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Journal of veterinary internal medicine2023; 38(3); 1858-1871; doi: 10.1111/jvim.16895

Vaccination for the prevention of equine herpesvirus-1 disease in domesticated horses: A systematic review and meta-analysis.

Abstract: Equine herpes virus type 1 (EHV-1) infection in horses is associated with respiratory and neurologic disease, abortion, and neonatal death. Objective: Vaccines decrease the occurrence of clinical disease in EHV-1-infected horses. Methods: A systematic review was performed searching multiple databases to identify relevant studies. Selection criteria were original peer-reviewed research reports that investigated the in vivo use of vaccines for the prevention of disease caused by EHV-1 in domesticated horses. Main outcomes of interest included pyrexia, abortion, neurologic disease, viremia, and nasal shedding. We evaluated risk of bias, conducted exploratory meta-analyses of incidence data for the main outcomes, and performed a GRADE evaluation of the quality of evidence for each vaccine subtype. Results: A total of 1018 unique studies were identified, of which 35 met the inclusion criteria. Experimental studies accounted for 31/35 studies, with the remainder being observational studies. Eight vaccine subclasses were identified including commercial (modified-live, inactivated, mixed) and experimental (modified-live, inactivated, deletion mutant, DNA, recombinant). Risk of bias was generally moderate, often because of underreporting of research methods, and sample sizes were small leading to imprecision in the estimate of the effect size. Several studies reported either no benefit or minimal vaccine efficacy for the primary outcomes of interest. Meta-analyses revealed significant heterogeneity was present, and our confidence in the quality of evidence for most outcomes was low to moderate. Conclusions: Our review indicates that commercial and experimental vaccines minimally reduce the incidence of clinical disease associated with EHV-1 infection.
© 2023 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals LLC on behalf of American College of Veterinary Internal Medicine.
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Publication Date: 2023-11-06 PubMed ID: 37930113PubMed Central: PMC11099739DOI: 10.1111/jvim.16895Google Scholar: Lookup
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  • Journal Article
  • Systematic Review
  • Meta-Analysis

Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

The article is about a systemic review and meta-analysis study to evaluate the efficacy of various vaccines in preventing equine herpes virus type 1 (EHV-1) diseases in horses. The study concludes that both commercial and experimental vaccines offer minimal reduction in the incidence of clinical diseases linked to EHV-1 infection.

Research Methodology

  • The researchers conducted a comprehensive systematic review pulling data from multiple databases to identify relevant studies about EHV-1 vaccines. The selection criteria were confined to original peer-reviewed studies that examined the in vivo use of vaccines for preventing diseases triggered by EHV-1 in horses.
  • Several outcomes of interest were considered in this review including fever (pyrexia), abortion, neurological disease, viremia, and nasal shedding.
  • The team analyzed the risk of bias, performed meta-analyses of incidence data for every identified outcome and carried out a GRADE evaluation of evidence quality for each vaccine subtype.

Results

  • A total of 1018 unique studies were identified during the review process and 35 of these met the inclusion criteria.
  • The large majority (31 out of 35) of these studies were experimental while the remainder were observational in nature.
  • Eight different subclasses of vaccines were identified in these studies including commercial forms (modified-live, inactivated, mixed) and experimental forms (modified-live, inactivated, deletion mutant, DNA, recombinant).
  • The risk of bias was generally moderate due to a frequent under-reporting research methodologies, and small sample sizes that led to imprecision in the estimate of effect size.
  • Many studies concluded either no or limited efficacy of the vaccine in relation to the primary outcomes of interest.
  • Significant heterogeneity was discovered within the meta-analyses with the research team holding low to moderate confidence in the quality of the evidence for most outcomes.

Conclusion

  • The systematic review reveals that both commercial and experimental vaccines offer minimal reduction in the occurrence of clinical disease associated with EHV-1 infection in horses.

Cite This Article

APA
Osterrieder K, Dorman DC, Burgess BA, Goehring LS, Gross P, Neinast C, Pusterla N, Hussey GS, Lunn DP. (2023). Vaccination for the prevention of equine herpesvirus-1 disease in domesticated horses: A systematic review and meta-analysis. J Vet Intern Med, 38(3), 1858-1871. https://doi.org/10.1111/jvim.16895

Publication

Journal of veterinary internal medicine
ISSN: 1939-1676
NlmUniqueID: 8708660
Country: United States
Language: English
Volume: 38
Issue: 3
Pages: 1858-1871

Researcher Affiliations

Osterrieder, Klaus
  • Institut für Virologie, Freie Universität Berlin, Berlin, Germany.
Dorman, David C
  • College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA.
Burgess, Brandy A
  • College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA.
Goehring, Lutz S
  • College of Agriculture, Food and Environment, University of Kentucky, Maxwell H. Gluck Equine Research Center, Lexington, Kentucky, USA.
Gross, Peggy
  • College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA.
Neinast, Claire
  • College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA.
Pusterla, Nicola
  • School of Veterinary Medicine, University of California, Davis, California, USA.
Hussey, Gisela Soboll
  • College of Veterinary Medicine, Michigan State University, Veterinary Medical Center, East Lansing, Michigan, USA.
Lunn, David P
  • School of Veterinary Science, University of Liverpool, Liverpool, UK.

MeSH Terms

  • Animals
  • Horses
  • Herpesvirus 1, Equid
  • Horse Diseases / prevention & control
  • Horse Diseases / virology
  • Herpesviridae Infections / veterinary
  • Herpesviridae Infections / prevention & control
  • Herpesviridae Infections / virology
  • Vaccination / veterinary
  • Herpesvirus Vaccines / therapeutic use
  • Herpesvirus Vaccines / immunology
  • Viral Vaccines / immunology

Conflict of Interest Statement

Authors declare no conflict of interest.

References

This article includes 56 references
  1. Oladunni FS, Horohov DW, Chambers TM. EHV‐1: a constant threat to the horse industry.. Front Microbiol 2019;10:2668.
    pmc: PMC6901505pubmed: 31849857
  2. Lunn DP, Davis‐Poynter N, Flaminio MJBF. Equine herpesvirus‐1 consensus statement.. J Vet Intern Med 2009;23:450‐461.
    pubmed: 19645832
  3. Allen GP, Kydd JH, Slater JD. Equid herpesvirus 1 and equid herpesvirus 4 infections.. In: Coetzer JAW, Tustin RC, eds. Infectious Diseases of Livestock. 1st ed. Newmarket: Oxford University Press; 2004:829‐859.
  4. Kydd JH, Smith KC, Hannant D. Distribution of equid herpesvirus‐1 (EHV‐1) in the respiratory tract of ponies: implications for vaccination strategies.. Equine Vet J 1994;26:466‐469.
    pubmed: 7889920
  5. Kydd JH, Smith KC, Hannant D. Distribution of equid herpesvirus‐1 (EHV‐1) in respiratory tract associated lymphoid tissue: implications for cellular immunity.. Equine Vet J 1994;26:470‐473.
    pubmed: 7889921
  6. Foote CE, Love DN, Gilkerson JR, Whalley JM. Detection of EHV‐1 and EHV‐4 DNA in unweaned thoroughbred foals from vaccinated mares on a large stud farm.. Equine Vet J 2004;36:341‐345.
    pubmed: 15163042
  7. Henninger RW, Reed SM, Saville WJ. Outbreak of neurologic disease caused by equine herpesvirus‐1 at a university equestrian center.. J Vet Intern Med 2007;21:157‐165.
    pubmed: 17338164
  8. . Management of an EHV‐1 outbreak at FEI events and its international impact.. Vet Rec 2021;189:e905.
    pubmed: 34505682
  9. Traub‐Dargatz JL, Pelzel‐McCluskey AM, Creekmore LH. Case‐control study of a multistate equine herpesvirus myeloencephalopathy outbreak.. J Vet Intern Med 2013;27:339‐346.
    pubmed: 23398291
  10. Higgins JPT, Chandler J, Cumpston M. Cochrane Handbook for Systematic Reviews of Interventions.. Chichester: John Wiley & Sons; 2020.
  11. Page MJ, McKenzie JE, Bossuyt PM. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.. BMJ 2021;372:n71.
    pmc: PMC8005924pubmed: 33782057
  12. Hooijmans CR, Rovers MM, de Vries RB. SYRCLE's risk of bias tool for animal studies.. BMC Med Res Methodol 2014;14:43.
    pmc: PMC4230647pubmed: 24667063
  13. Moller S, Ahrenfeldt LJ. Estimating relative risk when observing zero events‐frequentist inference and Bayesian credibility intervals.. Int J Environ Res Public Health 2021;18 (11) :5527.
    doi: 10.3390/ijerph18115527pmc: PMC8196730pubmed: 34064019google scholar: lookup
  14. Deeks JJ, Higgins JPT, Altman DG. Analysing data and undertaking meta‐analyses.. In: Higgins JPT, Thomas J, Chandler J, et al., eds. Cochrane Handbook for Systematic Reviews of Interventions Version 6.3.Chichester, UK: Cochrane; 2022.
  15. Guyatt GH, Oxman AD, Schunemann HJ. GRADE guidelines: a new series of articles in the Journal of Clinical Epidemiology.. J Clin Epidemiol 2011;64:380‐382.
    pubmed: 21185693
  16. Breathnach CC, Yeargan MR, Sheoran AS. The mucosal humoral immune response of the horse to infective challenge and vaccination with equine herpesvirus‐1 antigens.. Equine Vet J 2001;33:651‐657.
    pubmed: 11770985
  17. National Academies of Sciences, Engineering, and Medicine; Division on Earth and Life Studies; Board on Environmental Studies and Toxicology; Committee on Endocrine‐Related Low‐Dose Toxicity. Application of Systematic Review Methods in an overall Strategy for Evaluating Low‐Dose Toxicity From Endocrine Active Chemicals.. Washington, DC: The National Academies Press; 2017.
    pubmed: 28896009
  18. Office of Health Assessment and Translation (OHAT). Handbook for Conducting a Literature‐Base Health Assessment Using OHAT Approach for Systematic Review and Evidence Integration.. Bethesda, MD, USA: National Institute of Environmental Health Sciences; 2019.
  19. Barrandeguy ME, Lascombes F, Llorente J, Houssay H, Fernandez F. High case‐rate equine herpesvirus‐1 abortion outbreak in vaccinated polo mares in Argentina.. Equine Vet Educ 2002;14:132‐135.
  20. Bannai H, Kokado H, Matsumura T. Epizootiological investigation of equine herpesvirus type 1 infection among Japanese racehorses before and after the replacement of an inactivated vaccine with a modified live vaccine.. BMC Vet Res 2019;15:280.
    pmc: PMC6683523pubmed: 31387602
  21. Dutta SK, Shipley WD. Immunity and the level of neutralization antibodies in foals and mares vaccinated with a modified live‐virus rhinopneumonitis vaccine.. Am J Vet Res 1975;36:445‐448.
    pubmed: 164808
  22. Kydd JH, Wattrang E, Hannant D. Pre‐infection frequencies of equine herpesvirus‐1 specific, cytotoxic T lymphocytes correlate with protection against abortion following experimental infection of pregnant mares.. Vet Immunol Immunopathol 2003;96:207‐217.
    pubmed: 14592733
  23. Heldens JG, Hannant D, Cullinane AA. Clinical and virological evaluation of the efficacy of an inactivated EHV1 and EHV4 whole virus vaccine (Duvaxyn EHV1,4). Vaccination/challenge experiments in foals and pregnant mares.. Vaccine 2001;19:4307‐4317.
    pubmed: 11457558
  24. Mitchell D, Girard A, Papp‐Vid G. A challenge study on pregnant pony mares following vaccination with a modified live equine herpesvirus 1 (EHV 1) vaccine.. J Equine Med Surg 1978;1:69‐73.
  25. Purdy CW, Ford SJ, Porter RC. Equine rhinopneumonitis vaccine: immunogenicity and safety in adult horses, including pregnant mares.. Am J Vet Res 1978;39:377‐383.
    pubmed: 205144
  26. Burrows R, Goodridge D, Denyer MS. Trials of an inactivated equid herpesvirus 1 vaccine: challenge with a subtype 1 virus.. Vet Rec 1984;114:369‐374.
    pubmed: 6328728
  27. Goodman LB, Wagner B, Flaminio MJ. Comparison of the efficacy of inactivated combination and modified‐live virus vaccines against challenge infection with neuropathogenic equine herpesvirus type 1 (EHV‐1).. Vaccine 2006;24:3636‐3645.
    pubmed: 16513225
  28. Hannant D, Jessett DM, O'Neill T, Dolby CA, Cook RF, Mumford JA. Responses of ponies to equid herpesvirus‐1 ISCOM vaccination and challenge with virus of the homologous strain.. Res Vet Sci 1993;54:299‐305.
    pubmed: 8393207
  29. Perkins G, Babasyan S, Stout AE. Intranasal IgG4/7 antibody responses protect horses against equid herpesvirus‐1 (EHV‐1) infection including nasal virus shedding and cell‐associated viremia.. Virology 2019;531:219‐232.
    pubmed: 30928700
  30. Minke JM, Fischer L, Baudu P. Use of DNA and recombinant canarypox viral (ALVAC) vectors for equine herpes virus vaccination.. Vet Immunol Immunopathol 2006;111:47‐57.
    pubmed: 16580075
  31. Tsujimura K, Shiose T, Yamanaka T. Equine herpesvirus type 1 mutant defective in glycoprotein E gene as candidate vaccine strain.. J Vet Med Sci 2009;71:1439‐1448.
    pubmed: 19959893
  32. Goehring LS, Wagner B, Bigbie R. Control of EHV‐1 viremia and nasal shedding by commercial vaccines.. Vaccine 2010;28:5203‐5211.
    pubmed: 20538091
  33. Schnabel CL, Babasyan S, Rollins A. An equine herpesvirus type 1 (EHV‐1) Ab4 open reading frame 2 deletion mutant provides immunity and protection from EHV‐1 infection and disease.. J Virol 2019;93 (22) :e01011‐19.
    pmc: PMC6819910pubmed: 31462575
  34. Kydd JH, Hannant D, Robinson RS, Bryant N, Osterrieder N. Vaccination of foals with a modified live, equid herpesvirus‐1 gM deletion mutant (RacHDeltagM) confers partial protection against infection.. Vaccine 2020;38:388‐398.
    pubmed: 31629571
  35. Cornick J, Martens J, Martens R, Crandell R, McConnell S, Kit S. Safety and efficacy of a thymidine kinase negative equine herpesvirus‐1 vaccine in young horses.. Can J Vet Res 1990;54:260‐266.
    pmc: PMC1255647pubmed: 2162730
  36. Paillot R, Ellis SA, Daly JM. Characterisation of CTL and IFN‐gamma synthesis in ponies following vaccination with a NYVAC‐based construct coding for EHV‐1 immediate early gene, followed by challenge infection.. Vaccine 2006;24:1490‐1500.
    pubmed: 16269205
  37. Thomson GR, Mumford JA, Smith IM. Experimental immunization against respiratory disease due to equid herpesvirus 1 infection (rhinopneumonitis) using formalin‐inactivated virus with various adjuvants.. Vet Microbiol 1979;4:209‐222.
  38. van de Walle GR, May MA, Peters ST. A vectored equine herpesvirus type 1 (EHV‐1) vaccine elicits protective immune responses against EHV‐1 and H3N8 equine influenza virus.. Vaccine 2010;28:1048‐1055.
    pubmed: 19897066
  39. Burki F, Rossmanith W, Nowotny N. Viraemia and abortions are not prevented by two commercial equine herpesvirus‐1 vaccines after experimental challenge of horses.. Vet Q 1990;12:80‐86.
    pubmed: 2163560
  40. Mohd‐Azmi ML, Gibson J, Rixon F. Protection of specific‐pathogen‐free (Spf) foals from severe equine herpesvirus type‐1 (Ehv‐1) infection following immunization with non‐infectious L‐particles.. J Microbiol 2002;40:183‐192.
  41. Bannai H, Nemoto M, Tsujimura K. Comparison of protective efficacies between intranasal and intramuscular vaccination of horses with a modified live equine herpesvirus type‐1 vaccine.. Vet Microbiol 2018;222:18‐24.
    pubmed: 30080668
  42. Mumford JA, Bates J. Trials of an inactivated equid herpesvirus‐1 vaccine – challenge with a subtype‐2 virus.. Vet Rec 1984;114:375‐381.
    pubmed: 6328729
  43. Patel JR, Bateman H, Williams J, Didlick S. Derivation and characterisation of a live equid herpes virus‐1 (EHV‐1) vaccine to protect against abortion and respiratory disease due to EHV‐1.. Vet Microbiol 2003;91:23‐39.
    pubmed: 12441229
  44. Soboll G, Breathnach CC, Kydd JH, Hussey SB, Mealey RM, Lunn DP. Vaccination of ponies with the IE gene of EHV‐1 in a recombinant modified live vaccinia vector protects against clinical and virological disease.. Vet Immunol Immunopathol 2010;135:108‐117.
    pubmed: 20018383
  45. Purdy CW, Porter RC, Ford SJ. Equine rhinopneumonitis vaccine: immunogenicity and safety in foals.. Am J Vet Res 1978;39:745‐752.
    pubmed: 215062
  46. Patel JR, Didlick S, Bateman H. Efficacy of a live equine herpesvirus‐1 (EHV‐1) strain C147 vaccine in foals with maternally‐derived antibody: protection against EHV‐1 infection.. Equine Vet J 2004;36:447‐451.
    pubmed: 15253088
  47. Dolby CA, Hannant D, Mumford JA. Response of ponies to adjuvanted EHV‐1 whole virus vaccine and challenge with virus of the homologous strain.. Br Vet J 1995;151:27‐37.
    pubmed: 7735868
  48. Patel JR, Földi J, Bateman H, Williams J, Didlick S, Stark R. Equid herpesvirus (EHV‐1) live vaccine strain C147: efficacy against respiratory diseases following EHV types 1 and 4 challenges.. Vet Microbiol 2003;92:1‐17.
    pubmed: 12488066
  49. Wagner B, Perkins G, Babasyan S. Neonatal immunization with a single IL‐4/antigen dose induces increased antibody responses after challenge infection with equine herpesvirus type 1 (EHV‐1) at weanling age.. PLoS One 2017;12:e0169072.
    pmc: PMC5207648pubmed: 28045974
  50. Rufiange M, Rousseau‐Blass F, Pang DSJ. Incomplete reporting of experimental studies and items associated with risk of bias in veterinary research.. Vet Rec Open 2019;6:e000322.
    pmc: PMC6541106pubmed: 31205725
  51. Di Girolamo N, Giuffrida MA, Winter AL. In veterinary trials reporting and communication regarding randomisation procedures is suboptimal.. Vet Rec 2017;181:195.
    pubmed: 28487452
  52. Alpi KM, Vo TA, Dorman DC. Language consideration and methodological transparency in “systematic” reviews of animal toxicity studies.. Int J Toxicol 2019;38:135‐145.
    pubmed: 30791753
  53. Hooijmans CR, de Vries R, Leenaars M, Curfs J, Ritskes‐Hoitinga M. Improving planning, design, reporting and scientific quality of animal experiments by using the Gold Standard Publication Checklist, in addition to the ARRIVE guidelines.. Br J Pharmacol 2011;162:1259‐1260.
    pmc: PMC3058159pubmed: 21091655
  54. Conway A, Conway Z, Soalheira K, Sutherland J. High quality of evidence is uncommon in Cochrane systematic reviews in Anaesthesia, Critical Care and Emergency Medicine.. Eur J Anaesthesiol 2017;34:808‐813.
    pmc: PMC5680988pubmed: 29095726
  55. Pandis N, Fleming PS, Worthington H, Salanti G. The quality of the evidence according to GRADE is predominantly low or very low in oral health systematic reviews.. PloS One 2015;10:e0131644.
    pmc: PMC4498810pubmed: 26162076
  56. Marenzoni ML, De Waure C, Timoney PJ. Efficacy of vaccination against equine herpesvirus type 1 (EHV‐1) infection: systematic review and meta‐analysis of randomised controlled challenge trials.. Equine Vet J 2022;55:389‐404.
    pubmed: 35946376

Citations

This article has been cited 10 times.
  1. Kutumbetov L, Myrzakhmetova B, Tussipova A, Zhapparova G, Tlenchiyeva T, Bissenbayeva K, Nurabayev S, Kerimbayev A. Development and Preclinical Evaluation of a Lyophilized Vaccine Against Equine Herpesvirus Type 4 (EHV-4). Vaccines (Basel) 2025 May 31;13(6).
    doi: 10.3390/vaccines13060604pubmed: 40573935google scholar: lookup
  2. Pusterla N, Lawton K, Barnum S, Flynn K, Hankin S, Runk D, Mendonsa E, Doherty T. Management of an Equine Herpesvirus-1 Outbreak During a Multi-Week Equestrian Event. Viruses 2025 Apr 24;17(5).
    doi: 10.3390/v17050608pubmed: 40431620google scholar: lookup
  3. de la Cuesta-Torrado M, Vitale V, Velloso Alvarez A, Neira-Egea P, Diss C, Cuervo-Arango J. The Effect of Vaccination Status on Total Lymphocyte Count in Horses Affected by Equine Herpes Virus-1 Myeloencephalopathy. Animals (Basel) 2025 Apr 1;15(7).
    doi: 10.3390/ani15071019pubmed: 40218411google scholar: lookup
  4. de la Cuesta-Torrado M, Velloso Alvarez A, Santiago-Llorente I, Armengou L, Nieto F, Ríos J, Cruz-López F, Jose-Cunilleras E. Risk Factors and Long-Term Outcomes in Horses After the 2021 Outbreak of Equine Herpesvirus 1 Myeloencephalopathy, Valencia, Spain. J Vet Intern Med 2025 Mar-Apr;39(2):e70040.
    doi: 10.1111/jvim.70040pubmed: 40055829google scholar: lookup
  5. Pusterla N, Lawton K, Barnum S, Ross K, Purcell K. Investigation of an Outbreak of Equine Herpesvirus-1 Myeloencephalopathy in a Population of Aged Working Equids. Viruses 2024 Dec 21;16(12).
    doi: 10.3390/v16121963pubmed: 39772269google scholar: lookup
  6. Hu Y, Zhang SY, Sun WC, Feng YR, Gong HR, Ran DL, Zhang BZ, Liu JH. Breaking Latent Infection: How ORF37/38-Deletion Mutants Offer New Hope against EHV-1 Neuropathogenicity. Viruses 2024 Sep 16;16(9).
    doi: 10.3390/v16091472pubmed: 39339948google scholar: lookup
  7. Hu Y, Wu G, Jia Q, Zhang B, Sun W, Sa R, Zhang S, Cai W, Jarhen, Ran D, Liu J. Development of a live attenuated vaccine candidate for equid alphaherpesvirus 1 control: a step towards efficient protection. Front Immunol 2024;15:1408510.
    doi: 10.3389/fimmu.2024.1408510pubmed: 39021566google scholar: lookup
  8. Giessler KS, Goehring LS, Jacob SI, Davis A, Esser MM, Lee Y, Zarski LM, Weber PSD, Hussey GS. Impact of the host immune response on the development of equine herpesvirus myeloencephalopathy in horses. J Gen Virol 2024 May;105(5).
    doi: 10.1099/jgv.0.001987pubmed: 38767608google scholar: lookup
  9. Lunn DP, Burgess BA, Dorman DC, Goehring LS, Gross P, Osterrieder K, Pusterla N, Soboll Hussey G. Updated ACVIM consensus statement on equine herpesvirus-1. J Vet Intern Med 2024 May-Jun;38(3):1290-1299.
    doi: 10.1111/jvim.17047pubmed: 38497217google scholar: lookup
  10. Goehring L, Dorman DC, Osterrieder K, Burgess BA, Dougherty K, Gross P, Neinast C, Pusterla N, Soboll-Hussey G, Lunn DP. Pharmacologic interventions for the treatment of equine herpesvirus-1 in domesticated horses: A systematic review. J Vet Intern Med 2024 May-Jun;38(3):1892-1905.
    doi: 10.1111/jvim.17016pubmed: 38380685google scholar: lookup
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