Hepatitis A, B, and C: Learn the Differences

Hepatitis A, B, and C: Learn the Differences


Hepatitis A
Hepatitis B
Hepatitis C
Autoimmune Hepatitis

The only way to know if you have already been infected is to have your blood tested for HAV, HBV, or HCV infection. If you are concerned about your risk, talk to your health care provider about your need for blood testing. Viral hepatitis symptoms are similar no matter which type of hepatitis you have. If symptoms occur, you might experience any or all of the following: jaundice (yellowing of the skin and whites of the eyes), fever, loss of appetite, fatigue, dark urine, joint pain, abdominal pain, diarrhea, nausea, and vomiting.

Very rarely, a recently acquired case of viral hepatitis can cause liver failure and death. Sometimes in these instances, a liver transplant (if a liver is available) can save a life. Note: For all types of viral hepatitis, symptoms are less common in children than in adults, and for people of any age with HCV infection, they are less likely to experience symptoms.

What is the liver?

The liver is an organ that does many important things.

The liver

  • removes harmful chemicals from your blood
  • fights infection
  • helps digest food
  • stores nutrients and vitamins
  • stores energy

You cannot live without a liver.

 
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Hepatitis A

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What is hepatitis A?

Hepatitis A is a liver disease. Hepatitis means inflammation of the liver. Inflammation is the painful, red swelling that results when tissues of the body become injured or infected. Inflammation can cause organs to not work properly.

What causes hepatitis A?

Hepatitis A is caused by the hepatitis A virus (HAV). Viruses are germs that can cause sickness. For example, the flu is caused by a virus. People can pass viruses to each other.

How is it spread?

HAV is found in the feces of people with hepatitis A and is usually spread by close personal contact (including sex or sharing a household). It can also be spread by eating food or drinking water contaminated with HAV.

You could get hepatitis A from

  • eating food made by an infected person who didn’t wash his or her hands after using the bathroom.
  • drinking untreated water or eating food washed in untreated water.
  • placing a finger or object in your mouth that came into contact with an infected person’s stool.
  • having close personal contact with an infected person, such as through sex or caring for someone who is ill.

You cannot get hepatitis A from

  • someone sneezing or coughing on you.
  • sitting next to a person who has hepatitis A.
  • hugging an infected person.

Who should be vaccinated?

  • All children at age 1 year (i.e., 12-23 mos.)
  • Older children in cities and states where routine hepatitis A vaccination is recommended
  • Household contacts of infected persons
  • Sex partners of infected persons
  • Persons traveling to countries where hepatitis A is common (all except Canada, Western Europe, Japan, Australia, and New Zealand)
  • Men who have sex with men
  • Injecting and non-injecting drug users
  • Persons with chronic liver disease
  • Any person who wants protection from HAV infection

What if you are infected?

Incubation period: 15 to 50 days, average 28 days

There is no chronic infection. Once you have had HAV infection, you cannot get it again. About 15 out of 100 people infected with HAV will have prolonged illness or relapsing symptoms over a 6–9 month period.

What are the symptoms of hepatitis A?

Children younger than age 6 often have no symptoms. Older children and adults often get mild,flu likee symptoms, including

  • tiredness
  • upset stomach
  • fever
  • loss of appetite
  • stomach pain
  • diarrhea
  • dark yellow urine
  • light-colored stools
  • yellowish eyes and skin, called jaundice

How is hepatitis A diagnosed?

Blood tests will show if you have hepatitis A or another type of hepatitis.

What treatment helps?

  • There is no treatment for hepatitis A other than supportive care.
  • Avoid alcohol. It can worsen liver disease.
  • Hepatitis A usually gets better in a few weeks without treatment. Get lots of rest.
  • Your doctor may suggest medicines to help relieve your symptoms, or medicines you may want to avoid.
  • If symptoms persist, especially if you are an older person, then you should see a doctor again.

When you recover, your body will have learned to fight off a future hepatitis A infection. However, you can still get other kinds of hepatitis.

How is it prevented?

Hepatitis A vaccination is the best protection. The hepatitis A vaccine is given through two shots. The second shot is given 6 to 12 months after the first shot. Both shots are needed to be fully protected from the virus.

  • Vaccination is recommended for all children at age 1 year (i.e., 12–23 months), for older children who live in areas where hepatitis A vaccination programs are in place, for persons listed in risk groups (see above), and for any person who wishes to be protected from hepatitis A.
  • For a recent exposure to someone with HAV or if travel is soon (leaving in less than 4 weeks) to an area of the world where hepatitis A is common, see yourhealth caree provider about your need for a dose of immune globulin (IG).
  • If you are traveling to countries where hepatitis A is common, including Mexico, try to get both shots before you go. If you don’t have time to get both shots before you travel, get the first shot as soon as possible. Most people gain some protection within 2 weeks after the first shot.
  • Always wash your hands with soap after using the toilet, changing a diaper, and before preparing and eating food.
  • Hepatitis A vaccine can be administered to any person age 1 year or older who wants to be protected from HAV infection.
  • Use bottled water for drinking, making ice cubes, and washing fruits and vegetables when you are in a developing country

Hepatitis B

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What is hepatitis B?

Hepatitis B is caused by the hepatitis B virus (HBV). Hepatitis B is a liver disease. Hepatitis means inflammation of the liver. Inflammation is the painful, red swelling that results when tissues of the body become injured or infected. Inflammation can cause organs to not work properly.

Who gets hepatitis B?

Anyone can get hepatitis B, but some people are at higher risk, including

  • people who were born to a mother with hepatitis B
  • people who live with someone who has hepatitis B
  • people who have lived in parts of the world where hepatitis B is common
  • people who are exposed to blood or body fluids at work
  • people on hemodialysis
  • people who have had more than one sex partner in the last 6 months or have a history of sexually transmitted disease
  • injection drug users
  • men who have sex with men

How is it spread?

HBV is found in blood and certain body fluids. The virus is spread when blood or body fluid from an infected person enters the body of a person who is not immune. HBV is spread through having unprotected sex with an infected person, sharing needles or "works" when shooting drugs, exposure needle stickscks or sharps on the job, or from an infected mother to her baby during birth. Exposure to infected blood in ANY situation can be a risk for transmission.

You could get hepatitis B through contact with an infected person’s blood, semen, or other body fluid.

You could get hepatitis B from

  • being born to a mother with hepatitis B
  • having sex with an infected person
  • being tattooed or pierced with unsterilized tools that were used on an infected person
  • getting an accidental needle stick with a needle that was used on an infected person
  • using an infected person’s razor or toothbrush
  • sharing drug needles with an infected person

You cannot get hepatitis B from

  • shaking hands with an infected person
  • hugging an infected person
  • sitting next to an infected person

What are the symptoms of hepatitis B?

Hepatitis B usually has no symptoms. Adults and children ages 5 and older sometimes have one or more of the following symptoms:

  • yellowish eyes and skin, called jaundice
  • a longer than usual amount of time for bleeding to stop
  • swollen stomach or ankles
  • easy bruising
  • tiredness
  • upset stomach
  • fever
  • loss of appetite
  • diarrhea
  • light-colored stools
  • dark yellow urine

What is chronic hepatitis B?

Hepatitis B is chronic when the body can’t get rid of the hepatitis B virus. Children, especially infants, are more likely to get chronic hepatitis B, which usually has no symptoms until signs of liver damage appear. Without treatment, chronic hepatitis B can cause scarring of the liver, called cirrhosis; liver cancer; and liver failure.

Symptoms of cirrhosis include

  • yellowish eyes and skin, called jaundice
  • a longer than usual amount of time for bleeding to stop
  • swollen stomach or ankles
  • tiredness
  • nausea
  • weakness
  • loss of appetite
  • weight loss

    How is hepatitis B diagnosed?

    Hepatitis B is diagnosed through blood tests, which can also show if you have chronic hepatitis B or another type of hepatitis.

    Your doctor may suggest getting a liver biopsy if chronic hepatitis B is suspected. A liver biopsy is a test for liver damage. The doctor uses a needle to remove a tiny piece of liver, which is then looked at with a microscope.

    Who should be vaccinated?

    • All children and teens ages 0-18 years
    • International travelers to moderate- or high-risk areas of the world
    • Household contacts of chronically (life-long) infected persons
    • Immigrants & children of immigrants from areas with elevated HBV rates, such as Asia, Africa, the Pacific Islands, Eastern Europe
    • Sexually active persons who are not in long-term mutually monogamous relationships
    • Persons diagnosed with a sexually transmitted disease
    • Men who have sex with men
    • Sex partners of HBV-infected persons
    • Injecting drug users
    • Persons with severe kidney disease (including predialysis/dialysis)
    • All persons who wish to be protected from HBV infection

    What if you are infected?

    Incubation period: 45 to 160 days, average 120 days

    Chronic infection occurs in up to 90% of infants infected at birth; in 30% of children infected at ages 1-5 years; and in up to 6% of persons infected after age 5 years.

    In the U.S., 5,000 people die each year from hepatitis B. Death from chronic liver disease occurs in 15%-25% of chronically infected persons. People who have chronic HBV infection have a much higher risk of liver failure and liver cancer.

    See your doctor right away if you think you have been exposed to the hepatitis B virus. The first shot of the hepatitis B vaccine taken with a medicine called hepatitis B immune globulin may prevent you from getting sick.

    If you are at higher risk of hepatitis B, get tested. Many people do not know they are infected. Early diagnosis and treatment can help prevent liver damage.

    What treatment helps?

    Hepatitis B usually is not treated unless it becomes chronic.

    • Persons with chronic HBV infection should have a medical evaluation for liver disease every 6-12 months. Several antiviral medications are currently licensed for the treatment of persons with chronic hepatitis B. These drugs are effective in preventing serious liver problems in up to 40% of patients, but the drugs do not get rid of the virus.
    • Avoid alcohol. It can worsen liver disease.
    • There is no medication to treat recently acquired HBV infection.

    Chronic hepatitis B is treated with drugs that slow or stop the virus from damaging the liver. The length of treatment varies. Your doctor will help you decide which drug or drug combination is likely to work for you and will closely watch your symptoms to make sure treatment is working.

    Drugs given by shots include

    • interferon
    • peginterferon

    Drugs taken by mouth include

    • lamivudine
    • telbivudine
    • adefovir
    • entecavir

    Liver Transplantation

    Liver transplant is the last resort, but livers are not always available. A liver transplant may be necessary if chronic hepatitis B causes liver failure. Liver transplantation surgery replaces a failed liver with a healthy one from a donor. Medicines taken after surgery can prevent hepatitis B from coming back.

    How is it prevented?

    Hepatitis B vaccination is the best protection. The hepatitis B vaccine is given through three shots over a period of several months. There is no minimum age for vaccination. The second shot should be given at least 1 month after the first, and the last shot should be given at least 2 months after the second shot but no sooner than 4 months after the first. The hepatitis B vaccine is safe for pregnant women.

    You need all three shots to be fully protected. If you are traveling to a country where hepatitis B is common, try to get all the shots before you go. If you don’t have time to get all the shots before you go, get as many as you can. One shot may provide some protection against the virus.

    • Routine vaccination is recommended for all persons 0-18 years of age, for all newborns at birth before hospital discharge, for persons of all ages who are in risk groups for HBV infection (see above), and for any person who desires protection from hepatitis B.
    • Whenever a woman is pregnant, she should be tested for hepatitis B; infants born to HBV-infected mothers should be given HBIG (hepatitis B immune globulin) and vaccine within 12 hours of birth.
    • Persons who are not in mutually monogamous relationships should use latex condoms correctly and for every sexual encounter. (The efficacy of latex condoms in preventing infection with HBV is unknown, but their proper use may reduce transmission.)

    You can also protect yourself and others from hepatitis B if you

    • do not share drug needles.
    • wear gloves if you have to touch another person’s blood.
    • do not borrow another person’s toothbrush, razor, or anything else that could have blood on it.
    • make sure any tattoos or body piercings you get are done with sterile tools.
    • do not donate blood or blood products if you have hepatitis B.

    Hepatitis C

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    What is hepatitis C?

    Hepatitis C is caused by the hepatitis C virus (HCV). Hepatitis C is a liver disease. Hepatitis means inflammation of the liver. Inflammation is the painful, red swelling that results when tissues of the body become injured or infected. Inflammation can cause organs to not work properly.

    Who gets hepatitis C?

    Anyone can get hepatitis C, but some people are at higher risk, including

    • people who were born to a mother with hepatitis C.
    • people who have had more than one sex partner in the last 6 months or have a history of sexually transmitted disease.
    • people who had a blood transfusion or organ transplant before July 1992.
    • people with hemophilia who received blood products before 1987.
    • people who have used illegal injection drugs.

    How is it spread?

    You could get hepatitis C through contact with an infected person’s blood.

    You could get hepatitis C from

    • being born to a mother with hepatitis C.
    • having sex with an infected person.
    • being tattooed or pierced with unsterilized tools that were used on an infected person.
    • getting an accidental needle stick with a needle that was used on an infected person.
    • using an infected person’s razor or toothbrush.
    • sharing drug needles with an infected person.

    HCV is found in blood and certain body fluids. The virus is spread when blood or body fluid from an HCV-infected person enters another person's body. HCV is spread through sharing needles or "works" when shooting drugs, through exposure needle stickscks or sharps on the job, or sometimes from an infected mother to her baby during birth. It is possible to transmit HCV during sex, but it is not common.

    You cannot get hepatitis C from

    • shaking hands with an infected person
    • hugging an infected person
    • sitting next to an infected person

    What are the symptoms of hepatitis C?

    Most people have no symptoms until the virus causes liver damage, which can take 10 or more years to happen. Others have one or more of the following symptoms:

    • yellowish eyes and skin, called jaundice
    • a longer than usual amount of time for bleeding to stop
    • swollen stomach or ankles
    • easy bruising
    • tiredness
    • upset stomach
    • fever
    • loss of appetite
    • diarrhea
    • light-colored stools
    • dark yellow urine

    What is chronic hepatitis C?

    Hepatitis C is chronic when the body can’t get rid of the hepatitis C virus. Although some people clear the virus from their bodies in a few months, most hepatitis C infections become chronic. Without treatment, chronic hepatitis C can cause scarring of the liver, called cirrhosis; liver cancer; and liver failure.

    Symptoms of cirrhosis include

    • yellowish eyes and skin, called jaundice
    • a longer than usual amount of time for bleeding to stop
    • swollen stomach or ankles
    • tiredness
    • nausea
    • weakness
    • loss of appetite
    • weight loss
    • spider likeike blood vessels, called spider angiomas, that develop on the skin

    Who should be tested?

    • Injecting drug users
    • Recipients of clotting factors made before 1987
    • Hemodialysis patients
    • Recipients of blood or solid organ transplants before 1992
    • Infants born to HCV-infected mothers
    • People with undiagnosed abnormal liver test results Although HCV is not commonly spread through sex, persons having sex with multiple partners or with an infected steady partner may be at increased risk of HCV infection. There is no vaccine for hepatitis C.

    How is hepatitis C diagnosed?

    Hepatitis C is diagnosed through blood tests, which can also show if you have chronic hepatitis C or another type of hepatitis. Your doctor may suggest getting a liver biopsy if chronic hepatitis C is suspected. A liver biopsy is a test for liver damage. The doctor uses a needle to remove a tiny piece of liver, which is then looked at with a microscope.

    What if you are infected?

    Incubation period: 14 to 180 days, average 45 days

    Chronic infection occurs in 55%-85% of infected persons and 70% of chronically infected persons go on to develop chronic liver disease. In the U.S., 8-10,000 people die each year from hepatitis C. People who have chronic HCV infection have a much higher risk of liver failure and liver cancer. Chronic HCV-related liver disease is the leading cause for liver transplant.

    See your doctor and get tested if you are at higher risk of getting hepatitis C or if you think you were exposed to the hepatitis C virus. Many people do not know they are infected. Early diagnosis and treatment can help prevent liver damage.

    What treatment helps?

    Hepatitis C is not treated unless it becomes chronic. Chronic hepatitis C is treated with drugs that slow or stop the virus from damaging the liver.

    • Persons with chronic HCV infection should have a medical evaluation for liver disease every 6-12 months. There are drugs licensed for the treatment of persons with chronic hepatitis C. Combination therapy is currently the treatment of choice and can eliminate the virus in approximately 50% of patients with genotype 1 (the most common genotype in the U.S.).
    • Chronic hepatitis C is most often treated with the drug combination peginterferon and ribavirin, which attacks the hepatitis C virus. Peginterferon is taken through weekly shots and ribavirin is taken daily by mouth. Treatment lasts from 24 to 48 weeks.
    • Get vaccinated against hepatitis A and B.
    • Avoid alcohol. It can worsen liver disease.
    • There is no medication for the treatment of recently acquired hepatitis C.
    • A liver transplant may be necessary if chronic hepatitis C causes liver failure. Liver transplantation surgery replaces a failed liver with a healthy one from a donor. Drug treatment often must continue because hepatitis C usually comes back after surgery.

    How is it prevented?

    You can protect yourself and others from hepatitis C if you

    • do not share drug needles.
    • wear gloves if you have to touch another person’s blood.
    • do not borrow another person’s toothbrush, razor, or anything else that could have blood on it.
    • make sure any tattoos or body piercings you get are done with sterile tools.
    • do not donate blood or blood products if you have hepatitis C.
    • There is no vaccine to prevent hepatitis C.
    • HCV can be spread by sex, but this is not common. If you are not in a mutually monogamous relationship, use latex condoms correctly and every time to prevent the spread of sexually transmitted diseases. (The efficacy of latex condoms in preventing HCV infection is unknown, but their proper use may reduce transmission.) In addition to getting hepatitis A vaccine, you should also get hepatitis B vaccine.

    More information to help you prevent hepatitis B and hepatitis C

    • Don't share personal care items that might have blood on them, such as razors, toothbrushes, and washcloths.
    • Consider the risks if you are thinking about getting a tattoo or body piercing. You might get infected if the tools or dye have someone else's blood on them or if the artist or piercer does not follow good sterilization practices.
    • If you have or have had HBV or HCV infection, do not donate blood, organs, or tissue.
    • Don't shoot drugs. If you do, try to stop by getting into a treatment program. If you can't stop, never share drugs, needles, or "works" (syringes, water, spoons, or cotton). Get vaccinated against hepatitis A and B.

    Autoimmune Hepatitis

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    What is autoimmune hepatitis?

    Autoimmune hepatitis affects the liver.

    Autoimmune hepatitis is a disease in which the body’s immune system attacks liver cells. This immune response causes inflammation of the liver, also called hepatitis. Researchers think a genetic factor may make some people more susceptible to autoimmune diseases. About 70 percent of those with autoimmune hepatitis are female.

    The disease is usually quite serious and, if not treated, gets worse over time. Autoimmune hepatitis is typically chronic, meaning it can last for years, and can lead to cirrhosis—scarring and hardening—of the liver. Eventually, liver failure can result.

    Autoimmune hepatitis is classified as type 1 or type 2. Type 1 is the most common form in North America. It can occur at any age but most often starts in adolescence or young adulthood. About half of those with type 1 have other autoimmune disorders, such as

    • type 1 diabetes
    • proliferative glomerulonephritis, an inflammation of blood vessels in the kidneys
    • thyroiditis, an inflammation of the thyroid gland
    • Graves’ disease, the leading cause of overactive thyroid
    • Sjögren’s syndrome, a syndrome that causes dry eyes and mouth autoimmune anemia
    • ulcerative colitis, an inflammation of the colon and rectum leading to ulcers

    Type 2 autoimmune hepatitis is less common, typically affecting girls aged 2 to 14, although adults can have it too.

    What is autoimmune disease?

    One job of the immune system is to protect the body from viruses, bacteria, and other living organisms. The immune system usually does not react against the body’s own cells. However, sometimes it attacks the cells it is supposed to protect; this response is called autoimmunity. Researchers think certain bacteria, viruses, toxins, and drugs trigger an autoimmune response in people who are genetically susceptible to developing an autoimmune disorder.

    What are the symptoms of autoimmune hepatitis?

    Fatigue is probably the most common symptom of autoimmune hepatitis. Other symptoms include

    • an enlarged liver
    • jaundice
    • itching
    • skin rashes
    • joint pain
    • abdominal discomfort
    • spider angiomas, or abnormal blood vessels, on the skin
    • nausea
    • vomiting
    • loss of appetite
    • dark urine
    • pale or gray-colored stools

    People in advanced stages of the disease are more likely to have symptoms related to chronic liver disease, such as fluid in the abdomen—also called ascites—and mental confusion. Women may stop having menstrual periods.

    Symptoms of autoimmune hepatitis range from mild to severe. Because severe viral hepatitis or hepatitis caused by a drug—for example, certain antibiotics—have the same symptoms as autoimmune hepatitis, tests may be needed for an exact diagnosis. Doctors should also review and rule out all medicines a patient is taking before diagnosing autoimmune hepatitis.

    How is autoimmune hepatitis diagnosed?

    The doctor will make a diagnosis based on symptoms, blood tests, and a liver biopsy.

    • Blood tests. A routine blood test for liver enzymes can help reveal a pattern typical of hepatitis, but further tests, especially for autoantibodies, are needed to diagnose autoimmune hepatitis. Antibodies are proteins made by the immune system to fight off bacteria and viruses. Autoantibodies attack the body’s cells. In autoimmune hepatitis, the immune system makes one or more types of autoantibodies. The most common are antinuclear antibodies (ANA), smooth muscle antibodies (SMA), and antibodies to liver and kidney microsomes (anti-LKM). People with type 1 have ANA, SMA, or both, and people with type 2 have anti-LKM.

      Blood tests also help distinguish autoimmune hepatitis from other diseases that resemble it, such as viral hepatitis B or C or a metabolic disease such as Wilson disease.

    • Liver biopsy. A tiny sample of liver tissue, examined with a microscope, can help doctors accurately diagnose autoimmune hepatitis and tell how serious it is. This procedure is done in a hospital or outpatient surgical facility.

    How is autoimmune hepatitis treated?

    Treatment works best when autoimmune hepatitis is diagnosed early. With proper treatment, autoimmune hepatitis can usually be controlled. In fact, studies show that sustained response to treatment stops the disease from getting worse and may reverse some of the damage.

    The primary treatment is medicine to suppress, or slow down, an overactive immune system.

    Both types of autoimmune hepatitis are treated with daily doses of a corticosteroid called prednisone. Treatment may begin with a high dose of 30 to 60 mg per day and be lowered to 10 to 20 mg per day as the disease is controlled. The goal is to find the lowest possible dose that will control the disease.

    Another medicine, azathioprine (Imuran) is also used to treat autoimmune hepatitis. Like prednisone, azathioprine suppresses the immune system, but in a different way. Treatment may begin with both azathioprine and prednisone, or azathioprine may be added later, once the disease is under control. The use of azathioprine allows for a lower dose of prednisone, which in turn reduces predisone’s side effects.

    In about seven out of 10 people, the disease goes into remission within 3 years of starting treatment. Remission occurs when symptoms disappear and lab tests show improvement in liver function. Some people can eventually stop treatment, although many will see the disease return. People who stop treatment must carefully monitor their condition and promptly report any new symptoms to their doctor. Treatment with low doses of prednisone or azathioprine may be necessary on and off for years, if not for life.

    Some people with mild forms of the disease may not need to take medication. Doctors assess each patient individually to determine whether those with mild autoimmune hepatitis should undergo treatment.

    What are the side effects of prednisone and azathioprine?

    Both prednisone and azathioprine have side effects. Because high doses of prednisone are often needed to control autoimmune hepatitis, managing side effects is very important. However, most side effects appear only after a long period of time.

    Some possible side effects of prednisone are

    • weight gain
    • anxiety and confusion
    • thinning of the bones, a condition called osteoporosis
    • thinning of the hair and skin
    • diabetes
    • high blood pressure
    • cataracts
    • glaucoma

    Azathioprine can lower white blood cell counts and sometimes causes nausea and poor appetite. Rare side effects are allergic reaction, liver damage, and pancreatitis, which is an inflammation of the pancreas gland with severe stomach pain.

    Are other treatments for autoimmune hepatitis available?

    People who do not respond to standard immune therapy or who have severe side effects may benefit from other immunosuppressive agents such as mycophenylate mofetil, cyclosporine, or tacrolimus. People who progress to end-stage liver disease—also called liver failure—or cirrhosis may need a liver transplant. Transplantation has a 1-year survival rate of 90 percent and a 5-year survival rate of 70 to 80 percent.

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