Measles: Measles, also known as rubeola, is a highly contagious (easily spread) disease caused by the rubeola virus. Measles is contracted through exposure to other individuals infected with the rubeola virus.
Most individuals in the United States are vaccinated against measles as children.
The incubation period of measles from when the individual is exposed to when the rash develops is generally 14 days, with a range of 7-18 days. The disease is usually contagious (easily spread) to others from four days before until four days after the onset of the rash in the individual. Measles is spread very easily from person to person, when droplets of the virus are circulated through the air from an infected person coughing or sneezing.
The main symptom of measles is an itchy skin rash. The rash often starts on the head and moves down the body. Other symptoms include: fever, cough, runny nose, and conjunctivitis (also known as pink eye).
The World Health Organization (WHO) estimates that more than 30 million individuals are affected each year by measles worldwide, with more than one million deaths.
In response to the widespread use of the measles vaccine, the number of U.S. measles cases has steadily declined over the last 50 years. There were several thousand cases of the measles in 1950 before the measles vaccination was available, but in 2002 there were just 44.
Measles may lead to serious health problems. There is no treatment for measles, but the measles-mumps-rubella (MMR) vaccine can prevent it. Approximately 2% of individuals with measles will die.
Mumps: Mumps is a viral infection that primarily affects the parotid glands. The parotid glands are one of three pairs of salivary glands, located below and in front of the ears. If an individual contracts mumps, swelling due to fluid accumulation can occur in one or both parotid glands.
Mumps is transmitted by direct contact with saliva and discharges from the nose and throat of the infected individual.
The odds of contracting mumps are low in the United States. Mumps was common in the United States until the mumps vaccine was licensed in 1967. Before the vaccine, up to 200,000 cases of mumps occurred each year in the United States. Since then, the number of cases has dropped dramatically.
Rubella: Rubella, also known as German measles or three-day measles, is a contagious viral infection of the respiratory system best known by the distinctive red rash that may appear on the skin of those who contract it. Rubella is neither as infectious nor usually as severe as measles. However, if a pregnant woman contracts rubella, especially during her first trimester, the virus can cause death or serious birth defects in the developing fetus. Rubella is now rare in the United States because most children receive a vaccination against the infection at an early age. However, cases of rubella do occur, mostly in unvaccinated foreign-born adults and unvaccinated children. The disease is still common in many parts of the world, although more than half of all countries now use a rubella vaccine. The prevalence of rubella in some other countries is high, and it is highly recommended by healthcare providers that unvaccinated individuals be vaccinated before going abroad, especially if the individual is pregnant.
CAUSES AND RISK FACTORS
Measles: The cause of measles is the rubeola, or measles virus. The virus resides in the mucus in the nose and throat of the infected person. When the infected individual sneezes or coughs, droplets spray into the air. The infected mucus can land in others' noses or throats when they breathe. The virus can also be transmitted if the individual puts his/her fingers in the mouth or nose after touching an infected surface, such as a handrail or door knob. The virus remains active and contagious on infected surfaces for up to two hours. Measles spreads so easily that anyone who is not immunized will most likely become infected eventually.
Individuals who have not been immunized against measles are the most at risk for infection. Infants are generally protected from measles for six to eight months after birth, due to immunity passed on from their mothers who were previously vaccinated against measles. Older children usually receive measles immunization according to state and school health regulations.
Outbreaks of measles occur most often on college campuses, among young adults who have not been adequately immunized against measles. College campuses increase an individual's chances of exposure to the measles virus due to close quarters.
If an individual has already contracted measles, their body has built up its immune system to fight the infection, and they cannot get measles again. If the individual was born or living in the United States before 1957, they are probably immune to measles, even if they have never been vaccinated. This is because these individuals have lived through several years of measles epidemics and were likely infected by the measles virus. Even if they have never developed symptoms, they have most likely developed what is known as acquired immunity.
Measles is more common in less developed countries, particularly where people suffer from vitamin A deficiency as part of malnutrition. Vitamin A helps improve the immune system and is important in eye health. Travelers with plans to leave the United States should consider the risks of developing measles in other countries and make sure their vaccinations are up to date.
Approximately 30 million measles cases are reported annually. Most reported cases are from Africa.
Mumps: The cause of mumps is the mumps virus, which spreads easily from person to person through infected saliva. If the individual is not immune (either through previous exposure to the mumps or from vaccination), they can contract mumps by breathing in saliva droplets of an infected person who has just sneezed or coughed. Individuals can also contract mumps from sharing utensils or drinks with someone who has mumps.
Rubella: The cause of rubella is a virus that is passed from person to person. It can spread when an infected person coughs or sneezes or it can spread by direct contact with an infected person's respiratory secretions, such as mucus. It can also be transmitted from a pregnant woman to her unborn child. Rubella is a contagious condition. Individuals with the virus may spread it to others from one week before the onset of the rash until about one to two weeks after the rash disappears.
SIGNS AND SYMPTOMS
Measles: Measles symptoms usually show up in two stages. The first stage begins with a runny nose, cough, and a slight fever. The individual's eyes become red and sensitive to light as the virus spreads.
The second stage begins after three to seven days. The fever reaches 103-105
Fahrenheit. Red spots with bluish-white centers found inside the mouth on the inner lining of the cheek appear. These are called Koplik's spots. The rash usually starts on the face and then spreads to the chest, back, and arms and legs, including the palms and soles of the feet. The rash lasts for four to seven days and can be very uncomfortable. Severe itch is common. Koplik's spots can also develop on other sensitive areas of the body, such as the genitals.
Mumps: About one in five people infected with the mumps virus have no signs or symptoms at all. When individuals do have signs and symptoms, they usually appear about two to three weeks after exposure to the virus and may include: swollen, painful salivary glands on one or both sides of the face; pain with chewing or swallowing; fever; and weakness or fatigue. The primary sign of mumps is swollen salivary glands that cause the cheeks to puff out.
Often the signs and symptoms of rubella are so mild that they are difficult to notice, especially in children. If signs and symptoms do occur, they generally appear between two and three weeks after exposure to the virus. They typically last about two to three days and may include: a mild fever of 102 degrees Fahrenheit or lower; headache; stuffy or runny nose; inflamed, red eyes; enlarged, tender lymph nodes at the base of the skull, the back of the neck, and behind the ears; aching joints, especially in young women; and a fine, pink rash that begins on the face and quickly spreads to the trunk and then the arms and legs. The rash may itch and last for up to three days.
Health complications from measles are relatively common, ranging from relatively mild and less serious diarrhea, to pneumonia and encephalitis (inflammation of the brain). Complications are usually more severe amongst adults who catch the virus.
Post measles blindness: Post measles blindness occurs in developing countries in 1% of all children with measles and is caused mainly by malnutrition. Measles blindness is the single leading cause of blindness among children in low income countries, accounting for an estimated 15,000-60,000 cases of blindness per year worldwide.
Ear infection: Another possible complication from measles is ear infection. Measles can lead to an ear infection in nearly one out of every 10 children with the disease.
Encephalitis: About one in 1,000 people with measles develops encephalitis, an inflammation of the brain caused by a viral infection, which may cause vomiting, convulsions, and, rarely, coma. Encephalitis can occur closely following the contraction of measles or it can occur years later during adolescence as a result of a slow virus infection. The late form, called Dawson's encephalitis, is rare.
Upper respiratory problems: Pneumonia is another possible complication. As many as one in 15 people with measles get pneumonia, which can be life-threatening. Bronchitis, laryngitis, or croup are complications resulting from inflammation of the voice box or inflammation of the inner walls that line the main air passageways of the lungs caused by measles.
Diarrhea/vomiting: Diarrhea and vomiting are complications that are more common in infants and small children.
Pregnancy: Measles may also cause problems during pregnancy. Pregnant women need to take special care to avoid measles, because the disease can cause miscarriage, premature labor, or babies with low birth weights.
Low platelet count: Measles may cause a low platelet count. Platelets are the type of blood cells that are essential for blood clotting.
The risk of complications varies with age. Infants under the age of two years and adults over the age of 20 have a 20-30% chance of complications, often requiring hospitalization. School-age children have a 3-5% chance of developing serious complications. In developing countries, where malnutrition and vitamin A deficiency are common, measles has been known to kill as many as one out of four people who develop measles.
Complications of mumps are potentially serious, but rare.
Orchitis: Orchitis is an inflammatory condition that causes swelling of one or both testicles. Orchitis is painful, but it rarely leads to sterility (the inability to father a child).
Pancreatitis: Pancreatitis is swelling of the pancreas. Signs and symptoms of pancreatitis include pain in the upper abdomen.
Encephalitis: A viral infection, such as mumps, can lead to encephalitis or inflammation of the brain. Encephalitis can lead to neurologic problems and become life-threatening. Although it is serious, encephalitis is a rare complication of mumps.
Meningitis: Meningitis is infection and inflammation of the membranes and fluid surrounding the brain and spinal cord. Meningitis can occur if the mumps virus spreads through the bloodstream to infect the central nervous system. Like encephalitis, meningitis is a rare complication of mumps.
Others: Pain in the lower abdomen in women may be a symptom of this problem. Fertility does not seem to be affected. In rare cases, mumps can cause hearing loss, usually permanent, in one or both ears. Nausea and vomiting may also occur.
About 70% of adult women with rubella experience arthritis in the fingers, wrists, and knees, generally lasting for about one month. In rare cases, rubella can cause an ear infection (otitis media) or inflammation of the brain (encephalitis). However, if an individual is pregnant when rubella is contracted, the consequences for the unborn child may be severe. Up to 85% of infants born to mothers who had rubella during the first 11 weeks of pregnancy develop congenital rubella syndrome. This can cause a variety of problems, including growth retardation, cataracts, deafness, and heart defects at birth. The highest risk to the fetus is during the first trimester, but exposure later in pregnancy is also dangerous. Fortunately, an average of fewer than 10 babies is born with congenital rubella syndrome in the United States each year. Rubella occurs most frequently in adults who never received vaccinations, usually because they came from other countries where the MMR vaccine isn't widely used.
Measles: A doctor can usually diagnose measles based on the disease's characteristic rash as well as the small, bright red spots with bluish-white centers on the inside lining of the cheek. Because measles is so uncommon in the United States today, a doctor may take a blood sample from the patient to confirm whether the rash is truly measles. The individual's blood may be tested for the measles virus.
Mumps: If a doctor suspects that an individual has mumps, a virus culture or a blood test may be needed. The blood test can detect mumps antibodies, which indicate whether the individual had a recent or past infection. Most individuals who have mumps will be protected (immune) from getting mumps again. A small percentage of individuals who have been exposed to the mumps virus may be reinfected with mumps and have a milder form of the illness.
Rubella: The rubella rash can look like many other viral rashes. Doctors usually confirm rubella with the help of laboratory tests to detect the virus. Individuals may have a virus culture or a blood test, which can detect the presence of different types of rubella antibodies in the blood. These antibodies indicate whether the individual has had a recent or past infection or a rubella vaccine (MMR).
Measles: Healthcare providers recommend that individuals with measles maintain bed rest. Keeping the room relatively dark is recommended if there is sensitivity to light. Also, the removal of eye secretions with warm saline or water is important. It is also important not to rub the eyes or scratch the skin. It is recommended to use anti-itching (antipruritic) medications (such as Caladryl©) and tepid sponge baths where needed. A cool mist vaporizer can be used to relieve cough.
Non-immunized infants may be given the measles vaccination within 72 hours of exposure to the measles virus in order to provide protection against the disease. Pregnant women, infants, and individuals with weakened immune systems who are exposed to the virus may receive an injection that may help boost the immune system, called immune serum globulin. Immune serum globulin consists of proteins (antibodies) that can fight off infection. Antibodies are made by the body to fight off foreign substances, such as the measles virus. When given within six days of exposure to the virus, these antibodies can prevent measles or make symptoms less severe. A doctor should be consulted if an individual thinks his/her children have been exposed to the measles.
Over-the-counter (OTC) medications to relieve a fever, such as acetaminophen (Tylenol©), or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil©), may be used. Healthcare professionals recommend not giving aspirin to children because of the risk of Reye's syndrome, a rare but potentially fatal disease.
Reye's syndrome is a potentially fatal disease that causes numerous detrimental effects to many organs, especially the brain and liver. It is associated with aspirin consumption by children with viral diseases such as measles.
Antibiotics are a type of prescription medication that may be prescribed by a doctor if the individual develops a bacterial infection while infected with the measles. Possible bacterial infections include pneumonia or an ear infection. Antibiotics are not used to treat the measles infection, as measles is a viral infection.
Isolation is another part of treatment. Adults and children should be isolated at home until the fifth day of rash. Because measles is highly contagious from about four days before to four days after the rash breaks out, individuals with measles should not participate in activities in which they interact with other people during this period, such as playing with others. It may also be necessary to keep non-immunized people, including siblings and friends, out of the infected individual's house. A doctor can help talk to the families of those infected with measles about isolation issues. Any individual that has not been exposed to the measles virus or has not had a vaccination should be vaccinated.
Mumps: Because mumps is caused by a virus, antibiotics are not effective. Like most viral illnesses, a mumps infection must simply run its course. Fortunately, most children and adults recover from an uncomplicated case of mumps within two weeks. Symptoms can be relieved with OTC medications such as pain relievers.
Rubella: Treatment will not shorten the course of rubella infection, and symptoms are so mild that treatment usually is not necessary. However, doctors often recommend isolation from others, especially from pregnant women, during the infectious period. If rubella is contracted while pregnant, immune globulin therapy given into the veins (IV) may be prescribed to boost immunity and fight off the infection. This medication can reduce symptoms but does not eliminate the possibility of the baby developing rubella. Symptoms can be relieved with OTC medications such as pain relievers and anti-itch medications such as Caladryl©.
Note: Currently, there is little information available on the safety and effectiveness of integrative therapies for the prevention or treatment of measles, mumps, or rubella. The integrative therapies below with unclear or conflicting scientific evidence have been studied for antiviral effects in general and have not been studied in measles, mumps, or rubella specifically.
Strong scientific evidence:
Vitamin A: Vitamin A should be given to children diagnosed with measles in areas where vitamin A deficiency may be present. Giving vitamin A supplements to children with measles has been shown to be beneficial, by decreasing the length and impact of the disease. Side effects such as diarrhea, pneumonia, and death have been reduced by vitamin A. Measles treatment should be performed under the care of a doctor.
Vitamin A toxicity, or hypervitaminosis A, is rare in the general population. Vitamin A toxicity can occur with excessive amounts of vitamin A taken over short or long periods of time. Consequently, toxicity can be acute or chronic. An infant with acute vitamin A toxicity can develop a bulging fontalle (the soft spot on the head). Adults experience less specific symptoms such as headache, dizziness, fatigue, malaise, blurry vision, bone pain and swelling, nausea, and/or vomiting. Severe toxicity can lead to eye damage, high levels of calcium, and liver damage. Individuals with liver disease and those with a high alcohol intake may be at an increased risk for hepatotoxicity while taking vitamin A supplementation. Smokers who consume alcohol and beta-carotene may be at an increased risk for lung cancer or cardiovascular disease.
The U.S. Recommended Daily Allowance (RDA) for adults has been established by the U.S. Institute of Medicine of the National Academy of Sciences. Recommendations are: 900 micrograms per day (3,000 IU) for men; and 700 micrograms per day (2,300 IU) for women. For pregnant women 19 years and older, 770 micrograms per day (2,600 IU) is recommended. For lactating women 19 years and older, 1,300 micrograms per day (4,300 IU) is recommended.
Pediatric recommendations are: for children one to three years-old, 300 micrograms per day (1,000 IU); for children 4-8 years-old, 400 micrograms per day (1,300 IU); for children nine to 13 years-old, 600 micrograms per day (2,000 IU). For pregnant women between 14-18 years-old, 750 micrograms per day (2,500 IU) is recommended; for lactating women between 14-18 years-old, 1,200 micrograms per day (4,000 IU) is recommended.
Unclear or conflicting scientific evidence:
Alizarin: Limited available evidence suggests that alizarin may be of benefit in the treatment of viral infections. Additional research is needed in this area.
Avoid if allergic or hypersensitive to alizarin or any plants in the Rubiaceae family. Alizarin may be toxic and should not be handled for long periods of time, rubbed in the eyes, or eaten. Avoid if pregnant or breastfeeding.
Blessed thistle: Laboratory studies report no activity of blessed thistle against herpes viruses, influenza, or poliovirus. Effects of blessed thistle (or chemicals in blessed thistle called lignans) against HIV are not clear. Human research of blessed thistle as a treatment for viral infections is lacking.
Blessed thistle is generally considered to be safe when taken by mouth in recommended doses for short periods of time, with few reported side effects such as birth defects, bleeding, breathing problems, bruising, cancer of the nose or throat, increased production of stomach acid, itching, kidney disease, liver toxicity, skin rash, stomach discomfort, stomach ulcers, and vomiting. Allergic reactions to blessed thistle including rash may occur, as well as cross-sensitivity to mugwort and Echinacea. Cross-reactivity may also occur with bitter weed, blanket flower, Chrysanthemum, coltsfoot, daisy, dandelion, dwarf sunflower, goldenrod, marigold, prairie sage, ragweed or other plants in the Asteraceae/Compositae family. Avoid if pregnant or breastfeeding.
Cranberry: Limited laboratory research has examined the antiviral activity of cranberry. Further research is warranted in this area.
Avoid if allergic to cranberries, blueberries, or other plants of the Vaccinium species. Sweetened cranberry juice may affect blood sugar levels. Use cautiously with a history of kidney stones. Pregnant and breastfeeding women should avoid cranberry in higher amounts than what is typically found in foods.
Sorrel: There is currently not enough evidence on the proposed antiviral effects of sorrel. More research is needed.
Avoid large doses of sorrel because there have been reports of toxicity and death. This may be because of the oxalate found in sorrel. Many sorrel tinctures contain high levels of alcohol and should be avoided when driving or operating heavy machinery. These sorrel formulations may cause nausea or vomiting when taken with the prescription drugs metronidazole (Flagyl©) or disulfiram (Antabuse©). Avoid if pregnant or breastfeeding.
Turmeric: Turmeric is a perennial plant native to India and Indonesia, and it is often used as a spice in cooking. Based on early research, turmeric may help treat various viral infections. However, reliable human studies are lacking in this area.
Well-designed trials are needed.
Avoid if allergic or hypersensitive to turmeric (curcumin), yellow food colorings, or plants belonging to the Curcuma or Zingiberaceae (ginger) families. Use cautiously with a history of bleeding disorders, immune system deficiencies, liver disease, or gallstones. Use cautiously with blood thinners (e.g. warfarin). Use cautiously if pregnant or breastfeeding.
A vaccination against measles became available in 1963, and an improved measles vaccine became available in 1968. A combination measles-mumps-rubella (MMR) vaccine became available in 1971, and a combination measles-mumps-rubella-varicella (MMRV) vaccine became available in 2005.
The MMR vaccine contains live virus particles of the three viruses, which have been modified (attenuated) to stop them from producing the full effects of the disease. The vaccine is given by injection into the thigh or upper arm. It has been found that a booster in already immunized children before they enter school makes it more likely that the child will be properly protected. After initial immunization, a booster injection or booster dose is essentially a re-exposure to the MMR vaccine, intended to increase the individual's immunity back to protective levels against measles, mumps, and rubella. There is no risk of someone who has been vaccinated infecting other people with the viruses. The MMR vaccine is recommended for: all children and adolescents, beginning at age 12-15 months; adults born in 1957 or later without evidence of vaccination or evidence of immunity (antibodies in the bloodstream); healthcare workers, regardless of age; immigrants to the United States from other countries; and non-pregnant women of childbearing age without other evidence of immunity to rubella.
All children and adolescents should receive two doses. Doses are given no less than four weeks apart. Most children vaccinated at 12-15 months should receive the second dose at age four to six years. All older children and adolescents should receive the second dose at the next available opportunity, as long as there has been a four week interval since the previous dose.
The first dose of MMR vaccine produces immunity to measles in 95-98% of children vaccinated. The reason for the second dose is to protect those persons who did not become immune after one dose. After two doses of measles vaccine, 99% of persons become immune to the disease.
It is also recommended by healthcare professionals that a second dose of MMR for any adult born in 1957 or later who: is a student in a post-secondary educational institution (college); is an emigrant from another country; is a healthcare worker; plans to travel internationally; is exposed to measles in an outbreak setting; was previously vaccinated with killed measles vaccine; and was vaccinated with an unknown type of measles vaccine that was found ineffective during 1963-1967.
Between 2- 5% of individuals do not develop measles immunity after the first dose of vaccine due to variances in individual immunity. The second dose is to provide another chance to develop measles immunity for persons who did not respond to the first dose. It is also recommended that unvaccinated healthcare workers without other evidence of immunity to mumps receive one dose of live virus mumps vaccine (may be given as MMR).
Individuals who have documentation of receiving live measles vaccine in the 1960s do not need to be revaccinated. Persons who were vaccinated prior to 1968 with either inactivated (killed) measles vaccine or measles vaccine of unknown type should be revaccinated with at least one dose of live attenuated measles vaccine. This recommendation is intended to protect persons who may have received killed measles vaccine, which was available in 1963-1967 and was not effective. Live (also called attenuated) vaccines contain weakened forms of the organism that cause the disease, such as the MMR vaccination. Killed (or inactivated) vaccines are manufactured from dead organisms, such as the polio vaccine.
The use of a live vaccine for vaccinations causes side effects that can be similar to a very mild case of measles without complications such as pneumonia. More than 80% of children and adults will have no side effects at all.
Fever is the most common side effect of vaccination, occurring in 5-15% of vaccine recipients. About 5% of persons develop a mild rash. When they occur, fever and rash appear seven to 10 days after vaccination. About 25% of adult women receiving MMR vaccine develop temporary joint pain, although this symptom is related to the rubella component of the combined vaccine. Joint pain only occurs in women who are not immune to rubella at the time of vaccination. MMR vaccine may cause low platelet count at the rate of about one case per 30,000-40,000 vaccinated people.
More severe reactions to the MMR vaccine, including allergic reactions, are rare. About one person per million develops inflammation of the brain, which is probably caused by the measles vaccine virus. Symptoms may include nausea, vomiting, blurred vision, and headaches.
Transmission of the measles vaccine virus does not occur from a vaccinated person, including those who develop a rash. Therefore, healthcare professionals recommend no special precautions (such as isolation) in these individuals.
Individuals who experience a severe allergic reaction (such as hives, swelling of the lips, tongue, throat, or difficulty breathing) following the first dose of MMR should not receive a second dose. This reaction can be life-threatening, and medical attention should be sought immediately. Symptoms of a severe allergic reaction include difficulty breathing and loss of consciousness. Anyone that is aware that they are allergic to an MMR component (gelatin and neomycin) should not receive this vaccine.
As with all live virus vaccines, women known to be pregnant should not receive the MMR vaccine and pregnancy should be avoided for four weeks following vaccination with MMR. Live vaccines are usually not given in pregnancy due to the potential risk of causing the disease in the fetus. However, women who are breastfeeding can be vaccinated. Children and other household contacts of pregnant women should be vaccinated according to the recommended schedule.
Individuals with severe immune dysfunction should not be given MMR vaccine, as the live vaccine in these individuals may cause illness. This includes those with conditions such as congenital (at birth) immunodeficiency, acquired immunodeficiency syndrome (AIDS), leukemia, lymphoma, cancer, and those receiving treatment for cancer with drugs, radiation, or large doses of corticosteroids (such as prednisone). Household members of individuals with poor immunity should be vaccinated according to the recommended schedule.
Although individuals with AIDS or human immunodeficiency syndrome (HIV) infection with signs of serious immune deficiency should not be given MMR, persons with HIV infection without symptoms can and should be vaccinated against measles. If an individual has HIV without symptoms and was born before 1956, it is recommended by healthcare professionals to ask for an MMR vaccination.
In the past it was believed that persons who were allergic to eggs would be at risk of an allergic reaction from the vaccine because the vaccine is grown in tissue from chicken embryos. However, recent studies have found that this allergy rarely occurs. Allergy tests can be performed on the individual prior to using the vaccine to test if an allergy is present. Therefore, MMR may be given to egg-allergic individuals.
Although there have been some links between autism and the administration of vaccines containing mercury as a preservative (such as the MMR vaccine), the weight of currently available scientific evidence does not support the hypothesis that vaccines cause autism.
Because the risk of exposure to measles among travelers can be high, all travelers leaving the United States should make sure that they are vaccinated against measles, mumps, and rubella. If the individual has a weakened immune system, such as with acquired immunodeficiency syndrome (AIDS) or pregnancy, he/she should talk with a healthcare provider before traveling to countries where the MMR is not required by its citizens.
This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).
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