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COMMUNICABLE DISEASES

In this Chapter . . .

COMMUNICABLE DISEASE

 

 

Communicable diseases are those diseases which may be transmitted from person to person. (When a communicable disease is suspected, please keep in mind that this is a confidential matter.)

 

Communicable disease can be transmitted via any of the following routes:

  • Direct contact with infected individuals or body fluids.

  • Contact with contaminated objects such as clothing, bed linen, equipment, or other belongings.

  • Droplet spread by coughing, sneezing, or talking.

  • Airborne dust/particles or moisture in the air.

  • Contaminated food and water.

Any of the following signs and symptoms may indicate the beginning of a communicable disease:

 

            Fever (over 100.0°)             Jaundice                   Red and/or draining eye(s)

            Chills                                   Nausea                      Sore throat

            Cough                                  Pain                           Stiff neck with fever

            Headache                            Rash                            Vomiting

 

 

Controlling communicable disease in schools

 

Any person who is suspected of having a communicable disease should be excluded from school by the principal.  The student will need to remain in the health room, isolated, if possible, until arrangements are made for him/her to be taken home.  A copy of the “Unidentified Medical Condition” form should be sent home with the student. 

 

 

êALL DISEASES/CONDITIONS LISTED ON THE REPORTABLE DISEASE/CONDITIONS IN FLORIDA , PRACTITIONER GUIDE MUST BE REPORTED IMMEDIATELY TO YOUR SCHOOL RN. If nurse is unavailable, please call the School Health Office at 941-927-9000 X 32101 (see Reportable Diseases/Conditions in Florida , Practitioner Guide, 11/08 ).

 

 

In addition:

Whenever there is more than one student in a classroom with an unidentified or a diagnosed medical condition, the êschool RN must be notified.  If nurse is unavailable,  call the School Health Landings office (941-927-9000 extension 32101.  The school RN will contact the Florida Department of Health in Sarasota County Office of Epidemiology and Communicable Disease Control who will confirm the report through health department investigation.

 

When available, the professional judgment of the school RN shall be used to determine the exclusion/readmission to school, based on established protocols, in accordance with standard medical procedures and practice.  A written statement from the student’s licensed health care provider that the person is free from communicable disease is required for readmission to school.  If parent/guardian identifies Chickenpox, no note from doctor is required but student may not return to school until all lesions are dried to the crust stage.  êNote: all suspected or diagnosed cases of chickenpox must be reported to your school RN.

 

Persons at increased risk for complications include:

 

  •       Individuals with immune system disorders.

  •       Individuals with sickle cell disease.

  •    Individuals on steroid therapy.

  •    Individuals on chemotherapy.

  •      Individuals who are organ transplant recipients.

  •     Individuals with tracheostomies.

 


 

CHICKENPOX (also see Shingles)

 

 

 

 
Signs and Symptoms
  •    Young children - fever, headache, tiredness, loss of appetite, about the same time as rash appears.

  •    Older children and adults - above signs and symptoms may appear one or two days before onset of rash.

 Rash

A rash may change in appearance rapidly.  Sequence of rash:  (1) flat red spot (2) elevated area containing clear fluid (3) crusted lesions.  All stages of the rash may appear on any area of the body at one time.  Rash most dense on trunk; less dense on arms, legs and face, including scalp and inside of nose and mouth.

 

Cause

Varicella - zoster virus

 

Incubation Period

From contact to the development of signs and symptoms: usually 14-16 days.  May be as short as 10 days or as long as 21 days.

 

Transmission

Person is infectious to others 1-2 days prior to eruption of rash and until ALL lesions are dry and crusted (approximately 5-6 days).  Transmission directly from lesions or droplet, coughing, etc. or indirectly from clothing freshly soiled by discharge from vesicles or mucous membranes of infected person.

 

Treatment 

Itching may be minimized by soaking in water with baking soda or oatmeal.  Physicians will sometimes prescribe antihistamines if a child is uncomfortable or irritable.  Body temperature control may be necessary with some children.  Do not give aspirin or Pepto Bismol.

 

Complications

Uncommon.  Reye's Syndrome has been associated with chickenpox.  Immuno-compromised children are at higher risk for complications.  They may experience prolonged eruption of lesions and high fever, and are contagious throughout this period.

 

Immunization

Varicella Zoster vaccine (Varivax) is available through private pediatricians and the Florida Department of Health in Sarasota County.  Immunization after exposure can lessen the severity of the disease.   Clinical illness after re-exposure is rare, but may occur particularly in immuno-compromised persons.

 

 School Action

  •    Encourage parent/guardian to report cases to school office.

  •       The student is excluded from school until all lesions are dried to the crust stage.  Contact the school RN if you have any questions.

 

êAll suspected or diagnosed cases must be reported to the school RN and the School Health office (927-9000 extension 32101).

 

 

 

FIFTH DISEASE (Erythema Infectiosum)

 

 

 

 

Signs and Symptoms

First signs and symptoms are low grade fever, malaise, and a rash on the cheeks that gives a flushed appearance (sometimes referred to as a "slapped face" look).  Within two or three days the “lacy look”, a slightly raised rash, will spread to the arms, legs and trunk, usually not appearing on the palms or soles.  The duration of the illness is normally 5 to 10 days.  The rash will sometimes recur for several weeks, particularly when the individual is exposed to sunlight or heat, exercise, or stress. 

 

Cause

Parvovirus B19

 

Incubation Period

Time from contact to the development of signs and symptoms ranges from 4 to 20 days.

 

Transmission

Transmitted primarily through contact with infected respiratory secretions.  May be transmitted from mother to unborn child.

 

Treatment 

Parent/guardian should be urged to take children with the above symptoms to a physician to be diagnosed.

 

Complications

Exposed pregnant women should notify their obstetrician.

 

 School Action

  •    For re-entry to school: If rash is present, a physician statement of diagnosis and "not contagious” must accompany the student.

  •    Student should not be in school if they have a fever.

  •    References indicate the disease is most contagious before the onset of the rash.

êWhenever there is more than one student in a classroom diagnosed with Fifth Disease, notify the school RN and the School Health office (927-9000 extension 32101).

 

 

HAND-FOOT-AND-MOUTH DISEASE

 

Signs and Symptoms

Signs and symptoms include: fever, sores in mouth and rash on hands and feet.  The fever is usually gone in 3 or 4 days.  The mouth ulcers usually resolve in 7 days, but the rash on the hands and feet can last up to 10 days.  This disease mainly occurs in children 6 months to 4 years of age.

 

Cause

Enterovirus, especially Coxsackie A 16.

 

Incubation Period

The time from contact to the development of signs and symptoms ranges from 3-6 days.

 

Transmission

The illness is transmitted through respiratory droplets or direct contact with nasal or throat secretions of infected persons or fecal-oral route.

 

Treatment 

Parent/guardian should be advised to take a child with the above symptoms to a physician to be diagnosed.

 

Prevention

Hand washing, as always, is important to prevent the spread of the virus with emphasis on hand washing after toileting.  Proper cough etiquette should also be emphasized.

 

Complications

The most frequent complication is dehydration from refusing fluids due to mouth ulcers.

 

 School Action

  •    For re-entry to school: If rash is present, a physician statement of diagnosis and "not contagious” must accompany the student.

  •    Student is to remain at home until at least 24 hours after there is no longer a fever (without the use of a fever-reducing medicine).

 

 

INFECTIOUS HEPATITIS (Hepatitis A)

 

 

Signs and Symptoms

Fever, loss of appetite, vomiting, abdominal discomfort, indefinite feeling of being ill.  Dark urine (coffee color) with light stools may be noticed.  Yellow (jaundice) color of the skin and the whites of the eyes follow this in a few days.  Severity increases with age.  Children are more apt to have mild cases, frequently without jaundice.

 

Cause

Hepatitis virus, Type A

 

Incubation Period

Time from contact until the development of signs and symptoms 15-50 days, average of 28-30 days.

 

Transmission

The virus is present in intestinal contents of infected persons and is passed in bowel movements.  Where sanitation is poor, the virus can be transferred from sewage to drinking water, milk, vegetables, and seafood.  Close person-to-person contact, the use of contaminated articles, and failing to wash hands thoroughly after handling contaminated objects can be sources of transmission.  Person becomes infectious to others approximately two weeks before jaundice appears and remains infectious for about one week following evidence of jaundice.

 

Treatment

A physician should see all cases of suspected hepatitis.  Severity of cases can vary from illness of 1 to 2 weeks to an occasionally disabling disease of several months.  Bed rest and careful observation are recommended until signs and symptoms have subsided.

 

Complications

Severity tends to increase with age, but complete recovery is the rule.

 

 Immunization

There is a vaccine against Type A Hepatitis.  Close contacts of confirmed hepatitis cases such as household members, persons exposed in day care centers or other group living situations, or persons known to be exposed to contaminated food or water should receive immune globulin as soon after exposure as possible.  Immune globulin provides protection for about two months.

 

Prevention

It is better to avoid this disease by good personal and household hygiene, sanitary disposal of body wastes, training children in good toilet habits and HANDWASHING.

 

School Action

êAll known or suspected cases should be reported immediately to the school RN and the School Health office (927-9000 extension 32101).

 

 Emphasize good personal hygiene, particularly hand washing, to all students and staff members.

 

 

HEPATITIS B

 

 

 

Signs and Symptoms

Gradually developing loss of appetite, abdominal discomfort, nausea, and vomiting.  Sometimes joint pain and rash.  Often jaundice (yellowish tint of eyes and skin) appears later.  Fever may or may not be present.  Seriousness of illness varies.

 

Cause

Hepatitis B virus (HBV)

 

Incubation Period

Usually 45-180 days, average 60-90 days.

 

Transmission  

The virus is passed either directly from those who are already infected or indirectly from their body fluids.  The virus can live on a surface for up to 30 days.

 

The most common ways of getting the disease are:

  •   Through needle stick or needle sharing.

  •   Through breaks in the skin by way of cuts or scrapes and exposure to blood or other body fluids.

  •   Through exposure to blood or other body fluids via the eyes or mouth.

  •   Through sexual contact.

  •   Through body piercing or tattooing.

 

Treatment

Studies with antiviral drugs are in progress.

 

Complications  

Acute hepatic necrosis (liver tissue death), cirrhosis of the liver, liver cancer, chronic hepatitis, with or without symptoms, or death.

 

Immunization  

Hepatitis B vaccine is routine for infants and adolescents and is also indicated for persons with high risk of exposure to hepatitis.  Immunoglobulin (IG or HBIG) is used to immunize known contacts of persons with hepatitis.

 

 

School Action

  •   Utilize standard precautions in handling body fluids and items contaminated with body fluids.

  • êAll known or suspected cases should be reported immediately to the school RN and the School Health office (927-9000 extension 32101).

  •   Emphasize good personal hygiene, particularly hand washing, to all students and staff members.

 

 

IMPETIGO

 

 

Signs and Symptoms

Lesions, yellow to red, weeping and crusted or pustular, especially around the nose, mouth and cheeks, or on the extremities.  Early lesions are raised and contain fluid, later they contain pus, and finally become crusted.

 

Cause

Staphylococcal and streptococcal organisms (bacteria)

 

Incubation Period

Variable and indefinite.  Commonly 4-10 days.

 

Transmission

Impetigo is extremely contagious and is usually transmitted by contaminated hands, particularly where there are open draining areas.  Easily transmitted by direct contact with infected persons.  The hands are the most important instrument for transmitting infection. Good hand washing is vital.

 

Treatment

Application of an antibiotic ointment, after soaking crusts in mild, soapy water.  If infection is widespread, physicians will sometimes prescribe oral antibiotics.

 

Possible Complication

Seldom scarring.  Occasionally enlarged lymph nodes, which may indicate extensive infection or accompanying infection.

 

School Action

  •   Emphasize good hygiene, particularly hand washing.

  •   Student with suspected impetigo should be excluded from school until (a) a diagnosis in writing by a physician indicates a non-contagious skin ailment; or (b) student is being treated and lesions are satisfactorily covered; or (c) lesions are dry.

 

 

MEASLES

RUBELLA, RED MEASLES, 10-DAY MEASLES

 

       

 

Signs and Symptoms

Fever, general malaise, conjunctivitis, runny nose, and a cough start three to four days before rash appears and continue for approximately 10 days.

 

Rash

Rash appears first on face and neck and progresses down to involve trunk, arms and legs.  On the fifth day after the rash appears, it begins to fade.  Some scaling of skin on trunk may occur. 

 

Cause

Measles Rubella virus

 

Incubation Period 

Time from contact to development of disease is 7-18 days.

 

Transmission

Airborne droplet or direct contact with nasal or throat secretions of infected persons.  Child is infectious from first signs of illness until 5 or 6 days after rash appears.

 

Treatment     

Physician or health department should be contacted so diagnosis can be confirmed.  Parent/guardian should seek assistance from physician in dealing with child's signs and symptoms.

 

Complications - Most serious: encephalitis.  Others: deafness, otitis media, croup, pneumonia, diarrhea.

 

 Immunization

Available.  Should be administered after 12 months of age and again between 4-6 years of age.  Usually given with rubella and mump vaccines as MMR.

 

School Action

  • êAll known or suspected cases should be reported immediately to the school RN and the School Health office (927-9000 extension 32101).

  •   Emphasize good personal hygiene, particularly hand washing, to all students and staff members.

 

 

INFECTIOUS MONONUCLEOSIS (MONO)

 

 

 

Signs and Symptoms

Sore throat, malaise, swollen lymph nodes, and fever.  In young children the disease is generally mild and more difficult to recognize.  Most commonly recognized in high school and college students.

 

Cause

Epstein-Barr virus

 

Incubation Period 

Time from contact to the development of signs and symptoms - 4 to 6 weeks.

 

Transmission

Virus is transmitted from person to person through saliva either directly or

indirectly from contact with eating utensils, drinking glasses or beverage containers.

 

Treatment

In the early stages of mononucleosis, the primary management strategy is rest.  Many physicians feel that physical exertion and stress may prolong the course of symptoms or precipitate relapse.  This appears to be more of a problem in adolescents or young adults, many of whom complain of fatigue, with or without exertion, weeks or months after the onset of symptoms.

 

Complications

Uncommon

 

Immunization

None available

 

School Action

  •     Students with infectious mononucleosis can re-enter school as soon as symptoms subside and they are feeling well.

  •   They should present a note from a physician stating limitations of physical activity when returning to school.

  •     Most young children do not require restriction of activities.

 

 

MUMPS

 

 

                

 

Signs and Symptoms

Fever, swelling and tenderness of one or more of the salivary glands.

 

Cause

Virus Paramyxovirus

 

Incubation Period

Time from contact until the development of signs and symptoms - 14-21 days.

 

Transmission

By droplet (coughing, sneezing, etc.) and by direct contact with saliva of infected person.  Most infectious 24-48 hours before illness begins and can continue as long as 9 days after swelling is first observed.

 

Treatment

Parent/guardian should seek assistance from physicians in dealing with signs and symptoms.  Bed rest with observation of signs and symptoms is recommended.

 

Complications

Hearing impairment (rare)

 

Immunization

Available.  Should be administered after 12 months of age.  Usually given with measles and rubella vaccines as MMR.

 

School Action

  • êAll known or suspected cases should be reported immediately to the school RN and the School Health office (927-9000 extension 32101).

  •   Emphasize good personal hygiene, particularly hand washing, to all students and staff members.

 

 

Pink Eye (Acute Contagious Conjunctivitis)

 

 

 

Signs and Symptoms

Tearing, irritation, inflammation (redness) of the conjunctiva (lining of eyelids and covering of eye), swollen eyelids, crusting or discharge in one or both eyes.

 

Causes

Acute bacterial, viral, or allergic

 

Incubation Period

Bacterial is usually 24 to 72 hours.

 

Transmission

Contact with discharges from eyes and upper respiratory tract of infected persons and from contaminated fingers, clothing, or other articles.  Presumed contagious until symptoms have

resolved.

Treatment

 

If bacterial, antibiotic ointments or drops prescribed by a physician. If viral, will clear up with no specific antiviral treatment.

 

Complications

Unusual, if treated.  Eye pain, impaired vision, photophobia

 

School Action

  •    Students with suspected pink eye should be excluded from school until (a) a diagnosis in writing made by a physician indicates a non-contagious eye ailment; or (b) signs and symptoms have disappeared (usually within 48 hours after treatment begins).

  •    Spread of infection is minimized by careful hand washing.

 

 
PINWORMS

 

 

 

Signs and Symptom

Perianal itching, disturbed sleep, irritability and local irritation with secondary infection as a result of scratching the skin.  Worms usually come out of rectum at night and are most likely to be seen in anal region immediately after waking in the morning.

 

Cause

Intestinal parasite (nematode)

 

Incubation Period

Life cycle of parasite is 2 to 6 weeks.  Signs and symptoms may not be evident for  months.

 

Transmission

Direct transfer of infective eggs by hands from anus to mouth of the same or another person and indirectly through clothing, bedding, food, or other articles contaminated with eggs of the parasite. 

 

Treatment

Suspected cases should be seen by a physician for confirmation and treatment.  One dosage treatment is now available.  Bed linens and underwear should be changed daily.

 

Complications

Uncommon

 

Prevention

Good hygiene, particularly hand-washing

 

School Action

  •   Suspected cases should be referred to parent/guardian.  If signs and symptoms persist or if the parent/guardian is unresponsive, refer to the school RN.

  •   Unless symptoms are severe, exclusion is not necessary.

  •   Stress good hygiene, particularly hand-washing and change of underwear daily.

 

 

RINGWORM

 

 

 

Signs and Symptoms

  •    Ringworm of the Scalp - Small raised area spreads leaving scaly patches of temporary baldness.  Infected hairs become brittle and break off easily.  Occasionally, raised and draining areas develop.

  •    Ringworm of the Body - Flat, spreading, ring-shaped lesions.  Outer edge is usually reddish and may contain clear fluid or pus.  In later stages, outer edges will become scaly or crusted and central area will appear like normal skin.

  •    Ringworm of the Foot - (Athlete's Foot) - Scaling or cracking of skin, especially between toes, and blisters containing watery fluid.

 

Cause

Fungi

 

Incubation Period

Scalp - 10 to 14 days

Body - 4 to 10 days

Foot – unknown

 

Transmission

Direct or indirect contact with skin lesions of infected persons, contaminated articles and areas used by infected persons or with hair from infected persons and animals.

 

Treatment

Usually topical antifungal to be applied as directed by label.  For more serious cases, an oral antifungal medication may be prescribed.

 

School Action

  •    A student with suspected ringworm of scalp or body should be excluded until (a) a diagnosis in writing made by a physician indicates a non-contagious skin ailment; or (b) the student is being treated and lesions are satisfactorily covered.

  •    All equipment and articles which an infected student comes in contact with should be disinfected when ringworm infestation has been identified.

  •    Personal hygiene should be stressed.

 

 

RUBELLA (German measles or Three Day Measles)

 

 

 

 

Signs and Symptoms

A young child may have no signs and symptoms until rash appears; then low grade fever and tiredness.  Older children and adults usually have symptoms one to five days before rash, along with joint pain and swollen lymph nodes.  Swollen lymph glands behind the ears and at top of the back of head appear 5-10 days before the rash.

 

Rash

Rash is pink in color and begins on face and neck and progresses downward to trunk, arms and legs.  Lesions are usually discrete and begin to fade within 48 hours.

 

Cause

Rubella virus

 

Incubation Period

Time from contact to development of signs and symptoms 14 - 21 days.

 

Transmission

Transmission is by droplet spread (sneezing, coughing, etc.) or contact with infected persons.  Period of infectiousness is from about one week prior to appearance of rash to about five days after it appears.  Highly communicable.

 

Treatment

 Physician or public health department should be contacted so diagnosis can be confirmed.  Possible contacts with pregnant women should be identified and their immunity status determined.  Children with rubella should be treated according to symptoms.

 

Complications

There are seldom complications in young children.  Rubella can cause birth defects in the offspring of women who acquire the disease during pregnancy (especially if acquired during the first trimester).

 

 Immunization

Available.  Should be administered after 12 months of age.  (Usually given with measles and mumps vaccines as MMR.)

 

 School Action

  • êAll known or suspected cases should be reported immediately to the school RN and the School Health office (941-927-9000 extension 32101).

  •    Emphasize good personal hygiene, particularly hand washing, to all students and staff members.

 

 

SCABIES

 

             

 

 

Signs and Symptoms

Small raised areas or tiny raised burrows containing mites and eggs.  Lesions are most around finger webs, inside surface of wrists, elbows and folds under arms, and around waist.  The rash may appear generalized and secondary infection may occur due to scratching.  Itching is intense, particularly at night.

 

Cause

Mite (Sarcoptes scabiei)

 

Incubation Period

Two to six weeks after exposure until itching begins in persons with previous exposure.  Persons previously infected may develop symptoms 1-4 days after re-exposure.

 

Transmission

Transfer of mite by direct skin-to-skin contact and to a limited extent by contaminated garments and bed linens.  Communicable until mites and eggs has been destroyed, ordinarily after one or two treatments a week apart.

 

Treatment

Parents/guardian should contact their licensed health care provider regarding diagnosis and treatment.  Treatment requires a prescription specifically for scabies.

 

School Action

  •   A student with suspected scabies should be excluded from school until a diagnosis in writing by a physician indicates a non-contagious skin ailment; or upon completion of treatment.  The student should be watched for re-infestation (appearance of new lesions or continued itching) for 7-10 days after initial treatment.

  •   Persons with skin to skin contact with infested persons may need to be treated. 

  •   Launder or disinfect any articles used by infested persons.

 

 

SCARLET FEVER (Streptococcal Diseases)

 

           

 

 Signs and Symptoms

Fever, headache, chills, general malaise, rash; sore throat and vomiting within 12 hours of onset of rash.

 

Rash

Small, flat red dots.  Red areas become white when pressure is applied.  Rash develops most often on the neck, chest, axial, elbow, inner thighs, and groin.  Scaling of skin on the feet and hands may occur.

 

Cause

Group A beta hemolytic streptococci  (Streptococci can be cultured from the throat).

 

Incubation Period

Time from contact to the development of signs and symptoms: 1 - 3 days after close contact with an infected person.  Incidence is highest among small children and during cold weather.

 

Transmission

Usually by direct contact.  By indirect contact through objects or hands (rare).  Occasionally by food contaminated through coughing and sneezing.  Treated cases usually do not transmit infection after 48 hours.  Untreated cases can transmit infection as long as 21 days.

 

Treatment

A physician should see all suspected cases.  Administration of an antibiotic is the usual treatment of choice.

 

Possible Complications

Otitis media (ear infection), abscesses extending around the tonsils, sinusitis; in extreme cases, heart and kidney problems.

 

Immunization

None

 

School Action

  •  A student with Scarlet Fever may be readmitted to school 1-2 days after treatment begins, with a note from the doctor.

  • êAll known or suspected cases should be reported immediately to the school RN and the School Health office (927-9000 extension 32101).

    SHINGLES (also see Chickenpox)

 

 Signs and Symptoms

  •  First symptoms may be a headache, sensitivity to light, or flu-like symptoms without fever.

  •  Later there may be itching, tingling, or pain in a narrow area on one side of the body.

  •  That is often followed in a few days by a rash that becomes a cluster of fluid-filled blisters, similar to chickenpox, in this same area on one side of the body. Over the next 2-4 weeks these blisters crust over and heal. Once all the blisters have crusted, the person is no longer considered contagious.  Occasionally, no rash develops.

  •  Some people feel dizzy or weak while they have shingles.

  •  The pain from shingles may range from mild to severe and may continue after the blisters heal.

Cause

Varicella-zoster virus.  Shingles occurs when the virus that causes chickenpox starts up again in your body. After you get better from chickenpox, the virus “sleeps” (is dormant) in your nerve roots. Sometimes the virus stays dormant forever, but in some cases it “wakes up” when disease, stress, or aging weakens the immune system and then it causes shingles.

 

Transmission

A person with shingles cannot give another person shingles but can pass the virus to someone, usually a child, who has never had chickenpox and that person will develop chickenpox not shingles.

 

Treatment

There is no cure for shingles but treatment may help you get well sooner and prevent other problems. The sooner you start treatment, the better it works. The treatment is oral medication from the doctor.

 

Complications

Occasionally someone will develop postherpetic neuralgia or pain in the area where the rash was that continues for weeks to months after the rash is gone. Taking the oral medication may prevent this from occurring.

 

Immunization

 There is a shingles vaccine available for anyone older than 60 year old that may prevent shingles or make it less painful if you do get it.

 

School Action

  •   Persons with shingles should keep the rash covered and not touch or scratch the rash.

  •  As long as the area of the rash can be covered and any fluid from the blisters contained, the person can be in school.

  •  Hand washing, as always, is important to prevent the spread of the virus.

Reportable Diseases


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Last updated: 07/25/12