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Mpox outbreak
Factsheet and news
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UPDATE OF 28 APRIL 2023
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This document is composed of 3 different tabs: General information, Relevant news, and Scientific articles
The content and presentation of this document are subject to change as the situation evolves.
Every information presented comes from a valid and credible source.
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The redaction of this document is coordinated by:
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 Erica Telford, Nicolas Pulik, Keyla de Almeida Macêdo (ANRS | Emerging Infectious Diseases)
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The "General information" tab presents an overview, case definitions, guidelines, reported cases
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Overview
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https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON385
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Timeline- On 07 May 2022, WHO was informed of a confirmed case of monkeypox in an individual who travelled from the UK to Nigeria and then returned to the UK on the 03 May.

- On 13 May 2022, WHO was notified of 2 laboratory confirmed cases and 1 probable case of monkeypox, from the same household, in the UK. On 15 May, 4 additional laboratory confirmed cases have been reported in gay, bisexual, and other men who have sex with men (GBMSM). In contrast to the previous imported cases, no source of infection has been confirmed as of today.

- Suspected or confirmed cases have since then been notified in other countries within EU/EAA, the Americas, Asia, UK, Israel and Australia. WHO/ECDC reported approximately 1285 onfirmed cases as of 08 June 2022. The vaccination of high-risk contacts of cases has been recommended in several countries, including France.
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Epidemiology- Monkeypox is a sylvatic zoonosis with incidental human infections that usually occur sporadically in forested parts of Central and West Africa, where it considered endemic. It is caused by the monkeypox virus (orthopoxvirus family). The animal reservoir remains unknown, although is likely to be among rodents.
- It can be transmitted by contact and droplet exposure via exhaled large droplets. Contact with live and dead animals through hunting and consumption of wild game or bush meat are known risk factors.
- The incubation period of monkeypox is usually from 6-13 days but can range 5-21 days.
- The disease is often self-limiting with symptoms usually resolving spontaneously in 14-21 days. Symptoms can be mild or severe, and lesions can be very itchy or painful.

- There are two clades of monkeypox virus, the West African clade and Congo Basin (Central African) clade. The case fatality ratio for the West African clade has been documented to be around 1%, whereas for the Congo Basin clade, it may be as high as 10%.
- Children are also at higher risk, and monkeypox during pregnancy may lead to complications, congenital monkeypox or stillbirth.

- A vaccine has been approved for prevention of monkeypox, and traditional smallpox vaccine also provides protection, though these vaccines are not widely available and populations worldwide under the age of 40 or 50 years no longer benefit from the protection afforded by prior smallpox vaccination programmes.

- Concerns about monkeypox becoming endemic in countries where it previously was not drives some recommendations, namely for infected people to avoid contact with pet animals.
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WHO surveillance case definitions for the current mpox outbreak in non-endemic countries (2022)
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Source : https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON385
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ConfirmedA case meeting the definition of either a suspected or probable case and is laboratory confirmed for monkeypox virus by detection of unique sequences of viral DNA either by RT-PCR and/or sequencing
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ProbableA person meeting the case definition for a suspected case

AND one or more of the following:
- has an epidemiological link (face-to-face exposure, including health workers without eye and respiratory protection); direct physical contact with skin or skin lesions, including sexual contact; or contact with contaminated materials such as clothing, bedding or utensils to a probable or confirmed case of monkeypox in the 21 days before symptom onset
- reported travel history to a monkeypox endemic country in the 21 days before symptom onset
- has had multiple or anonymous sexual partners in the 21 days before symptom onset
- has a positive result of an orthopoxvirus serological assay, in the absence of smallpox vaccination or other known exposure to orthopoxviruses
- is hospitalized due to the illness
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SuspectedA person of any age presenting in a monkeypox non-endemic country with an unexplained acute rash

- AND one or more of the following signs or symptoms, since 15 March 2022: headache, acute onset of fever (>38.5oC),l ymphadenopathy (swollen lymph nodes), myalgia (muscle and body aches), back pain, asthenia (profound weakness)

- AND for which the following common causes of acute rash do not explain the clinical picture: varicella zoster, herpes zoster, measles, Zika, dengue, chikungunya, herpes simplex, bacterial skin infections, disseminated gonococcus infection, primary or secondary syphilis, chancroid, lymphogranuloma venereum, granuloma inguinale, molluscum contagiosum, allergic reaction (e.g., to plants); and any other locally relevant common causes of papular or vesicular rash.

N.B. It is not necessary to obtain negative laboratory results for listed common causes of rash illness in order to classify a case as suspected.
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DiscardedA suspected or probable case for which laboratory testing by PCR and/or sequencing is negative for monkeypox virus.
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Santé publique France case definition (19.05.2022)
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Source : https://www.santepubliquefrance.fr/content/download/437302/file/def_cas_CAT_monkeypox_19052022.pdf
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Confirmed- A positive monkeypox virus-specific qPCR or RT-PCR result, or
- a positive generic Orthopoxvirus qPCR result in a person with recent risk of exposure to the monkeypox virus in the 3 weeks prior to the onset of signs (return from travel to an endemic area or signs (return from a trip to an endemic area or where virus is circulating, contact with a person returning from a trip to an endemic or where virus is circulating, contact person of a probable or confirmed case)
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ProbableA person who has experienced a felt or measured fever (> 38°C) followed by a vesicular rash suggestive of mokeypox, and who reports high or moderate risk contact with a confirmed or probable case in France, or a confirmed case in another country, in the 3 weeks preceding the onset of symptoms
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Suspected- A felt or measured fever (>38°C), followed by a vesicular rash suggesting monkeypox, or
- pneumonia or encephalitis without an identified cause with a history of a vesicular rash suggesting monkeypox at the beginning of the disease
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Guidelines and practical information from French authorities, ECDC, and WHO
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22/12/2022Surveillance, case investigation and contact tracing for mpox (monkeypox): interim guidance, 22 December 2022https://www.who.int/publications/i/item/WHO-MPX-Surveillance-2022.4
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16/11/2022Vaccines and immunization for monkeypox: Interim guidance, 16 November 2022https://www.who.int/publications/i/item/WHO-MPX-Immunization
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16/11/2022Background document for the SAGE October 2022 session on monkeypox vaccineshttps://www.who.int/publications/i/item/WHO-MPX-Immunization-Background-2022
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11/10/2022Monkeypox : la HAS complète ses recommandations sur la vaccinationhttps://www.has-sante.fr/jcms/p_3376314/fr/monkeypox-la-has-complete-ses-recommandations-sur-la-vaccination
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05/10/2022Monkeypox Strategic Preparedness, Readiness, and Response Plan (SPRP)https://www.who.int/publications/m/item/monkeypox-strategic-preparedness--readiness--and-response-plan-(sprp)
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15/09/2022Réponses Rapides : infection par le virus Monkeypox – Prise en charge en médecine de 1er recourshttps://www.has-sante.fr/jcms/p_3361191/fr/reponses-rapides-infection-par-le-virus-monkeypox-prise-en-charge-en-medecine-de-1er-recours#:~:text=R%C3%A9ponse%20Rapide%201%20%3A%20L'infection,%2C%20vaisselle...).
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08/09/2022Monkeypox (MPX) Reporting Protocol 2022https://www.ecdc.europa.eu/en/publications-data/monkeypox-mpx-reporting-protocol-2022
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01/09/2022Avis de l’Anses portant sur « des recommandations relatives à la réduction du risque de diffusion du virus Monkeypox aux animaux en France » - Deuxième partiehttps://www.anses.fr/fr/system/files/SABA2022SA0102-1.pdf
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24/08/2022Vaccines and immunization for monkeypox: Interim guidance, 24 August 2022https://www.who.int/publications/i/item/WHO-MPX-Immunization-2022.2-eng
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19/08/2022EMA’s Emergency Task Force advises on intradermal use of Imvanex / Jynneos against monkeypoxhttps://www.ema.europa.eu/en/news/emas-emergency-task-force-advises-intradermal-use-imvanex-jynneos-against-monkeypox
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16/08/2022Monkeypox infection prevention and control guidance for primary and acute care settingshttps://www.ecdc.europa.eu/en/publications-data/monkeypox-infection-prevention-and-control-guidance-primary-and-acute-care
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28/07/2022Monkeypox : CORE protocol for an international adaptive multi-country clinical trial of the safety and efficacy of treatments for patients with monkeypox virus diseasehttps://www.anrs.fr/en/actualites/1127/monkeypox-core-protocol-international-trial-safety-and-efficacy-treatments
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23/07/2022Second meeting of the International Health Regulations (2005) (IHR) Emergency Committee regarding the multi-country outbreak of monkeypoxhttps://www.who.int/news/item/23-07-2022-second-meeting-of-the-international-health-regulations-(2005)-(ihr)-emergency-committee-regarding-the-multi-country-outbreak-of-monkeypox
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22/07/2022EMA recommends approval of Imvanex for the prevention of monkeypox diseasehttps://www.ema.europa.eu/en/news/ema-recommends-approval-imvanex-prevention-monkeypox-disease
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24/06/2022Monkeypox : informations pour les professionnels de santéhttps://solidarites-sante.gouv.fr/soins-et-maladies/maladies/maladies-infectieuses/article/monkeypox-informations-pour-les-professionnels-de-sante
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18/07/2022Public health advice for gay, bisexual and other men who have sex with men on the recent outbreak of monkeypoxhttps://www.who.int/publications/m/item/monkeypox-public-health-advice-for-men-who-have-sex-with-men
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14/07/2022Prendre en charge les patients - fiches pratiqueshttps://www.coreb.infectiologie.com/fr/prendre-en-charge-les-patients-fiches-pratiques.html
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11/07/2022Monkeypox : ressources et supports de communicationhttps://solidarites-sante.gouv.fr/soins-et-maladies/maladies/maladies-infectieuses/monkeypox/article/monkeypox-ressources-et-supports-de-communication
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08/07/2022Monkeypox : une vaccination préventive proposée aux personnes les plus à risque d’expositionhttps://www.has-sante.fr/jcms/p_3351308/fr/avis-n2022-0039/ac/sespev-du-7-juillet-2022-du-college-de-la-haute-autorite-de-sante-relatif-a-la-vaccination-contre-le-virus-monkeypox-en-preexposition-des-personnes-a-haut-risque-d-exposition
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08/07/2022Monkeypox outbreak: technical briefingshttps://www.gov.uk/government/publications/monkeypox-outbreak-technical-briefings
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06/07/2022Multi-country outbreak of monkeypox, External situation report #1 - 6 July 2022https://www.who.int/publications/m/item/multi-country-outbreak-of-monkeypox--external-situation-report--1---6-july-2022
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04/07/2022Risk communication and community engagement approaches during the monkeypox outbreak in Europe, 2022https://www.ecdc.europa.eu/en/publications-data/risk-communication-and-community-engagement-monkeypox-outbreak
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29/06/2022Monkeypox (MPX) Reporting Protocol 2022https://www.ecdc.europa.eu/en/publications-data/monkeypox-mpx-reporting-protocol-2022
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28/06/2022Considerations for contact tracing during the monkeypox outbreak in Europe, 2022https://www.ecdc.europa.eu/en/publications-data/considerations-contact-tracing-during-monkeypox-outbreak-europe-2022
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28/06/2022Public health advice for gatherings during the current monkeypox outbreakhttps://www.who.int/publications/i/item/WHO-MPX-Gatherings-2022.1
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24/06/2022Surveillance, case investigation and contact tracing for monkeypox: interim guidance, 24 June 2022https://www.who.int/publications/i/item/WHO-MPX-Surveillance-2022.2
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24/06/2022Risk communication and community engagement (RCCE) for monkeypox outbreaks: Interim guidance, 24 June 2022https://www.who.int/publications/i/item/WHO-MPX-RCCE-2022.1
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20/06/2022Monkeypox : avis de l’ANSM concernant la vaccination contre la variole du singehttps://ansm.sante.fr/actualites/monkeypox-avis-de-lansm-concernant-la-vaccination-contre-la-variole-du-singe
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20/06/2022Monkeypox : la stratégie vaccinale réactive précisée pour les primo-vaccinés et les enfantshttps://www.has-sante.fr/jcms/p_3345056/fr/monkeypox-la-strategie-vaccinale-reactive-precisee-pour-les-primo-vaccines-et-les-enfants
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14/06/2022Interim advice for public health authorities on summer events during the monkeypox outbreak in Europe, 2022https://www.ecdc.europa.eu/en/publications-data/interim-advice-public-health-authorities-summer-events-during-monkeypox-outbreak
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14/06/2022Vaccines and immunization for monkeypox: Interim guidance, 14 June 2022https://www.who.int/publications/i/item/who-mpx-immunization-2022.1
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10/06/2022Clinical management and infection prevention and control for monkeypox: Interim rapid response guidance, 10 June 2022https://www.who.int/publications/i/item/WHO-MPX-Clinical-and-IPC-2022.1
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10/06/2022Navigating monkeypox: considerations for gay and bisexual men and other men who have sex with menhttps://www.ecdc.europa.eu/en/publications-data/navigating-monkeypox-considerations-gay-and-bisexual-men-and-msm
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04/06/2022Monkeypox minimum dataset case reporting form (CRF)https://www.who.int/publications/m/item/monkeypox-minimum-dataset-case-reporting-form-(crf)
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02/06/2022Interim advice on Risk Communication and Community Engagement during the monkeypox outbreak in Europe, 2022https://www.ecdc.europa.eu/en/publications-data/interim-advice-risk-communication-and-community-engagement-during-monkeypox
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25/05/2022COREB - Monkeypox factsheethttps://www.coreb.infectiologie.com/fr/monkeypox.html
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25/05/2022DGS (France) - Alert document - Updatehttps://solidarites-sante.gouv.fr/IMG/pdf/corruss_actualisation_dgs-urgent_n_2022_55_-_cas_d_infections_autochtones_par_le_virus_monkeypox.pdf
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24/05/2022HCSP - Conduite à tenir autour d’un cas suspect, probable ou confirmé d’infection à Monkeypox virushttps://www.hcsp.fr/Explore.cgi/avisrapportsdomaine?clefr=1212
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20/05/2022HAS - Avis n° 2022.0034/SESPEV du 20 mai 2022 du collège de la Haute Autorité de santé relatif à la vaccination contre Monkeypoxhttps://www.has-sante.fr/upload/docs/application/pdf/2022-05/avis_n2022.0034_sespev_du_20_mai_2022_du_college_de_la_has_relatif_a_la_vaccination_contre_la_variole_du_singe_monkeypox_vir.pdf
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19/05/2022Santé publique France - Case definition and actions to be takenhttps://www.santepubliquefrance.fr/content/download/437302/file/def_cas_CAT_monkeypox_19052022.pdf
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19/05/2022DGS (France) - Alert documenthttps://solidarites-sante.gouv.fr/IMG/pdf/2022-dgs-urgent_55_monkeypox.pdf
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2022WHO - Monkeypox Oubreak Toolboxhttps://www.who.int/emergencies/outbreak-toolkit/disease-outbreak-toolboxes/monkeypox-outbreak-toolbox
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2021OpenWHO - Monkeypox epidemiology, preparedness and responsehttps://openwho.org/courses/monkeypox-intermediate
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2021WHO - All items on monkeypoxhttps://www.who.int/emergencies/emergency-events/item/monkeypox
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2019WHO Fact sheet on monkeypoxhttps://www.who.int/news-room/fact-sheets/detail/monkeypox
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2019ECDC Factsheet for health professionals on monkeypoxhttps://www.ecdc.europa.eu/en/all-topics-z/monkeypox/factsheet-health-professionals
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2018ECDC - Rapid risk assessment: Monkeypox cases in the UK imported by travellers returning from Nigeria, 2018https://www.ecdc.europa.eu/en/publications-data/rapid-risk-assessment-monkeypox-cases-uk-imported-travellers-returning-nigeria
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Confirmed cases and deaths (25/04/23)
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https://worldhealthorg.shinyapps.io/mpx_global/
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CountryCases confirmed by WHODeaths confirmed by WHO
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United States of America
3015244
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Brazil1090416
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Colombia40900
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Mexico396514
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Peru380020
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Canada14800
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Chile14402
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Argentina11282
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Ecuador5333
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Guatemala4041
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Bolivia (Plurinational State of)
2650
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Puerto Rico2110
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Costa Rica2210
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Panama2231
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Paraguay1250
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El Salvador1040
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Dominican Republic520
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Uruguay190
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Jamaica210