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McGeoch LJ, Hoban A, Sawyer C, Rabie H, Painset A, Browning L, Brown D, McCarthy C, Nelson A, Firme A, Pista Â, Moreno J, Martins JV, Silveira L, Machado J, Vasconcelos P, Olufon O, Inzoungou-Massanga C, Douglas A, McCormick J, Larkin L, Balasegaram S. Salmonella Saintpaul outbreak associated with cantaloupe consumption, the United Kingdom and Portugal, September to November 2023. Epidemiol Infect 2024; 152:e78. [PMID: 38705587 DOI: 10.1017/s0950268824000670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Abstract
In September 2023, the UK Health Security Agency identified cases of Salmonella Saintpaul distributed across England, Scotland, and Wales, all with very low genetic diversity. Additional cases were identified in Portugal following an alert raised by the United Kingdom. Ninety-eight cases with a similar genetic sequence were identified, 93 in the United Kingdom and 5 in Portugal, of which 46% were aged under 10 years. Cases formed a phylogenetic cluster with a maximum distance of six single nucleotide polymorphisms (SNPs) and average of less than one SNP between isolates. An outbreak investigation was undertaken, including a case-control study. Among the 25 UK cases included in this study, 13 reported blood in stool and 5 were hospitalized. One hundred controls were recruited via a market research panel using frequency matching for age. Multivariable logistic regression analysis of food exposures in cases and controls identified a strong association with cantaloupe consumption (adjusted odds ratio: 14.22; 95% confidence interval: 2.83-71.43; p-value: 0.001). This outbreak, together with other recent national and international incidents, points to an increase in identifications of large outbreaks of Salmonella linked to melon consumption. We recommend detailed questioning and triangulation of information sources to delineate consumption of specific fruit varieties during Salmonella outbreaks.
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Affiliation(s)
- Luke J McGeoch
- Field Service South-East and London, Health Protection Operations Division, UK Health Security Agency, London, UK
- Field Epidemiology Training Programme, UK Health Security Agency, London, UK
| | - Ann Hoban
- Gastrointestinal Infections and Food Safety (One Health) Division, Clinical and Public Health Group, UK Health Security Agency, London, UK
| | - Clare Sawyer
- Field Service South-East and London, Health Protection Operations Division, UK Health Security Agency, London, UK
| | - Hussein Rabie
- Gastrointestinal Infections and Food Safety (One Health) Division, Clinical and Public Health Group, UK Health Security Agency, London, UK
| | - Anaïs Painset
- Gastrointestinal Bacteria Reference Unit, Clinical and Public Health Group, UK Health Security Agency, London, UK
| | - Lynda Browning
- Clinical and Protecting Health Directorate, Public Health Scotland, Glasgow, UK
| | - Derek Brown
- Scottish Microbiology Reference Laboratory (SMiRL), Glasgow, UK
| | - Caitlin McCarthy
- Clinical and Protecting Health Directorate, Public Health Scotland, Glasgow, UK
| | - Andrew Nelson
- Communicable Disease Surveillance Centre, Public Health Wales, Cardiff, UK
| | - Ana Firme
- Public Health Emergencies Operations Centre, Directorate-General of Health, Lisbon, Portugal
| | - Ângela Pista
- National Reference Laboratory for Gastrointestinal Infections, Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal
| | - Joana Moreno
- Directorate of Information and Analysis, Directorate-General of Health, Lisbon, Portugal
| | - João Vieira Martins
- Directorate of Information and Analysis, Directorate-General of Health, Lisbon, Portugal
| | - Leonor Silveira
- National Reference Laboratory for Gastrointestinal Infections, Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal
| | - Jorge Machado
- National Reference Laboratory for Gastrointestinal Infections, Department of Infectious Diseases, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal
| | - Paula Vasconcelos
- Public Health Emergencies Operations Centre, Directorate-General of Health, Lisbon, Portugal
| | - Oluwakemi Olufon
- Rapid Investigation Team, Field Services, Health Protection Operations Division, UK Health Security Agency, London, UK
| | - Carmellie Inzoungou-Massanga
- Rapid Investigation Team, Field Services, Health Protection Operations Division, UK Health Security Agency, London, UK
| | - Amy Douglas
- Gastrointestinal Infections and Food Safety (One Health) Division, Clinical and Public Health Group, UK Health Security Agency, London, UK
| | - Jacquelyn McCormick
- Gastrointestinal Infections and Food Safety (One Health) Division, Clinical and Public Health Group, UK Health Security Agency, London, UK
| | - Lesley Larkin
- Gastrointestinal Infections and Food Safety (One Health) Division, Clinical and Public Health Group, UK Health Security Agency, London, UK
| | - Sooria Balasegaram
- Field Service South-East and London, Health Protection Operations Division, UK Health Security Agency, London, UK
- Gastrointestinal Infections and Food Safety (One Health) Division, Clinical and Public Health Group, UK Health Security Agency, London, UK
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2
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Moore HL, Aabye M, Hoban A, Rosner B, Lefevre SK, Litrup E, Müller L, Ethelberg S, Simon S, Balasegaram S, Larkin L, Jernberg C, Takkinen J. Multinational collaboration in solving a European Salmonella Braenderup outbreak linked to imported melons, 2021. Euro Surveill 2024; 29:2300273. [PMID: 38179625 PMCID: PMC10905663 DOI: 10.2807/1560-7917.es.2024.29.1.2300273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/23/2023] [Indexed: 01/06/2024] Open
Abstract
A genomic cluster of Salmonella Braenderup ST22, a serovar of Salmonella enterica subsp. enterica which causes symptoms of gastrointestinal illness, was notified by Danish authorities to the European Centre for Disease Prevention and Control (ECDC) on 3 May 2021. By 6 July 2021, S. Braenderup outbreak cases (n = 348) had been reported from 12 countries in the European Union/European Economic Area (EU/EEA) and the United Kingdom (UK), including 68 hospitalised cases. With support from affected EU/EEA countries, and in partnership with the European Food Safety Authority (EFSA), ECDC established an international outbreak investigation team to rapidly identify the source and prevent outbreak spread. Consumption information was shared with affected countries through a standard line list, revealing that 124 of 197 cases (63%) reported having eaten (any) melons within 7 days prior to disease onset. The speed and completeness of the investigation, which identified the outbreak vehicle as galia melons imported from Honduras in June 2021, was a direct result of extensive collaboration and information sharing between countries' national food safety and public health authorities. This article describes the outbreak and the benefits, successes, and challenges of multi-country collaboration for consideration in future large foodborne outbreaks across Europe.
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Affiliation(s)
- Hannah L Moore
- UK Field Epidemiology Training Program (UK FETP), UK Health Security Agency, London, United Kingdom
- UK Health Security Agency, London, United Kingdom
| | - Martine Aabye
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, (ECDC), Stockholm, Sweden
- Statens Serum Institut, Copenhagen, Denmark
- The Danish Health Authority, Copenhagen, Denmark
| | - Ann Hoban
- UK Health Security Agency, London, United Kingdom
| | | | | | - Eva Litrup
- Statens Serum Institut, Copenhagen, Denmark
| | - Luise Müller
- UK Health Security Agency, London, United Kingdom
| | - Steen Ethelberg
- Statens Serum Institut, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | - Cecilia Jernberg
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Johanna Takkinen
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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3
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Benson HE, Reeve L, Findlater L, Vusirikala A, Pietzsch M, Olufon O, Matthews E, Hoban A, Painset A, Balasegaram S, Larkin L, Weir S, Heinsbroek E. Local Salmonella Enteritidis restaurant outbreak investigation in England provides further evidence for eggs as source in widespread international cluster, March to April 2023. Euro Surveill 2023; 28:2300309. [PMID: 37410382 PMCID: PMC10370042 DOI: 10.2807/1560-7917.es.2023.28.27.2300309] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 07/05/2023] [Indexed: 07/07/2023] Open
Abstract
We report a 5-single nucleotide polymorphism cluster of Salmonella Enteriditis in England, part of a global cluster of S. Enteritidis ST11. Forty-seven confirmed cases have been investigated of whom 25 were linked to a restaurant. In addition, there were 18 probable cases with restaurant exposure. Epidemiological investigations suggested eggs or chicken as the most likely cause of the outbreak but were unable to distinguish between those two food vehicles. Ongoing food chain investigations indicated links to imported eggs from Poland.
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Affiliation(s)
- Helen E Benson
- East of England Health Protection Team, UK Health Security Agency, Cambridge, United Kingdom
| | - Lucy Reeve
- Field Service East of England, UK Health Security Agency, Cambridge United Kingdom
| | - Lucy Findlater
- Field Service South East and London, UK Health Security Agency, London, United Kingdom
| | - Amoolya Vusirikala
- Field Service South East and London, UK Health Security Agency, London, United Kingdom
| | - Maaike Pietzsch
- Field Service Rapid Investigation Team, UK Health Security Agency, London, United Kingdom
| | - Oluwakemi Olufon
- Field Service Rapid Investigation Team, UK Health Security Agency, London, United Kingdom
| | - Eve Matthews
- Gastrointestinal Infections and Food Safety (One Health) Division, UK Health Security Agency, London, United Kingdom
| | - Ann Hoban
- Gastrointestinal Infections and Food Safety (One Health) Division, UK Health Security Agency, London, United Kingdom
| | - Anaïs Painset
- Gastrointestinal Bacteria Reference Unit, Public Health Microbiology Division, UK Health Security Agency, London, United Kingdom
| | - Sooria Balasegaram
- Field Service South East and London, UK Health Security Agency, London, United Kingdom
- Gastrointestinal Infections and Food Safety (One Health) Division, UK Health Security Agency, London, United Kingdom
| | - Lesley Larkin
- Gastrointestinal Infections and Food Safety (One Health) Division, UK Health Security Agency, London, United Kingdom
| | - Sarah Weir
- East of England Health Protection Team, UK Health Security Agency, Cambridge, United Kingdom
| | - Ellen Heinsbroek
- Field Service East of England, UK Health Security Agency, Cambridge United Kingdom
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Chan YW, Hoban A, Moore H, Greig DR, Painset A, Jorgensen F, Chattaway MA, Jenkins C, Balasegaram S, McCormick J, Larkin L. Two Outbreaks of Foodborne Gastrointestinal Infection Linked to Consumption of Imported Melons, United Kingdom, March to August 2021. J Food Prot 2023; 86:100027. [PMID: 36916586 DOI: 10.1016/j.jfp.2022.100027] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 12/15/2022]
Abstract
The aim of this study was to describe two foodborne outbreaks caused by contaminated imported melon and make recommendations for future practice. Between March and July 2021, there was an outbreak of 113 cases of Salmonella Braenderup in the UK (62% female, median age 61 years, 33% hospitalized). Analytical epidemiological studies identified Galia melons as the vehicle of infection (OR 671.9, 95% CI 39.0-58,074.0, p < 0.001). Subsequently, the outbreak strain was isolated from two samples of Galia melon imported from Latin America. In July and August 2021, there was an outbreak of 17 cases of Shiga toxin-producing Escherichia coli (STEC) O157:H7 in the UK (53% female, median age 21 years, 35% were hospitalized). Review of the STEC surveillance questionnaire data, followed by the analysis of responses from a modified hypothesis-generating questionnaire, implicated eating precut watermelon from retailer B sourced from Europe as the vehicle of infection. Outbreaks of gastrointestinal pathogens caused by contaminated food of nonanimal origin are a global public health concern. Given the difficulty in removing pathogens from the flesh of ready-to-eat fruit and vegetables, public health interventions should target all steps of the food chain prior to consumption, from cultivation on the farm to processing/packing and distribution.
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Affiliation(s)
- Yung-Wai Chan
- Gastrointestinal Infections and Food Safety (One Health) Division, UK Health Security Agency, London NW9 5HT, UK
| | - Ann Hoban
- Gastrointestinal Infections and Food Safety (One Health) Division, UK Health Security Agency, London NW9 5HT, UK
| | - Hannah Moore
- UK Field Epidemiology Training Program (UK FETP), UK Health Security Agency, UK
| | - David R Greig
- Gastrointestinal Bacteria Reference Unit, UK Health Security Agency, London NW9 5HT, UK
| | - Anais Painset
- Gastrointestinal Bacteria Reference Unit, UK Health Security Agency, London NW9 5HT, UK
| | - Frieda Jorgensen
- Food Water and Environmental Microbiology Laboratory Porton, UK Health Security Agency, Salisbury SP4 0JG, UK
| | - Marie A Chattaway
- Gastrointestinal Bacteria Reference Unit, UK Health Security Agency, London NW9 5HT, UK
| | - Claire Jenkins
- Gastrointestinal Infections and Food Safety (One Health) Division, UK Health Security Agency, London NW9 5HT, UK; Gastrointestinal Bacteria Reference Unit, UK Health Security Agency, London NW9 5HT, UK.
| | | | - Jacquelyn McCormick
- Gastrointestinal Infections and Food Safety (One Health) Division, UK Health Security Agency, London NW9 5HT, UK
| | - Lesley Larkin
- Gastrointestinal Infections and Food Safety (One Health) Division, UK Health Security Agency, London NW9 5HT, UK
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Larkin L, Pardos de la Gandara M, Hoban A, Pulford C, Jourdan-Da Silva N, de Valk H, Browning L, Falkenhorst G, Simon S, Lachmann R, Dryselius R, Karamehmedovic N, Börjesson S, van Cauteren D, Laisnez V, Mattheus W, Pijnacker R, van den Beld M, Mossong J, Ragimbeau C, Vergison A, Thorstensen Brandal L, Lange H, Garvey P, Nielsen CS, Herrera León S, Varela C, Chattaway M, Weill FX, Brown D, McKeown P. Investigation of an international outbreak of multidrug-resistant monophasic Salmonella Typhimurium associated with chocolate products, EU/EEA and United Kingdom, February to April 2022. Euro Surveill 2022; 27. [PMID: 35426359 PMCID: PMC9012091 DOI: 10.2807/1560-7917.es.2022.27.15.2200314] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
An extensive multi-country outbreak of multidrug-resistant monophasic Salmonella Typhimurium infection in 10 countries with 150 reported cases, predominantly affecting young children, has been linked to chocolate products produced by a large multinational company. Extensive withdrawals and recalls of multiple product lines have been undertaken. With Easter approaching, widespread product distribution and the vulnerability of the affected population, early and effective real-time sharing of microbiological and epidemiological information has been of critical importance in effectively managing this serious food-borne incident.
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Affiliation(s)
- Lesley Larkin
- Gastrointestinal Infections and Food Safety (One Health Unit), UK Health Security Agency, London, United Kingdom
| | - Maria Pardos de la Gandara
- Institut Pasteur, Université Paris Cité, Centre National de Référence des E. coli, Shigella et Salmonella, Unité des Bactéries pathogènes entériques, Paris, France
| | - Ann Hoban
- Gastrointestinal Infections and Food Safety (One Health Unit), UK Health Security Agency, London, United Kingdom
| | - Caisey Pulford
- Gastrointestinal Infections and Food Safety (One Health Unit), UK Health Security Agency, London, United Kingdom
| | | | - Henriette de Valk
- Sante Publique France, Direction des Maladies Infectieuses Unité EAZ, Paris, France
| | - Lynda Browning
- Clinical and Protecting Health Directorate, Public Health Scotland, Glasgow, United Kingdom
| | - Gerhard Falkenhorst
- Robert Koch Institute, Department of Infectious Disease Epidemiology FG 35 - Gastrointestinal Infections, Zoonoses and Tropical Infections, Berlin, Germany
| | - Sandra Simon
- Robert Koch Institute, Department of Infectious Diseases, Unit for Enteropathogenic Bacteria and Legionella / National Reference Centre for Salmonella and other Bacterial Enterics, Wernigerode, Germany
| | - Raskit Lachmann
- Robert Koch Institute, Department of Infectious Disease Epidemiology FG 35 - Gastrointestinal Infections, Zoonoses and Tropical Infections, Berlin, Germany
| | - Rikard Dryselius
- Public Health Agency of Sweden, Unit for Zoonoses and Antibiotic Resistance, Stockholm, Sweden
| | - Nadja Karamehmedovic
- Public Health Agency of Sweden, Unit for laboratory surveillance of bacterial pathogens, Stockholm, Sweden
| | - Stefan Börjesson
- Public Health Agency of Sweden, Unit for Zoonoses and Antibiotic Resistance, Stockholm, Sweden
| | - Dieter van Cauteren
- Epidemiology of infectious diseases, Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Valeska Laisnez
- ECDC Fellowship Programme, Field Epidemiology path (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
- Epidemiology of infectious diseases, Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Wesley Mattheus
- National Reference Centre for Salmonella and Shigella, Sciensano, Brussels, Belgium
| | - Roan Pijnacker
- National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, Netherlands
| | - Maaike van den Beld
- National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, Netherlands
| | - Joël Mossong
- Health Inspection, Health Directorate, Luxembourg
| | - Catherine Ragimbeau
- Laboratoire National de Santé, Epidemiology and Microbial Genomics, Dudelange, Luxembourg
| | | | - Lin Thorstensen Brandal
- Department of Infection Control and Preparedness, Norwegian Institute of Public Health, Oslo, Norway
| | - Heidi Lange
- Department of Infection Control and Preparedness, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Charlotte Salgaard Nielsen
- ECDC Fellowship Programme, Field Epidemiology path (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
- HSE -Health Protection Surveillance Centre, Dublin, Ireland
| | - Silvia Herrera León
- Instituto de Salud Carlos III. Centro Nacional de Microbiología, Madrid, Spain
| | - Carmen Varela
- Instituto de Salud Carlos III. CIBER epidemiología y salud pública. Madrid, Spain
| | - Marie Chattaway
- Specialist Scientific Reference Service (Salmonella), Gastrointestinal Bacteria Reference Unit, UK Health Security Agency, London, United Kingdom
| | - François-Xavier Weill
- Institut Pasteur, Université Paris Cité, Centre National de Référence des E. coli, Shigella et Salmonella, Unité des Bactéries pathogènes entériques, Paris, France
| | - Derek Brown
- Scottish Microbiology Reference Laboratories, Glasgow, United Kingdom
| | - Paul McKeown
- HSE -Health Protection Surveillance Centre, Dublin, Ireland
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Jørgensen F, McLauchlin J, Verlander NQ, Aird H, Balasegaram S, Chattaway MA, Dallman T, Herdman MT, Hoban A, Lai S, Larkin L, McCormick J, Reeves LS, Willis C. Levels and genotypes of Salmonella and levels of Escherichia coli in frozen ready-to-cook chicken and turkey products in England tested in 2020 in relation to an outbreak of S. Enteritidis. Int J Food Microbiol 2022; 369:109609. [DOI: 10.1016/j.ijfoodmicro.2022.109609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 11/26/2022]
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Daly A, Hoban A, Egan C, Moore D, Kiely P. The Implications of Delayed Access to MRI Imaging: A 3-month Historical Prospective Study. Ir Med J 2017; 110:524. [PMID: 28657268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- A Daly
- Orthopaedic Department, Our Lady's Children's Hospital, Crumlin, Dublin 12
| | - A Hoban
- Orthopaedic Department, Our Lady's Children's Hospital, Crumlin, Dublin 12
| | - C Egan
- Orthopaedic Department, Our Lady's Children's Hospital, Crumlin, Dublin 12
| | - D Moore
- Orthopaedic Department, Our Lady's Children's Hospital, Crumlin, Dublin 12
| | - P Kiely
- Orthopaedic Department, Our Lady's Children's Hospital, Crumlin, Dublin 12
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Rahman E, Malebranche L, Malodiya A, Dang D, Bathina J, Mahoney D, Hoban A, Kolm P, Weintraub W. In the era of primary PCI, is emergent coronary angiography increasingly necessary to rule out STEMI before a diagnosis of pericarditis can be made. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p4484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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