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5 : Monkeypox: an Emerging Infection for Humans?

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Abstract:

Human monkeypox was first identified in 1970 in the Democratic Republic of the Congo (DRC) in an area where smallpox had been eliminated about 2 years previously. Monkeypox, a zoonotic and probably respiratorily acquired disease, resembles smallpox clinically but differs biologically and epidemiologically of all these differences, the most important is that spread between humans is limited. Experimental monkeypox infections in several species of animals, including nonhuman primates, have demonstrated infectivity and pathogenesis following infection by aerosol, intranasal inoculations, or parenteral administration. Numerous infections and other syndromes that cause papulovesicular and vesiculopustular eruptions can resemble human monkeypox. Clinical manifestations of human diseases caused by poxviruses have been provided in this chapter. There was evidence to suggest cocirculation of varicella-zoster virus, as five of six active monkeypox cases living in one household also had serological evidence (IgM) of recent varicella-zoster virus infection. In January 1999, the Technical Advisory Group Meeting on Human Monkeypox was convened by the World Health Organization (WHO). The advisory group reviewed the clinical, epidemiologic, and laboratory results from the recent outbreaks and identified areas for further surveillance and research on the public health impact of human monkeypox. The WHO document on collection, storage and shipping of specimens from humans for monkeypox and hemorrhagic viruses should be updated.

Citation: Breman J. 2000. Monkeypox: an Emerging Infection for Humans?, p 45-67. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 4. ASM Press, Washington, DC. doi: 10.1128/9781555816971.ch5
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Figures

Image of Figure 1.
Figure 1.

Dendrogram illustrating the similarities and differences between orthopoxvirus DNAs. Modified from reference .

Citation: Breman J. 2000. Monkeypox: an Emerging Infection for Humans?, p 45-67. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 4. ASM Press, Washington, DC. doi: 10.1128/9781555816971.ch5
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Image of Figure 2.
Figure 2.

Five photos of a child with monkeypox on the 8th day of rash. Note inguinal lymphadenopathy and dense concentration of lesions on the lower face and hands. (Photos courtesy of World Health Organization, M. Szczeniowski.)

Citation: Breman J. 2000. Monkeypox: an Emerging Infection for Humans?, p 45-67. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 4. ASM Press, Washington, DC. doi: 10.1128/9781555816971.ch5
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References

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1. Arita, I.,, and D. A. Henderson. 1968. Smallpox and monkeypox in non-human primates. Bull. W. H. O. 39: 277 283.
2. Arita, I.,, R. Gispen,, S. S. Kalter,, L. T. Wah,, S. S., Marennikova,, R. Netter,, and I. Tagaya. 1972. Outbreaks of monkeypox and serological surveys in non-human primates. Bull. W. H. O. 46: 625 631.
3. Bedson, H. S.,, and J. J. Duckworth. 1963. Rabbitpox: an experimental study of the pathways of infection in rabbits. J. Pathol. Bacteriol. 85: 1 20.
4. Bray, M.,, M. Martinez,, D. F. Smee,, D. Kefauver,, F. Thompson,, and J. W. Huggins. 2000. Cidofovir protects mice against lethal aerosol or intranasal cowpox virus challenge. J. Infect. Dis. 181: 10 19.
5. Breman, J. G.,, E. com,, J. H. Nakano,, H. Godfrey,, and J. G. Gautun. 1977. Human poxvirus disease after smallpox eradication. Am. J. Trop. Med. Hyg. 26: 273 281.
6. Breman, J. G.,, and J. Bernadou,, and J. H. Nakano. 1977. Poxvirus in West Africa nonhuman primates: serological survey results. Bull. W. H. O. 55: 605 612.
7. Breman,, J. G., Kalisa-Ruti,, M. V., Steniowski,, E. Zanotto,, A. L. Gromyko,, and I. Arits. 1980. Human monkeypox, 1970-79. Bull. W. H. O. 58: 165 182.
8. Brernan, J. G., 1984>. Poxviruses, p. 594 602. In K. S. Warren, and A. A. F. Mahmound (ed.), Tropical and Geographical Medicine. McGraw Hill Co., New York, N.Y.
9. Breman, J. G.,, and D. A. Henderson. 1998. Poxvirus dilemmas-monkeypox, smallpox, and biologic terrorism. N. Engl. J. Med. 339: 556 559.
10.Centers for Disease Control and Prevention. 1991. Vaccinia (smallpox) vaccine: recommendations of the Immunization Practices Advisory Committee. Morb. Mortal. Wkly. Rep. 40(RR-14): 110.
11. Centers for Disease Control and Prevention. 1997. Human monkeypox-Kasai Oriental, Zaire. 1996-1997. Morb. Mortal. Wkly. Rep. 46: 304307.
12. Centers for Disease Control and Prevention. 1997. Human monkeypox-Kasai Oriental, Democratic Republic of Congo, February 1996-0ctober 1997. Morb. Mortal. Wkly. Rep. 46: 11681171.
13. Cho, C. T.,, and H. A. Wenner. 1973. Monkeypox virus Bacterial. Rev. 37: 1 18.
14. Cohen, J. 1997. Is an old virus up to new tricks? Science 277: 312 313.
15. Douglas, N.,, and K. Dumbell. 1992. Independent evolution of monkeypox and variola viruses. J. Virol. 66: 7565 7567.
16. Douglas, N. J.,, M. Richardson,, and K. R. Dumbell. 1994. Evidence for recent genetic variation in monkeypox viruses. J. Gen. Viral. 75: 1303 1309.
17. Durnbell, K. R.,, and L. C. Archard. 1980. Comparison of white pock (h) mutants of monkeypox virus with parental monkeypox and with variola-like viruses isolated from animals. Nature (London) 286: 29 32.
18. Esposito, J. J.,, and J. C. Knight. 1985. Orthopoxvirus DNA: a comparison of restriction profiles and maps. Virology 143: 230 251.
19. Esposito, J. J.,, J. H. Nakano,, and J. F. Obijeski. 1985. Can variola-like viruses be derived from monkeypox virus? An investigation based on DNA mapping. Bull. W. H. O. 63: 695 703.
20. Esposito, J. J.,, J. F. Obijeski,, and J. H. Nakano. 1977. Serological relatedness of monkeypox. variola, and vaccinia viruses. J. Med. Virol. 1: 35 47.
21. Esposito, J. J.,, J. F. Obijeski,, and J. H. Nakano. 1977. The virion and soluble antigen proteins of variola, monkeypox and vaccinia viruses. J. Med. Virol. 1: 95 110.
22. Esposito, J. J.,, J. F. Obijeski,, and J. H. Nakano. 1978. Orthopoxvirus DNA: strain differentiation by electrophoresis of restriction endonuclease fragmented virion DNA. Virology 89: 53 66.
22a.. Esposito, J. J.,, and R. F. Massung,. 1995. Poxviruses infecting humans, p. 1131 1138. In P. R. Murray,, E. J. Baron,, M. A. Pfaller, et al. (ed.), Manual of Clinical Microbiology, 6th ed. American Society for Microbiology, Washington, D.C.
23. Fenner, F.,, D. A. Henderson,, I. Arits,, Z. Ježek,, and I. D. Ladnyi. 1988. Smallpox and Its Eradication. World Health Organization, Geneva, Switzerland.
24. Fenner, F.,, and J. H. Nakano,. 1988. Poxviridae, p. 177 210. In E. H. Lennette,, P. Halonen,, and F. A. Murphy (ed.), Laboratory Diagnosis of Infectious Diseases: Prinicples and Practices, vol. II. Viral, Rickettsial and Chlamydial Diseases. Springer, New York, N.Y.
25. Fenner, F., 1996. Poxviruses, p. 2673 2683. In B. N. Fields,, D. N. Knipe,, and P. M. Howley (ed.), Field's Virology, 3rd ed. Lippincott-Raven, Philadelphia, Pa.
25a.. Fenner, F. 1948. The pathogenesis of the acute exanthems. Lancet ii: 915 920.
26. Fine, P. E. M.,, Z. Ježek,, and B. Grab. 1988. The transmission potential of monkeypox virus in human population. Int. J. Epidemiol. 17: 643 650.
27. Foster, S. 0.,, E. W. Brink,, D. L. Hutchins,, J. M. Pifer,, B. Lourie,, C. R. Moser,, E. C. Cummings,, O. E. K. Kuteyi,, R. E. A. Eke,, J. B. Titus,, E. A. Smith,, J. W. Hicks,, and W. H. Foege. 1972. Human monkeypox. Bull. W H. O. 46: 569 576.
28. D. R., Franz,, P. B. Jahrling,, A. M. Friedlander,, D. J. McClain,, D. L. Hoover,, W. R. Bryne,, J. A. Parlin,, G. W. Christopher,, and E. M. Eitzen, Jr. 1997. Clinical recognition and management of patients exposed to biological warfare agents. JAMA 278: 399 411
29. Gispen R.,, and B. Brand-Saathof. 1972. White poxvirus strains from monkeys. Bull. W H. O. 46: 585 592.
30. Gispen, R.,, and B. Brand-Saathof. 1974. Three specific antigens produced in vaccinia, variola and monkeypox infections. J. Infect. Dis. 129: 289 295.
31. Gispen, R.,, B. Brand-Saathof,, and A. C. Hekker. 1976. Monkeypox-specific antibodies in human and simian sera from the Ivory Coast and Nigeria. Bull W H. O. 55: 605 612.
32. Hahon, N.,, and McGavran, M. H. 1961. Air-borne infectivity of the variola-vaccinia group of pox viruses for the cynomolgus monkey, Macaca irus. J. Infect. Dis. 109: 294 298.
33. Heberling, R. L.,, and S. S. Kalter. 1971. Induction, course and transmissibility of monkeypox in the baboon ( Papio cynocephalus). J. Infect. Dis. 124: 33 38.
34. Henderson, D. A.,, T. V. Inglesby,, J. G. Bartlett,, M. S. Ascher,, E. Eitzen,, P. B. Jahrling,, J. Haur,, M. Layton,, J. McDade,, M. T. OsterhoIm,, T. O'Toole,, G. Parker,, T. Perl,, P. K. Russell,, and K. Tonat. 1999. Smallpox as a biological weapon: medical and public health management. JAMA 281: 2127 2137.
35. Heymann, D. L.,, M. V. Szczeniowski,, and K. Esteves. 1998. Re-emergence of monkeypox in Africa: a review of the past six years. Br. Med. Bull. 54: 693 702.
36. Hope Simpson, R. E. 1952. Infectiousness of communicable diseases in the household. Lancet ii: 549 554.
37. Hutchinson, H. D.,, D. W. Ziegler,, D. E. Wells,, and J. H. Nakano. 1977. Differentiation of variola, monkeypox, and vaccinia antisera by radioimmunoassay. Bull. W H. O. 55: 613 623.
38. Ibrahim, M. S.,, R. S. Lofts,, P. B. Jahrling,, E. A. Henchal,, V. W. Weedn,, M. A. Northrup,, and P. Belgrader. 1998. Real-time microchip PCR for detecting single-base differences in viral and human DNA. Anal. Chem. 70: 2013 2017.
39. Ježek, Z.,, L. Arita,, M. Mutombo,, C. Dunn,, J. H. Nakano,, and M. Szczeniowski. 1985. Four generations of probable person-to-person transmission of human monkeypox. Am. J. Epidemiol. 123: 1004 1012.
40. Ježek, Z.,, I. Arita,, M. Szczeniowski,, M., K,. M. Paluku,, K. Ruti,, and J. H. Nakano. 1985. Human tanapox in Zaire: clinical and epidemiological observation on 264 cases confirmed by laboratory examination. Bull. W H. O. 63: 1027 1035.
41. Ježek, Z.,, and Fenner F. 1988. Human monkeypox. Monog. Virol. 17: 1 140.
42. Ježek, Z.,, B. Grab,, and H. Dixon. 1987. Stochastic model for interhuman spread of monkeypox. Am. J. Epidemiol. 126: 1082 1092.
43. Ježek, Z.,, B. Grab,, K. M. Paluku,, and M. Szczeniowski. 1988. Human monkeypox: disease pattern, incidence and attack rates in rural areas of northern Zaire. Trap. Geogr. Med. 40: 73 84.
44. Ježek, Z.,, B. Grab,, M. Szczeniowski,, M., K,. M. Paluku,, and M. Mutombo. 1987. Clinicoepidemiological features of monkeypox patients with an animal or human source of infection . Bull. W. H. O. 126: 1082 1092.
45. Ježek, Z.,, B. Grab,, M. Szczeniowski,, K. M. Paluku,, and M. Mutombo. 1988. Human monkeypox: secondary attack rates. Bull. W. H. O. 66: 465 470.
46. Ježek, Z.,, S. S. Marennikova,, M. Mutombo,, J. H. Nakano,, K. M. Paluku,, and M. Szczeniowski. 1986. Human monkeypox: a study of 2,510 contacts of 214 patients. J. Infect. Dis. 154: 551 555.
47. Ježek, Z.,, J. H. Nakano,, I. Arita,, M. Mutombo,, M. Szczeniowski,, and C. Dunn. 1987. Serological survey for human monkeypox infections in a selected population in Zaire. J. Trap. Med. Hyg. 90: 31 38.
48. Ježek, Z.,, M. Szczeniowski,, K. M. Paluku,, M. Putombo,, and B. Grab. 1987. Human monkeypox: clinical features of 282 patients. J. Infect. Dis. 156: 293 298.
49. Ježek, Z.,, M. Szczeniowski,, K. M. Paluku,, M. Mutombo,, and B. Grab. 1988. Human monkeypox: confusion with chickenpox. Acta Trap. 45: 297 307.
50. Khodakevicb, L.,, Z. Ježek,, and K. Kinzana. 1986. Isolation of monkeypox virus from wild squirrel infected in nature. Lancet i: 98 99.
51. Khodakevich, L.,, M. Szczeniowski,, D. M,. Mambu-ma-Disu,, Z. Ježek,, S. S. Marennikova,, J. H. Nakano,, D. Messinger. 1987. Role of squirrels in sustaining monkeypox virus transmission. Trap. Geogr. Med. 39: 115 122.
52. Khodakevich, L.,, M. Szczeniowski,, Mamburna Disu,, Z. Ježek,, S. S. Marennikova,, J. H. Nak-ano,, and F. Meier. 1987. Monkeypox virus in relation to the ecological features surrounding human settlements in Bumba zone, Zaire. Trap. Geogr. Med. 39: 56 63.
53. Ladnyi, I. D.,, P. Ziegler,, and A. Kima. 1972. A human infection caused by monkeypox virus in Basankusu Territory, Democratic Republic of the Congo. Bull. W. H. O. 46: 593 597.
53a.. Lloyd, E. S.,, S. R. Zaki,, P. E. Rollin,, K. Tshioko,, M. A. Bwaka,, T. G. Ksiazek,, P. Calain,, W. J. Shieh,, M. K. Konde,, E. Verchueren,, H. N. Perry,, L. Manguindula,, J. Kabwau,, R. Ndambi,, and C. J. Peters. 1999. Long-term disease surveillance in Bandundu region, Democratic Republic of the Congo: a model for early detection and prevention of Ebola hemorrhagic fever. J. Infect. Dis. 179(Suppl.): 274 280.
54. Lourie, B.,, P. G. Bingham,, H. H. Evans,, S. O. Foster,, J. H. Nakano,, and K. L. Herrmann. 1972. Human infection with monkeypox virus: laboratory investigation of six cases in West Africa. Bull. W. H. O. 46: 633 639.
55. Mackett, M.,, and L. C. Archard. 1979. Conservation and variation in Orthopoxvirus genome structure J. Gen. Viral. 45: 683 701.
56. Marennikova, S. S.,, E. B. Gurvich,, and E. M. Shelukhina. 1971. Identification of virus indistinguishable from variola virus among monkeypox virus strains. Vopr. Virusol. 4: 470 473. (In Russian.)
57. Marennikova, S. S.,, E. M. Shelukhina,, N. N. Maltseva,, K. L. CimiskJan,, and G. R. Macevic. 1972. Isolation and properties of the casual agent of a new variola-like disease (monkeypox) in man. Bull. W. H. O. 46: 599 611.
58. Marennikova, S. S.,, E. M. Shelukhina,, N. N. Maltseva,, and I. D. Ladnyi 1972. Poxviruses from clinically ill and asymptomatically infected monkeys and a chimpanzee. Bull. W. H. O. 46: 613 620.
59. Marennikova, S. S.,, E. M. Shelukhina,, L. N. Khodakevich,, and N. N. Yanova. 1986. Isolation of monkeypox virus form wild-living African squirrel. Vopr. Virusol. 2: 238 241.
60. Marennikova, S. S.,, E. M. Shelukhina,, and O. A. Zhukova. 1989. Experimental infection of squirrels Sciurus vulgaris by monkey pox virus. Acta Virol. 33: 399.
61. Meyer, A.,, J. J. Esposito,, F. Gras,, T. Kolakowski,, M. Fatras,, and G. Muller. 1991. First appearance of monkey pox in human beings in Gabon. Med. Trap. 51: 53 57.
62. Meyer, H.,, M. Pfeffer,, and H. J. Rziha. 1994. Sequence alterations within and downstream of the A-type inclusion protein genes allow differentiation of Orthopoxvirus species by polymerase chain reaction. J. Gen. Viral. 75: 1975 1981.
63. Mnkinda, V. B. K.,, G. Mwenia,, M. Kilundu,, D. L. Heymann,, A. S. Khan,, and J. J. Esposito. 1997. Reemergence of human monkeypox in Zaire in 1996. Lancet ii: 1449 1450.
64. Muller, G.,, A. Meyer,, F. Gras,, P. Emmerich,, T. Kolakowski,, and J. J. Esposito. 1988. Monkeypox virus in liver and spleen of child in Gabon. Lancet i: 769 770.
65. Mutombo, M. W.,, I. Arita,, and Z. Ježek. 1983. Human monkeypox transmitted by a chimpanzee in a tropical rain-forest area of Zaire. Lancet i: 735 737.
66. Nakano, J. H.,, and J. J. Esposito,. 1989. Poxviruses, p. 224 265. In N. J. Schmidt, and R. W. Emmons (ed.), Diagnostic Procedures for Viml, Rickettsial and Chlamydial Infections, 6th ed. American Public Health Association, Washington, D.C.
67. Neubauer, H.,, U. Reischl,, S. Ropp,, J. J. Esposito,, H. Wolf,, and H. Meyer. 1998. Specific detection of monkeypox virus by polymerase chain reaction. J. Virol. Methods 74: 201 207.
68. Noble, J., Jr. 1970. A study of New and Old World monkeys to determine the likelihood of a simian reservoir of smallpox. Bull. W. H. O. 42: 509 514.
69. Peters, J. C. 1966. A monkeypox-enzooty in the "Blijdorp" Zoo. Tijdschr. Diergeneeskd. 91: 387 391.
70. Pfeffer, M.,, H. Meyer,, and M. Wiedmann. 1994. A chain reaction targeting two adjacent nucleotides allows the difIerentiation of cowpox virus from other Orthopoxvirus species. J. Virol. Methods 49: 353 360.
71. Richardson, M.,, and K. Dumbell. 1994. Comparisons of monkeypox viruses from animal to human infections in Zaire. Trap. Geogr. Med. 46: 327 329.
72. Richman, D. D.,, P. H. Cleveland,, M. N. Oxman,, and K. M. Johnson. 1982. The binding of staphylococcal protein A by sera of different animals. J. Immunol. 128: 2300 2305.
73. Ropp, S. L.,, Q. Jin,, J. C. Knight,, R. F. Massung,, and J. J. Esposito. 1995. PCR strategy for identification and differentiation of smallpox and other orthopoxviruses. J.Clin. Microbial. 33: 2069 2076.
74. Saliou, P.,, and J. G. Breman. 1977. La surveillance épidémiologique des maladies transmissibles dans les pays tropicaux: les principles et son application pratique pour trois maladies soumises au règlement sanitaire international (choléra, fièvre jaune et variole). Med. Afr. Noire 24: 93 107.
75. Saliou, P.,, J. L. Rey,, J. G. Breman,, and P. Stoeket 1977. Une année d'utilisation en Haute Volta d'une mallette pour la surveillance du choléra, de la fièvre jaune et de la variole. Bull. Soc. Pathol. Exot. 70: 544 552.
76. Tchokoteu, P. F.,, I. Kago,, E. Tetanye,, P. Ndoumbe,, D. Pignon,, and J. Mbede. 1991. Variola or a severe case of varicella? A case of human variola due to monkeypox virus in a child from the Cameroon. Ann. Soc. Belg. Med. Trop. 71: 123 128.
77. von Magnus, P.,, E. K. Anderson,, K. B. Peterson,, and A. Birch-Anderson. 1959. A pox-like disease in cynomolgus monkeys. Acta. Pathol. Microbiol. Scand. 46: 156 176.
78. Walls, H. H.,, D. W. Ziegler,, and J. H. Nakano. 1980. A study of the specificities of sequential antisera to variola and monkeypox viruses by radioimmunoassay. Bull. W. H. O. 58: 131 138.
79. Walls, H. H.,, D. W. Ziegler,, and J. H. Nakano. 1981. Characterization of antibodies to orthopoxviruses in human sera by radioimmunoassay. Bull. W. H. O. 59: 253 262.
80. Wenner, H. A.,, C. T., Cho,, C. R. Bolano,, and P. S. Kamitsuka. 1969. Studies on the pathogenesis of monkeypox. II. Dose response and virus dispersion. Arch. Gen. Virusforsch. 27: 166 178.
81. Wenner, H. A.,, D. Macasaet,, P. S. Kamitsuka,, and P. Kidd. 1968. Monkeypox. I. Clinical, virologic and immunologic studies. Am. J. Epidemiol. 87: 551 566.
82. World Health Organization. 1992. Monkeypox, 1991: Gabon. Wkly. Epidemiol. Rec. 67: 101102.
83. World Health Organization. 1997. Human monkeypox in Kasai Oriental, Democratic Republic of the Congo (former Zaire): preliminary report of October 1997 investigation. Wkly. Epidemiol. Rec. 72: 369372.
84. World Health Organization. 1997. Monkeypox in the Democratic Republic of the Congo (former Zaire). Wkly. Epidemiol. Rec. 72: 258.
85. World Health Organization. 1999. Technical Advisory Group of Human Monkeypox: Report of a WHO Meeting, January 11-12, 1999. Publication no. WHO/CDSICSR/ APH/99.5. World Health Organization, Geneva, Switzerland.
86. Ziegler, D. W.,, H. D. Hutchinson,, J. P. Koplan,, and J. H. Nakano. 1975. Detection by radioimmunoassay of antibodies in human smallpox patients and vaccinees. J. Clin. Microbial. 1: 311 317.

Tables

Generic image for table
Table 1.

Monkeypox in captive animals, 1958 to 1968

Citation: Breman J. 2000. Monkeypox: an Emerging Infection for Humans?, p 45-67. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 4. ASM Press, Washington, DC. doi: 10.1128/9781555816971.ch5
Generic image for table
Table 2.

Causes of papulovesicular and maculopapular eruptions

Citation: Breman J. 2000. Monkeypox: an Emerging Infection for Humans?, p 45-67. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 4. ASM Press, Washington, DC. doi: 10.1128/9781555816971.ch5
Generic image for table
Table 3.

Clinical manifestations of human diseases caused by poxviruses

Citation: Breman J. 2000. Monkeypox: an Emerging Infection for Humans?, p 45-67. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 4. ASM Press, Washington, DC. doi: 10.1128/9781555816971.ch5
Generic image for table
Table 4.

Human monkeypox patients reported from western and central Africa, 1970-1999

Citation: Breman J. 2000. Monkeypox: an Emerging Infection for Humans?, p 45-67. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 4. ASM Press, Washington, DC. doi: 10.1128/9781555816971.ch5

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