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Vaccination for special risk groups

Vaccination for women who are planning pregnancy, pregnant or breastfeeding

Giving recommended vaccines before, during and after pregnancy protects both the mother and the baby.

Recently added

This page was added on 08 June 2018.

Updates made

This page was updated on 16 August 2024. View history of updates

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Overview

Pregnant women are at increased risk of certain vaccine preventable diseases such as Influenza which can lead to pregnancy complications and poor health outcomes in their infant. Vaccination during pregnancy does not only protect the mother but also generates antibodies that can cross the placenta, providing protection to the unborn baby and immunity that may persist for several months after birth, which is important for preventing diseases such as pertussis in infants too young to be vaccinated.1,2 Women who are planning pregnancy, pregnant or breastfeeding are therefore recommended to have their vaccination needs assessed e.g., as part of their pre-conception screen, and to receive certain vaccines during their pregnancy.

Women planning pregnancy

Women planning pregnancy should have their vaccination needs assessed as part of any pre-conception health check. In particular, consider vaccines for:

  • hepatitis B
  • measles
  • mumps
  • rubella
  • varicella
  • COVID-19
  • respiratory syncytial virus (RSV)

It is also important to ask women of child-bearing age who present for vaccination about the possibility of pregnancy as part of routine pre-vaccination screening. This is so that they are not given any vaccines that are not recommended in pregnancy (see Pre-vaccination screening). Advise women who receive live vaccines to avoid pregnancy within 28 days of vaccination. However, it is important to note that this is based on vaccine product information and not supported by clinical data.

See Infographic. Vaccination for women who are planning pregnancy, pregnant or breastfeeding

Serological testing

If a woman’s vaccination or infection history is uncertain, she can have serological testing to determine immunity to:

  • hepatitis B
  • measles
  • mumps
  • rubella

Routine serological testing for varicella does not provide a reliable measure of vaccine-induced immunity, although it can indicate whether the woman has immunity through natural infection (see Varicella).

Assess women with risk factors for pneumococcal disease, including smokers, and Aboriginal and Torres Strait Islander women, for pneumococcal vaccination.

See also Pneumococcal disease for more details about vaccination requirements.

Pregnant women

Recommended vaccines for pregnant women

Pregnant women are routinely recommended to receive:

  • influenza vaccine, at any time during pregnancy
  • pertussis-containing vaccine (dTpa — reduced antigen diphtheria-tetanus-acellular pertussis), between mid 2nd trimester and early 3rd trimester (preferably between 20 and 32 weeks gestation)
  • respiratory syncytial virus vaccine (Abrysvo only) between 28 and 36 weeks gestation

See Table. Vaccines that are routinely recommended in pregnancy: inactivated vaccines.

See also the disease-specific chapters in this Handbook for more details.

See Infographic. Vaccination for women who are planning pregnancy, pregnant or breastfeeding.

Table. Vaccines that are routinely recommended in pregnancy: inactivated vaccines

See also the disease-specific chapters in this Handbook for more details.

Vaccine Recommendation Comments
Influenza Recommended for all pregnant women at any stage of pregnancy, particularly those who will be in the 2nd or 3rd trimester during the influenza season Clinical trial data and observational studies show no increased risk of congenital defects or adverse effects in the fetuses of women who received influenza vaccine during pregnancy. Pregnancy increases the risk of severe influenza. Influenza immunisation protects the mother, and also protects her newborn baby in the first few months after birth.2 See Influenza.
dTpa (diphtheria-tetanus-acellular pertussis) Recommended as a single dose between mid 2nd trimester and early 3rd trimester of each pregnancy (ideally at 20–32 weeks) Vaccination during pregnancy reduces the risk of pertussis in pregnant women and their young infants by 90%.2,3 Studies have found no evidence of an increased risk of adverse pregnancy outcomes related to pertussis vaccination during pregnancy.4-9 Optimal protection is provided when the vaccine is given soon after 20 weeks and protection is lower if given within 2 weeks of birth. See Pertussis for more details.
Respiratory syncytial virus (Abrysvo only)

Recommended as a single dose between 28 and 36 weeks gestation.

Advice on potential repeat vaccination during subsequent pregnancies will be provided in the future as more data become available. The need for revaccination with each subsequent pregnancy is anticipated based on first principles and experience with other vaccines recommended in pregnancy.

 A clinical trial found vaccine efficacy of 57% in infants born to mothers who received Abrysvo, against hospitalisation from RSV for up to 6 months.10 There was no conclusive evidence of a significant difference in preterm births or other adverse pregnancy outcomes in the Abrysvo trials. Vaccination before 28 weeks is not recommended as a precautionary approach due to an imbalance in the number of preterm births and neonatal deaths seen in low- and middle-income countries during another discontinued maternal RSV vaccine trial.11 Vaccination beyond 36 weeks is permitted; however, protection is lower if given within 2 weeks of birth. See respiratory syncytial virus (RSV) for more details.
Table. Vaccines that are not routinely recommended in pregnancy: inactivated bacterial vaccines
Vaccine Recommendation Comments
dT (diphtheria-tetanus) Not routinely recommended as a dT only vaccine. Pregnant women can receive dT vaccine under certain circumstances, such as to manage a tetanus-prone wound, however depending on timing during pregnancy, a dTpa may be a preferred option (see Pertussis). Many pregnant women have received tetanus- and diphtheria-containing vaccines, with no increased risk of congenital abnormalities in their fetuses.12-14 See Diphtheria and Tetanus for more details.
Cholera (oral) Not routinely recommended There are limited data on the safety of oral cholera vaccine in pregnancy.2,15
Hib (Haemophilus influenzae type b) Not routinely recommended. Pregnant women can receive Hib vaccine if they are at increased risk of Hib disease (eg women with asplenia). Limited data suggest that Hib vaccination during pregnancy is unlikely to harm the fetus.16
MenB (meningococcal B) or MenACWY (quadrivalent meningococcal conjugate) Not routinely recommended. Pregnant women can receive meningococcal vaccines if they are at increased risk of the disease (see Meningococcal disease). There are limited data on the safety of meningococcal conjugate vaccines in pregnancy.17 Where clinically indicated, pregnant women can receive these vaccines.2,18
PCV (pneumococcal conjugate vaccine) - 13vPCV (13-valent pneumococcal conjugate), 15vPCV (15-valent pneumococcal conjugate) or 20vPCV (20-valent pneumococcal conjugate) Not routinely recommended. Pregnant women can receive pneumococcal conjugate vaccine if they have very high risk of invasive pneumococcal disease (IPD) (eg those who do not have a spleen or evidence of reduced splenic function, or immunocompromised, or have cerebrospinal fluid leak) (see Pneumococcal disease). No data are available. Vaccination with PCV during pregnancy has not been evaluated, although it is unlikely to result in adverse effects. Women of child-bearing age with known risk factors for IPD (including smokers) can receive the vaccine before pregnancy or as soon as practicable after delivery (see Pneumococcal disease).
23vPPV (23-valent pneumococcal polysaccharide) Not routinely recommended. Pregnant women can receive 23vPPV if they have very high risk of IPD (eg those who do not have a spleen or evidence of reduced splenic function, or immunocompromised, or have cerebrospinal fluid leak) (see Pneumococcal disease). Pregnant women have received 23vPPV during clinical trials19 with no evidence of adverse effects. However, data are limited. Women of child-bearing age with known risk factors for IPD (including smokers) can receive the vaccine before pregnancy or as soon as practicable after delivery (see Pneumococcal disease).
Q fever Not routinely recommended No data available.
Typhoid Vi polysaccharide Not routinely recommended. Pregnant women can receive typhoid Vi polysaccharide vaccine if they are travelling to endemic countries where water quality and sanitation are poor. No data are available.20 Vaccination with typhoid Vi polysaccharide vaccine during pregnancy has not been directly evaluated, although it is unlikely to result in adverse effects.
Table. Vaccines that are not routinely recommended in pregnancy: inactivated viral vaccines
Vaccine Recommendation Comments
COVID-19 Not routinely recommended in previously vaccinated women, but can be considered on an individual basis. Unvaccinated women are recommended to receive COVID-19 vaccine. Vaccine can be given at any stage of pregnancy. Safe use of mRNA COVID-19 vaccines in pregnancy has been demonstrated.21 See COVID-19.
Hepatitis A

Not routinely recommended. Pregnant women can receive hepatitis A vaccine if:

  • they are travelling to areas of moderate to high endemicity
  • they have increased risk of exposure through lifestyle factors or exposure to a person known to have acute hepatitis A
  • severe outcomes may be expected (eg women with pre-existing liver disease)
 Limited data are available. Pregnant women who are non-immune and at increased risk for hepatitis A should receive hepatitis A vaccine.2,22
Hepatitis B Not routinely recommended. Susceptible pregnant women can receive hepatitis B vaccine if it would otherwise be recommended (eg as post-exposure prophylaxis in a non-immune pregnant woman after a significant exposure to hepatitis B). Limited data are available. Women who are non-immune and at increased risk for hepatitis B should receive hepatitis B vaccine.23
Mpox vaccine (JYNNEOS) Not routinely recommended. Post-exposure preventive vaccination during pregnancy may be considered after a risk–benefit assessment.

MVA-BN mpox vaccine has not been formally evaluated in pregnant or lactating women, but limited animal studies have identified no vaccine-related fetal malformations. No adverse events have been reported from use of MVA-BN in pregnant women, though data are limited to fewer than 300 pregnancies.24  

Post-exposure preventive vaccination during pregnancy may be considered after a risk–benefit assessment. Any decision on the use of vaccine should take into account the likelihood of mpox disease in pregnancy, and the risks to both the mother and fetus.
Japanese encephalitis (JE) (JEspect inactivated vaccine) Not routinely recommended. Pregnant women at high risk of acquiring JE can receive inactivated JE vaccine. Limited data are available. JE infection is associated with miscarriage. Assess whether pregnant women who are at high risk of JE need vaccination. If the risk of JE is high, pregnant women should receive the inactivated vaccine, JEspect (not Imojev, which is a live attenuated vaccine).2,25
IPV (inactivated poliovirus) Not routinely recommended. Pregnant women at high risk of poliovirus exposure (eg travelling to endemic countries) can receive IPV vaccine. Limited data suggest that polio vaccination during pregnancy is unlikely to harm the fetus.20 Pregnant women should receive IPV vaccine only when clearly indicated.
Rabies Pregnant women can receive rabies vaccine if required, such as for post-exposure prophylaxis. Limited data suggest that rabies vaccination during pregnancy is unlikely to harm the fetus.26-29 Pregnancy is never a contraindication to rabies vaccination if there is a significant risk of exposure (related to occupation or travel), or if there has been a potential exposure to rabies virus, Australian bat lyssavirus or another bat lyssavirus.2,30,31
Zoster (recombinant zoster vaccine [Shingrix]) Not routinely recommended. Pregnant women at high risk of severe outcomes from herpes zoster (eg severe immunocompromise) can receive Shingrix. There are no data on the use of Shingrix in women who are pregnant or breastfeeding. As the vaccine is not preventing infection, but reactivation of endogenous virus, women of child-bearing age who are immunocompromised and assessed to benefit from zoster vaccination, are recommended to receive Shingrix vaccine either: before a planned pregnancy, or as soon as practicable after delivery.
Table. Vaccines that are not recommended in pregnancy
Vaccine Recommendation Comments
HPV (human papillomavirus) (inactivated viral vaccine) Not recommended

Clinical trials and limited data from observational studies where HPV vaccine was inadvertently given during pregnancy indicate that there is no increased risk of adverse effects on the fetus.32-34

If a woman becomes pregnant during a course of HPV vaccination, stop the course and complete it after delivery.
Yellow fever (live attenuated viral vaccine) Not recommended Advise pregnant women against going to rural areas where yellow fever is endemic. However, if travel to a country with a risk of yellow fever virus transmission is unavoidable, pregnant women should receive yellow fever vaccine.2,35,36 Many pregnant women have received yellow fever vaccine with no adverse outcomes,37 however there have been case reports of transmission to infants during pregnancy.
Table. Vaccines that are contraindicated in pregnancy: live attenuated vaccines
Vaccine Recommendation Comments
BCG (bacille Calmette–Guérin) (live attenuated bacterial vaccine) Contraindicated The risk is only hypothetical. BCG vaccine has not been shown to cause fetal damage.2,38
Oral typhoid (live attenuated bacterial vaccine) Contraindicated No data are available on the safety of oral typhoid vaccine in pregnant women. However, because of the theoretical risk of using a live attenuated vaccine, pregnant women should receive inactivated typhoid Vi polysaccharide vaccine instead39 (see Table. Vaccines that are not routinely recommended in pregnancy: inactivated bacterial vaccines).
Oral cholera (live attenuated bacterial vaccine) Contraindicated No data are available on the safety of live oral cholera vaccine in pregnant women. However, because of the theoretical risk of using a live attenuated vaccine, pregnant women should receive inactivated oral cholera vaccine instead (see Table. Vaccines that are not routinely recommended in pregnancy: inactivated bacterial vaccines).
Japanese encephalitis (Imojev) (live attenuated viral vaccine) Contraindicated No data are available about using Imojev vaccine in pregnant or breastfeeding women. However, because of the theoretical risk of using a live attenuated vaccine, pregnant women should receive inactivated Japanese encephalitis (JEpect) instead. Women of child-bearing age should avoid pregnancy for 28 days after vaccination with Imojev.
MMR (measles-mumps-rubella) or MMRV (measles-mumps-rubella-varicella) (live attenuated viral vaccines) Contraindicated
  • The risk is only hypothetical. Despite concerns that live attenuated rubella vaccine virus might cause congenital abnormalities, pregnant women have received rubella vaccine (either monovalent or as MMR, and usually inadvertently) without harm to the fetus.40,41 Even though rubella vaccine virus can infect the fetus, there is no evidence that it causes congenital rubella syndrome in infants.42 Women who receive rubella vaccine during pregnancy do not need to consider terminating the pregnancy.41
  • As a precautionary measure women of child-bearing age should avoid pregnancy for 28 days after vaccination.
  • All pregnant women are recommended to be tested for immunity to rubella. Susceptible women should receive rubella vaccine as soon as possible after delivery and have their serological status checked after vaccination.
Rotavirus (live attenuated viral vaccine) Contraindicated Rotavirus vaccines are not registered or recommended for use in adolescents or adults.
Varicella (live attenuated viral vaccine) Contraindicated The risk of congenital varicella syndrome is only hypothetical. Newborns of women who have inadvertently been given varicella vaccine in early pregnancy have not had congenital varicella syndrome.43 Women of child-bearing age should avoid pregnancy for 28 days after vaccination.
Zoster (Zostavax) (live attenuated viral vaccine) Contraindicated The risk of disseminated zoster is only hypothetical. Women of child-bearing age are unlikely to be eligible for vaccination, because zoster vaccine is registered for use in people ≥50 years of age. If women of child-bearing age have inadvertently been given zoster vaccine, they should avoid pregnancy for 28 days afterwards.

Inactivated vaccines

Most inactivated vaccines are not routinely recommended for pregnant women.

Other than influenza, and diphtheria-, tetanus- and pertussis-containing vaccines, many inactivated vaccines are not routinely recommended during pregnancy, as a precaution. However, pregnancy is not an absolute contraindication to receiving these vaccines.

Fever associated with infection may be teratogenic. However, in clinical studies, most inactivated vaccines are not associated with increased rates of fever in adults (compared with placebo).44,45

Pregnant women are recommended to receive inactivated vaccines (other than influenza and dTpa) when the benefits of protection outweigh the risks.

Pregnant women can also reduce their risk by avoiding exposure to vaccine-preventable diseases during pregnancy. Strategies include changing travel plans, and avoiding high-risk behaviours or occupational exposures.

See:

Live attenuated viral vaccines

Live attenuated viral vaccines are contraindicated in pregnant women.

Live attenuated viral vaccines are contraindicated in pregnant women. This is because of the hypothetical risk of harm if the vaccine virus replicates in the fetus.

See Rubella and Varicella.

Inadvertently giving a live attenuated viral vaccine during pregnancy or shortly before pregnancy

The risk of adverse effects on the fetus following inadvertant administration of live attentuaated viral vaccine during pregnancy or shortly before pregnancy is a theoretical one.

The woman does not need to consider terminating the pregnancy if a live attenuated vaccine was inadvertently given and should be provided reassurance.2

Report inadvertent administration of a vaccine contraindicated in pregnancy to the Therapeutic Goods Administration. See Adverse events following immunisation for details on how to do this.

Post-marketing studies of pregnancy outcomes after vaccination are important to understand the safety profile of vaccines in pregnancy. Because of this, some vaccine manufacturers also have pregnancy registries, specific for their products, that accept reports of vaccines received during pregnancy.

An example is a registry in the United States for vaccines that contain varicella-zoster virus that was in place from March 1995 to October 2013 (see Varicella).

Yellow fever vaccine for pregnant women

Pregnant women are not recommended to receive the live attenuated yellow fever vaccine. However, travel to a country with a risk of yellow fever may be unavoidable. In this case, weigh the risks and benefits of yellow fever vaccination, and discuss other strategies to reduce the risk of acquiring yellow fever with the woman, such as avoiding mosquitoes (see Yellow fever).

See Table. Vaccines that are contraindicated in pregnancy: live attenuated vaccines.

Immunoglobulins as pre- or post-exposure prophylaxis

Immunoglobulins as pre- or post-exposure prophylaxis

Immunoglobulins for use as pre- or post-exposure prophylaxis are not routinely recommended for pregnant women. Limited data are available on the use of immunoglobulins during pregnancy. There are no known risks to the fetus if a pregnant woman receives immunoglobulin. Susceptible pregnant women at risk of acquiring, or being exposed to, certain vaccine-preventable diseases can receive immunoglobulins at any time during pregnancy.

See Table. Use of immunoglobulins as pre- or post-exposure prophylaxis during pregnancy.

Table. Use of immunoglobulins as pre- or post-exposure prophylaxis during pregnancy
Immunoglobulin Recommendation Comments
Pooled or hyperimmune immunoglobulins

Susceptible pregnant women exposed to the following can receive post-exposure immunoglobulin:

 Limited data are available. There is no known risk to the fetus from passive immunisation of pregnant women with immunoglobulins, given at any stage of pregnancy. For more details, see Passive immunisation and the relevant disease-specific chapters in this Handbook.

Contact between pregnant women and people who have recently received live vaccines

Household contacts of pregnant women should be age-appropriately vaccinated. It is safe for contacts of pregnant women to receive measles-, mumps-, rubella- and varicella-containing vaccines; zoster vaccine; and rotavirus vaccine.

Measles, mumps or rubella vaccine viruses are not transmitted from vaccinated household contacts to pregnant women.

Varicella-zoster vaccine virus (from people vaccinated with varicella or zoster vaccines) has an almost negligible risk of transmission. Advise vaccine recipients with a varicella-like rash to cover the rash if in contact with a pregnant woman.

There is a very small possibility that rotavirus vaccine viruses can be transmitted to pregnant contacts. However, the benefit of immunising infants to protect against rotavirus disease and, in turn, reduce the risk of rotavirus in household contacts far outweighs any theoretical risk to the pregnant woman or the fetus (see Rotavirus). 

Use of immunosuppressive therapy during pregnancy

Inactivated vaccines and immunosuppressive therapy

Women who are receiving immunosuppressive therapy during pregnancy can also receive inactivated vaccines, where indicated. For more details, see:

This includes pregnant women who have received short-term antenatal corticosteroids — for example, after a preterm labour.

Live attenuated vaccines and immunosuppressive therapy

Certain immunosuppressive medicines, such as bDMARDs (biological disease-modifying anti-rheumatic drugs), used to manage a medical condition in a pregnant woman may cross the placenta and be detectable in the infant. This is especially true if given during the 3rd trimester.46-48

In this setting, infants are not recommended to receive live attenuated vaccines in the first few months of their life, particularly BCG vaccine49 (see also Tuberculosis). This is because the infant may have a reduced immune response to vaccination, and vaccine virus/bacteria replication and related adverse effects could increase. Although no specific intervals are indicated, the infant should be 6 months old before receiving a BCG vaccine.50

There are limited data on the use of other live vaccines in infants born to women who have received immunosuppressive therapy during pregnancy. Theoretically, there is a risk with giving rotavirus vaccines, so infants born to mothers who received bDMARDs during pregnancy are not recommended to receive rotavirus vaccine (see also Rotavirus)51-53

Drug levels may be measured to guide decision-making. If an infant aged <15 weeks has serum testing that shows no detectable bDMARD levels, rotavirus vaccine can safely be given according to the recommended schedule, which must commence by 15 weeks of age. If an infant still has detectable bDMARD levels at 15 weeks of age, they should not receive rotavirus vaccine.

Infants should receive inactivated vaccines according to the recommended schedule. However, immune responses may be suboptimal. Such infants may need extra inactivated vaccine doses — seek expert advice.

Women who are breastfeeding

Vaccination is never contraindicated in breastfeeding women. For most vaccines, an infant’s immune response to vaccination in relation to breastfeeding has been considered. In general, breastfeeding does not adversely affect immunisation, and breastfeeding is not a contraindication for any vaccines recommended in infants.

See Infographic. Vaccination for women who are planning pregnancy, pregnant or breastfeeding.

Rubella vaccine virus

Rubella vaccine virus may be secreted in human breast milk, and the virus can be transmitted to breastfed infants. However, if an infant becomes infected, they have no symptoms or only mild symptoms.54-56

Hepatitis B virus

Infants born to mothers who are positive for hepatitis B surface antigen (HBsAg) can be breastfed, as long as the infant is appropriately immunised at birth. Although studies have found hepatitis B virus in the breast milk of mothers with hepatitis B virus infection, breastfeeding poses no additional risk of virus transmission, compared with formula feeding, in vaccinated infants.57

Yellow fever vaccine

Breastfeeding women should not receive yellow fever vaccine unless the mother has a high risk of acquiring yellow fever, or cannot avoid or postpone travel.58,59 Although extremely rare, there have been several case reports of probable transmission of the yellow fever vaccine virus to infants through breast milk.58-59

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Page history

Last updated
Last reviewed

Updates to reflect new recommendations for RSV vaccine Abrysvo in pregnant women. 

Updates to reflect the availability of the mpox vaccine, JYNNEOS. Updates to include detail on JYNNEOS use in pregnancy, if indicated, as post-exposure preventive vaccination.  

Update to Table. Vaccines that are contraindicated in pregnancy: live attenuated vaccines to reflect the availability of oral cholera vaccine.

Minor updates to clinical guidance including inclusion of COVID-19 vaccine in Table. Vaccines that are not routinely recommended in pregnancy: inactivated viral vaccines.

Updates to reflect addition of 20vPCV in Table. Vaccines that are not routinely recommended in pregnancy: inactivated bacterial vaccines.

Updates to Table. Vaccines that are not routinely recommended in pregnancy: inactivated bacterial vaccines to include 15-valent pneumococcal conjugate vaccine.

Updated guidance to include recombinant zoster vaccine (Shingrix) in Table. Vaccines that are not routinely recommended in pregnancy: inactivated viral vaccines.

Guidance on vaccination of infants exposed to bDMARDs (biological disease-modifying anti-rheumatic drugs) in utero has been updated. Infants born to mothers who received bDMARDs during pregnancy are not recommended to receive rotavirus vaccine. Drug levels may be measured to guide decision-making.

Updates to reflect new recommendations for RSV vaccine Abrysvo in pregnant women. 

Updates to reflect the availability of the mpox vaccine, JYNNEOS. Updates to include detail on JYNNEOS use in pregnancy, if indicated, as post-exposure preventive vaccination.  

Update to Table. Vaccines that are contraindicated in pregnancy: live attenuated vaccines to reflect the availability of oral cholera vaccine.

Minor updates to clinical guidance including inclusion of COVID-19 vaccine in Table. Vaccines that are not routinely recommended in pregnancy: inactivated viral vaccines.

Updates to reflect addition of 20vPCV in Table. Vaccines that are not routinely recommended in pregnancy: inactivated bacterial vaccines.

Updates to Table. Vaccines that are not routinely recommended in pregnancy: inactivated bacterial vaccines to include 15-valent pneumococcal conjugate vaccine.

Updated guidance to include recombinant zoster vaccine (Shingrix) in Table. Vaccines that are not routinely recommended in pregnancy: inactivated viral vaccines.

Guidance on vaccination of infants exposed to bDMARDs (biological disease-modifying anti-rheumatic drugs) in utero has been updated. Infants born to mothers who received bDMARDs during pregnancy are not recommended to receive rotavirus vaccine. Drug levels may be measured to guide decision-making.

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