The flu, or influenza, is a viral disease of the respiratory tract—the nose, throat, bronchial tubes and lungs—and is highly contagious. It is spread though airborne droplets of moisture produced by coughs or sneezes. When you breathe these germs in through your nose or mouth, you may come down with the flu, generally within one to four days of exposure.
The flu is a potentially serious disease that can lead to hospitalization, or, in severe cases, death. Even healthy people can become very sick from the flu. Death rates from the flu vary from season to season. Flu-related deaths have ranged from a low of 3,000 to a high of 49,000 between 1976 and 2007, according to the U.S. Centers for Disease Control and Prevention (CDC). Outbreaks frequently start in school-age children, who carry the virus home and spread it to other groups.
And, beginning with the 2009-2010 flu season, there was a new flu to contend with—H1N1 flu (“swine flu”), which caused the first flu pandemic in more than 40 years. Since this outbreak, the seasonal flu vaccines have included coverage for the 2009 H1N1 flu. The seasonal trivalent flu vaccine usually contains one of each of the three kinds of influenza viruses that most commonly circulate among people today: influenza A (H1N1), influenza A (H3N2) and influenza B viruses. For the 2013-14 season, there are more flu vaccine options available than ever before. See thePrevention section for more information.
Flu seasons are unpredictable. The 2011-2012 flu season affected a record low number of people, but the 2012-2013 flu season was moderately severe. The flu season in the United States commonly peaks in January or February, but it can begin as early as October and continue into May. Because flu can be so serious and can spread so rapidly, the CDC recommends that everyone age 6 months and older get vaccinated every year. A yearly flu vaccine is the first and most important step in protecting against flu, according to the CDC.
Vaccines are especially important to those most susceptible to flu complications, including older people, children, pregnant women, people who are morbidly obese, people with compromised immune systems and those with chronic illnesses such as heart disease, kidney disease, asthma, COPD and diabetes. The most serious, often life-threatening complication of the flu is pneumonia. Other complications include ear infection, bronchitis, dehydration and worsening of chronic conditions, such as congestive heart failure, asthma or diabetes. Croup and a lung disease called bronchiolitis can also arise as complications in infants and young children.
In addition, the severity of illness is increased by exposure to cigarette smoke, which can injure airways and damage the cilia, the tiny hair-like structures that help keep airways clear. Toxic fumes, industrial smoke and other air pollutants are also risk factors.
There is also evidence that influenza can be more dangerous for women in their second or third trimester of pregnancy. The strain and stress of pregnancy on a woman’s lungs, combined with the type of influenza, can lead to pulmonary problems, although there doesn’t appear to be any danger to the fetus from the influenza virus itself.
There are three strains of the flu virus:
- Type A results in severe illness that easily spreads throughout a population, even globally, affecting a large number of people at the same time.
- Type B is a generally less severe strain that tends to affect fewer people.
- Type C causes very mild symptoms, so mild that many people don’t even realize they’re sick.
The influenza virus changes its genetic makeup every year. That’s why you can get the flu every year and why a flu vaccine containing the new virus is recommended annually for everyone 6 months and older.
This constantly changing virus presents a particular challenge to medical science, making it impossible to create a single vaccine to prevent the disease. Instead, the World Health Organization (WHO) and the CDC monitor each new strain of influenza virus as it appears, assessing which may be the predominant virus in the following year’s flu season. Scientists use this data, collected by a surveillance network, to develop a vaccine each year against the specific virus they predict will predominate. For the 2013-2014 season, the standard trivalent flu vaccine contains one influenza A (H3N2) virus, one influenza A (H1N1) virus and one influenza B virus. Starting this year, there is also a quadrivalent vaccine available that contains a fourth strain, a different B virus.
Ask your health care professional for more information about restrictions and availability of flu vaccine or visit the CDC’s website : www.healthinfi.com
In terms of prevention and treatment, drugs called neuraminidase inhibitors (NAI)—also referred to as antivirals—attack influenza viruses, at the cellular level and block the viruses’ ability to escape from cells already infected, thus preventing the infections from spreading.
These antiviral medications can also prevent the flu, which can help contain the virus in certain settings, such as family members passing the flu to one another in a household or coworkers spreading it in the workplace.
Many people confuse the terms “cold” and “flu” because the illnesses share some of the same features. Both are caused by viruses that infect the respiratory tract, mainly during the winter, and both can cause symptoms such as coughing and sore throat. A cold is a minor viral infection of the nose and throat and can occur in any season. More than 200 viruses are known to cause the common cold.
It’s important to know the difference between the cold and flu because each illness is treated differently. You know you have the flu when you feel as though you’ve been hit by a truck and experience symptoms such as high fever, severe headache, muscle and body aches and extreme tiredness, along with coughing and nasal symptoms. A cold is less severe and often includes a runny nose, sneezing and coughing. Unlike flu, colds typically don’t cause fever.
The flu causes muscle and joint pain, high fever, a deep cough, chills, fatigue and weakness that usually send you straight to bed for three to five days or longer. Afterward, cough and tiredness may persist for days or even weeks. Other symptoms include headache, eye pain and sometimes a stuffy nose and sore throat. Some strains of the flu also produce vomiting and diarrhea. Symptoms usually come on suddenly once you’ve been exposed to the virus.
While there is such a thing as “stomach flu,” it is not caused by the influenza virus. Most people with stomach flu are infected with one of the many gastroenteritis viruses that cause temporary nausea and vomiting. If you’ve been in contact with someone who has the flu and you begin to experience flu-like symptoms, chances are you have the virus. Only your health care professional can diagnose your symptoms accurately, so it’s important to call for an appointment as soon as your symptoms develop to see if you’re a candidate for prescription antiviral medication.
If you think you’ve been exposed to someone who has the flu and you begin to experience symptoms, the CDC currently recommends you stay home and keep away from others as much as possible and avoid travel, work, school or public places for at least 24 hours after your fever is gone (without the use of fever-reducing medication) except to get medical care or for other necessities.
If you become severely ill or you are in one of the groups at high risk for complications, (children younger than five, pregnant women, people of any age with certain chronic medical conditions like asthma, COPD, diabetes or heart disease, people who are immunosuppressed due to HIV infection or because they are taking immunosuppressive medications, and people over age 65), call your health care professional or seek medical treatment. In children, warning signs necessitating emergency medical care include fast breathing or trouble breathing; bluish or gray skin color; not drinking enough fluids; severe or persistent vomiting; not waking up or not interacting; being so irritable that the child does not want to be held; and flu-like symptoms that improve but then return with fever and worsening cough.
In adults, warning signs necessitating emergency medical care include difficulty breathing or shortness of breath; pain or pressure in the chest or abdomen; sudden dizziness; confusion; severe or persistent vomiting; and flu-like symptoms that improve but then return with fever and worsening cough.
Antiviral medications can be used to treat people who are severely ill with flu. To be effective, antiviral medications should be taken within 12 to 48 hours of the onset of symptoms.
Flu often develops into acute bronchitis—an inflammation of the bronchi, the air passages or tubes to the lungs. Symptoms include:
- A fever, 100 to 102 degrees Fahrenheit.
- An irritating, dry, painful cough that starts to produce small amounts of white or light yellow sputum after two or three days; at this stage the fever often recedes, and the pain from coughing diminishes. If your sputum is yellow-green or green in color, you may have a bacterial infection.
Even after the condition improves, a slight cough commonly remains for another week or two. Most cases of acute bronchitis simply represent continued inflammation from viral infection, rather than a bacterial complication. Many people benefit from short-term use of an inhaled bronchodilator such as albuterol (Accuneb, Proventil, Ventolin or ProAir). You usually don’t need antibiotics, regardless of how long your cough has lasted. However, if you have a cough for three weeks or more, you should be carefully evaluated to rule out pneumonia or bacterial bronchitis. If you are producing green secretions when you cough, you may have a bacterial infection and need antibiotics.
Pneumonia symptoms typically appear after you feel like you’ve just about recovered from the flu. Symptoms include:
- high fever
- shaking chills
- chest pain with each breath
- continuous hacking cough that produces thick, yellow-greenish-colored phlegm, or sputum, or sputum with blood in it
- extreme weakness and fatigue
The Flu in Children
Children are both highly likely to get the flu and the most likely to transmit it to others. In fact, studies find that:
- Children are more likely than adults to get the flu and to have complications with the illness. The flu is most serious in children under age 2.
- Families with school-age children experience more flu infections than those without because schools are ideal locations for viruses to attack and spread. On average, about one-third of family members of school-aged children are infected with the flu each year.
- Children do not have as much natural immunity to influenza as adults because they have had less lifetime exposure. Also, close contact with other children in school, home and day-care settings increases a child’s risk of getting and spreading the virus.
When you have the flu, the most important thing is rest. Plus, if you stay home, there’s less risk that you’ll spread the flu to other people. Flu can continue to be contagious for up to five to seven days after symptoms appear.
The following may help with flu symptoms:
- Ask your health care professional about the prescription antiviral drugs oseltamivir (Tamiflu) or zanamivir (Relenza). Antivirals attack the virus at the source and should be started within 12 to 48 hours from the time the first symptoms appear to be effective. If taken within the proper timeframe, antivirals can help you feel better faster. Tamiflu, an oral medication available in capsule or liquid form, is approved for people one year and older. Relenza, an inhaled medication, is approved for people seven years and older. Side effects are mild and may include nausea and, less commonly, vomiting. Relenza may cause some nasal irritation.
- Drink plenty of fluids. Hot liquids may relieve the feeling of congestion and loosen phlegm.
- Take a pain reliever like acetaminophen for aches and fever. However, don’t use aspirin or products containing aspirin on anyone under 19 years of age, because there is a strong link between aspirin and Reye’s Syndrome, a disease that affects all body organs, particularly the brain and liver, in children.
- Take a cough suppressant for relief from a dry, hacking cough when trying to sleep. A cough that produces mucus or phlegm is not necessarily a symptom of flu, but it can be a symptom of a cold or other illness. If you are coughing up phlegm, you may have developed a secondary bacterial infection that needs to be treated by a health care professional. Don’t use a suppressant if you are coughing up mucus; it’s important that you get those substances out of your lungs.
- Use a humidifier, respirator or steamer in the bedroom to help ease congestion.
Because the flu is a viral infection, it cannot be treated with antibiotics. Antibiotics only kill bacteria and thus are useless against the flu. Taking antibiotics when you don’t need them contributes to an important public health problem—antibiotic resistance. Some diseases that were once easily cured by antibiotics have become resistant to treatment. For example, earlier this century, antibiotics nearly eliminated dreaded bacterial diseases like tuberculosis and gonorrhea. However, years of widespread misuse have allowed “antibiotic-resistant” forms of these illnesses to become more common.
To avoid getting the flu or to reduce its severity, the CDC now recommends all people age 6 months and older get a flu shot as soon as it is available each fall. Vaccination is especially important for people at high risk for complications from the flu, including those who are pregnant, are age 65 or older, have a chronic health problem, are health care workers or live or work around the elderly. The vaccine helps your immune system fight off the flu virus when you’re exposed.
If you’re allergic to eggs or running a fever, don’t get a vaccine without talking first with your health care professional. The flu vaccine has been shown to be completely safe to take during pregnancy, but again, discuss this with your health care professional. The most common side effect of the vaccine is soreness at the site of the injection. Essentially everyone can receive the flu vaccine, but it is important if you have concerns to discuss these issues with your health care provider.
While the vaccine itself cannot cause the flu, you could be exposed to the flu within two weeks after vaccination, before you have time to develop antibodies or immune resistance. Then, when you get sick, you might think the vaccine caused it. Because your immune system needs several weeks to respond to the vaccine, the best time to get vaccinated is in October or November since most flu activity occurs in January or later. Some flu seasons can last as late as May, and the 2009 H1NI flu was reported even in summer. No matter the date, it’s still worth getting vaccinated any time during flu season. You start to develop some immunity from the vaccine within a few days to two weeks.
Planning Ahead: Recommendations for Flu Vaccinations
The U.S. Centers for Disease Control and Prevention (CDC) recommends that everyone 6 months and older get vaccinated against the flu. There are several types of flu vaccinations available:
- A standard trivalent flu shot, which protects against the three strains of flu that researchers anticipate will be the most common that season; approved for people ages 6 months and older
- A standard trivalent flu shot grown in cell culture; approved for people 18 and olderv
- A quadrivalent vaccine that protects against the same three viruses in the trivalent vaccine, plus another B virus
- A nasal spray vaccine that uses a live virus, available in trivalent and quadrivalent versions; approved for people 2 through 49 who do not have an underlying medical condition that may make them susceptible to flu complications, such as a weakened immune system, heart or lung disease, kidney problems, diabetes or pregnancy; children 2 through 17 who take aspirin or medicines containing aspirin also shouldn’t get the nasal spray
- A thimerosal-free vaccine
While everyone should get a vaccine each flu season, it is particularly important for certain groups to get vaccinated because they are at risk for serious flu-related complications or they live with or care for people at risk for developing these complications. These groups include:
- pregnant women
- children younger than age five, but especially children younger than two
- people age 65 or over
- anyone with chronic medical conditions, especially asthma or chronic bronchitis and emphysema
- anyone in a long-term care facility or nursing home
- anyone who lives with or cares for those at high risk of complications from flu, including:
- health care workers
- household contacts and out-of-home caregivers of children younger than 6 months
- people within regular contact with those at risk for flu complications
The above recommendations do not apply to live-active-influenza-virus-type vaccines. FluMist and FluMist Quadrivalent, intranasal live-active flu vaccines that prevent the same flu strains as the inactive vaccines, are options for children at least two years old and adults up to age 49.
The live-vaccine nasal sprays appear to be as effective as injected flu vaccine, although they cost more and should not be given to certain people including pregnant or breastfeeding women, people with weakened immune systems and certain other ailments or conditions. Talk to your health care provider to see if it’s right for you.
If you or a family member wants to receive a flu vaccine but cannot locate a source, you can search by zip code at the following American Lung Association.
In addition, some public clinics offer the vaccine. Ask your health care professional for more information about restrictions and availability of the flu vaccine.
Who Should Not Be Vaccinated
There are some people who should not be vaccinated with injected influenza vaccine, according to the CDC. These include those who:
- are under 6 months of age
- have a severe allergy to chicken eggs, although your allergist can likely immunize you safely, and there are some egg-free vaccines available
- have had a severe reaction to a previous influenza vaccination
- developed Guillain-Barré syndrome within six weeks of getting an influenza vaccine
- have a fever (wait until your fever subsides)
Prescription Antiviral Medication for Flu Prevention
Prescription antiviral medications, used as an adjunct to vaccination, may be extremely helpful in preventing the onset of flu. If you have been around someone who has the flu, a doctor can prescribe antiviral medication to help prevent you from catching the virus. However, it’s important to contact the doctor fast, as antiviral medication should be taken within the first 12 to 48 hours of exposure to the virus. After taking oseltamivir (Tamiflu) within 48 hours of the first appearance of flu symptoms, adults felt better 30 percent faster (within 1.3 days) than adults with the flu who did not take the medication. And children taking Tamiflu felt better 26 percent faster (within 1.5 days) than children who didn’t take the medication.
According to the CDC, it’s important that antiviral drugs be used early to treat people who are at risk for developing serious complications from the flu, such as the very young and the very old and people with certain high-risk medical conditions, or for people who are very sick with the flu. Other people may also be treated with antiviral drugs this season. However, most people who come down with the flu and are otherwise healthy do not need to take antiviral drugs.
Use of antivirals is dependent on availability. If Tamiflu and Relenza become in short supply, they may first be given to people who have been hospitalized or are at risk for severe complications from the flu.
Minimizing Your Risk
Here are several simple common-sense things you can do to protect yourself from the flu and to help prevent the spread of the flu virus:
- Cover your mouth and nose when you sneeze or cough and teach your children to do the same. Use tissues, not handkerchiefs, and dispose of the tissue after one use. Also, try not to touch your mouth, nose or eyes to avoid spreading germs.
- Keep your distance (at least three feet), if possible, from people who have the flu, because the virus is spread when an infected person coughs or sneezes.
- Wash your hands frequently to reduce your risk of catching a cold or flu. Ordinary soap is sufficient. If soap and water are not available, use an alcohol-based hand cleaner. Antibacterial soaps add little protection, particularly against viruses. In fact, a study suggests that although hand washing with soap reduced the number of pneumonia-related infections in children under five by 50 percent, and there was no difference in the results when antibacterial soap was used instead of regular soap.
- Avoid second-hand cigarette smoke and, if you smoke, try to quit.
- Try to maintain a healthy lifestyle to build your immunity by following a nutritious diet, getting enough sleep, drinking lots of water and minimizing stress. Eating lots of fruits and vegetables, which are rich in antioxidants and other important plant-based chemicals, may help strengthen your immune system.
- If you are sick with flu-like illness, the CDC recommends you stay home for at least 24 hours after your fever is gone (without the aid of fever-reducing medication) except to get medical care or for other necessities.
The herbal remedy echinacea gets a lot of attention for its claims to prevent colds and flu or for minimizing symptoms, if they do develop. However, most studies on this herb find no benefits when it comes to preventing either colds or flu. Studies do find, however, that using echinacea at the beginning of a cold can reduce the length and intensity of the illness. Because there are no standards or quality controls available for supplements like echinacea (including what part of the plant is used in the supplement) and some supplements may cause toxic side effects in large doses, you should always discuss natural remedies with your health care professional before taking them.
There is no evidence that large doses of vitamin C prevent or cure colds or the flu. However, several studies find that zinc lozenges may reduce the length and intensity of colds and flu. Gels and nasal sprays containing zinc recently came under fire from the U.S. Food and Drug Administration. In 2009, the FDA warned consumers not to use three zinc-containing products administered through the nose. Those three products (Zicam Cold Remedy Nasal Gel and Zicam Cold Remedy Swabs for adults and kids) may cause loss of sense of smell.
Facts to Know
1. Influenza, or the flu, is a viral disease of the respiratory tract—the nose, throat, bronchial tubes and lungs. It’s similar to a cold in that both are caused by viruses that infect the respiratory tract, mainly in the winter season, and both can cause symptoms such as coughing and sore throat. A cold is a minor viral infection of the nose and throat, and its primary symptoms are nasal stuffiness, sneezing, runny nose, sore throat and cough. Influenza is more serious, and its major symptoms are high fever, severe aches and pains, cough with mucus production, tiredness and weakness.
2. The flu is highly contagious and is spread though airborne droplets of moisture produced when someone with the flu coughs or sneezes. When you breathe in these germs, you may come down with the flu, generally within one to four days of being exposed.
3. Rates of influenza infection vary among age groups and from one season to another, according to the U.S. Centers for Disease Control and Prevention (CDC).
4. Flu seasons are unpredictable, and in some years, flu outbreaks are severe. The CDC estimates that over a period of 31 years, the number of flu-related deaths has ranged from a low of about 3,000 to a high of about 49,000 Americans.
5. Smoking can increase your risk for the flu and complications from the flu, because smoking injures your airways and damages the cilia, tiny hair-like structures that help keep the airways clear.
6. The most serious, often life-threatening complication of the flu is pneumonia. Other complications include ear infection, bronchitis, dehydration and worsening of chronic conditions, such as congestive heart failure, asthma or diabetes. Croup and a lung disease called bronchiolitis can develop as complications in infants and young children.
7. The influenza virus changes its genetic makeup from year to year, which means that each year you’re likely exposed to a new virus. That’s why you can get the flu every year, and why a flu vaccine is recommended annually. Vaccines, which are made with killed or inactivated virus or viral fragments of those strains, work by forcing the immune system to make antibodies that fight circulating strains of influenza.
8. A flu vaccination is your best chance to protect yourself against the flu. You should get a seasonal flu vaccine every year because the flu vaccine is formulated to keep up with constantly changing flu viruses.
9. The nasal mist flu vaccine, FluMist and FluMist Quadrivalent, are also available from your health care professional. This live-active influenza-virus-type vaccine is recommended for children at least age 2 and adults up to the age of 49. It is effective in preventing the same flu types contained in the inactive injectable versions of the flu vaccine.
10. Prescription antiviral medications, such as oseltamivir (Tamiflu) and zanamivir (Relenza), can be used to treat and prevent the flu if used within 12 to 48 hours of symptom onset or exposure to the virus.
1. Why should I get a flu vaccine? Isn’t there a chance it could give me the flu?
A flu vaccination is your best chance to protect yourself against the flu. People do not get the flu from a flu vaccine, but some people who have immunity against one of the flu proteins contained in the flu vaccine can feel achy for a day or so after the vaccine. This is not the flu.
2. What is the difference between vaccine and antivirals?
Vaccination is the first line of defense against the flu. Adults and children over 6 months of age should have a flu vaccine annually. The flu vaccine helps the body build antibodies that provide you with immunity to the flu. However, the flu vaccine is not 100 percent effective. If you get vaccinated but still come down with the flu, ask your doctor about prescription antiviral medications. Antivirals attack the virus at the source and can help you feel better faster. It is important to remember that antivirals must be taken within 12 to 48 hours of symptom onset for optimal effectiveness.
3. I feel awful. Why won’t my health care professional prescribe antibiotics for me?
Because the flu is a viral infection, it cannot be treated with antibiotics. Antibiotics only kill bacteria and thus are useless against the flu. Taking antibiotics when you don’t need them contributes to antibiotic resistance—an increasingly common and alarming trend where disease-causing bacteria no longer respond to treatment. However, your health care professional can prescribe antiviral medication. If taken within 12 to 48 hours of symptom onset, antivirals can help lessen flu symptoms and the duration of the illness.
4. When I blow my nose, the mucus is greenish. Doesn’t this mean I have an infection and need antibiotics?
A “green” runny nose is not necessarily an indication of a bacterial infection, but it could be. You should check with your health care professional. Persistent green secretions lasting beyond five to seven days can indicate a sinus infection, in which case you may need antibiotics.
5. What medications are available for influenza?
Antiviral medications, such as oseltamivir (Tamiflu) and zanamivir (Relenza), can be prescribed by a health care professional to both treat and prevent influenza. These prescription medications can shorten the duration of flu by one to two days and may reduce complications, including pneumonia and bronchitis. Additionally, if you’ve been exposed to the flu, you can take antiviral medication to prevent coming down with the virus. However, for optimal effectiveness, antiviral medication should be started within 12 to 48 hours of symptom onset or exposure.
Note: Never give aspirin to a feverish child under age 19 who has the flu. Reye’s syndrome is a severe and potentially fatal illness that affects children, following use of aspirin-containing products for viral infections. Reye’s syndrome affects all the organs, most severely the liver and the brain. A child’s risk for developing this disease is markedly lowered by avoiding aspirin use whenever they have a viral infection.
6. How can I tell if I have the flu or a cold?
The symptoms of the flu come on suddenly and include a fever (usually high), headache, muscle aches, severe deep cough with mucus production, tiredness, weakness and chest discomfort. Sometimes it involves a stuffy nose, sneezing and sore throat. A cold, on the other hand, rarely causes a fever, headache, extreme exhaustion or severe aches and pains. Its most prominent symptoms are a stuffy nose, runny nose with clear secretions, sneezing, sore throat and a mild to moderate cough.
7. When do I need to call my health care professional?
It’s important to contact your health care provider if you experience flu symptoms or if you’ve been exposed to the virus. To be effective at treating or preventing the flu, prescription antiviral medications, such as oseltamivir (Tamiflu) and zanamivir (Relenza), should be taken within 12 to 48 hours of symptom onset or exposure. You should call your health care professional if you develop these hallmark flu symptoms: o sudden onset of illness o an illness so bad you feel entirely drained and immobile o a high and persistent fever, over 101 degrees Fahrenheit o severe aches and pains, which can include headache o fatigue and weakness that persists o chest pain other than over your windpipe o coughing up thick or discolored mucus o facial swelling or pain o earache In the meantime, the CDC recommends you stay home and keep away from others as much as possible for at least 24 hours after your fever is gone (without the use of fever-reducing medication) except to get medical care or for other necessities.
8. Does chicken soup really help?
There is nothing medicinal or magical about chicken soup. However, warm liquids can help break up your chest congestion, helping you feel better.
9. I started to feel better, but then my symptoms came back with more severe coughing, chest pain and redevelopment of fever. Did I relapse?
It’s not unusual for the flu to lead to pneumonia. These cases of pneumonia result when bacteria, viruses and other organisms invade the lungs and cause them to become inflamed. The body’s defense mechanisms ordinarily prevent these bacteria from reaching the lungs, but when the defenses are weakened, by the flu, severe pneumonia may develop. Bacterial pneumonia symptoms will appear after you start feeling like you’re recovering from the flu. A brief period of improvement is followed by the sudden onset of: o high fever o shaking chills o chest pain with each breath o a continuous hacking cough that produces thick, yellow-greenish-colored phlegm, or sputum; or sputum with blood in it o extreme weakness and fatigue
You should always check with your health care professional right away if you have these symptoms.
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