Eurosurveillance最新文献

{"title":"Locally acquired malaria: a retrospective analysis of long-term surveillance data, European France, 1995 to 2022.","authors":"Hugues Delamare, Arnaud Tarantola, Marc Thellier, Clémentine Calba, Olivier Gaget, Paul-Henri Consigny, Frederic Simard, Sylvie Manguin, Elise Brottet, Marie-Claire Paty, Sandrine Houze, Henriette De Valk, Harold Noël","doi":"10.2807/1560-7917.ES.2024.29.41.2400133","DOIUrl":"10.2807/1560-7917.ES.2024.29.41.2400133","url":null,"abstract":"<p><p>BackgroundIn European France, the bulk of malaria cases are travel-related, and only locally acquired cases are notifiable to assess any risk of re-emergence.AimsWe aimed to contribute to assessing the health impact of locally acquired malaria and the potential of malaria re-emergence in European France by documenting modes of transmission of locally acquired malaria, the <i>Plasmodium</i> species involved and their incidence trends.MethodsWe retrospectively analysed surveillance and case investigation data on locally acquired malaria from 1995 to 2022. We classified cases by most likely mode of transmission using a classification derived from the European Centre for Disease Prevention and Control. A descriptive analysis was conducted to identify spatial and temporal patterns of cases.ResultsFrom 1995 to 2022, European France reported 117 locally acquired malaria cases, mostly due to <i>Plasmodium falciparum</i> (88%) and reported in Île-de-France (54%), Paris Region. Cases were classified as Odyssean malaria (n = 51), induced malaria (n = 36), cryptic malaria (n = 27) and introduced malaria (n = 3). Among the 117 patients, 102 (93%) were hospitalised, 24 (22%) had severe malaria and seven (7%) died.ConclusionLocally acquired malaria remains infrequent in European France, with four reported cases per year since 1995. However, with the recent increasing trend in Odyssean malaria and climate change, the risk of re-emergence in non-endemic countries should be monitored, particularly in areas with autochthonous competent vectors. The vital risk of delayed diagnosis should make physicians consider locally acquired malaria in all patients with unexplained fever, especially when thrombocytopenia is present, even without travel history.</p>","PeriodicalId":12161,"journal":{"name":"Eurosurveillance","volume":null,"pages":null},"PeriodicalIF":9.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11484917/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142399846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increasing trends in hepatitis E hospitalisations in Spain, 1997 to 2019.","authors":"María Guerrero-Vadillo, Marina Peñuelas, Rocío Carmona, Inmaculada León-Gómez, Carmen Varela","doi":"10.2807/1560-7917.ES.2024.29.43.2400118","DOIUrl":"10.2807/1560-7917.ES.2024.29.43.2400118","url":null,"abstract":"<p><p>BackgroundHepatitis E, a viral hepatitis caused mainly by the ingestion of raw or undercooked food, is not a notifiable disease in Spain.AimTo analyse the temporal trends, epidemiological characteristics and factors associated with severe disease from hepatitis E hospitalisations in Spain from 1997 to 2019.MethodsHospitalisation records were obtained from the Spanish National Hospital Discharge Database. Temporal trends and seasonality were analysed by Poisson regression in years 1997-2015 and 2016-19, given changes in hospital discharge databases. Multivariate logistic regression was used to identify factors associated with severe disease.ResultsHepatitis E hospitalisation incidence increased from 0.22 cases per 1,000,000 inhabitants in 1997 to a maximum of 2.95 in 2018. Seasonality was observed during 2016-19 period, with more cases in the second and third quarters of the year. The incidence was higher in men vs women, and in the population aged over 40 years. Factors independently associated with death were age ≥ 50 years (adjusted odds ratio (aOR): 2.43), chronic liver disease (aOR: 4.29), HIV infection (aOR: 3.00) and hepatitis B/C (aOR: 2.11).ConclusionsHepatitis E hospitalisations have increased in Spain in recent years, being more severe in cases with older age, chronic hepatic diseases and HIV infection. A greater incidence in men over 40 years and a possible seasonality were observed. Further studies are needed to assess the seasonality, geographical distribution and impact of the disease to guide public health actions for prevention and control.</p>","PeriodicalId":12161,"journal":{"name":"Eurosurveillance","volume":null,"pages":null},"PeriodicalIF":9.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11513759/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhanced laboratory surveillance of respiratory infection disclosed the rapid rise of enterovirus D68 cases, northern Italy, August to September 2024.","authors":"Elena Pariani, Antonio Piralla, Laura Pellegrinelli, Federica Giardina, Vincenzo Navobi Porrello, Greta Romano, Cristina Galli, Laura Sandri, Guglielmo Ferrari, Sandro Binda, Luigi Vezzosi, Gabriele Del Castillo, Sabrina Buoro, Danilo Cereda, Fausto Baldanti","doi":"10.2807/1560-7917.ES.2024.29.41.2400645","DOIUrl":"10.2807/1560-7917.ES.2024.29.41.2400645","url":null,"abstract":"<p><p>We report a considerable increase in enterovirus D68 (EV-D68) cases since July 2024, culminating in an ongoing outbreak of acute respiratory infections in northern Italy, accounting for nearly 90% of all enterovirus infections. The outbreak was identified by community- and hospital-based surveillance systems, detecting EV-D68 in individuals with mild-to-severe respiratory infections. These strains belonged to B3 and a divergent A2 lineage. An increase in adult cases was observed. Enhanced surveillance and molecular characterisation of EV-D68 across Europe are needed.</p>","PeriodicalId":12161,"journal":{"name":"Eurosurveillance","volume":null,"pages":null},"PeriodicalIF":9.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11484921/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142399845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of the autumn 2023 COVID-19 vaccine dose in hospital-based healthcare workers: results of the VEBIS healthcare worker vaccine effectiveness cohort study, seven European countries, season 2023/24.","authors":"Camelia Savulescu, Albert Prats-Uribe, Kim Brolin, Anneli Uusküla, Colm Bergin, Catherine Fleming, Rita Murri, Viesturs Zvirbulis, Dace Zavadska, Vania Gaio, Corneliu P Popescu, Raluca Hrisca, Maria Cisneros, Miriam Latorre-Millán, Liis Lohur, Jonathan McGrath, Lauren Ferguson, Katleen De Gaetano Donati, Ilze Abolina, Dagne Gravele, Ausenda Machado, Simin-Aysel Florescu, Mihaela Lazar, Pilar Subirats, Laura Clusa Cuesta, Jacklyn Sui, Claire Kenny, Rosaria Santangelo, Dainis Krievins, Elza Anna Barzdina, Camila Valadas Henriques, Alma Gabriela Kosa, Saftica-Mariana Pohrib, Carmen Muñoz-Almagro, Ana Milagro, Sabrina Bacci, Anthony Nardone","doi":"10.2807/1560-7917.ES.2024.29.44.2400680","DOIUrl":"10.2807/1560-7917.ES.2024.29.44.2400680","url":null,"abstract":"<p><p>COVID-19 vaccination recommendations include healthcare workers (HCWs). We measured COVID-19 vaccine effectiveness (CVE) of the autumn 2023 dose against laboratory-confirmed SARS-CoV-2 infection in a prospective cohort study of 1,305 HCWs from 13 European hospitals. Overall CVE was 22% (95% CI: -17 to 48), 49% (95% CI: -8 to 76) before and -11% (95% CI: -84 to 34) after the start of BA.2.86/JN.1 predominant circulation. Autumn 2023 COVID-19 vaccination led to a moderate-to-low reduction in SARS-CoV-2 infection incidence in HCWs. Monitoring of CVE is crucial for COVID-19 prevention.</p>","PeriodicalId":12161,"journal":{"name":"Eurosurveillance","volume":null,"pages":null},"PeriodicalIF":9.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11528902/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142557484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Attribution of invasive group A streptococcal infections (iGAS) to predisposing viral infections, the Netherlands, 2010 to 2023.","authors":"Brechje de Gier, Jan van de Kassteele, Liselotte van Asten, Annelot F Schoffelen, Mariette Hooiveld, Margreet Jm Te Wierik, Nina M van Sorge, Hester E de Melker","doi":"10.2807/1560-7917.ES.2024.29.40.2300739","DOIUrl":"10.2807/1560-7917.ES.2024.29.40.2300739","url":null,"abstract":"<p><p>BackgroundAfter most COVID-19 pandemic control measures were lifted in 2022, many infectious diseases re-emerged. An increase in invasive group A streptococcal (iGAS) infections among adults and young children was reported by several countries. Viral infections including influenza and varicella, known risk factors for iGAS infection, also increased.AimTo estimate the proportion of GAS skin and soft tissue infections (SSTI) and pneumonia/sepsis in children (≤ 5 years) attributable to varicella, and the proportion of GAS pneumonia/sepsis in children and adults attributable to potentially predisposing respiratory viruses influenza A and B, RSV, hMPV and SARS-CoV-2 in the Netherlands.MethodsWe performed time series regression using weekly data on respiratory viruses, varicella and non-invasive GAS infections and GAS isolates cultured from blood, lower airways, skin, pus and wounds, from January 2010 to March 2023.ResultsIn 2010-19, 50% (95% CI: 36-64) of GAS SSTI in children were attributable to varicella. Between January 2022 and March 2023, 34% (95% CI: 24-43) of GAS SSTI cases were attributable to varicella. Of iGAS pneumonia/sepsis between January 2022 and March 2023, 34% (95% CI: 20-49) and 25% (95% CI: 18-32) was attributable to respiratory virus infections in children and adults, respectively, with the largest contributor (17%) being influenza A.ConclusionsPredisposing viral infections likely contributed to, but cannot fully explain, the observed iGAS increase among children and adults in 2022-23 in the Netherlands. Public health measures to control viral infections, such as vaccination against varicella or influenza, might reduce the iGAS disease burden.</p>","PeriodicalId":12161,"journal":{"name":"Eurosurveillance","volume":null,"pages":null},"PeriodicalIF":9.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11451131/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor: First detection of a <i>Mycobacterium tuberculosis</i> XDR clinical isolate harbouring an RpoB I491F mutation in a Ukrainian patient treated in Germany, October 2023.","authors":"Florian Heger, Alexander Indra","doi":"10.2807/1560-7917.ES.2024.29.42.2400665","DOIUrl":"https://doi.org/10.2807/1560-7917.ES.2024.29.42.2400665","url":null,"abstract":"","PeriodicalId":12161,"journal":{"name":"Eurosurveillance","volume":null,"pages":null},"PeriodicalIF":9.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11487919/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Monkeypox Clade Ib virus introduction into Burundi: first findings, July to mid-August 2024.","authors":"Néhémie Nzoyikorera, Cassien Nduwimana, Leonard Schuele, David F Nieuwenhuijse, Marion Koopmans, Saria Otani, Frank M Aarestrup, Théogène Ihorimbere, Denis Niyomwungere, Armstrong Ndihokubwayo, Idrissa Diawara, Alexis Niyomwungere, Dionis Nizigiyimana, Marie Noelle Uwineza, Bas B Oude Munnink, Joseph Nyandwi","doi":"10.2807/1560-7917.ES.2024.29.42.2400666","DOIUrl":"10.2807/1560-7917.ES.2024.29.42.2400666","url":null,"abstract":"<p><p>We describe cases with monkeypox virus (MPXV) Clade Ib in Burundi from their first detection in July until 20 August 2024. Testing 442 people with vesicular lesions confirmed 170 cases (98 male; 72 female), 82 (48%) being < 15 years old. Differential diagnosis of the first 30 individuals testing MPXV negative revealed chickenpox in 20. Cases occurred in 26 of 49 Burundi health districts, but mostly in Bujumbura Nord (88/170; 67%). Case-derived MPXV genetic sequences from Burundi and South-Kivu (Democratic Republic of the Congo), clustered together in phylogenetic analysis.</p>","PeriodicalId":12161,"journal":{"name":"Eurosurveillance","volume":null,"pages":null},"PeriodicalIF":9.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11487920/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating indicator-based and event-based surveillance data for risk mapping of West Nile virus, Europe, 2006 to 2021.","authors":"Kyla Serres, Diana Erazo, Garance Despréaux, María F Vincenti-González, Wim Van Bortel, Elena Arsevska, Simon Dellicour","doi":"10.2807/1560-7917.ES.2024.29.44.2400084","DOIUrl":"10.2807/1560-7917.ES.2024.29.44.2400084","url":null,"abstract":"<p><p>BackgroundWest Nile virus (WNV) has an enzootic cycle between birds and mosquitoes, humans being incidental dead-end hosts. Circulation of WNV is an increasing public health threat in Europe. While detection of WNV is notifiable in humans and animals in the European Union, surveillance based on human case numbers presents some limitations, including reporting delays.AimWe aimed to perform risk mapping of WNV circulation leading to human infections in Europe by integrating two types of surveillance systems: indicator-based and event-based surveillance.MethodsFor indicator-based surveillance, we used data on human case numbers reported to the European Centre for Disease Prevention and Control (ECDC), and for event-based data, we retrieved information from news articles collected through an automated biosurveillance platform. In addition to these data sources, we also used environmental data to train ecological niche models to map the risk of local WNV circulation leading to human infections.ResultsThe ecological niche models based on both types of surveillance data highlighted new areas potentially at risk of WNV infection in humans, particularly in Spain, Italy, France and Greece.ConclusionAlthough event-based surveillance data do not constitute confirmed occurrence records, integrating both indicator-based and event-based surveillance data proved useful. These results underscore the potential for a more proactive and comprehensive strategy in managing the threat of WNV in Europe by combining indicator- and event-based and environmental data for effective surveillance and public health response.</p>","PeriodicalId":12161,"journal":{"name":"Eurosurveillance","volume":null,"pages":null},"PeriodicalIF":9.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11528904/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142557487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potentially zoonotic pathogens and parasites in opportunistically sourced urban brown rats (<i>Rattus norvegicus</i>) in and around Helsinki, Finland, 2018 to 2023.","authors":"Tuomas Aivelo, Hussein Alburkat, Nina Suomalainen, Rebekka Kukowski, Petra Heikkinen, Antti Oksanen, Otso Huitu, Rauni Kivistö, Tarja Sironen","doi":"10.2807/1560-7917.ES.2024.29.40.2400031","DOIUrl":"10.2807/1560-7917.ES.2024.29.40.2400031","url":null,"abstract":"<p><p>BackgroundBrown rats (<i>Rattus norvegicus</i>) are synanthropic rodents with worldwide distribution, which are known to harbour many zoonotic pathogens and parasites. No systematic zoonotic surveys targeting multiple pathogens and parasites have previously been conducted in urban rats in Finland.AimIn Helsinki, Finland, we explored the presence and prevalence in brown rats of certain pathogens and parasites (including helminths, viruses and bacteria) across potentially zoonotic taxa.MethodsWe opportunistically received rat carcasses from pest management operators and citizens from 2018 to 2023. We searched for heart- or lungworms, performed rat diaphragm digestion to check for <i>Trichinella</i> and morphologically identified intestinal helminths. We assessed virus exposure by immunofluorescence assay or PCR, and detected bacteria by PCR (<i>Leptospira</i>) or culture (<i>Campylobacter</i>).ResultsAmong the rats investigated for helminths, no heart- or lungworms or <i>Trichinella</i> species were detected and the most common finding was the cestode <i>Hymenolepis nana</i> (in 9.7% of individuals sampled, 28/288). For some of the surveyed virus taxa, several rats were seropositive (orthopoxviruses, 5.2%, 11/211; arenaviruses, 2.8%, 6/211; hantaviruses 5.2%, 11/211) or tested positive by PCR (rat hepatitis E virus, 1.8%, 4/216). <i>Campylobacter jejuni</i> (6.6%, 17/259) and <i>Leptospira interrogans</i> (1.2%, 2/163) bacteria were also present in the rat population examined.ConclusionsPrevalences of potentially zoonotic pathogens and parasites in brown rats in Helsinki appeared low. This may explain low or non-existent diagnosis levels of rat-borne pathogen and parasite infections reported in people there. Nevertheless, further assessment of under-diagnosis, which cannot be excluded, would enhance understanding the risks of zoonoses.</p>","PeriodicalId":12161,"journal":{"name":"Eurosurveillance","volume":null,"pages":null},"PeriodicalIF":9.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11451135/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142371395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contact behaviour before, during and after the COVID-19 pandemic in the Netherlands: evidence from contact surveys, 2016 to 2017 and 2020 to 2023.","authors":"Jantien A Backer, Eric R A Vos, Gerco den Hartog, Cheyenne C E van Hagen, Hester E de Melker, Fiona R M van der Klis, Jacco Wallinga","doi":"10.2807/1560-7917.ES.2024.29.43.2400143","DOIUrl":"10.2807/1560-7917.ES.2024.29.43.2400143","url":null,"abstract":"<p><p>BackgroundThe first wave of the COVID-19 pandemic in 2020 was largely mitigated by limiting contacts in the general population. In early 2022, most contact-reducing measures were lifted.AimTo assess whether the population has reverted to pre-pandemic contact behaviour and how this would affect transmission potential of a newly emerging pathogen.MethodsWe compared two studies on contact behaviour in the Netherlands: the PIENTER Corona study, conducted during and after the pandemic (held every 2-6 months from April 2020) and the PIENTER3 study (2016-17, as pre-pandemic baseline). In both, participants (ages 1-85 years) reported number and age group of all face-to-face persons contacted on the previous day in a survey. Transmission potential was examined using the next-generation matrix approach.ResultsWe found an average of 15.4 (95% CI: 14.3-16.4) community contacts per person per day after the pandemic in May 2023, 13% lower than baseline (17.8; 95% CI: 17.0-18.5). Among all ages, children (5-9 years) had the highest number of contacts, both pre- and post-pandemic. Mainly adults aged 20-59 years had not reverted to pre-pandemic behaviours, possibly because they more often work from home. Although the number of contacts is lower compared to the pre-pandemic period, the effect on transmission potential of a newly emerging respiratory pathogen is limited if all age groups were equally susceptible.ConclusionContinuous monitoring of contacts can signal changes in contact patterns and can define a 'new normal' baseline. Both aspects are needed to prepare for a future pandemic.</p>","PeriodicalId":12161,"journal":{"name":"Eurosurveillance","volume":null,"pages":null},"PeriodicalIF":9.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11513762/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}