Tips For Staying Healthy During Flu Season
NEAL CONAN, host:
This is TALK OF THE NATION. I'm Neal Conan in Washington.
Every fall, we prepare for the seasonal flu, which can be expected to claim around 35,000 American lives every year, about 100 people a day. And this year there is also swine flu, the H1N1 virus that arrived last spring and never really went away. Since April, a million of us have been infected by it, and it continues to spread, a thousand dead so far, 76 of them children.
Vaccines for both kinds of flu have been developed and are in the process of distribution. By winter, the height of the flu season, the Centers for Disease Control and Prevention believes there will be enough for everyone. But many still have questions about this flu, the vaccine, how much they should worry, and what kinds of preparations are prudent.
Today, our guest is one of the world experts on infectious disease, Dr. Anthony Fauci, director of the National Institute of Allergies and Infectious Diseases. So if you have questions for him, give us a call: 800-989-8255. Email us: email@example.com. You can also join the conversation on our Web site. That's at npr.org. Click on TALK OF THE NATION.
Later in the program, a reporter's notebook with Quil Lawrence in Baghdad. But first, Anthony Fauci joins us from the National Institutes of Health in Bethesda, Maryland. And doctor, nice to have you back on the program.
Dr. ANTHONY FAUCI (Director, National Institute of Allergies and Infectious Diseases): It's good to be here.
CONAN: I wonder, when was the first time you heard about this H1N1 swine flu?
Dr. FAUCI: Actually, when it was first noticed in California and Mexico. So that was right in the beginning of April of this year, was the first time we knew that we were dealing with a brand new influenza virus.
CONAN: And how does that - how does it get identified like that?
Dr. FAUCI: Well, what happened is that individuals - first in Mexico and then in California - had a flu-like illness and at the time, they were doing some new tests on trying to determine what subgroup or classification of influenza it was. And it didn't code to any of the known influenzas that we were tracking.
So it turned out, when you did sufficient molecular analysis of it, that it was actually an influenza, an A influenza, and it had the designation H1N1, which is the way we designate, by the letter H and N. But it was an H1N1 that we had never before seen in the human species. So that's how we got it.
CONAN: And how unusual is it that you get these novel kinds of viruses?
Dr. FAUCI: Well, it's unusual to get the evolution or the emergence of a completely novel virus, but it's even more unusual for that novel virus to be able to jump species and replicate and spread so efficiently in humans the way this particular 2009 H1N1 has. Getting new viruses and seeing them emerge as you do surveillance in animals is not that unusual, but the unusual aspect was what it has been doing.
CONAN: And as I understand it, this is - we call it swine flu, but it also has genetic components from other animals, including us.
Dr. FAUCI: Yes, it does. It has genetic components from birds, and genetic components from humans and from swine. It had been in swine for about 10 years.
What you could do when you look at the evolution of viruses, you can get a good mapping of where that virus has been hanging out for a period of time prior to your identification of it.
So clearly, this virus was in pigs for a considerable period of time -they estimate about 10 years - before it jumped species and got into humans.
CONAN: At this stage, we can't get it from pigs. And of course, it's perfectly safe, in this respect, to eat pork and that sort of thing. So that's what - some people object to the name swine flu. But I wonder, should we expect it to mutate again?
Dr. FAUCI: Well, you always have the possibility, particularly with influenzas, that they will continue to mutate. Right now, this virus, interestingly, is virtually identical to what it was when we first isolated it in April. It has not changed substantially at all.
It is the same virus, which is very good news for us, because we made a vaccine, which as you mentioned earlier in the show, is in the process of being distributed now. And that vaccine was perfectly matched to what we saw in April of this year, which is exactly the virus that's currently circulating here in the United States now and throughout the world. So the good news is, we have a very good match with the vaccine.
CONAN: And as I'm sure will come as no surprise to you, you're going to get questions of people skeptical of this vaccine and of vaccines in general, and that was the point, before we get to people's questions - they have a lot of them. But before we go to those questions, how much skepticism do you face all the time from the seasonal flu vaccine? Do people say, wait a minute; I'm not so sure about this?
Dr. FAUCI: Well, you know, there's always skepticism about vaccines and some of it, I mean, is understandable but not really justified by the scientific facts.
The seasonal flu vaccine has a track record over decades, given to hundreds of millions of people, to be very safe. Its safety record is really very, very good. It's effective in preventing seasonal flu.
This is particularly important for elderly individuals because every year, as you had mentioned earlier, about 36,000 people die each year of seasonal flu. About 92 percent of them are elderly individuals, and the majority of those - when I say elderly, I mean older than 65 - and the majority of those are older than 80 years old.
So getting vaccinated, particularly if you're an elderly individual, is important. The reason this flu is a bit different is that it's spreading efficiently, but when it does cause serious disease, it disproportionately does that in younger individuals as opposed to older individuals.
CONAN: Including some who are perfectly healthy.
Dr. FAUCI: Exactly. About - of the deaths that we've had so far, about 70 percent of them are among individuals who have underlying medical conditions that would predispose them to the complications of influenza, but about 25 or 30 percent of them are people who are otherwise completely well.
CONAN: Well, let's get callers in on the conversation. Our guest is Dr. Anthony Fauci, director of the National Institute of Allergies and Infectious Diseases at NIH up in Bethesda, Maryland. 800-989-8255. Email is firstname.lastname@example.org. Joe's on the line from Cleveland.
JOE (Caller): Hello?
CONAN: Hi, Joe, you're on the air. Go ahead.
JOE: Hi. I just have one question. I've heard different things about the vaccine. Is it made with the live viruses or live cultures, as opposed to dead cultures that all the other vaccines were made with? I'll take my question off the air.
CONAN: Thanks, Joe.
JOE: Thank you.
Dr. FAUCI: OK, good question. The flu vaccines that we distribute seasonally, and that we are and will be distributing for the H1N1 now and over the subsequent months, there are two types.
One is what's called a completely inactivated vaccine. What you do is, you grow the virus in eggs, you purify it, and you either kill it or inactivate it and take some of the purified components and give it to an individual. That's called the inactivated vaccine.
The other is an attenuated, or weakened, live version of the virus. You do not completely kill it. You weaken it so that it can't cause disease, and you administer it by spraying it into the nose. It's called FluMist.
The vast majority of the vaccines that are going to be distributed in this country are of the inactivated or kill type, but there will be doses of the FluMist available for people from 2 years old to 49 years old, with some exceptions in that group.
CONAN: Let's go next to Michelle, Michelle with us from Southington, Connecticut.
MICHELLE (Caller): Yes. My doctor, my pediatrician, is not recommending right now that we get the swine flu vaccine for our kids, ages 7 and 5. And I was just wondering if you can address some of the concerns regarding the side effects, or the Guillain-Barre Syndrome that they've been referring, to that happened in the '70s.
Dr. FAUCI: Well, I would have to disagree with your pediatrician, with all due respect, because younger individuals, particularly children, are those who are more susceptible to getting infected and to the serious complications.
What most people don't appreciate is that this vaccine is strikingly similar to the seasonal flu vaccine that we have a very good track record with over decades, administering it to hundreds of millions of people.
This is what we call a strain change. The virus is a bit different, but the vaccine is made in exactly the same way. If this virus were identified earlier than April, let's say in November or so, it would have been incorporated into the seasonal flu vaccine, and I doubt whether people would be making any kind of a fuss of it being quote, a new vaccine. But just because of the timing and the fact that it's given as a separate vaccine, there's this understandable but not really scientifically based concern that somehow, this has risks associated with it that are not associated with the seasonal vaccine.
MICHELLE: Right. We've always been firm believers in the seasonal vaccine and we've always gotten it and, you know, I wanted to be first in line to get the swine flu vaccine for my kids. And you know, they just were saying that they were kind of holding off and, you know, kind of concerned about the safety and efficacy of it before the actual - before everyone started actually getting it in the States here, and I was just wondering if you had any information about how, I guess, Australia and some of the other continents had received it already and how the kids were faring with the shot there.
Dr. FAUCI: Well, Australia has not received it and administered before we did. They went into their flu season. They just ended, because they're in the Southern Hemisphere, but they did not get the H1N1 vaccine prior to us.
We did clinical trials on it. There were no safety red flags at all, and as I want to re-emphasize, not only were there no safety problems with the ones that we did in the clinical trial over the past couple of months, but as I mentioned, this is very similar to the seasonal flu vaccine in which we have decades of experience with safety.
With regard to efficacy, we've shown in the clinical trials that this vaccine induces a response that is very predictive of protection. So we have confidence that if administered, that this will be an effective vaccine in the same way that the seasonal flu vaccine is effective.
CONAN: If Michelle or any of the other callers wanted to suggest to their pediatricians or their other doctors where they should go to get information, where would that be, at NIH or CDC?
Dr. FAUCI: Well, the CDC has a phenomenal Web site. You can go flu.gov, or you can go right onto the cdc.gov Web site, and you can get all the information that you need about influenza in general and specifically about the H1N1, including the vaccination information.
CONAN: Michelle, good luck.
MICHELLE: Thank you very much.
CONAN: Bye-bye. Here's an email from Deb in Marshall, North Carolina. My boyfriend has no spleen, so his immune system is a bit compromised. Should he get the flu vaccine? He's 40 years old.
Dr. FAUCI: Yes. People who have immunological compromise at an age of a young adult less than 65 years old; individuals, for example, between 18 and 64 who have compromised immune system, they should get the H1N1 as a one-of-five target groups of individuals.
In addition, since your boyfriend doesn't have a spleen, he should make sure that he gets the pneumococcal vaccine for pneumococcal pneumonia.
CONAN: Our guest is Dr. Anthony Fauci, one of the world's experts on infectious disease. If you have questions for him, give us a call: 800-989-8255. Email is email@example.com. We're talking about flu, both the H1N1 swine flu and the seasonal flu, which should be arriving shortly, much to your distress. Give us a call again: 800-989-8255. Email: firstname.lastname@example.org. Stay with us. I'm Neal Conan. It's the TALK OF THE NATION from NPR News.
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CONAN: This is TALK OF THE NATION. I'm Neal Conan in Washington. Many of us know someone who's suffered from swine flu, if we haven't been diagnosed ourselves. Vaccines are available, but H1N1 continues to spread. Today, facts on the flu. Dr. Anthony Fauci is taking your questions. He directs the National Institute of Allergies and Infectious Diseases.
If you'd like to talk with him about swine or seasonal flu, about prevention and testing and about the vaccines: 800-989-8255. Email us: email@example.com. You can join the conversation from our Web site. That's at npr.org. Click on TALK OF THE NATION.
Email from Laura in Cincinnati: What can I say to other parents at my child's school who swear they have been adversely affected by vaccines in the past and don't believe in vaccines, and won't have their child vaccinated? I believe in vaccinations and want my child to be surrounded by others who have been vaccinated. Dr. Fauci?
Dr. FAUCI: Well, if you're talking about things like influenza vaccine, the track record of safety for influenza vaccine is extraordinarily good. If you look at the balance, as we all should, of the risk versus the benefit of any medical intervention, it is very clear that the risk of the vaccine is extraordinarily low, almost unmeasurable when you're dealing with the influenza, for which we have great experience with. And the risk, particularly among young people, of not only getting sick with this influenza but also the possibility of serious illness - and as I mentioned earlier, one of the issues with this virus is that it disproportionately affects the young. And when there are serious complications, it is generally among young individuals.
We're seeing that in children who are getting hospitalized, and there are deaths in children that could have been avoided with a vaccine. Pregnant women are particularly susceptible to the complications of influenza. In fact, there have been 28 deaths among pregnant women and in those situations, it could have been avoided. Pregnant women are six times more likely to get the complications of influenza when they're infected as are non-pregnant people.
CONAN: Let's go to James, James with us from Wichita.
JAMES (Caller): Hello, Dr. Fauci, great article in the New York Times. I wanted to read you a quick article from the University of Southern California by Caleb Finch. His colleagues reported that men who were in their mother's womb during the September peak of the 1918 swine flu pandemic have been 23 percent more likely to have had heart attacks since they turned 60 than siblings who were either not born or not conceived. The risk is 17 percent greater for women.
In that same group from 1918, babies whose mothers had ordinary flu in early pregnancy are seven times as likely to develop schizophrenia. This means a lot to me, because a good friend of mine had the swine flu, developed pneumonia, and he died three weeks ago, and I just can't hardly live without him.
CONAN: So James, numbers are hard on the radio. Is what you're saying, according to that summation of that article, that women who are pregnant and get the flu, their children are much more likely to develop a lot of problems later in life.
JAMES: Growth problems, seven times more likely to get schizophrenia, actually shorter, stunted growth, and it's all blamed on the chemical cytokines.
CONAN: All right, Dr. Fauci, is he on the right page there?
Dr. FAUCI: Well, I mean, I'm not so sure about the numbers or percentages, but I can say in general - I mean, I haven't seen that article, and I don't want to comment on it. But in general - and this relates to what I was saying before about pregnant women. When pregnant women get infected with influenza, they are more likely to develop serious disease. And whenever a woman who's pregnant gets serious infection, it is not good for the woman, and it certainly is not good for the fetus. And that's the reason why I think that some of the numbers that the gentleman mentioned are certainly feasible and possible that that is, indeed, the case. I'm not familiar with those specific numbers but clearly, that's one of the reasons why we want to protect pregnant women with the vaccine - not only for the sake of the woman, obviously, but also for the sake of the fetus.
CONAN: And James, we're sorry about your friend's death. I know those are very hard to take.
JAMES: I am, too, because I had enough intelligence to tell him what was going to happen, but he denied everything. He had a pain in his chest. He just said it was a pulled muscle. I could have helped him but please, I hope I help other people. Don't fool around. Get a vaccination, please. Thank you.
CONAN: James, thanks very much. Bye-bye. Let's go to a tweet, this from Dreamboat514. My 17-year-old has an IgA - capital I, small G, capital A - deficiency. Is a quarantine until seven days after vaccine reasonable? Should we also take other measures?
Dr. FAUCI: What I would do with the daughter is, I would get the inactivated vaccine, and after an inactivated vaccine, you wouldn't have to quote, quarantine your daughter at all. It would be perfectly fine to have her go out into the population after she gets the vaccination.
CONAN: And the inactivated is the shot?
Dr. FAUCI: That is the shot, yes.
CONAN: And what's an IgA deficiency?
Dr. FAUCI: An IgA deficiency is a relatively common immunodeficiency that occurs - probably the most common of the immunodeficiencies, where one particular type of an antibody that you have, which is the protein in your body that protects you against infection, is deficient. And in some of those individuals, they may have an increased propensity to infection. In many individuals, it's a relatively benign disease.
CONAN: Here's a tweet from jamiemcq15. Are there any updates on distribution of the vaccinations? I'm six months pregnant. Do I get to be first in line?
Dr. FAUCI: Well, first of all, being six months pregnant, you should get vaccinated. You're among the five priority groups that need to be vaccinated. I would check with your local and state health departments as to what the availability of vaccines are. But as a pregnant woman, you should be given the high priority to get the H1N1 as well as the seasonal flu vaccine.
CONAN: Let's go to Toni(ph), and Toni's calling from Cincinnati.
TONI (Caller): Yes, hi, really enjoying your show.
CONAN: Thank you.
TONI: Hello, Doctor.
Dr. FAUCI: Hi.
TONI: My question is: With a vaccination, can you still get the virus?
Dr. FAUCI: Well, vaccines are not 100 percent effective. So if you get vaccinated, there is a much, much greater chance that you won't get infected with influenza than if you did not get vaccinated. But it's never 100 percent. So in answer to your question specifically - if you get vaccinated, can you still get the virus - the answer is yes, but at a much, much, much lower probability than if you did not get vaccinated.
TONI: OK, well, thank you very much.
CONAN: Thanks for the call, Toni. What are the symptoms, by the way? What should we look for?
Dr. FAUCI: Well, when you're talking about influenza, it has some classical symptoms: fever, headache, muscle aches, cough. And when it gets serious, you can get difficulty breathing and get some - what we call pneumonic problems, which is you can get pneumonia, either a viral pneumonia or a secondary pneumonia. But it's fundamentally feeling awful, with a headache, chills, aches, sore throat and respiratory symptoms.
CONAN: Let's go to Colin, Colin with us from Marietta - Marietta, Ohio. Excuse me, I almost put you in the wrong state there.
COLIN (Caller): Oh, thank you. My question was, is there any contraindications to the vaccine, to taking it? Are there any pre-existing conditions that I should be aware of that would not allow me to take the vaccine?
Dr. FAUCI: Well, first of all, the one that's the most prevalent one is that if you have an allergy to eggs, since the virus is grown in eggs, you would not want to take the vaccine.
When you're talking about the injectable vaccine versus the live, attenuated FluMist, there are certain individuals who should not take the FluMist. It's only approved for people 2 years old to 49 years old. But if you are - have an immunosuppressed state or if you are pregnant or if you have asthma or a respiratory condition, you should take the injectable and not the FluMist.
But the overarching one of the contraindications is if you have an allergy to what might be a residual product in the vaccine, which is egg proteins.
CONAN: Are there other vaccines available for people who do have egg…
Dr. FAUCI: Unfortunately not because all of the influenza vaccines, both the killed or inactivated vaccine as well as the attenuated FluMist, are all made in eggs.
CONAN: All right, Colin, thanks very much.
COLIN: Oh, thank you.
CONAN: Bye-bye. Let's go next to Amy, Amy in Iowa City.
AMY (Caller): Hello?
CONAN: Hi, Amy. You're on the air.
AMY: Hi. I'm a college professor, and I think that most of my students, when they feel ill, are staying home - at least they email me to tell me that that's what's going on. But today I gave an exam, and there was all kinds of sniffling and coughing all over the place, and I'm wondering what kind of germs are still going to exist on exam papers or how long germs can live on things, not in the air?
Dr. FAUCI: Well, germs, when you say germs, let's talk specifically about influenza A, which is the subject of what we're talking about right now, because different microbes live for variable periods of time. Viruses generally can hang around for hours, rarely days. That's the reason why - what seems to get not mentioned as much now, as we're into the time of giving vaccinations, there are still some very low-tech things that you can do, and that is frequently wash your hands. If you are there in the classroom and you're collecting the papers and there's not a restroom whereby - where you can wash your hands and get those alcohol gels that you can rub on your hands…
Dr. FAUCI: …before and after you pick up those papers, because it is conceivable - not likely, but quite conceivable - that there could be some virus or some mucus that's on the papers that get handed in, that you'd want to protect yourself in by washing your hands.
AMY: Thank you very much.
CONAN: Thanks for the call, Amy. And similarly, we should sneeze into our elbows, as we've all learned from "Sesame Street"?
Dr. FAUCI: Yes, indeed.
CONAN: All right. Let's see if we can get another caller on the line. Let's go to Carla, Carla with us from Sacramento.
CARLA (Caller): Hi.
Dr. FAUCI: Hi.
CARLA: Hi. I have a question - a two-part question, actually. I was recently reading a book, it's entitled "Flu," and it was published in 1999, but it indicated in the book that the H1N1 virus had been identified in 1936. So I was wondering why it's considered at this point a new virus and why there hasn't been any, I guess, vaccine developed up to this point, you know, to enable people to be inoculated against it prior to this.
Dr. FAUCI: Right.
CARLA: And my second part was…
CONAN: Why don't we take it one at a time, Carla?
Dr. FAUCI: OK.
CARLA: OK, thank you.
Dr. FAUCI: So first of all, H1N1 was not identified in 1936. The first time…
Dr. FAUCI: …we saw it was in 1918, in fact. That was the famous…
Dr. FAUCI: …pandemic of 1918.
Dr. FAUCI: We also have had H1N1s who circulate every year. And one of the seasonal flu components of the seasonal flu vaccine is actually an H1N1. This is a different H1N1. So even though…
Dr. FAUCI: …it is given the broad, generic terminology of H1N1, there are many different types of H1N1. And this new one that we're dealing with now, in 2009, is really completely different from the circulating seasonal influenza H1N1. So it's been around for awhile, but not this particular virus.
Dr. FAUCI: This particular virus was first identified in April of this year, and it's the first time that humans have ever been infected with this type of virus.
CONAN: And the…
CONAN: …second one, Carla?
CARLA: Also in the book, it had indicated - and I'm not sure if I'm pronouncing this correctly, but in the - this flu virus, the swine flu virus, I think, in 1976, the swine flu that - I think that the concern was that the - Guillain-Barre virus or symptoms. And it also stated that in the military and also in Norway, who gave the same shot, that there was no increase in that and maybe that it was just because of - I guess, stirs feared up by the government that that was going to happen. And I was wondering if that's correct…
CARLA: …or if there were some…
CONAN: Let's get an answer. OK?
Dr. FAUCI: OK. So let me briefly give you the story. In 1976…
Dr. FAUCI: …a new virus - the swine flu virus, actually - appeared in Fort Dix, New Jersey, a couple of…
Dr. FAUCI: …hundred recruits got sick. One died. They made a vaccine against it. It was an H1N1 type of a virus, so they made a vaccine against it. And they decided to vaccinate widely in this country, 40 million people. The problem is that the virus never got out of Fort Dix, so there was no pandemic even though everyone at the time in 1976 was afraid we were going to get another 1918 pandemic. So they widely vaccinated people. As it turned out…
Dr. FAUCI: …there was a complication at a relatively low frequency of a disease called Guillain-Barre, which is a disease that results in paralysis, peripheral paralysis of your arms and your legs, and sometimes even your ability to breathe. And we saw that it generally occurs about one in 100,000 people. And there was an increase by a couple of people per 100,000. We never saw Guillain-Barre before 1976 associated with vaccines, nor have we seen it since. The problem in 1976 is that since the pandemic never materialized, there was all the risk of the vaccine and no risk of the pandemic. So the balance of risk benefit was distorted because people were being vaccinated and there was no pandemic.
Dr. FAUCI: It's very different from the situation we're facing now…
CONAN: All right.
Dr. FAUCI: …where you have an ongoing pandemic.
CONAN: Carla, thanks very much.
CARLA: All right. Thank you.
CONAN: We're talking with Dr. Anthony Fauci. You're listening to TALK OF THE NATION from NPR News.
And just along that same line, Doctor, are you concerned that given the numbers of people who are going to be given this vaccine, someone is going to suffer a heart attack shortly after they get it; some pregnant woman is going to have a miscarriage.
Dr. FAUCI: Well, there's no doubt that that's going to happen, and that's the reason why you have to keep the public well informed. There are a certain number of background events that occur in health whether or not there's vaccinations, whether or not there's influenza - and you mentioned a couple of them. There are, you know, a couple of thousand miscarriages per week. There are scores of Guillain-Barre. There are thousands of heart attacks each day in the United States. The way you get around of there being an inappropriate attribution to a vaccine is to get a full understanding of what the background rate is, and make sure that it doesn't inappropriately get attributed to a vaccine when it is purely circumstance that has nothing to do with the vaccine.
CONAN: And let's get one more question in - Susan, Susan with us from Cary, North Carolina.
SUSAN (Caller): Yes. Hello, Doctor. I wanted to ask - well, mine was a two-part question. One, I have a child that we already have had a suspected case of H1N1. We weren't tested because we were not hospitalized. But the doctors believed that it was that. Should she get the vaccine? And two, my question is, I've been hearing some talk of a new preservative that is in this vaccine. And I hear a lot of talk about the vaccine itself but not about a new preservative that has not been tested previously.
Dr. FAUCI: Oh, OK. So…
CONAN: And I'm afraid we just have a few seconds left.
Dr. FAUCI: OK. First of all, since you're not absolutely certain that the child - your child had H1N1, the child should be vaccinated. So, the answer…
Dr. FAUCI: …to the first question is yes. Secondly, there's no new preservative. Some of the vaccine doses, the multi-dose vials have thimerosal, which is a compound that prevents the contamination of the material in the vial. This has been used for many years. There was concern - and is concern that that causes problems. Scientifically, there's no evidence whatsoever that the preservative causes any problems.
SUSAN: So there is no other preservative other than thimerosal that's being used…
Dr. FAUCI: No.
SUSAN: …in this by GlaxoSmithKline products?
Dr. FAUCI: No. There's no new preservatives that I'm aware of.
Dr. FAUCI: Right.
CONAN: Susan, thanks very much for the call.
SUSAN: Thank you.
CONAN: Bye-bye. And Dr. Fauci, thank you so much for your time today.
Dr. FAUCI: You're quite welcome.
CONAN: Anthony Fauci joined us from the institute - the National Institutes of Health, where he's the director of the National Institute of Allergies and Infectious Diseases.
Coming up, Afghanistan now a fixture on the front pages, but more than 120,000 Americans continue to fight in Iraq - what's quickly becoming our other war. Quil Lawrence, NPR's Baghdad bureau chief, joins us for a "Reporter's Notebook." Stay with us.
I'm Neal Conan, TALK OF THE NATION, NPR News.
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