Box Jellyfish: Stings, Victims and Deaths

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Box jellyfish warning sign in Australia
Box jellyfish venom causes very rapid onset of circulatory problems. It has a high mortality rate because toxic reaction spreads very quickly throughout the body.The amount of venom injected into humans by box jellies has a big impact on whether a victim dies or lives. It is estimated that if six meters (20 feet) of tentacles comes into contact with human skin — and all nematocysts on those tentacles “fire” — the amount of venom injected is enough to cause death in just a few minutes. Humans that are stung typically have symptoms such as extreme pain, shortness of breath, and purple welts. Some victims have become irrational and suffered cardiac arrest. The symptoms usually begin within five minutes of being stung and can last up to two weeks before subsiding. [Source: Timothy Schmidt, Animal Diversity Web (ADW)]

Box jellyfish don’t hunt humans but a random brush can lead to death within minutes. Survivors bear purple rope- like scars for life. Once while Hammer was carrying buckets with box jellyfish to his a truck, a breeze blew a single tentacle against some exposed skin on his arm. "I felt as if I had been branded by red-hot steel," he said. "My first instinct was to claw at my skin but I knew that dropping the bucket would be too dangerous. Wincing with pain, I managed to lift the bucket onto the truck. Then I examined the damage: a fiery welt, braided with characteristic bands of the box jelly's tentacle.”

"I was lucky," he continued. "Only about an inch of tentacle had stuck to my arm. It takes ten feet or more to deliver a fatal dose of box jelly venom. An inch was enough for me. A hundred that level of pain was unimaginable.” National Geographic showed some horrible photographs of sting victims from the Queensland Life Saving Manual. One was a little girl with nasty strings of welts on her torso and another was a child with scars that looked like thick concentration of varicose veins. Although both victims survived they were scared for life with macabre purple and scarlet tentacle marks. Survivors have described the pain as “like having a bucket of fire poured on me”.“Chironex is by far the world’s most venomous creature,” says Seymour. “It makes venomous snakes look like amateurs.”

Websites and Resources: Animal Diversity Web (ADW); National Oceanic and Atmospheric Administration (NOAA); Fishbase; Encyclopedia of Life; Smithsonian Oceans Portal ; Monterey Bay Aquarium ; MarineBio

Box Jellyfish Victims

box jellyfish at Finlay's Point, South Africa

The sting of a box jellyfish can be fatal to humans and has accounted for more than 60 deaths in the last 100 years. Most fatalities are documented in children and young adults in Australia. But not all of them are. in 1990 Chiropsalmus quadrumanus stung to death a 4-year-old boy in the shallows of a beach near Galveston, Texas. Chiropsalmus quadrumanus has also been reported in the waters off North Carolina, Brazil, Venezuela and French Guiana. [Source: Paul Raffaele, Smithsonian magazine, June 2005]

In January 1992 a Cairns man spent two nights in the hospital after being stung on the neck, chest and back. The man, a local newspaper reported, was swimming a 150 meters north of a stinger resistant enclosure and was pulled out of the water by friends. Lifeguards "dowsed" him with vinegar. "Ambulance officers treated the man with pressure bandages," the report said, "and although he was heavily sedated with painkillers...he was screaming and writhing in agony."

In 2003, seven-year-old Jarred Crook was swimming at Mission Beach in Queensland, Australia. Suddenly he screamed. His grandfather pulled him from the water, but the writhing boy soon collapsed. With an hour he was dead of cardiac arrest — a victim of a box jellyfish. [Source: John Eliot, National Geographic, July 2005]

Irukandji Syndrome

Irukandji Syndrome is the name of the illness that occurs after someone has been sting by a Irukandji box jellyfish. It causes waves of intense aches all over the body, severe cramps, nausea, vomiting, fever and anxiety. Scientists are working on an antidote but are hampered by a lack of funding. Zoologist Dr Jamie Seymour, of James Cook University, said: "The amount of painkillers that a person in severe Irukandji pain gets from doctors is similar to someone that's been in a near fatal car crash."

According to Animal Diversity Web: Usually about 30 minutes after a person is stung by C. barnesi the victim begins to experience the following symptoms: a severe back or headache, shooting pain throughout the muscles in their chest and abdomen, nausea, anxiety, restlessness, and sometimes vomiting. Occasionally fluid may fill the lungs, which if not treated could be fatal. These symptoms can last from hours to days and requires hospitalization. [Source: Vishal Patel and Selina Ruzi, Animal Diversity Web (ADW) /=]

Carukia barnesi was named after Dr. Jack Barnes who was searching for the jellyfish who caused the Irukandji syndrome. He had confirmed that the jellyfish he found did cause Irukandji syndrome by stinging himself, his son, and a surf life saver, sending them all to the hospital, in 1964. It was Hugo Flecker, however, that had named the overall syndrome caused by this jellyfish, the Irukandji syndrome.

Paul Raffaele wrote in Smithsonian magazine: No one even knew what irukandji looked like in the 1950s, when a Cairns doctor, Jack Barnes, went searching for whatever it was that stung, and then sickened, hundreds of people at Queensland beaches each summer. Over several years, he tested on his own body the sting of every jellyfish he could collect from beaches in and around Cairns, but none produced the Irukandji syndrome. Then, one day in 1961, he found a tiny jellyfish of a kind he’d never seen before. [Source: Paul Raffaele, Smithsonian magazine, June 2005]

As a curious crowd gathered around him, he asked for volunteers to be stung. The first to step forward was his own 9-year-old son, Nick. “I said, ‘Try it on me, Dad, try it on me,’ ” Nick recalled years later in an interview with the Sydney MorningHerald Magazine. “So, he ended up stinging me first, then himself, then a big local lifeguard called Chilla Ross.” The three returned to the Barnes family home where, 20 minutes after being stung on the beach, they began to feel the venom’s terrifying effects. Chilla Ross began screaming, “Let me die.” Nick remembers vomiting “as Dad carried me upstairs, then I was lying on a bed swallowing painkillers. I felt pretty terrible” — so terrible, in fact, that he found himself “thinking that dying mightn’t be a bad idea.” But he survived, as did Ross and his father. Three years later, Jack Barnes described the ordeal in the Australian Medical Journal, writing that all three of them had been “seized with a remarkable restlessness and were in constant movement, stamping about aimlessly, swinging their arms, flexing and extending their bodies, and generally twisting and writhing.” In honor of Jack Barnes’ discovery, the creature that stung them was given the scientific name Carukia barnesi.

Irukandji Syndrome Fatalies

In January 2002, a British man holidaying in Australia died two days after being stung by a thumbnail-sized box jellyfish. Associated News reported: Richard Jordan, 58, was swimming with his wife off Hamilton Island in Queensland when he brushed against the Irukandji jellyfish. Mr Jordan sought medical attention after being stung on Tuesday since he was concerned about his heart condition. He went into a coma and was airlifted to hospital where he died. Susan Boyd, spokeswoman for the Hamilton Island Resort in the Whitsundays, said the sting aggravated Mr Jordan's heart condition and high blood pressure-leading to cerebral haemorrhage. The beaches on the island remained open but guests were advised to swim in the pool. [Source: Frank Thorne, Associated Newspapers, February 1, 2002}

Jordan died on Irukandji Syndrome. See Above. Zoologist Dr Jamie Seymour, of James Cook University, said: said if the death proved to be the result of Irukandji syndrome, it would be the first such death anywhere in the world. "It's incredibly significant," he said. "It's the sort of thing we've been saying for a while — that these animals have the potential to kill people." Little is known about the peanut-sized stinger, whose tentacles may be up to one meter long. Mr Jordan's death follows something of an epidemic of jellyfish stings this Christmas in the region, as unusual weather has driven the jellyfish towards Queensland's beaches.

In 1997, Des Houghton wrote in The Times: Irukandji jellyfish “may hold the key to the unexplained deaths of dozens of swimmers in tropical Australia. Doctors at Australia's Venom Research Institute suspect that the irukandji jellyfish has a sting so toxic that it can induce heart attacks and breathing difficulties that lead to drowning. Ken Winkel, head of the institute, said between 60 and 100 people a year are treated for serious irukandji stings in Queensland alone. However, it was probable that many irukandji victims may mistakenly think they have suffered heart attacks because the creature's toxin has a delayed reaction, with syptoms not immediately apparent. [Source: Des Houghton, The Times of London, December 27 1997 ]

Russell Hore, a marine biologist, has been campaigning for the development of an anti-venom since he was stung. "I was swimming at an offshore island marine park when I felt a stinging sensation on my neck," he said. "Within five minutes I had developed stomach cramps and pain in my lower spine that was knife-like. My chest became restricted and my hair was standing on end." He spent five days fighting for his life in intensive care.

Aborigines in northern Australia and Papua New Guinea have for generations told stories of pretty little stingers that paralyse swimmers. It is only recently, however, that researchers have begun to understand the seriousness of the irukandji threat. Doctors say victims can be unaware that they have been stung and almost never see the irukandji. They want more money for research. In the past 50 years Australia has produced anti-venom for a host of deadly creatures, including the tiger snake, the taipan, the brown snake, the redback spider and the irukandji's larger, more deadly relative, the box jellyfish.

Death of Robert King

In April 2002, American tourist Robert King, 44, from Columbus, Ohio, was stung while snorkeling on the Great Barrier Reef. King died in the Townsville Hospital a few days later .Tests revealed the jellyfish to be a previously unknown species likely related to box jellyfishs. King is believed to have developed irukandji syndrome from the sting, causing a rapid rise in blood pressure and a cerebral hemorrhage. "I had warned Bob of the deadly creatures in Australia," his partner Michele Carlson said in a statement. "We had joked in an e-mail recently about the poisonous snakes and ... jellyfish." King's death came less than three months after British tourist Richard Jordan died [Source: Associated Press, April 14, 2002]

Paul Raffaele wrote in Smithsonian magazine: King was snorkeling when he felt a mild sting on his chest and came back onto the boat. Within 25 minutes his face flushed tomato-red as severe pain gripped his stomach, chest and back muscles. The skipper radioed for a medevac chopper, whose crew injected King with a massive dose of pethidine, an opiate-like painkiller, then winched him from the boat and rushed him to Cairns. [Source: Paul Raffaele, Smithsonian magazine, June 2005]

By the time he was wheeled into the emergency ward at Cairns Base Hospital, King’s speech was slurred. He was put on a ventilator, as doctors pumped him full of painkillers while racing to save his life. A local zoologist, Jamie Seymour, was called in to take a scraping of the sting site. While he worked, Seymour noticed that King’s blood pressure was spiking dramatically. King lost consciousness; then, Seymour says, “an artery or vein in his brain blew.” Blood flooded King’s brain tissues, and two days later he died.

After analyzing the shape and size of the stinging cells, which were about an inch long, Seymour blamed King’s death on a nearly transparent jellyfish the size of a thumbnail ---one of at least ten related species of small jellyfish whose sting can plunge victims into what doctors call the Irukandji syndrome. “The symptoms overwhelm you,” says Seymour, who himself was stung by an irukandji on the lip, the only part of his body uncovered as he scuba-dived looking for specimens near an island off Cairns in late 2003. “On a pain scale of 1 to 10, it rated between 15 and 20,” he says, describing the vomiting, the cramps and the feeling of panic. “I was convinced I was going to die.” But he was lucky; not all species of irukandji administer fatal stings, and he recovered within a day.

Box Jellyfish Fatalities in Thailand

In 2015, there a number of box jellyfish stings were reportedly around Koh Samui, Thailand, including the recent death of a 20-year old German woman. These stings occurred at Chaweng, Lamai, Mae Nam, Lipa Noi and on Ang Thong island. Nearby Koh Phangan also reports stings including two fatalities in the past 12 months. Other victims have been hospitalised.

In October 2015 the 20 year old woman from Germany decided to take a dip with a friend at night. and the Samui Times reported: It was a fatal mistake. Lamai Beach on Samui's east coast was rocked by agonising screams as the women ran out of the water and collapsed on the sand. Help arrived and the two women were splashed with vinegar. But tragically for one of the girls, she had received such severe box jellyfish stings that no amount of vinegar could save her. She died on the way to hospital. Her friend was kept in for observation and thankfully survived.

“A jet ski operation at Lamai spotted jellyfish in the region on the day. While some effort was made to spread the word, it wasn't enough. There are no physical warning signs at Lamai Beach. There is no system or network of communication to disseminate information and warnings. Phuket is also busy but it has a 'dangerous jellyfish' strategy. There are warning and information signs and vinegar poles at beaches around that island. This is also the case on Koh Chang, Koh Mak and others.

In July 2015, a 31 year-old woman from Bangkok died after being stung by a box jellyfish on the island of Koh Phangan. The incident coincided with the island's Full Moon Party and occurred at around 8:00pm. he woman, Chayanan Surinwent swimming at Haad Rin beach , along with 3 friends Ms Surin was severely stung on areas including torso, arms and legs and sadly died within minutes of being stung. In August 2014 a young French boy suffered the same tragic fate on the other side of the island. Thai authorities managing the box jellyfish situation in Thailand have urged Koh Phangan locals to act though they have continually resisted any prevention activities made available to them.

What Its Like to Be Stung by a Box Jellyfish No.1

David Ball, an Australian, posted on in 2013: In December 2010 I was stung by an Irukandji box jellyfish in Malaysia. We were staying on Langkawi Island in Malaysia at the end of 2010. On one afternoon we decided to go on a sunset cruise, one which has a net off the side of the boat so you can have a 'spa' as they call it in the very warm ocean water. After having a great time for about 15 minutes, I noticed I had been stung (three marks) on the abdomen (just above the hip). At first I thought it was just a normal sting, so the captain ran vinegar on it and I wasn't very worried (I was going to get back in the water). It stung a bit, but not more than a blue-bottle which sting us a fair bit in Australia (nb: I am Australian)

Thirty minutes later and my back began cramping with excruciating pain. It started from my kidney area (back only at the start) and moved up to my neck. The pain felt like every muscle in my back was cramping and I could do nothing to release it. As the pain got worse, so did my mental state. I think of myself as a pretty pain-tolerant guy but this pain made me go very weird. I thought that I was going to die. I began screaming at the boat staff to get me to a hospital ASAP. Luckily, I managed to get on a speed boat back to the port and get taken immediately to a hospital. I think it's important to note that I wasn't intentionally doing any of this, the pain was so severe and my mental state so convinced my end was looming, I literally went crazy.

After getting to the hospital, I had to walk some distance, and I noticed that as I walked it didn't feel 'better' but was less intense. My mental state was so fragile, that after being told by the Langkawi Doctor that "there aren't any dangerous jellyfish in langkawi" so we'll just "give you a few injections" I literally ran away from the hospital (when my girlfriend went to the bathroom). I was delirious and hallucinating as I ran away from the hospital and I still cannot explain why I was acting that way.

So after I had run away from the hospital, we were driven back to my resort (Berjaya - the other end of Langkawi island!). I was still in excruciating pain, however, I was convinced I could 'fight it'. To cut a long story short, two hours later of rediculuous pain and still more weird behaviour I needed pain killers. So back to the hospital we went (another 30 min ride). This time my 'head' was back to normal and I had one anti histamine injection and two pain killing injections. The pain lessened a bit, but was still very sore. I was mentally and physically drained and asked to leave the hospital with some pain killing tablets.

That night in bed, (6 hours after the sting and after the injections above) I was still very sore, but mentally I was 'back'. The next day I didn't move from bed (except for a failed 100m walk where I grew to exhausted to keep going) and the next day I managed to walk to the hotel's beach and lay on a daybed and read/sleep. For one month after the sting, I still had weird shooting pains in my back. So, that's what it was like for me being stung by a jellyfish. Not nice!

What Its Like to Be Stung by a Box Jellyfish No.2

J Corbett, who graduated University of Otago in 2020, posted in Quora.come in 2018: The sting itself feels like a burn without any heat. What happens next is far, far worse. One of these got my cheek when I was diving on the Great Barrier Reef. I was cursing my stars, because we were 60 kilometers offshore, where they don’t tend to live, and it was April, at the very end of jellyfish season when most of them aren’t around – I was specifically told by my instructor they weren’t a worry at that time. On top of that I got stung on the one place of my body not covered with a string suit, so it was a triple-whammy of tough luck.

When I researched the sting afterwards it said some people don’t notice it. To me, it was a strong, sharp burn that kept going after the jellyfish was pulled off my face. The best example I can think of is squirting vinegar into an open wound, or the like. It was a 3 or a 4, not too bad but definitely irritating, and applying vinegar as you do to jellyfish stings did nothing. The area that was stung developed welts within about ten minutes, the sort you get on skin that has been slapped very hard or stung by nettles. These disappeared after a couple of hours.

Within a minute after being stung I felt mild back pain along my spine, about parallel with my obliques. It felt like the cramping of a pulled or tired muscle, and I had the urge to stretch it. This grew gradually over the next half hour and spread into my legs until the point where I couldn’t stand up. At this point I started throwing up and was put on oxygen by the staff on the boat I was staying on. Within forty minutes the pain in my back and legs was so severe it nearly stopped me from breathing, and it took immense concentration not to black out. At this point the pain was at a 9 or a 10, though I imagine it would be worse for someone who was not an otherwise healthy 20 year old.

Within an hour the pain was so bad that I started screaming, and could not stop. Around about now is where my memory gets bad; I can only recall the events in a disassociated way, like I know what happened but wasn’t experiencing it myself. I sweated very badly and this made me intermittently hot and cold so I was kicking the duvet about a bit. Because of the cramping nature of the pain my body instinctively tried to curl into a ball, but this increased the pain so I had to fight against my muscles to stay in a more streamlined position.

Sign at a beach in Australia

What was worst about this experience was the fear I felt. I knew irukandji were a risk in the area despite being told they weren’t around, so I had a hunch when things started to get back of what was going on. When I was having breathing troubles I felt like I was going to die. Some victims reported feeling doomed, so if that were the case for me then this was how it was manifested. On top of this was the terror that the pain would continue to get worse, which I can only describe as a psychologically breaking experience.

After two hours I was given ibuprofen which very marginally reduced the pain to the point where I could stop screaming but could not talk. After four hours the paramedics arrived on a speedboat (they’d been driving the liveaboard back so we RV’d somewhere in the middle) and gave me fentanyl, which knocked the pain down to about a 5 or 6. This felt like a general ache and massive fatigue, which went down gradually once I reached the hospital.

The aftermath was just as grim. The whole thing is emotionally exhausting. When I was recovering I was a rollercoaster, feeling shocked that I survived something like that, outraged that it had happened to me, guilty that I’d ruined everyone’s trip and had my family worried sick at home, and frustrated that I couldn’t remember how it felt, so there was no catharsis.

There’s no question that it was the worst ordeal I’ve ever experienced, but the upside is that chances are, I’ll never be in so much pain in my life again. And still, you haven’t really had an Australian experience unless you’ve been assailed by a venomous creature. Just try and keep your cheeks covered.

Protection From Box Jellyfish

nets used for protection from box jellyfish

From October to May box jellyfish can be found on the northern and northeast coast of Australia, as far east as Rockhampton behind the Great Barrier Reef, and as far west Broom. During the summer one doctor said: "it is quite unsafe to swim the ocean in tropical northern Australia." Fortunately for the Australian scuba diving industry, box jellyfish are not found very often around the Great Barrier Reef. They prefer the extremely warm and placid water found in northern Australia during the summer.

The box jellyfish season runs from about November to June in Queensland. They are more active during the day than at night. They rely on a visual system to hunt their prey and this of course is easier during daylight. Many attacks happen at night because can’t see the jellfish. Box jellyfish are more or less transparent and are almost as difficult to spot during the day than at night. The only way to swim (day or night) and be 100 percent protected is to wear a lycra suit. Such suits are produced in Australia by the Stinger Suit Company.

Precautions against box jellyfish include staying out of the water, swimming inside stinger nets in "swimmer resistant" areas , wearing protective clothing such as pantyhose and tight fitting shirts. Surfers wear pantyhose on both their legs and arms to protect themselves from box jellyfish stings. Scientist put on long pants, long-sleeve shirts and gloves taped to their wrists when handling buckets of jellyfish on land. Lifesaver warn swimmers to wear lycra, but neoprene scuba diving outfits are not necessary. The reason for this is that box jellyfish have short singer capsules are too short to puncture skin covered by a thin layer of clothing.

Treatment for Box Jellyfish Stings

In the case of a severe box jellyfish sting, signs in northern Australia advise: 1) flood the sting area with vinegar; 2) give artificial respiration if breathing stops; and 3) give closed chest massage if the heart stops. For minor stings one should flood the sting area with vinegar and then apply a soothing cream or lotion. Health advisories say: if stung immediately pour at least two liters if vinegar over the adhering tentacles to deactivate the stinging cells. This does not reduce the pain. Do not rub the victim's skin, keep them immobile and use artificial respiration until medical assistance can be obtained.

medicinal vinegar

There is an antivenin for box jellyfish. It was developed in the 1970s by injecting a small amounts of venom into sheep who then in turn produced antibodies with anti-venom. "It can be very effective," says one doctor, "Normally breathing often begins almost immediately, and pain relief usually occurs within minutes. Later scarring is frequently reduced."

Paul Raffaele wrote in Smithsonian magazine: Doctors are having increasing success in treating the damage they do to humans. An antivenin for Chironex stings — made from antibodies created in sheep that are injected with the venom — is now administered to victims in northern Australian hospitals. There is no antivenin yet for the Irukandji syndrome, but Lisa-ann Gershwin is edging toward an important breakthrough — the first-ever mass breeding of tiny box jellyfish in a lab, from specimens she caught at Palm Cove this year. So far she’s managed to breed just a handful of the “up to a million” jellyfish that she says researchers like Ken Winkel need to develop an effective antivenin. [Source: Paul Raffaele, Smithsonian magazine, June 2005]

More promising for serious irukandji stings, at least in the short term, is a treatment being used in the TownsvilleHospital’s intensive care unit: the infusion of a solution of magnesium sulfate directly into a victim’s veins. “We’ve seen it swiftly reduce, to safe levels, the hypertension, and it lessens the pain considerably,” says Michael Corkeron, one of the unit’s physicians. But, he cautions, “we still have more to learn, including the correct dosage, before magnesium becomes standard treatment.”

Fatalities are now in decline. Many beaches now use stinger nets to keep them away from swimmers. City councils refer to computer models that predict the end of the box jellyfish season Because vinegar stops Chironex from firing venom, Australian lifeguards keep it on hand. [Source: John Eliot, National Geographic, July 2005]

Studying Box Jellyfish and How They Can Prolong Erections

Jamie Seymour at James Cook University studies box jellyfish and comes up with ways to protect the pubic. He studies their movements, using sonic tags attached to the creatures with nontoxic superglue. Tiny ultrasonic transmitters a centimeter wide are glue to the jellyfish’s bell. Only seven attempts had succeeded as of July 2005 but he was still the first scientist o tag jellyfish. Cook’s work began in 1999 when the tags stayed on for only two days. Later he developed a method in which he attached the tags to the inside of the jellyfish’s bell, where they were less likely to fall off. On his own first hand encounter with a large box jellyfish near a pier, Seymour told National Geographic: “Before I knew it, my hands and feet were wrapped in tentacles. I came out and couldn’t walk straight. Tears were streaming down my face.” His lycra suit saved him along with a dousing of vinegar. [Source: John Eliot, National Geographic, July 2005]

In 2004, AFP reported: A strong cocktail of toxins from the potentially deadly irukandji jellyfish may hold a remedy for impotent men, according to an Australian researcher. James Cook University academic Lisa-Ann Gershwin said she believes a sting from an irukandji tentacle, which causes excruciating pain, anxiety, paralysis and a potentially fatal rise in blood pressure, also causes prolonged erections in male victims."This is a bizarre extra symptom of irukandji syndrome in addition to the really dreadful life-threatening symptoms the syndrome gives," Gershwin said. [Source: AFP, July 30, 2004]

Gershwin said she believes she has identified the particular species of irukandji responsible, after a local doctor, Peter Fenner, noticed the symptom in male patients. She said isolating the cause of the erections from the toxins carried by the jellyfish could lead to a remedy for male impotency. But the species concerned is extremely rare and had so far only been found around the Whitsunday Islands off the Queensland coast of north-eastern Australia. "If we can get this other species into culture, certainly it would be able to supply the number of specimens that would be necessary to do that kind of research, to actually look at an impotency medication." However, it has not yet reached the stage where it would be feasible for a pharmaceutical company to begin work on it, she said.

Image Sources: Wikimedia Commons, NOAA

Text Sources: Animal Diversity Web (ADW); National Oceanic and Atmospheric Administration (NOAA); Wikipedia, National Geographic, Live Science, BBC, Smithsonian, New York Times, Washington Post, Los Angeles Times, The New Yorker, Reuters, Associated Press, Lonely Planet Guides and various books and other publications.

Last Updated May 2023

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