009455209a9b1ee0d431032ac1da13f9 ckae219.pdf 7af2fe295326052843e68ef201d7059bca2bf07b ckae219.pdf 620f9740a63a4791737bfd5c041f3bf58b8732ca3304b5601dbdf31c976b1d00 ckae219.pdf Title: Effectiveness of the AZD1222 vaccine against COVID-19 hospitalization in Europe: final results from the COVIDRIVE test-negative case–control study Subject: Doi: 10.1093/eurpub/ckae219 European Journal of Public Health, 35, 2, 2025 Publication Date: 21/01/2025 Abstract Marketing authorization holders of vaccines typically need to report brand-specific vaccine effectiveness (VE) to the regulatory authorities as part of their regulatory obligations. COVIDRIVE (now id. DRIVE) is a European public–private partnership for respiratory pathogen surveillance and studies of brand-specific VE with long-term follow-up. We report the final VE results from a two-dose primary series AZD1222 (ChAdOx1 nCoV-19) vaccine schedule in ≥18-year-old individuals not receiving boosters. Patients (N = 1,333) hospitalized with severe acute respiratory infection at 14 hospitals in Austria, Belgium, Italy, and Spain were included in the test-negative case–control study in 2021–2023. Absolute VE was calculated using generalized additive model (GAM), generalized estimating equation (GEE), and spline-based area under the curve (AUC, measuring VE up to 6 months after the last dose of AZD1222). Overall VE (against coronavirus disease 2019 [COVID-19] hospitalization) of an AZD1222 primary series was estimated as 65% using GEE (95% confidence interval [CI]: 52.9–74.5), and 69% using GAM (95% CI: 50.1–80.9) over the 22-month study period (comparator group: unvaccinated patients). The AUC of the spline-based VE estimate was 74.1% (95% CI: 60.0–88.3). VE against hospitalization in study participants who received their second AZD1222 dose 2 months or less before hospitalization was 86% using GEE (95% CI: 77.8–91.4), 93% using GAM (95% CI: 67.2–98.6). During this study period, where mainly the severe acute respiratory syndrome coronavirus 2 Omicron variant was circulating, a two-dose primary series AZD1222 vaccination conferred protection against COVID-19 hospitalization up to at least 6 months after the last dose. Creator: Servigistics Arbortext Advanced Print Publisher 11.1.4667/W Producer: PDFlib+PDI 9.0.7p3 (C++/Win32) CreationDate: Mon Mar 24 07:22:28 2025 CET ModDate: Mon Mar 24 07:24:37 2025 CET Custom Metadata: yes Metadata Stream: yes Tagged: yes UserProperties: no Suspects: no Form: none JavaScript: no Pages: 6 Encrypted: no Page size: 612.283 x 790.866 pts Page rot: 0 File size: 951981 bytes Optimized: no PDF version: 1.5 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- EYRRYY+MinionPro-It Type 1C Custom yes yes yes 720 0 HGQMJI+MinionPro-Regular Type 1C Custom yes yes yes 725 0 CGYPWI+STIX-Regular Type 1C Custom yes yes yes 730 0 MFHJGW+TimesNewRomanPSMT CID TrueType Identity-H yes yes yes 735 0 YSMPNB+FrutigerLTStd-Bold Type 1C Custom yes yes yes 740 0 ASTDNP+FrutigerLTStd-Roman Type 1C Custom yes yes yes 745 0 TeX_CM_Maths_Symbols Type 1 Builtin yes no yes 750 0 TeX_CM_Roman Type 1 Builtin yes no yes 754 0 CHDLCR+STIXTwoMath-Regular CID TrueType Identity-H yes yes yes 758 0 JTKQYF+FrutigerLTStd-Italic Type 1C Custom yes yes yes 763 0 Frutiger-Roman Type 1 Builtin yes no yes 768 0 TeX_CM_Maths_Italic Type 1 Builtin yes no yes 59 0 MPCGKN+FrutigerLTStd-BoldItalic Type 1C Custom yes yes yes 76 0 MathematicalPi-Four Type 1 Builtin yes no yes 12 0 DGIZCW+STIX-Italic Type 1C Custom yes yes yes 20 0 Symbol Type 1 Builtin yes no no 25 0 KGSVQY+MinionPro-Bold Type 1C Custom yes yes yes 32 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2025-10-15 03:53:12 CEST RepresentationInformation: ckae219.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2025-10-14 15:19:36 CEST Size: 951981 Format: PDF Version: 1.5 Status: Well-Formed, but not valid SignatureMatches: PDF-hul ErrorMessage: Invalid indirect destination - referenced object 'lckae219-FM1' cannot be found ID: PDF-HUL-149 ErrorMessage: Invalid indirect destination - referenced object 'bckae219-B5' cannot be found ID: PDF-HUL-149 ErrorMessage: Invalid indirect destination - referenced object 'bckae219-B3' cannot be found ID: PDF-HUL-149 ErrorMessage: Invalid indirect destination - referenced object 'bckae219-B6' cannot be found ID: PDF-HUL-149 ErrorMessage: Invalid indirect destination - referenced object 'bckae219-B4' cannot be found ID: PDF-HUL-149 ErrorMessage: Invalid indirect destination - referenced object 'bckae219-B7' cannot be found ID: PDF-HUL-149 ErrorMessage: edu.harvard.hul.ois.jhove.module.pdf.PdfInvalidException: Invalid indirect destination - referenced object 'bckae219-B4' cannot be found ID: PDF-HUL-122 Offset: 873508 ErrorMessage: edu.harvard.hul.ois.jhove.module.pdf.PdfInvalidException: Invalid indirect destination - referenced object 'bckae219-B7' cannot be found ID: PDF-HUL-122 Offset: 873508 ErrorMessage: edu.harvard.hul.ois.jhove.module.pdf.PdfInvalidException: Invalid indirect destination - referenced object 'bckae219-B6' cannot be found ID: PDF-HUL-122 Offset: 873508 ErrorMessage: edu.harvard.hul.ois.jhove.module.pdf.PdfInvalidException: Invalid indirect destination - referenced object 'bckae219-B3' cannot be found ID: PDF-HUL-122 Offset: 873508 ErrorMessage: edu.harvard.hul.ois.jhove.module.pdf.PdfInvalidException: Invalid indirect destination - referenced object 'bckae219-B5' cannot be found ID: PDF-HUL-122 Offset: 873508 ErrorMessage: edu.harvard.hul.ois.jhove.module.pdf.PdfInvalidException: Invalid indirect destination - referenced object 'lckae219-FM1' cannot be found ID: PDF-HUL-122 Offset: 873508 MIMEtype: application/pdf Profile: Tagged PDF PDFMetadata: Objects: 808 FreeObjects: 1 IncrementalUpdates: 2 DocumentCatalog: ViewerPreferences: HideToolbar: false HideMenubar: false HideWindowUI: false FitWindow: false CenterWindow: false DisplayDocTitle: true NonFullScreenPageMode: UseNone Direction: L2R ViewArea: CropBox ViewClip: CropBox PrintArea: CropBox PageClip: CropBox PageLayout: SinglePage PageMode: UseOutlines Language: en Outlines: Item: Title: Active Content List Destination: mkchap_artid Children: Item: Title: Introduction Destination: mkchap1__sec Item: Title: Methods Destination: mkchap2__sec Item: Title: Results Destination: mkchap3__sec Item: Title: Discussion Destination: mkchap4__sec Item: Title: Acknowledgements Destination: mkchap5_ack1_ack Item: Title: Conflict of interest Destination: mkchap5__sec Item: Title: Funding Destination: mkchap6__sec Item: Title: Data availability Destination: mkchap7__sec Item: Title: References Destination: mkchap8_ref1_ref-list Info: Title: Effectiveness of the AZD1222 vaccine against COVID-19 hospitalization in Europe: final results from the COVIDRIVE test-negative case control study Subject: Doi: 10.1093/eurpub/ckae219 European Journal of Public Health, 35, 2, 2025 Publication Date: 21/01/2025 Abstract Marketing authorization holders of vaccines typically need to report brand-specific vaccine effectiveness (VE) to the regulatory authorities as part of their regulatory obligations. COVIDRIVE (now id. DRIVE) is a European public–private partnership for respiratory pathogen surveillance and studies of brand-specific VE with long-term follow-up. We report the final VE results from a two-dose primary series AZD1222 (ChAdOx1 nCoV-19) vaccine schedule in ≥18-year-old individuals not receiving boosters. Patients (N = 1,333) hospitalized with severe acute respiratory infection at 14 hospitals in Austria, Belgium, Italy, and Spain were included in the test-negative case–control study in 2021–2023. Absolute VE was calculated using generalized additive model (GAM), generalized estimating equation (GEE), and spline-based area under the curve (AUC, measuring VE up to 6 months after the last dose of AZD1222). Overall VE (against coronavirus disease 2019 [COVID-19] hospitalization) of an AZD1222 primary series was estimated as 65% using GEE (95% confidence interval [CI]: 52.9–74.5), and 69% using GAM (95% CI: 50.1–80.9) over the 22-month study period (comparator group: unvaccinated patients). The AUC of the spline-based VE estimate was 74.1% (95% CI: 60.0–88.3). VE against hospitalization in study participants who received their second AZD1222 dose 2 months or less before hospitalization was 86% using GEE (95% CI: 77.8–91.4), 93% using GAM (95% CI: 67.2–98.6). During this study period, where mainly the severe acute respiratory syndrome coronavirus 2 Omicron variant was circulating, a two-dose primary series AZD1222 vaccination conferred protection against COVID-19 hospitalization up to at least 6 months after the last dose. Creator: Servigistics Arbortext Advanced Print Publisher 11.1.4667/W Producer: PDFlib+PDI 9.0.7p3 (C++/Win32) CreationDate: Mon Mar 24 07:52:28 CET 2025 ModDate: Mon Mar 24 07:54:37 CET 2025 ID: 0xb1ca6c40b822b4669f33939edbe6b4eb, 0xec2486128a9117115b2a5691f7006f80 Filters: FilterPipeline: DCTDecode Images: Image: NisoImageMetadata: FormatName: image/jpg CompressionScheme: JPEG ImageWidth: 1500 ImageHeight: 1096 ColorSpace: RGB BitsPerSample: 8 BitsPerSampleUnit: integer Fonts: Type0: Font: BaseFont: CHDLCR+STIXTwoMath-Regular Encoding: Identity-H ToUnicode: true Font: BaseFont: MFHJGW+TimesNewRomanPSMT Encoding: Identity-H ToUnicode: true Type1: Font: BaseFont: Frutiger-Roman FirstChar: 32 LastChar: 252 FontDescriptor: FontName: Frutiger-Roman Flags: Symbolic FontBBox: -50, -180, 1000, 720 FontFile: true ToUnicode: true Font: BaseFont: KGSVQY+MinionPro-Bold FontSubset: true FirstChar: 11 LastChar: 18 FontDescriptor: FontName: KGSVQY+MinionPro-Bold Flags: Nonsymbolic, ForceBold FontBBox: -318, -360, 1684, 1024 FontFile3: true EncodingDictionary: BaseEncoding: WinAnsiEncoding Differences: true ToUnicode: true Font: BaseFont: YSMPNB+FrutigerLTStd-Bold FontSubset: true FirstChar: 1 LastChar: 58 FontDescriptor: FontName: YSMPNB+FrutigerLTStd-Bold Flags: Nonsymbolic, ForceBold FontBBox: -166, -250, 1000, 935 FontFile3: true EncodingDictionary: BaseEncoding: WinAnsiEncoding Differences: true ToUnicode: true Font: BaseFont: ASTDNP+FrutigerLTStd-Roman FontSubset: true FirstChar: 2 LastChar: 82 FontDescriptor: FontName: ASTDNP+FrutigerLTStd-Roman Flags: Nonsymbolic FontBBox: -169, -250, 1000, 935 FontFile3: true EncodingDictionary: BaseEncoding: WinAnsiEncoding Differences: true ToUnicode: true Font: BaseFont: MPCGKN+FrutigerLTStd-BoldItalic FontSubset: true FirstChar: 1 LastChar: 3 FontDescriptor: FontName: MPCGKN+FrutigerLTStd-BoldItalic Flags: Nonsymbolic, Italic, ForceBold FontBBox: -168, -250, 1087, 935 FontFile3: true EncodingDictionary: BaseEncoding: WinAnsiEncoding Differences: true ToUnicode: true Font: BaseFont: MathematicalPi-Four FirstChar: 33 LastChar: 251 FontDescriptor: FontName: MathematicalPi-Four Flags: Symbolic FontBBox: -50, -180, 1000, 720 FontFile: true ToUnicode: true Font: BaseFont: TeX_CM_Maths_Symbols FirstChar: 1 LastChar: 138 FontDescriptor: FontName: TeX_CM_Maths_Symbols Flags: Symbolic FontBBox: -50, -180, 1000, 720 FontFile: true ToUnicode: true Font: BaseFont: EYRRYY+MinionPro-It FontSubset: true FirstChar: 1 LastChar: 40 FontDescriptor: FontName: EYRRYY+MinionPro-It Flags: Nonsymbolic, Italic FontBBox: -201, -360, 1684, 1002 FontFile3: true EncodingDictionary: BaseEncoding: WinAnsiEncoding Differences: true ToUnicode: true Font: BaseFont: TeX_CM_Roman FirstChar: 1 LastChar: 127 FontDescriptor: FontName: TeX_CM_Roman Flags: Symbolic FontBBox: -50, -180, 1000, 720 FontFile: true ToUnicode: true Font: BaseFont: DGIZCW+STIX-Italic FontSubset: true FirstChar: 1 LastChar: 1 FontDescriptor: FontName: DGIZCW+STIX-Italic Flags: Nonsymbolic, Italic FontBBox: -970, -305, 1429, 1023 FontFile3: true EncodingDictionary: BaseEncoding: WinAnsiEncoding Differences: true ToUnicode: true Font: BaseFont: HGQMJI+MinionPro-Regular FontSubset: true FirstChar: 1 LastChar: 81 FontDescriptor: FontName: HGQMJI+MinionPro-Regular Flags: Nonsymbolic FontBBox: -290, -360, 1684, 989 FontFile3: true EncodingDictionary: BaseEncoding: WinAnsiEncoding Differences: true ToUnicode: true Font: BaseFont: Symbol FirstChar: 1 LastChar: 255 FontDescriptor: FontName: Symbol Flags: Symbolic FontBBox: -50, -180, 1000, 720 FontFile: true Font: BaseFont: CGYPWI+STIX-Regular FontSubset: true FirstChar: 1 LastChar: 1 FontDescriptor: FontName: CGYPWI+STIX-Regular Flags: Nonsymbolic FontBBox: -970, -486, 2208, 1023 FontFile3: true EncodingDictionary: BaseEncoding: WinAnsiEncoding Differences: true ToUnicode: true Font: BaseFont: JTKQYF+FrutigerLTStd-Italic FontSubset: true FirstChar: 1 LastChar: 3 FontDescriptor: FontName: JTKQYF+FrutigerLTStd-Italic Flags: Nonsymbolic, Italic FontBBox: -169, -250, 1091, 930 FontFile3: true EncodingDictionary: BaseEncoding: WinAnsiEncoding Differences: true ToUnicode: true Font: BaseFont: TeX_CM_Maths_Italic FirstChar: 1 LastChar: 127 FontDescriptor: FontName: TeX_CM_Maths_Italic Flags: Symbolic FontBBox: -50, -180, 1000, 720 FontFile: true ToUnicode: true CIDFontType2: Font: BaseFont: MFHJGW+TimesNewRomanPSMT CIDSystemInfo: Registry: Adobe Registry: Identity Supplement: 0 FontDescriptor: FontName: MFHJGW+TimesNewRomanPSMT Flags: Nonsymbolic FontBBox: -568, -307, 2000, 1007 FontFile2: true Font: BaseFont: CHDLCR+STIXTwoMath-Regular CIDSystemInfo: Registry: Adobe Registry: Identity Supplement: 0 FontDescriptor: FontName: CHDLCR+STIXTwoMath-Regular Flags: Nonsymbolic FontBBox: -978, -1641, 3072, 2627 FontFile2: true XMP: uuid:5e395f5d-e0b9-283f-5379-ee998bc53c3b uuid:93A37153-9059-2ECE-B6A3-23AFFD88A9CC 2025-03-24T11:52:28+05:30 2025-03-24T11:54:37+05:30 Servigistics Arbortext Advanced Print Publisher 11.1.4667/W 2025-03-24T11:54:37+05:30 PDFlib+PDI 9.0.7p3 (C++/Win32) Effectiveness of the AZD1222 vaccine against COVID-19 hospitalization in Europe: final results from the COVIDRIVE test-negative case–control study Leonie de Munter Wilhelmine Meeraus Akshat Dwivedi Marianna Mitratza Chloé Wyndham-Thomas Lucy Carty Mario Ouwens Wendy Hartig-Merkel Laura Drikite Griet Rebry Irma Casas Ainara Mira-Iglesias Giancarlo Icardi Susana Otero-Romero Sebastian Baumgartner Charlotte Martin Xavier Holemans Gerrit Luit ten Kate Kaatje Bollaerts Sylvia Taylor Doi: 10.1093/eurpub/ckae219 European Journal of Public Health, 35, 2, 2025 Publication Date: 21/01/2025 Abstract Marketing authorization holders of vaccines typically need to report brand-specific vaccine effectiveness (VE) to the regulatory authorities as part of their regulatory obligations. COVIDRIVE (now id. DRIVE) is a European public–private partnership for respiratory pathogen surveillance and studies of brand-specific VE with long-term follow-up. We report the final VE results from a two-dose primary series AZD1222 (ChAdOx1 nCoV-19) vaccine schedule in ≥18-year-old individuals not receiving boosters. Patients (N = 1,333) hospitalized with severe acute respiratory infection at 14 hospitals in Austria, Belgium, Italy, and Spain were included in the test-negative case–control study in 2021–2023. Absolute VE was calculated using generalized additive model (GAM), generalized estimating equation (GEE), and spline-based area under the curve (AUC, measuring VE up to 6 months after the last dose of AZD1222). Overall VE (against coronavirus disease 2019 [COVID-19] hospitalization) of an AZD1222 primary series was estimated as 65% using GEE (95% confidence interval [CI]: 52.9–74.5), and 69% using GAM (95% CI: 50.1–80.9) over the 22-month study period (comparator group: unvaccinated patients). The AUC of the spline-based VE estimate was 74.1% (95% CI: 60.0–88.3). VE against hospitalization in study participants who received their second AZD1222 dose 2 months or less before hospitalization was 86% using GEE (95% CI: 77.8–91.4), 93% using GAM (95% CI: 67.2–98.6). During this study period, where mainly the severe acute respiratory syndrome coronavirus 2 Omicron variant was circulating, a two-dose primary series AZD1222 vaccination conferred protection against COVID-19 hospitalization up to at least 6 months after the last dose. © The Author(s) 2025. Published by Oxford University Press on behalf of the European Public Health Association. application/pdf PStill version 1.84.42 True 3 A http://ns.adobe.com/pdf/1.3/ pdf Adobe PDF Schema internal A name object indicating whether the document has been modified to include trapping information Trapped Text http://ns.adobe.com/xap/1.0/mm/ xmpMM XMP Media Management Schema internal UUID based identifier for specific incarnation of a document InstanceID URI internal The common identifier for all versions and renditions of a document. OriginalDocumentID URI http://www.aiim.org/pdfa/ns/id/ pdfaid PDF/A ID Schema internal Part of PDF/A standard part Integer internal Amendment of PDF/A standard amd Text internal Conformance level of PDF/A standard conformance Text Pages: Page: Sequence: 1 Annotations: Annotation: Subtype: Link Rect: 204, 627, 208, 637 Flags: Print Destination: 706 Annotation: Subtype: Link Rect: 311, 627, 315, 637 Flags: Print Destination: 706 Annotation: Subtype: Link Rect: 317, 627, 322, 637 Flags: Print Destination: 706 Annotation: Subtype: Link Rect: 401, 627, 405, 637 Flags: Print Destination: 706 Annotation: Subtype: Link Rect: 499, 627, 503, 637 Flags: Print Destination: 706 Annotation: Subtype: Link Rect: 237, 616, 241, 626 Flags: Print Destination: 706 Annotation: Subtype: Link Rect: 295, 616, 299, 626 Flags: Print Destination: 706 Annotation: Subtype: Link Rect: 374, 616, 378, 626 Flags: Print Destination: 706 Annotation: Subtype: Link Rect: 485, 616, 489, 626 Flags: Print Destination: 706 Annotation: Subtype: Link Rect: 556, 616, 561, 626 Flags: Print Destination: 706 Annotation: Subtype: Link Rect: 173, 605, 177, 615 Flags: Print Destination: 706 Annotation: Subtype: Link Rect: 233, 605, 237, 615 Flags: Print Destination: 706 Annotation: Subtype: Link Rect: 239, 605, 243, 615 Flags: Print Destination: 706 Annotation: Subtype: Link Rect: 245, 605, 249, 615 Flags: Print Destination: 706 Annotation: Subtype: Link Rect: 348, 605, 352, 615 Flags: Print Destination: 706 Annotation: Subtype: Link Rect: 354, 605, 358, 615 Flags: Print Destination: 706 Annotation: Subtype: Link Rect: 437, 605, 445, 615 Flags: Print Destination: 706 Annotation: Subtype: Link Rect: 447, 605, 456, 615 Flags: Print Destination: 706 Annotation: Subtype: Link Rect: 222, 594, 231, 604 Flags: Print Destination: 706 Annotation: Subtype: Link Rect: 346, 594, 354, 604 Flags: Print Destination: 706 Annotation: Subtype: Link Rect: 442, 595, 452, 605 Flags: Print Annotation: Subtype: Link Rect: 452, 594, 460, 604 Flags: Print Destination: 706 Annotation: Subtype: Link Rect: 545, 594, 553, 604 Flags: Print Destination: 706 Annotation: Subtype: Link Rect: 212, 583, 220, 593 Flags: Print Destination: 706 Annotation: Subtype: Link Rect: 300, 583, 304, 593 Flags: Print Destination: 706 Annotation: Subtype: Link Rect: 306, 583, 310, 593 Flags: Print Destination: null Annotation: Subtype: Link Rect: 374, 583, 379, 593 Flags: Print Destination: 706 Annotation: Subtype: Link Rect: 381, 583, 385, 593 Flags: Print Destination: null Page: Sequence: 2 Annotations: Annotation: Subtype: Link Rect: 50, 712, 55, 721 Flags: Print Destination: 30 Annotation: Subtype: Link Rect: 230, 617, 234, 626 Flags: Print Destination: 30 Annotation: Subtype: Link Rect: 239, 617, 243, 626 Flags: Print Destination: 30 Annotation: Subtype: Link Rect: 224, 575, 228, 584 Flags: Print Destination: 30 Annotation: Subtype: Link Rect: 194, 491, 202, 500 Flags: Print Destination: 30 Annotation: Subtype: Link Rect: 232, 134, 236, 143 Flags: Print Destination: 30 Annotation: Subtype: Link Rect: 546, 691, 555, 700 Flags: Print Destination: 30 Annotation: Subtype: Link Rect: 560, 691, 560, 700 Flags: Print Destination: 30 Annotation: Subtype: Link Rect: 309, 680, 318, 689 Flags: Print Destination: 30 Annotation: Subtype: Link Rect: 373, 670, 382, 679 Flags: Print Destination: 30 Annotation: Subtype: Link Rect: 417, 628, 426, 637 Flags: Print Destination: 30 Annotation: Subtype: Link Rect: 450, 617, 458, 626 Flags: Print Destination: 30 Annotation: Subtype: Link Rect: 312, 428, 334, 437 Flags: Print Destination: 5 Annotation: Subtype: Link Rect: 444, 386, 448, 395 Flags: Print Destination: 30 Annotation: Subtype: Link Rect: 443, 334, 464, 342 Flags: Print Destination: 5 Annotation: Subtype: Link Rect: 450, 239, 478, 248 Flags: Print Destination: 10 Annotation: Subtype: Link Rect: 457, 197, 486, 206 Flags: Print Destination: 10 Annotation: Subtype: Link Rect: 312, 113, 341, 122 Flags: Print Destination: 18 Annotation: Subtype: Link Rect: 540, 92, 544, 101 Flags: Print Destination: 30 Annotation: Subtype: Link Rect: 348, 82, 380, 91 Flags: Print Destination: 10 Page: Sequence: 3 Annotations: Annotation: Subtype: Link Rect: 57, 398, 86, 407 Flags: Print Destination: 18 Annotation: Subtype: Link Rect: 177, 377, 204, 386 Flags: Print Destination: 18 Annotation: Subtype: Link Rect: 241, 366, 245, 375 Flags: Print Destination: 30 Annotation: Subtype: Link Rect: 179, 303, 188, 312 Flags: Print Destination: 30 Annotation: Subtype: Link Rect: 108, 219, 112, 228 Flags: Print Destination: 30 Annotation: Subtype: Link Rect: 118, 219, 127, 228 Flags: Print Destination: 30 Annotation: Subtype: Link Rect: 273, 219, 282, 228 Flags: Print Destination: 30 Annotation: Subtype: Link Rect: 288, 219, 297, 228 Flags: Print Destination: 30 Annotation: Subtype: Link Rect: 494, 335, 503, 344 Flags: Print Destination: 30 Annotation: Subtype: Link Rect: 409, 314, 418, 323 Flags: Print Destination: 30 Annotation: Subtype: Link Rect: 516, 303, 524, 312 Flags: Print Destination: 30 Annotation: Subtype: Link Rect: 374, 250, 383, 259 Flags: Print Destination: 30 Annotation: Subtype: Link Rect: 550, 208, 559, 217 Flags: Print Destination: 30 Page: Sequence: 4 Annotations: Annotation: Subtype: Link Rect: 230, 29, 235, 38 Flags: Print Destination: 30 Page: Sequence: 5 Annotations: Annotation: Subtype: Link Rect: 504, 704, 507, 711 Flags: Print Destination: 18 Annotation: Subtype: Link Rect: 465, 561, 469, 568 Flags: Print Destination: 18 Annotation: Subtype: Link Rect: 528, 561, 531, 568 Flags: Print Destination: 18 Annotation: Subtype: Link Rect: 54, 489, 64, 497 Flags: Print Destination: 18 Annotation: Subtype: Link Rect: 54, 479, 64, 487 Flags: Print Destination: 18 Page: Sequence: 6 Annotations: Annotation: Subtype: Link Rect: 47, 718, 51, 725 Flags: Print Destination: 1 Annotation: Subtype: Link Rect: 47, 676, 51, 683 Flags: Print Destination: 1 Annotation: Subtype: Link Rect: 47, 634, 51, 641 Flags: Print Destination: null Annotation: Subtype: Link Rect: 47, 612, 51, 619 Flags: Print Destination: null Annotation: Subtype: Link Rect: 47, 571, 51, 578 Flags: Print Destination: null Annotation: Subtype: Link Rect: 47, 539, 51, 546 Flags: Print Destination: null Annotation: Subtype: Link Rect: 47, 497, 51, 504 Flags: Print Destination: null Annotation: Subtype: Link Rect: 47, 465, 51, 472 Flags: Print Destination: 10 Annotation: Subtype: Link Rect: 47, 433, 51, 440 Flags: Print Destination: 1 Annotation: Subtype: Link Rect: 47, 391, 54, 398 Flags: Print Destination: 1 Annotation: Subtype: Link Rect: 131, 361, 295, 368 Flags: Print Annotation: Subtype: Link Rect: 59, 351, 290, 358 Flags: Print Annotation: Subtype: Link Rect: 59, 341, 134, 348 Flags: Print Annotation: Subtype: Link Rect: 47, 329, 54, 336 Flags: Print Destination: 1 Annotation: Subtype: Link Rect: 309, 734, 316, 741 Flags: Print Destination: 1 Annotation: Subtype: Link Rect: 309, 712, 316, 719 Flags: Print Destination: 1 Annotation: Subtype: Link Rect: 309, 690, 316, 697 Flags: Print Destination: 1 Annotation: Subtype: Link Rect: 309, 668, 316, 675 Flags: Print Destination: 1 Annotation: Subtype: Link Rect: 309, 646, 316, 653 Flags: Print Destination: 5 Annotation: Subtype: Link Rect: 309, 604, 316, 611 Flags: Print Destination: 5 Annotation: Subtype: Link Rect: 461, 574, 556, 581 Flags: Print Annotation: Subtype: Link Rect: 321, 564, 554, 571 Flags: Print Annotation: Subtype: Link Rect: 321, 554, 351, 560 Flags: Print Annotation: Subtype: Link Rect: 309, 542, 316, 549 Flags: Print Destination: 5 Annotation: Subtype: Link Rect: 309, 500, 316, 507 Flags: Print Destination: 5 Annotation: Subtype: Link Rect: 309, 468, 316, 474 Flags: Print Destination: 5 Annotation: Subtype: Link Rect: 309, 436, 316, 442 Flags: Print Destination: 5 Annotation: Subtype: Link Rect: 309, 403, 316, 410 Flags: Print Destination: 5 Annotation: Subtype: Link Rect: 309, 372, 316, 378 Flags: Print Destination: 5 Annotation: Subtype: Link Rect: 336, 361, 409, 368 Flags: Print Annotation: Subtype: Link Rect: 309, 350, 316, 356 Flags: Print Destination: 5 Checksum: 250e7f4b Type: CRC32 Checksum: 009455209a9b1ee0d431032ac1da13f9 Type: MD5 Checksum: 7af2fe295326052843e68ef201d7059bca2bf07b Type: SHA-1 Checksum: 620f9740a63a4791737bfd5c041f3bf58b8732ca3304b5601dbdf31c976b1d00 Type: SHA-256