Peres MG, Bacchiega TS, Appolinário CM, Vicente AF, Mioni MSR, Ribeiro BLD, Fonseca CRS, Pelícia VC, Ferreira F, Abrahão JS, Megid J. A laboratory-confirmed, inadvertent transmission of vaccinia virus from an unusual source highlights the importance of epidemiologic tracing, proper biosafety practices in the clinical diagnostic laboratories, and educating clinicians and laboratorians to potential bioterrorism-initiated outbreaks as well as look-alike disease discrimination. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. Many millions of vaccinations were performed in the past, and therefore the opportunity for spread within families has been considerable. Rehfeld IS, Guedes MI, Fraiha AL, Costa AG, Matos AC, Fiúza AT, Lobato ZI. Thank you for submitting a comment on this article. Vaccinia virus is shed from the vaccination lesion of healthy primary vaccinees from approximately the third day to the end of the third week after vaccination; transmission of vaccinia virus is rare but does occur. Styczynski A, Burgado J, Walteros D, Usme-Ciro J, Laiton K, Farias AP, Nakazawa Y, Chapman C, Davidson W, Mauldin M, Morgan C, Martínez-Cerón J, Patiña E, López Sepúlveda LL, Torres CP, Cruz Suarez AE, Olaya GP, Riveros CE, Cepeda DY, Lopez LA, Espinosa DG, Gutierrez Lozada FA, Li Y, Satheshkumar PS, Reynolds M, Gracia-Romero M, Petersen B. Emerg Infect Dis. Contact with live vaccinia virus from the lesion at the site of vaccination is the underlying cause of secondary transmission. Ten civilians have acquired vaccinia virus from recently vaccinated military personnel, presumably via sexual contact. Viruses. Matos ACD, Rehfeld IS, Guedes MIMC, Lobato ZIP. Vaccinia virus infections can be transmissible and can cause severe complications in those with weakened immune systems. The interesting nosocomial outbreaks described by Sepkowitz [3] included remote spread. All cases in which intrafamilial spread has occurred have involved intimate contact. Sentinel mice showed orthopoxvirus antibodies, and VACV DNA and infectious virus were detected in their faeces and intestines, even after six rounds of natural transmission. Vaccinia, a rare cutaneous and sometimes systemic reaction to smallpox vaccination that can occur in vaccinees or in close contacts of vaccinees, has been reported more frequently in the medical literature since the US military revived its long-discontinued smallpox vaccination program in late 2002. Brain Tumor Basic Science Faculty Position, PHYSICIAN, FULL PROFESSOR HEAD OF THE PEDIATRIC SERVICE, Copyright © 2021 Infectious Diseases Society of America. Outbreaks of this disease in humans have been reported since the late 1990s and have spread throughout Brazil (1). Unintended transmission of vaccinia virus can occur through contact with civilian and military personnel vaccinated under the U.S. Department of Defense smallpox vaccination program. Horizontal transmission was assessed by exposure of sentinel mice to wood shavings contaminated with excrement, to mimic a natural infection. Breast Tumor Microenvironment in Black Women: A Distinct Signature of CD8+ T Cell Exhaustion. The purpose of this study was to determine whether horizontal transmission of recombinant vaccinia virus vaccines occurs postinoculation in strain 13 guinea pigs and to what degree. In addition, the detection of a virus-positive signal in larvae and a virus-negative signal in the royal jelly of the same bee colonies excluded the possibility of foodborne transmission contributing to virus infections in the larval stages of bees and suggest possible vertical transmission. MODE OF TRANSMISSION: The virus can be spread through the contact of a recently vaccinated individual with an unvaccinated person. 2017 Nov 15;9(11):340. doi: 10.3390/v9110340. Oliveira JS, Figueiredo PO, Costa GB, Assis FL, Drumond BP, da Fonseca FG, Nogueira ML, Kroon EG, Trindade GS. Vaccinia virus is a member of the orthopoxvirus genus of the Chordopoxvirinae subfamily 1). Acci… Silva NIO, de Oliveira JS, Kroon EG, Trindade GS, Drumond BP. Vaccinia virus is shed from the vaccination lesion of healthy primary vaccinees from approximately the third day to the end of the third week after vaccination; transmission of vaccinia virus is rare but does occur. Individuals living in the same household as but without physical contact with the vaccinee have not been shown to acquire vaccinia virus. Inadvertent transmission of vaccinia virus to patients with illnesses that are contraindications to vaccination is theoretically possible. Vaccinia virus (VACV) has been associated with several bovine vaccinia outbreaks in Brazil, affecting cattle and humans. A Novel ISM-SAM Strategy, Based on Gas Chromatography-Mass Spectrometry Analysis, to Compensate for Matrix Effects in the Determination of Pyruvic Acid. Vaccinia virus infections are not generally regarded as naturally occurring, although vaccinee-to-cattle and cattle-to-human transmissions occurred on farms during the smallpox eradication campaign. Vaccinees should be educated about the potential for spread. Bovine Vaccinia: Insights into the Disease in Cattle. Viruses. This site needs JavaScript to work properly. 2019 Dec;25(12):2169-76. doi: 10.3201/eid2512.181114. These outbreaks included small numbers of patients who developed vaccinia virus infection when they were in different rooms from index case patients with eczema vaccinatum. Said, Charles Haile, Venkataraman Palabindala, Naomi Barker, Robert Myers, Ruth Thompson, Lucy Wilson, Frances Allan-Martinez, Jay Montgomery, Benjamin Monroe, Danielle Tack, Mary Reynolds, Inger Damon, David Blythe Sepkowitz [3] recently reviewed nosocomial outbreaks of vaccinia virus infection, mostly from the pre-1960s era. The dimensions of the virion are roughly 360 × 270 × 250 nm, with a mass of approximately 5–10 fg. However, occlusive dressings may predispose to maceration and possible bacterial superinfection, and therefore we recommend that dressings be changed when the vaccination site is examined or when fluid accumulation is noticed. Currently, health care workers (HCWs) in the United States are being vaccinated against smallpox, and there is a possibility that this will be expanded to a more widespread vaccination program. We strongly doubt that transmission from the respiratory tract occurs after normal vaccination with NYCBOH strain vaccinia virus. USA.gov. Common sense and reasonable caution should be used in caring for the vaccination lesions of vaccinees who are not in contact with persons with enhanced susceptibility to adverse events associated with smallpox vaccination (e.g., HIV-infected individuals, transplant recipients, atopic patients, and patients with burns). Currently, most vaccinations of HCWs and military personnel involve individuals who were vaccinated in the remote past. This will reduce direct shedding and greatly reduce the amount of virus picked up during scratching. Israel recently vaccinated ∼18,000 HCWs. Fourth, most transmission was to patients hospitalized for serious atopic dermatitis. The life cycle of vaccinia begins when the virus fuses with the plasma membrane of a susceptible cell via a protein-based entry-fusion complex or is absorbed by cellular endosomes. What is added by this report? Arch Virol. Airborne infection isolation precautions, such as use of negative-pressure rooms and N-95 or greater respirators, are not necessary for care of patients with vaccinia, unless procedures that cause aerosolization of the virus are performed. However, if an insufficient number of vaccinated HCWs are available, then only HCWs without contraindications for smallpox vaccination should be allowed to provide direct care. Viruses. Gurvich et al. There is also the possibility of transmission of vaccinia virus by the aerosol route, since some secondary cases have occurred on the same hospital floor as a bedbound source patient. The New York City Board of Health (NYCBOH) strain is the only one currently used in vaccines licensed in the United States, and it is generally regarded to be the least reactogenic of the strains in use during the era of smallpox eradication [10]. When Epidemics Collide: Why People with HIV May Have Worse COVID-19 Outcomes and Implications for Vaccination. fixed virus a virus whose virulence and incubation period have been stabilized by serial passage and have remained fixed during further transmission, as opposed to a street virus. Transmission of vaccinia virus can occur when a recently vaccinated person has contact with a susceptible person. Sexual contact with a civilian recently vaccinated against smallpox resulted in secondary and tertiary transmission of vaccinia virus. Peres MG, Bacchiega TS, Appolinário CM, Vicente AF, Mioni MSR, Ribeiro BLD, Fonseca CRS, Pelícia VC, Ferreira F, Oliveira GP, Abrahão JS, Megid J. Vaccinial virulence is apparently strain dependent. Patients with immunodeficiencies of various types and patients with malignancies and other disorders that might have led to susceptibility to contact vaccinia were housed in these units. PLoS One. Sporadic outbreaks of infection caused by the vaccinia virus subspecies buffalopox virus, which involve transmission between milking buffalo, cattle, … One concern about the present vaccination policy is the possibility that unvaccinated individuals might acquire infection by contact with vaccinees. In the first documented US case of eczema vaccinatum since 1988, secondary transmission of vaccinia virus occurred from a vaccinated father to his child. It is preferred that vaccinated HCWs provide direct care for patients with serious vaccinial complications. 2018 Mar 9;10(3):120. doi: 10.3390/v10030120. Analysis of the different samples collected from VACV-GP2infectedmice. In no instance did nosocomial spread of vaccinia virus occur, despite prolonged hospitalization and the presence of large viral lesions in the skin of seriously ill patients with progressive vaccinia or eczema vaccinatum. Transmission of vaccinia virus, possibly through sexual contact, to a woman at high risk for adverse complications Severe adverse events, including eczema vaccinatum (EV), can result after smallpox vaccination. J. Michael Lane, Vincent A. Fulginiti, Transmission of Vaccinia Virus and Rationale for Measures for Prevention, Clinical Infectious Diseases, Volume 37, Issue 2, 15 July 2003, Pages 281–284, https://doi.org/10.1086/377236. (by extension) The virus which causes this infection. There has been no transmission within health care settings. No transmission of vaccinia virus to hospital contacts occurred in the 10-year period 1961–1970 at the University of Colorado Hospital in Denver (then Colorado General Hospital). Several dozen children with progressive vaccinia (many of whom had very prolonged hospital stays), with eczema vaccinatum, and with severe accidental inoculations were housed in single rooms in units that initially had open ward beds; subsequently, all children were housed in individual rooms. Unvaccinated contact with a vaccinated individual was the usual mode of transmission. The AIDS Vaccine Clinical Trials Network, © 2003 by the Infectious Diseases Society of America. NLM Said, USPHS, Maria A. There are no available data about VACV environmental circulation or the role of wildlife in the emergence of an outbreak. These rigorous practices may be prudent in situations in which HCWs are in contact with atopic or immunocompromised patients [4]. Oxford University Press is a department of the University of Oxford. Standard and contact precautions will prevent transmission in routine circumstances. Airborne transmission (at >2 m), probably via small-droplet nuclei, has been documented [15]. All staff were instructed in what was then routine infection-control practice: use of cap, gown, and gloves and hand washing before and after visiting patients with vaccinia (V.A.F., personal observations). Although the virus can be found in the bloodstream and pharynx of patients with adverse events involving vigorous viral replication and/or abnormal host defenses, particularly eczema vaccinatum and progressive vaccinia, epidemiologic evidence for airborne spread is scant. 2020 Dec 30;13(1):43. doi: 10.3390/v13010043. Clipboard, Search History, and several other advanced features are temporarily unavailable. Together, these data suggest that murine excrement could play a relevant role in VACV spread and transmission, perhaps helping to explain how these viruses circulate between their natural hosts. 2015 May 22;10(5):e0127350. Your comment will be reviewed and published at the journal's discretion. Please check for further notifications by email. Epub 2009 Aug 27. Current concepts: how contagious is vaccinia? doi: 10.1371/journal.pone.0127350. Vaccinia virus (VACV) has been associated with several bovine vaccinia outbreaks in Brazil, affecting cattle and humans. The Advisory Committee on Immunization Practices (ACIP) and the Healthcare Infection Control Practices Advisory Committee (HICPAC) recommendations state that vaccinated HCWs need not take administrative leave and can continue to work with patients, even patients with contraindications to smallpox vaccination [4]. It occurred ∼20–60 times for each million primary vaccinations in the 1950s and 1960s. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. There were only 4 such transmissions documented in this review. Lederman E, Miramontes R, Openshaw J, Olson VA, Karem KL, Marcinak J, et al. eCollection 2015. Said, USPHS *Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Maryland Department of Health and Mental Hygiene, 201 W. Preston Street, Baltimore, MD 21201. First, transmission is rare. Long-lasting stability of Vaccinia virus strains in murine feces: implications for virus circulation and environmental maintenance. In the current US program, ∼36,000 civilian HCWs and 20,000 military HCWs have been vaccinated. Vaccinia virus (VACV) has been associated with several bovine vaccinia outbreaks in Brazil, affecting cattle and humans. No specific receptor used to facilitate entry into the cell has yet been discovered. Vaccinia Virus in Blood Samples of Humans, Domestic and Wild Mammals in Brazil. Common mechanisms for transmission include contact with contaminated bandages and intimate sexual contact. Vaccinia virus (VACV) is the live viral component of smallpox vaccine. A policy of permissive vaccination of citizen volunteers is under discussion, but implementation plans have not yet been put into effect [1]. Good hand hygiene practices are essential; any commercial hand soap is acceptable. Search for other works by this author on: Department of Pediatrics, University of Arizona, Department of Pediatrics, University of Colorado, Bush lays out plan on smallpox shots; military is first, Contact vaccinia—transmission of vaccinia from smallpox vaccination. We feel that these conclusions are prudent and wise. The vaccination site is frequently itchy, and vaccinia virus can be transferred manually after scratching of such a site. Here, There, and Everywhere: The Wide Host Range and Geographic Distribution of Zoonotic Orthopoxviruses. The conclusions of this review are worth emphasis. Second, transmission generally requires very close personal contact. As of 15 May 2003, there was no transmission to patients. Transmission of vaccinia virus from vaccinees to others is rare but has been documented [2, 3]. The presence of cough was probably an important factor in creating airborne transmission. Transmission of Vaccinia Virus, Possibly Through Sexual Contact, to a Woman at High Risk for Adverse Complications Maria A. Third, HCWs rarely spread vaccinia. - "Vaccinia virus Transmission through Experimentally Contaminated Milk Using a Murine Model" Studies are currently under way to examine viral shedding from the respiratory tracts of healthy persons vaccinated for the first time. Exposure to the vaccination site can result in contact transmission or inadvertent autoinoculation, which often is self-limited (1,2). Many of the nonvaccinia patients in these wards had been vaccinated in the past, but many were infants too young to be vaccinated, and others simply had not yet been vaccinated. Epub 2011 Sep 16. Contact spread of the live attenuated vaccinia virus is considered the predominant method of secondary transmission. New data may be acquired as the current vaccination program progresses, and these conclusions should be reviewed and updated as better information is collected. 2012 Jan;12(1):61-4. doi: 10.1089/vbz.2011.0671. Vaccinia virus is usually injected in the dermis where a localized lesion appears (a "take"), and then scabs over and heals in about 10-14 days Footnote 4. Contact of a vaccinia virus lesion and broken skin is the most common mode of transmission between humans, although it has been shown that human-to-cattle and cattle-to-human transmission can occur, usually by touching Vaccinia is spread by touching a vaccination site before it has healed or by touching bandages or clothing that have been contaminated with live virus from the smallpox vaccination site On the other hand, Professor Heim inquired minutely into all the circumstances of the case, and says he is convinced of the variolation of the cow, and of the transmission from her of a disease similar to vaccinia. 2009;154(9):1551-3. doi: 10.1007/s00705-009-0470-1. Viremia and viruria do occur in patients with progressive vaccinia and eczema vaccinatum, which are serious and life-threatening complications of vaccination that occur in individuals with immunodeficiencies and atopic dermatitis, respectively [14] (V.A.F., personal observations). Patients with eczema vaccinatum and progressive vaccinia shed copious amounts of virus from the skin lesions and therefore present the greatest risk for secondary transmission. The absence of transmission under these circumstances suggests that modern contact precautions would prevent vaccinia virus transmission from patients with complications of smallpox vaccination and that airborne infection isolation procedures, such as use of single-patient rooms with negative pressure and N-95 respirators, are not required.  |  Eczema vaccinatum resulting from the transmission of vaccinia virus from a smallpox vaccinee: an investigation of potential fomites in the home environment. Common mechanisms for transmission include contact with contaminated bandages and intimate sexual contact. This article briefly reviews the transmission of vaccinia and comments on the currently recommended infection-control policies. Since VACV was isolated from rodents in Brazil, we investigated shedding and transmission of VACV strains in mice. However, there is no way to rule out the possibility that the virus was spread by fomites or the hands of HCWs. Vector Borne Zoonotic Dis. Vaccinia virus is unlikely to be isolated from the blood, urine, or respiratory tracts of healthy patients immunized with vaccines derived from the NYCBOH strain. Viruses. Fifth, transmission did not result in postvaccinial encephalitis or progressive vaccinia. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. Once virions are constructed and DNA is enc… Please enable it to take advantage of the complete set of features! Alcohol-based hand rubs are effective in removing vaccinia virus [4]. Dry gauze dressings probably do not need to be routinely changed, but when exudate wets the gauze visibly, a new dressing should be applied. We recommend that vaccinated HCWs cover the site with loose gauze dressings and, when caring for patients with immunosuppression or extensive disruptive skin disorders, cover the dressings with semipermeable membranes. Host Range: Several mammals, including humans, rabbits, cows and river buffalo have been shown to contain the virus Modes of Transmission. Vaccinia virus in Feces and Urine of Wild Rodents from São Paulo State, Brazil. Vaccinia virus Transmission through Experimentally Contaminated Milk Using a Murine Model. Postulation of respiratory spread is unnecessary to explain these outbreaks, although this method of transmission cannot be definitely excluded. These outbreaks took place before concern about nosocomial infection led to greater emphasis on hand hygiene.  |  Transmission of vaccinia virus after smallpox vaccination is a concern.  |  helper virus one that aids in the development of a defective virus by supplying or restoring the activity of the viral gene or enabling it to form a protein coat. Good hand hygiene is essential for HCWs who are in contact with vaccinia virus, including their own vaccination sites. 2009; 27:375–7. The site should be covered with loose gauze dressing, and long sleeves should be worn. HICPAC has recently examined policies to prevent transmission of vaccinia virus [4]. 7,8. Vaccinia virus (VACV) is known to have a wide host range but rarely causes severe disease in an immunocompetent host. We agree with the ACIP and HICPAC that the vaccination site should be covered with gauze, a semipermeable dressing, and a layer of clothing during patient care and that dressings should be changed every 3–5 days, or more frequently if exudates accumulate. Transmission of vaccinia virus, possibly through sexual contact, to a woman at high risk for adverse complications Maria A. Vaccine. Noninvasive Ventilatory Support of COVID-19 Patients Outside the Intensive Care Units (WARd-COVID). Vaccinia virus Transmission through Experimentally Contaminated Milk Using a Murine Model PLOS ONE , Dec 2019 Izabelle Silva Rehfeld , Maria Isabel Maldonado Coelho Guedes , Ana Luiza Soares Fraiha , Aristóteles Gomes Costa , Ana Carolina Diniz Matos , Aparecida Tatiane Lino Fiúza , Zélia Inês Portela Lobato We report on a cluster of 4 cases of vaccinia virus infection in Maryland, USA, likely acquired at a martial arts gym. Sixth, apparently no transmission occurred from revaccinees. [16] isolated vaccinia virus from the pharynx from several patients who developed “vaccinial angina,” or tonsillitis, after vaccination. 2018 Jan 18;10(1):42. doi: 10.3390/v10010042. As mentioned above, airborne transmission in the ward at the University of Colorado Hospital was never documented. NIH Abrahão JS, Trindade Gde S, Ferreira JM, Campos RK, Bonjardim CA, Ferreira PC, Kroon EG. Prudent management of the vaccination site by HCWs should virtually eliminate transmission. In a recent study, no vaccinia virus was isolated from cultures of pharyngeal samples obtained at 5 time points during the first 13 days after vaccination from 119 vaccinees, of whom 45% were primary vaccinees (R. Engler and M. Klote, written communication, 8 April 2003). HHS The manifestations of contact vaccinia are expressed in the skin, which offers further evidence that direct contact, not respiratory spread, is responsible. Once the virus has entered the cell, the viral core is released into the cytoplasm of the cell, where virally packaged transcriptases initiate transcription of early genes. Natural human infections with VACV occur by close contact with infected cattle during milking. Vaccinia Virus. Smallpox itself is generally transmitted from the respiratory tract via large droplets and requires unprotected exposure within ∼2 m of the patient. Feces, blood, oral swabs (Oss), and tissues were collected at different times, and the nested-PCR, IHC, and PRNT techniques were performed. The evidence for respiratory spread of vaccinia virus is not compelling, and therefore droplet or airborne infection precautions should not be necessary, even for vaccinated HCWs who are caring for patients who experienced serious adverse events after smallpox vaccination in the past. Vaccinia Virus Natural Infections in Brazil: The Good, the Bad, and the Ugly. To the Editor:Vaccinia virus (VACV) causes exanthematous disease (bovine vaccinia) in Brazil. Since VACV was isolated from rodents in Brazil, we investigated shedding and transmission of VACV strains in mice. We conducted a prospective examination of the protection afforded by vaccination-site bandages in … In a national survey in the United States conducted after smallpox had been eliminated, there were 66 cases, with no deaths, among 14.5 million vaccinees. [2]. The program has not developed as rapidly as planned but may expand in the future. These reports have made some members of the health care community concerned about the potential for airborne transmission of vaccinia virus, which has implications for infection-control practices for vaccinated HCWs, as well as patients hospitalized because of adverse events that occurred after vaccination. Most of the outbreaks occurred in nations in which vaccinia virus strains that are more virulent and reactogenic than the NYCBOH strain were used. Vaccinia virus is shed from the primary vaccination lesion of humans and guinea pigs from approximately the third day to the end of the third week after vaccination [5, 6]. Formerly director of the Smallpox Eradication Program, Centers for Disease Control and Prevention, Atlanta, Georgia. Respiratory vaccinia virus transmission is well established, yet the effects of allergic airway disease on the host response to intra-pulmonary vaccinia virus infection remain poorly defined. HCWs have frequent contact with immunosuppressed or atopic patients, which heightens concerns about the possibility of transmission. Department of Family and Preventive Medicine, Emory School of Medicine, Reprints or correspondence: Dr. J. Michael Lane, 869 Clifton Rd., Atlanta, GA 30307-1223 (. This recommendation requires scrupulous adherence to recommended hand hygiene practices, use of a semipermeable dressing over gauze on the vaccination lesion, inspection of the vaccination site at the beginning of each work day, and adherence to appropriate infection-control measures to prevent transmission to patients. The ACIP and HICPAC currently recommend that persons, especially HCWs, likely to come into contact with patients with enhanced susceptibility to vaccinia virus should cover their vaccination site with 2 gauze pads and that a semipermeable occlusive dressing should be placed over the gauze [4, 17]. Contact with live vaccinia virus from the lesion at the site of vaccination is the underlying cause of secondary transmission. 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There are no available data about VACV environmental circulation or the role of wildlife in the emergence of an outbreak. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. COVID-19 is an emerging, rapidly evolving situation. Data on the transmission of vaccinia in the United States and the United Kingdom were reviewed recently by Neff et al. Initial plans called for vaccination of 450,000 HCWs, with progressive expansion of the program to 5–10 million HCWs. This is prudent, because the risk of developing serious adverse events attributable to vaccination is lower among revaccinees [8, 9]. It has a linear, double-stranded DNA genome approximately 190 kbp in length, which encodes approximately 250 genes. These 10 transmissions occurred among ∼260,000 primary vaccinees outside of health care settings, from personnel who either did not cover their vaccination sites or covered them with a standard bandage. Vaccinia virus is an orthopoxvirus used in the live vaccine against smallpox. Despite this possibility, only a very few instances of spread, usually to eczematous patients, have occurred. Inadvertent transmission of vaccinia virus to patients with illnesses that are contraindications to vaccination is theoretically possible. Two studies of recombinant NYCBOH-derived vaccinia strains found vaccinia virus on 0 of 100 [5] and 3 of 103 [18] swabs taken from the outer surfaces of such semipermeable dressings. We recommend that long sleeves be worn over such dressings and that scrupulous attention be paid to hand hygiene. Studies aimed at documenting viral shedding (or lack thereof) with modern techniques, including PCR, are currently under way. 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