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CDC, VVPDB personnel were not involved in any clinical decisions regarding these patients. All decisions were made by physicians treating these cases. Patient blood samples and biopsy material were obtained by physicians after provision of informed consent. CDC\u2019s direct role involving the patients was only laboratory testing of specimens.2. Archived FFPE specimens from patients with granuloma were tested with non-disclosure of patient information, which was determined to be ethically acceptable by the Internal Review Board at the CDC. This work was determined to be non-applicable for human subject regulations (ID number 2014 6417).3. In addition, RV RT-PCR detection and sequencing analysis in the biopsy material for possible rubella virus in these tissue specimens was done for the purpose of possible public health response as a part of ongoing CDC surveillance for rubella virus. Note that rubella virus-positive granulomas have been shown to shed divergent infectious rubella virus, which is the public health concern. In addition, CDC, VVPDB, rubella team personnel have international public health responsibilities as part of the CDC Global Specialized Laboratory in the WHO Measles and Rubella Laboratory Network.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics Statements"}}]}}