applicable Containment Level 2 requirements for personal protective equipment and clothing outlined in the CBS should be followed.

Note: A local risk assessment will identify the appropriate hand, foot, head, body, eye/face, and respiratory protection, and the PPE requirements for the containment zone should be documented in Standard Operating Procedures.  

Other precautions: Procedures involving high concentrations of B. parapertussis, or procedures that generate aerosols should be conducted in a biological safety cabinetFootnote 40.

Section VIII: Handling and storage

Spills: Allow aerosols to settle. Wearing protective clothing, gently cover the spill with absorbent paper towel and apply suitable disinfectant, starting at the perimeter and working towards the centre. Allow sufficient contact time before clean upFootnote 41.

Disposal: All materials/substances that have come in contact with the infectious agent must be completely decontaminated before they are removed from the containment zone.  This can be achieved by using a decontamination method that has been demonstrated to be effective against the infectious material, such as chemical disinfectants, autoclaving, irradiation, incineration, an effluent treatment system, or gaseous decontaminationFootnote 41.

Storage: The applicable Containment Level 2 requirements for storage outlined in the CBS should be followed. Containers of infectious material or toxins stored outside the containment zone should be labelled, leakproof, impact resistant, and kept either in locked storage equipment or within an area with limited accessFootnote 41

Section IX: Regulatory and other information

Regulatory information: The import, transport, and use of pathogens in Canada is regulated under many regulatory bodies, including the Public Health Agency of Canada, Health Canada, Canadian Food Inspection Agency, Environment and Climate Change Canada, and Transport Canada. Users are responsible for ensuring they are compliant with all relevant acts, regulations, guidelines, and standards.

Canadian Regulatory Context: At the time of publication of this PSDS, this pathogen is subject to official control. The following is a non-exhaustive list of applicable designations, regulation, or legislation:

Updated: August, 2019

Prepared by: Centre for Biosecurity, Public Health Agency of Canada.

Although the information, opinions, and recommendations contained in this Pathogen Safety Data Sheet are compiled from sources believed to be reliable, we accept no responsibility for the accuracy, sufficiency, or reliability or for any loss or injury resulting from the use of the information. Newly discovered hazards are frequent and this information may not be completely up to date.

Copyright© Public Health Agency of Canada, 2018, Canada

References

Footnotes

Footnote 1

Bergfors, E., B. Trollfors, J. Taranger, T. Lagergard, V. Sundh, and G. Zackrisson. 1999. Parapertussis and pertussis: differences and similarities in incidence, clinical course, and antibody responses. Int. J. Infect. Dis. 3:140-146.

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Footnote 2

Cherry, J. D., and U. Heininger. 2014. Pertussis and Other Bordetella Infections, p. 1616. In Anonymous Feigin and Cherry's textbook of pediatric infectious diseases, Seventh ed., . Elsevier/Saunders.

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Footnote 3

Sanden, G. N., and R. S. Weyant. 2005. Genus III. Bordetella, p. 662. In G. M. Garrity, D. J. Brenner, N. R. Krieg, and J. T. Staley (eds.), Bergey's Manual of Systematic Bacteriology, Second Edition. Volume Two: The Proteobacteria (Part C). Springer, USA.

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Footnote 4

He, Q., J. Mertsola, and M. K. Viljanen. 2006. Bordetella spp., p. 253-264. In S. H. Gillespie and P. M. Hawkey (eds.), Principles and Practice of Clinical Bacteriology. John Wiley & Sons, Ltd.

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Footnote 5

Bouchez, V., and N. Guiso. 2015. Bordetella pertussis, B. parapertussis, vaccines and cycles of whooping cough. Pathog. Dis. 73:1.

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Footnote 6

Hoppe, J. E. 1999. Update on respiratory infection caused by Bordetella parapertussis. Pediatr. Infect. Dis. J. 18:375-381.

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Footnote 7

Watanabe, M., and M. Nagai. 2004. Whooping cough due to Bordetella parapertussis: an unresolved problem. Expert Rev. Anti Infect. Ther. 2:447-454.

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Footnote 8

Zouari, A., H. Smaoui, D. Brun, E. Njamkepo, S. Sghaier, E. Zouari, R. Felix, K. Menif, N. Ben Jaballah, N. Guiso, and A. Kechrid. 2012. Prevalence of Bordetella pertussis and Bordetella parapertussis infections in Tunisian hospitalized infants: results of a 4-year prospective study. Diagn. Microbiol. Infect. Dis. 72:303-317.

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Footnote 9

Liese, J. G., C. Renner, S. Stojanov, B. H. Belohradsky, and Munich Vaccine Study Group. 2003. Clinical and epidemiological picture of B pertussis and B parapertussis infections after introduction of acellular pertussis vaccines. Arch. Dis. Child. 88:684-687.

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Footnote 10

Mastrantonio, P., P. Stefanelli, M. Giuliano, Y. H. Rojas, d. A. Ciofi, A. Anemona, and A. E. Tozzi. 1997. Bordetella parapertussis Infection in Children: Epidemiology, Clinical Symptoms, and Molecular Characteristics of Isolates. J. Clin. Microbiol. 36:999-1002.

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Footnote 11

Tomialoic, R., P. Stefanoff, I. Paradowska-Stankiewicz, A. Zasada, and M. Sadkowska-Todys. 2015. Incidence and factors predicting whooping cough due to parapertussis diagnosis among patients referred to general practitioners, Poland, 2009–2011. Eur J Clin Microbiol Infect Dis. 34:101.

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Footnote 12

Lautrop, H. 1971. Epidemics of parapertussis. 20 years' observations in Denmark. Lancet. 1:1195-1198.

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Footnote 13

Zuelzer, W. W., and W. E. Wheeler. 1946. Parapertussis pneumonia: Report of two fatal cases. The Journal of Pediatrics. 29:493-497.

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Footnote 14

World Health Organization. Dept. of Vaccines and Biologicals. 2003. WHO–recommended standards for surveillance of selected vaccine-preventable diseases. 28.

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Footnote 15

Porter, J. F., K. Connor, and W. Donachie. 1994. Isolation and characterization of Bordetella parapertussis-like bacteria from ovine lungs. Microbiology. 140 ( Pt 2):255-261.

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Footnote 16

Hester, S. E., L. L. Goodfield, J. Park, H. A. Feaga, Y. V. Ivanov, L. Bendor, D. L. Taylor, and E. T. Harvill. 2015. Host Specificity of Ovine Bordetella parapertussis and the Role of Complement. PLoS One. 10:e0130964.

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Footnote 17

Chen, W., M. R. Alley, and B. W. Manktelow. 1988. Pneumonia in lambs inoculated with Bordetella parapertussis: clinical and pathological studies. N. Z. Vet. J. 36:138-142.

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Footnote 18

Martin, W. B. 1996. Respiratory infections of sheep. Comp. Immunol. Microbiol. Infect. Dis. 19:171-179.

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Footnote 19

Brinig, M. M., K. B. Register, M. R. Ackermann, and D. A. Relman. 2006. Genomic features of Bordetella parapertussis clades with distinct host species specificity. Genome Biol. 7:R81-2006-7-9-r81.

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Footnote 20

Broome, C. V., R. R. Facklam, and D. W. Fraser. 1980. Pneumococcal Disease after Pneumococcal Vaccination. N. Engl. J. Med. 303:549-552.

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Footnote 21

Cherry, J. D., and B. L. Seaton. 2012. Patterns of Bordetella parapertussis respiratory illnesses: 2008-2010. Clin. Infect. Dis. 54:534-537.

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Footnote 22

He, Q., M. K. Viljanen, H. Arvilommi, B. Aittanen, and J. Mertsola. 1998. Whooping cough caused by Bordetella pertussis and Bordetella parapertussis in an immunized population. JAMA. 280:635-637.

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Footnote 23

Heininger, U. 2010. Update on pertussis in children. Expert Rev. Anti Infect. Ther. 8:163-173.

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Footnote 24

van der Zee, A., C. Agterberg, M. Peeters, F. Mooi, and J. Schellekens. 1996. A clinical validation of Bordetella pertussis and Bordetella parapertussis polymerase chain reaction: comparison with culture and serology using samples from patients with suspected whooping cough from a highly immunized population. J. Infect. Dis. 174:89-96.

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Footnote 25

Elahi, S., D. R. Thompson, S. Strom, B. O'Connor, L. A. Babiuk, and V. Gerdts. 2008. Infection with Bordetella parapertussis but not Bordetella pertussis causes pertussis-like disease in older pigs. J. Infect. Dis. 198:384-392.

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Footnote 26

Zhang, Q., Z. Yin, Y. Li, H. Luo, Z. Shao, Y. Gao, L. Xu, B. Kan, S. Lu, Y. Zhang, M. Li, M. Liu, P. Yao, Z. Zhao, and Q. He. 2014. Prevalence of asymptomatic Bordetella pertussis and Bordetella parapertussis infections among school children in China as determined by pooled real-time PCR: a cross-sectional study. Scand. J. Infect. Dis. 46:280-287.

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Footnote 27

Hoppe, J. E., and C. G. Simon. 1990. In vitro susceptibilities of Bordetella pertussis and Bordetella parapertussis to seven fluoroquinolones. Antimicrob. Agents Chemother. 34:2287-2288.

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Footnote 28

Mortensen, J. E., and G. L. Rodgers. 2000. In vitro activity of gemifloxacin and other antimicrobial agents against isolates of Bordetella pertussis and Bordetella parapertussis. J. Antimicrob. Chemother. 45 Suppl 1:47-49.

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Footnote 29

Watanabe, M., and Y. Haraguchi. 1989. In vitro susceptibility of Bordetella parapertussis to various antimicrobial agents. Antimicrob. Agents Chemother. 33:968-969.

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Footnote 30

Wang, Z., Z. Cui, Y. Li, T. Hou, X. Liu, Y. Xi, Y. Liu, H. Li, and Q. He. 2014. High prevalence of erythromycin-resistant Bordetella pertussis in Xi'an, China. Clin. Microbiol. Infect. 20:O825-30.

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Footnote 31

Gupta, R. K., S. N. Saxena, S. B. Sharma, and S. Ahuja. 1988. Studies on the optimal conditions for inactivation of Bordetella pertussis organisms with glutaraldehyde for preparation of a safe and potent pertussis vaccine. Vaccine. 6:491-496.

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Footnote 32

Rutala, W. A. 1996. APIC guideline for selection and use of disinfectants. 1994, 1995, and 1996 APIC Guidelines Committee. Association for Professionals in Infection Control and Epidemiology, Inc. Am. J. Infect. Control. 24:313-342.

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Footnote 33

Hancock, C. O. 2013. Heat Sterilization, p. 277-293. In A. P. Fraise, P. A. Lambert, and J. Y. Maillard (eds.), Russell, Hugo & Ayliffe's: Principles and Practice of Disinfection, Preservation and Sterilization, Fifth Edition. Wiley-Blackwell.

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Footnote 34

Kramer, A., I. Schwebke, and G. Kampf. 2006. How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC Infect. Dis. 6:130-2334-6-130.

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Footnote 35

Koepke, R., M. L. Bartholomew, J. C. Eickhoff, R. A. Ayele, D. Rodd, J. Kuennen, J. Rosekrans, D. M. Warshauer, J. H. Conway, and J. P. Davis. 2015. Widespread Bordetella parapertussis Infections-Wisconsin, 2011-2012: Clinical and Epidemiologic Features and Antibiotic Use for Treatment and Prevention. Clin. Infect. Dis. 61:1421-1431.

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Footnote 36

Liko, J., S. G. Robison, and P. R. Cieslak. 2017. Do Pertussis Vaccines Protect Against Bordetella parapertussis? Clin. Infect. Dis. 64:1795-1797.

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Footnote 37

Khelef, N., B. Danve, M. J. Quentin-Millet, and N. Guiso. 1993. Bordetella pertussis and Bordetella parapertussis: two immunologically distinct species. Infect. Immun. 61:486-490.

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Footnote 38

U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, and National Institutes of Health. 2009. Biosafety in Microbiological and Biomedical Laboratories, 5th Edition. , United States. https://www.cdc.gov/biosafety/publications/bmbl5/bmbl.pdf.

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Footnote 39

Public Health Agency of Canada. 2015. Human Pathogens and Toxins Act (HPTA), Ottawa, Canada. https://laws.justice.gc.ca/eng/acts/H-5.67/FullText.html

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Footnote 40

Government of Canada. 2015. Canadian Biosafety Standard, Ottawa, Canada. http://canadianbiosafetystandards.collaboration.gc.ca/cbs-ncb/index-eng.php.

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Footnote 41

Government of Canada. 2016. Canadian Biosafety Handbook, 2nd edition, Ottawa, Canada. http://canadianbiosafetystandards.collaboration.gc.ca/cbh-gcb/index-eng.php.

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