Preventing Communicable Diseases in the Day Care/School Setting
(Prevention Guidelines for Child Care Centers and Schoos)
Printable version
Click here to go to the list of communicable diseases covered in these guidelines
Controlling communicable diseases in day care and school settings is of utmost importance. Providing a safe, comfortable, and healthy environment facilitates the educational process, encourages social development, and allows children to acquire healthy attitudes toward organized settings.
However, children who are ill or feel unwell can create difficulties in group settings. An ill child often demands more attention from the teacher or caregiver and cannot fully participate in group or educational activities. Worse yet, the child with a communicable disease may spread the illness to others. Accordingly, it is essential that educators and day care providers control the spread of communicable diseases by safe, effective, and practical efforts.
The purpose of this booklet is to provide an accessible reference of concise information on common childhood communicable diseases. Each disease is described in detail, including signs and symptoms, methods of transmission, prevention practices and exclusion policies for children from the school or day care setting. Tips on the prevention and control of communicable diseases have been included, as well as information on hand washing, playground safety, and general sanitation guidelines.
Concerned parents often request communicable disease information from educators and caregivers. Pages of this booklet may be photocopied and distributed to parents and others in order to provide accurate information on communicable diseases and measures to prevent their spread.
A directory of local health departments has been listed for your convenience. Your local health department can provide a wealth of information and services to your facility, including assistance in the control of a communicable disease outbreak. In addition, day care providers should report those diseases reportable by law to their local health departments, as well as any other increased number of illnesses. This helps to prevent the spread of disease and to keep accurate records of communicable disease in your community and our state.
Information can also be found on the Utah Department of Health, Office of Epidemiology’s website at http://health.utah.gov/epi/
It is hoped that this guide will be used as a reference in order to help keep our children, Utah's children, healthy.
Contents:
Preventing Communicable Diseases - Helpful Tips
Communicable Disease Notification Letter for Parents
Local Health Departments
2009 Immunization Schedule
Communicable Diseases:
HELPFUL TIPS:
Hand washing is the single most important way to prevent the spread of communicable diseases. Use soap, warm water and disposable paper towels. Wash your hands frequently and teach children to wash their hands, too. Hand washing reduces the number of microorganisms on hands that can spread communicable diseases.
Open the window to let the fresh air in! Well-ventilated rooms help reduce the numbers of airborne germs inside. Airing out the rooms is important, even in the winter. When it's cold outside, we spend the majority of time inside. Respiratory diseases easily spread from coughs and sneezes. Opening the window at least once a day lets the germs out and fresh air in.
Follow a good housekeeping schedule and disinfect in the proper way. Make sure that the floors, walls and bathrooms are clean! Clean and disinfect toys at least weekly. Disinfect the food preparation surfaces, eating surfaces and diapering tables. The simplest way to disinfect a surface includes three steps. The first step is to clean the surface with soap and thoroughly rinse with clean water. The second step is to spray or wipe the surface with a solution of 1/4 cup of household bleach in one gallon of water. The final step is to let the surface air dry in order to give the disinfectant time to work. Be careful not to use this solution on surfaces that could be damaged, such as carpets. This preparation is inexpensive and kills bacteria, viruses and most parasites. If you prefer to use a commercial disinfectant, you may. It is important, however, to measure the amount of disinfectant according to the directions on the bottle to get the necessary concentration needed to disinfect.
Require that children are up to date on immunizations. An immunization schedule is in the back of this booklet. Check immunization records and update them regularly. Do your part to help eliminate vaccine-preventable diseases. Remember, "An ounce of prevention is worth a pound of cure."
Do not share personal items among children and keep their belongings separate. Do not allow children to share belongings such as hair brushes, food, clothing, hats, pacifiers or other items. Separate children's coats, hats, and bedding items.
Separate children by using space wisely. Maintain distance between sleeping areas, mats, cribs or cots. Keep children in groups and consistently assign caregivers to the same group. Keep diapered and toilet-trained children separate to prevent spread of diarrheal diseases.
Exclude sick children and staff. The Exclusion Policies as outlined in the Child Day Care Rules have been included. Sending a sick child home with his/her parent helps to prevent the other children from becoming ill with a communicable disease.
Dear Parent:
On __________________________, a child in our class became ill with the communicable disease listed on the attached sheet.
Because your child might have been exposed to this illness, it is necessary for you to watch your child for the signs and symptoms listed on the attached fact sheet. If your child becomes ill, prompt medical attention or treatment may help resolve the infection. It may be necessary to keep him/her at home until the symptoms resolve or until your child receives treatment. The fact sheet explains more about the signs, symptoms, and other concerns.
By notifying you of this possible exposure, we are providing the best possible care for your child. In any setting, it is common for some children to become ill with childhood diseases. At times, they are not preventable. When we notify you of an illness, we are trying to control the spread and prevent new cases of illness. We try to keep our children healthy and happy.
If you have any questions about signs or symptoms of this illness, please contact a staff member, the local health department or the Utah Department of Health, Bureau of Epidemiology at (801) 538-6191.
Sincerely,
____________________________________
Teacher
____________________________________
Date
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CHICKENPOX*
(varicella – zoster virus)
Incubation, Signs and Symptoms
Incubation Period: 2-3 weeks, usually 14-16 days.
Signs and Symptoms: Skin rash often consisting of small blisters all over the body, which leave scabs. Eruption comes in crops. There may be pimples, blisters and scabs all present at the same time. Mild fever. Sometimes this infection is mild and only a few blisters are present.
Methods of Transmission
Chickenpox is spread by direct contact, droplet or airborne spread of secretions from the respiratory tract of an infected person. Also, indirectly by contact with articles freshly soiled with the discharges from blisters or vesicles of an infected person.
Minimum Control Measures
Communicable Period: As long as 5 days but normally 1-2 days before blisters appear, and until all blisters are crusted and scabbed, or until 5 days after the appearance of the blisters. Contagiousness can be longer in a person with altered immunity.
Control: EXCLUDE infected children from school and childcare until all of the blisters are crusted and scabbed. EXCLUDE susceptible contacts (i.e. those children who have not had chickenpox disease or the vaccination) from day 10 through day 21 following exposure to a case of chickenpox within the same kindergarten class or grade level for which chickenpox is required for attendance.
Vaccine-Preventable: Chickenpox vaccine is recommended at 12-18 months of age and is required by law for kindergarten school and for 7th grade entry. It is recommended that children younger than thirteen years of age, without disease history, should receive one dose of vaccine. Adolescents thirteen years of age and olderand adults without disease history should receive two doses of vaccine at least four weeks apart.
Other Information
Notify parents if you suspect their child has been exposed to chickenpox. Children should not be given aspirin or salicylate-containing compounds because the administration of these products increases the risks of Reye syndrome. Acetaminophen may be used for fever control. Early signs and symptoms include a skin rash, vomiting, and confusion. Medical care should be sought immediately if Reye syndrome is suspected.
Chickenpox is generally a more severe disease in adults. Also, children with certain chronic diseases, such as leukemia or Acquired Immunodeficiency Syndrome (AIDS), are at extremely high risk for complications. Pregnant women who have not had chickenpox are not immune and should avoid exposure because illness could harm the fetus. A susceptible pregnant woman who has had exposure should consult with her physician immediately.
Shingles or zoster infections are not caused from exposure to chickenpox, but caused by reactivation of the virus in the body. Therefore, adults are not at risk for shingles when exposed to a person with chickenpox. *Chickenpox is reportable. The patient’s demographics, vaccination status, and clinical information should be reported to the local health department.
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COLDS
Incubation, Signs and Symptoms
Incubation Period: Between 12 hours and 5 days, usually 48 hours; it varies with virus.
Signs and Symptoms: Irritated throat, watery discharge from nose and eyes, sneezing, chills, and general body discomfort.
Methods of Transmission
Varies--includes inhalation of airborne droplets and direct contact with an infected person. Also by contact with articles soiled by discharges from the nose or throat of an infected person.
Minimum Control Measures
Communicable Period: Varies depending on virus. The exact period is unknown, but thought to be at least 24 hours before onset of symptoms until 5 days after onset.
Control: EXCLUDE the child who feels very unwell or has a fever. Otherwise, exclusion is not generally practical.
Other Information
Children and adults should wash hands after touching nasal discharge, such as after wiping a nose. Tissues should be disposable, used only once, and thrown away.
Children should be taught to turn and cough into their shoulders or elbows if they cannot cover their mouths and noses with a tissue.
Prevention practices include: 1) good handwashing practices with warm running water, soap, and disposable paper towels for both children and staff; 2) proper cleaning and disinfection of both the environment and toys; 3) proper ventilation or airing out the room each day, including during cold weather; and 4) proper spacing of cots or sleeping mats so children will not be crowded together.
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CROUP
Incubation, Signs and Symptoms
Incubation Period: parainfluenza virus infections: 3-6 days; adenovirus infections: 2-14 days.
Signs and Symptoms: Fever, wheezing, difficult breathing, and agitation. Croup is often accompanied by cold-like symptoms, bark-like cough, irritated throat, discharge from nose and eyes, sneezing, chills and general body discomfort.
Methods of Transmission
Contact with respiratory secretions or airborne droplets from an infected person. Indirectly by articles soiled with discharges of the nose and throat from an infected person. Usually caused by same group of viruses that cause colds.
Minimum Control Measures
Communicable Period: Varies depending on virus, the exact period unknown. Parainfluenza virus infection may be shed for 3 to 16 prior to symptoms,to 8 days after onset of symptoms.
Control: EXCLUDE the child with fever and/or difficult breathing. A child should be excluded any time the illness prevents the child from participating comfortably in the daily activities or if the child demands more attention than the staff can adequately give.
Other Information
Many times croup syndromes will be better during the day and worse at night. Croup is an immune response of the lower respiratory tract to infection with the same viruses that cause colds. No one understands why some children develop croup and others don't. If children are exposed to a child with croup they will usually develop a cold, rather than croup symptoms.
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CYTOMEGALOVIRUS (CMV)
Incubation, Signs, and Symptoms
Incubation Period: Information about this is not exact. Illness following transfusion with infected blood begins 20-60 days after the transfusion. Infections acquired during birth may occur 3 to 12 weeks after delivery. The time frame for onset of symptoms following person to person transmission is unknown, since most people never become ill.
Signs and Symptoms: Most children and adults infected with CMV do not have symptoms. Those who do may have fever, swollen glands, and feel tired. Immunocompromised people (such as AIDS patients or those receiving cancer treatments) may have a more serious illness such as pneumonia or inflammation of the eye. The most severe form of the disease occurs when a mother infects her fetus. Most prenatal infections are without symptoms. However, about 10% of these babies later have some type of disability such as hearing loss, learning disabilities, or mental retardation.
Methods of Transmission
Communicable Period: Most children who become infected with CMV at birth, will shed the virus for many months, with a range of 6 months up to 5-6 years. Adults shed the virus for a shorter period, usually months, but may persist for years. Even if an individual is no longer shedding the virus or the infection is no longer communicable, CMV can remain in the body throughout a person’s lifetime.
Control: Children with CMV infection should not be excluded from school. Also no attempts to prevent children from spreading CMV should be made, as many children will be infected with the virus naturally. Routine screening for CMV of staff at childcare centers and schools is not recommended.
There is usually no treatment for CMV. However, patients with AIDS or cancer who have an eye infection may be treated with ganciclovir.
Other Information
Pregnant women should be careful to wash their hands after changing diapers or having contact with urine or saliva. Those working in day care centers should not kiss babies or young children on the mouth. Pregnant women should ask their doctor about CMV infections.
Good hand hygiene is the best preventive method.
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DIARRHEAL DISEASES*
Incubation, Signs and Symptoms
Incubation Period: Varies depending on causative agent.
Signs and Symptoms: An increased number of stools compared with the child's normal pattern with increased water and/or decreased form. May be accompanied by nausea, vomiting, abdominal cramping, headache and/or fever. Note that breastfed babies may normally have unformed stools.
Methods of Transmission
Person-to-person contact, in the majority of cases by fecal-oral route (ingesting very tiny amounts of fecal material from an infected person through contaminated hands or objects). Possibly from improperly refrigerated, reheated, or contaminated foods. Contaminated water and food are not usually the source of diarrhea in day care centers.
Minimum Control Measures
Communicable Period: Varies depending on causative agent. There is increased risk of disease for children in diapers and staff caring for these children.
Control: Always EXCLUDE children and staff with diarrhea. Children and staff should thoroughly wash hands after diaper changes and toilet use. Disposable table liners should be used on the changing table. Disinfect the changing table after each use. Educate staff regarding fecal-oral route of transmission. Caregivers who change diapers must not handle food. Separate diapered children from toilet-trained children.
Other Information
If two or more children or staff members in one classroom experience diarrhea within a 48-hour period, an infectious agent should be suspected. NOTIFY YOUR LOCAL HEALTH DEPARTMENT. Stool testing and treatment may be necessary.
*Any individual case of diarrhea due to bacteria, such as Salmonella, E. coli, Shigella or the protozoan Giardia, should be reported to your local health department. Also report any pattern of illness which is unusual or an increased number of illnesses/cases.
Schools or centers with outbreaks of diarrhea should contact their local health departments.
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DIPHTHERIA*
Incubation, Signs and Symptoms
Incubation Period: 2-4 days, with a range of one to ten days.
Signs and Symptoms: Gradual onset over 1-2 days. Diphtheria usually occurs as a white or gray patch or patches of membrane surrounding inflammation and soreness in the throat or nose. Glands in the neck are swollen. Low-grade fever often accompanies symptoms.
Diphtheria can occur as a skin, vaginal, eye, or ear infection. However, this occurs very infrequently and is more common in tropical regions, among homeless persons, and those living in crowded conditions. Diphtheria can be life threatening.
Methods of Transmission
Primarily by contact with a person infected with diphtheria. Diphtheria may be transmitted by a symptomatic person or a carrier. Infectious fluids include discharges from the nose, throat, eye or skin lesions. In rare instances, diphtheria can be transmitted by contact with articles soiled by discharges from the lesions of an infected person.
Minimum Control Measures
Communicable Period: Variable, usually 2 weeks or less and seldom for more than 4 weeks. Effective antibiotic therapy and antitoxin is necessary. Patients that have been treated with an effective antibiotic treatment usually are communicable for fewer than 4 days. The rare chronic carrier may shed bacteria for up to 6 months.
Control: EXCLUDE all patients that have or are suspected to have diphtheria. Identify close contacts of a person diagnosed with diphtheria. Persons who have been exposed to diphtheria must seek medical attention immediately. Close contacts, regardless of immunization status, should be cultured for diphtheria and are often given antibiotic treatment to prevent illness. Close contacts should be given a diphtheria booster appropriate for age.
Other Information
All children attending Utah schools and early childhood programs are required by law to be immunized at the age of 2 months, 4 months, 6 months, 15-18 months, at kindergarten entry and for entry into the 7th grade. . Diphtheria is a life-threatening but vaccine-preventable disease
Infection can occur in immunized and partially immunized persons, as well as those who aren't immunized. The disease occurs more frequently and has more severe symptoms in unimmunized persons.
*Report the number of diagnosed cases to your local health department. Also report any pattern of illness which is unusual or an increased number of illnesses/cases.
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EAR INFECTION (otitis media)
Incubation, Signs and Symptoms
Incubation Period: Varies depending upon the causative agent, usually secondary to an upper respiratory infection.
Signs and Symptoms: Inflammation of the middle ear with fluid in the middle ear. May be accompanied by fever, pain, impaired hearing, diarrhea, nausea, vomiting, or irritability. Occurs most frequently in children under 3 years. Generally accompanies or comes after an upper respiratory infection.
Methods of Transmission
Direct contact with respiratory secretions or droplets from an infected person. Indirectly from articles contaminated with respiratory secretions from an infected person.
Minimum Control Measures
Communicable Period: Varies depending upon the causative agent.
Control: EXCLUDE the child who has fever or feels unwell. Child may return after 24 hours of antibiotic therapy prescribed by a physician, or when symptoms subside.
Other Information
Ear infections are usually secondary to an upper respiratory tract infection.
Preventive measures include:
1) teaching children to turn and cough into their shoulders or elbows, or cover their mouths with a tissue
2) using tissues one time only with prompt disposal;
3) discouraging mouthing behaviors;
4) proper ventilation;
5) separating children during nap times; and
6) proper handwashing.
7) ask your provider about vaccines that may reduce infections
FIFTH DISEASE
(parvovirus B19, erythema infectiosum)
Incubation, Signs and Symptoms
Incubation Period: 4-14 days but can be as long as 28 days. Rash and joint symptoms occur 2-3 weeks after infection.
Signs and Symptoms: Marked redness of cheeks ("slapped-face" appearance) that is often followed by a red, lace-like rash on the trunk and body. The rash can fluctuate in intensity and recur with exposure to sunlight or changes in the environmental temperature for weeks to months, although not all infected persons have a rash. Child may have a slight fever or feel unwell.
It is estimated that about 50% of adults have had previous infection and are immune. In adults the rash is often absent, but arthritis lasting for days to months may occur. In 25% of infected adults, the person is asymptomatic (without any symptoms). Immunodeficient persons with infection may experience chronic anemia.
Methods of Transmission
Primarily from direct contact, droplet, or airborne spread of respiratory secretions. Rarely by transfusion of blood or blood products. Vertically, from mother to fetus.
Minimum Control Measures
Communicable Period: The exact period is unknown, but children are thought to be most infectious 7-10 days before the rash breaks out; the disease is not communicable after the rash appears. Persons with aplastic crises (absence of normal cell development) are communicable up to one week after the onset of symptoms. Immunosuppressed patients may be infectious for months to years.
Control: EXCLUDE the child who has a fever or feels unwell. Otherwise, exclusion is not generally practical. Proper handwashing and disposal of tissues can help to lessen transmission
Other Information
In people with chronic red blood cell disorders, such as sickle-cell disease, infection may result in severe anemia. Infection has also been associated with arthritis in adults.
Some pregnant women have miscarried after becoming infected with parvovirus B19. However, the risk for this occurring is relatively low. Pregnant women who subsequently find that they have been in contact with children during the incubation period (4-20 days before signs or symptoms) may want to follow up with their physicians to discuss the option of serological testing to determine their immune status. Although women who work primarily with children are at increased risk of infection, a routine policy to exclude pregnant women from the workplace when parvovirus B19 is occurring is not recommended. Occupational settings are not the only place where transmission may occur. Prevention methods to avoid infection include proper handwashing, teaching children to cover their mouth when coughing, and disposal of tissues for respiratory secretions.
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GIARDIASIS*
(Giardia enteritis, lambliasis)
Incubation, Signs, Symptoms
Incubation Period: 5-25 days or longer, usually 7-10 days.
Signs and Symptoms: Symptoms can include diarrhea, gas, cramps, bloating, weight loss, fatigue and loose and "greasy" stools. Many people infected with the Giardia parasite show no symptoms.
Methods of Transmission
In daycare centers and schools most infections are spread by person-to-person contact via the fecal-oral route (ingesting very tiny amounts of fecal material from an infected person through contaminated hands or objects). In day care centers, the disease is less often transmitted through contaminated water or food. Drinking untreated water, such as drinking from rivers or streams, is a major source of infection. Giardia organisms in dogs, beavers and other animals are infectious for humans and can contaminate water.
Often, an asymptomatic person spreads the infection by not properly washing hands after bowel movements or after changing diapers.
Minimum Control Measures
Communicable Period: Entire period of infection.
Control: Always EXCLUDE child and staff with diarrhea. Children and staff must thoroughly wash hands after toilet use and diaper changes. Hands should be washed before meals and snacks. Monitor handwashing practices among children. Educate staff regarding fecal-oral route of transmission.
Staff that change diapers must not prepare food. Separate diapered and toilet-trained children.
Wash and disinfect toys on a regular basis, particularly toys that have or could be put into children's mouths.
Children who are not toilet trained should not use wading pools. Alternative forms of recreational water play, such as running through sprinklers, prevent giardiasis from spreading.
Other Information
*Report this illness to your local health department. Also report any pattern of illness which is unusual or an increased number of illnesses/cases.
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HAND, FOOT, AND MOUTH DISEASE
(enteroviral vesicular stomatitis with exanthem)
Incubation, Signs and Symptoms
Incubation Period: 3-5 days.
Signs and Symptoms: Small painful blisters in the mouth, on the gums and tongue. Blisters may also occur on the palms, fingers and soles of the feet. Usually the blisters persist from 7-10 days. A person with hand, foot, and mouth disease may be asymptomatic (with no symptoms).
Methods of Transmission
Direct contact with nose and throat discharges, respiratory droplets, or feces from an infected person.
Minimum Control Measures
Communicable Period: During the illness and perhaps longer because this virus persists in the stool for several weeks.
Control: EXCLUDE the child who feels unwell or has a fever. Wash hands thoroughly after toilet use, diaper changes, and nose blowing. Discard used tissues in the proper place. Use tissues only once.
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HEAD LICE
(pediculosis)
Incubation, Signs and Symptoms
Incubation Period: The nits (eggs) of lice may hatch in 1 week. Sexual maturity is reached approximately 8-10 days after hatching.
Signs and Symptoms: Infestation of the head and hairy parts of the body with adult lice, larvae and nits. This results in itching and irritation of the scalp and skin. Female lice are generally the size of a sesame seed. Eggs or nits are tiny tan or pearl-gray specks that attach to the hair shaft close to the scalp.
Methods of Transmission
Almost exclusively by contact with an infested person. Transmission can occur from sharing hats, combs and brushes, or by other articles recently in contact with the head of an infested person. Lice DO NOT jump or fly. Hair length does not influence infestation.
Minimum Control Measures
Communicable Period: From time of infestation until after completion of initial treatment.
Control: EXCLUDE from attendance until after first treatment with a medicated product, such as pyrethrin (Rid® and others). Parents of affected children should be notified and informed that their child must be properly treated before returning to school on the day after treatment.
Person must be retreated in 7-10 days in order to kill remaining nits. Follow the manufacturer's directions carefully. Remove the nits by using a fine-tooth comb. The nits can be loosened before combing by applying a damp towel to the scalp for 30 to 60 minutes, or by soaking the hair with white vinegar followed by applying a damp towel to the scalp for 30 to 60 minutes. Commercial rinses containing 8% formic acid may also be used to loosen the nits. All products must be used according to the manufacturer's directions.
Lice cannot live away from the host for more than 48 hours. Eggs do not survive away from the scalp for more than 7 days.
Thoroughly vacuum the environment including furniture. Insecticide sprays have not been proven useful. Laundering washable items in hot water and/or using the hottest drying cycle will destroy lice and nits. Non-washable items, such as stuffed toys, may be dry cleaned or placed in tightly sealed plastic bags for 10 days in order to destroy nits. Soak combs and brushes in hot water for 10 minutes or wash with pediculicide shampoo.
Other Information
Lindane-containing compounds (Kwell) should not be used on infants or small children or by women who are pregnant or nursing. The local health department should be notified of outbreaks of lice. When a child is found with head lice, all contacts and family members of the child should be examined carefully. Those infested should be treated.
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HEPATITIS A*
Incubation, Signs and Symptoms
Incubation Period: 15-50 days; normally 25-30 days.
Signs and Symptoms: Preschool-aged children infected with the hepatitis A virus are usually asymptomatic (with few or no symptoms). Cases occurring in a day care center are often not recognized until a family member suddenly develops symptoms. Symptoms may include: fever, malaise (aches), lack of appetite, abdominal discomfort with nausea and vomiting, fatigue, tea-colored urine, and onset of jaundice (yellowing of the skin and/or whites of the eyes). Infected children sometimes have abdominal discomfort, a general feeling of being unwell, lack of appetite and/or jaundice.
Methods of Transmission
Person-to-person contact by the fecal-oral route (ingestion of tiny amounts of fecal particles from contaminated objects or hands). The virus is excreted in the infected person's feces for 1-3 weeks before onset of symptoms. Peak levels of the virus are excreted 1-2 weeks before symptoms appear. Maximum infectivity occurs during the latter half of the incubation period and continues until a few days after the symptom of jaundice.
Outbreaks have occurred from infected food handlers and from eating raw or undercooked shellfish from sewage- or fecal-contaminated waters. Hepatitis A is more frequently spread in day care centers or other settings where diapered children attend. Risk of transmission is lower in the school setting, generally, because children are toilet trained.
Minimum Control Measures
Communicable Period: Most communicable for 1-2 weeks prior to the onset of symptoms. Diminishes after the onset of symptoms.
Control: EXCLUDE from attendance until the fever is gone and at least 1 week after the onset of illness. The ill person should be under a physician's care. Prompt administration of immune globulin (IG) to contacts helps prevent the spread of hepatitis A. Education of staff and children about good hygiene measures, including frequent hand washing, is essential for the control of hepatitis A.
There is a vaccine for prevention of the hepatitis A virus. The first dose is recommended to be given at 12 months of age. The second dose is recommended at least 6 months after the first dose. Hepatitis A is required for kindergarten entry. Contact your local health department or your family physician for more information on the hepatitis A vaccine.
Other Information
Contact the local health department for help in controlling the disease and for immune globulin (IG) recommendations. Hand washing for all persons is vitally important to prevent acquiring or transmitting hepatitis A. Persons caring for diapered children are at increased risk for acquiring the disease. They must exercise caution by practicing good hand washing techniques. The diaper changing area should be cleaned and disinfected after each use, not just during a disease outbreak. *Hepatitis A should be reported to your local health department.
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HEPATITIS B*
Incubation, Signs and Symptoms
Incubation Period: As long as 45-180 days; averages 60-90 days.
Signs and symptoms: The disease is usually mild in children. Symptoms develop slowly and may include loss of appetite, stomach pain, nausea and vomiting. Sometimes skin rashes, joint pains, fever and jaundice (yellowing of the skin and whites of the eyes) develop.
Methods of Transmission
Hepatitis B may be spread by the following ways: 1) through sexual activity, 2) by direct contact with infected blood and body fluids, 3) by in utero transmission (an infected mother may transmit the virus to her baby during birth, although it is rare and only accounts for only <2% of perinatal infections) and 4) by using contaminated sharps or needles. It is unlikely, but hepatitis B can be transmitted by biting (through saliva) if skin is broken. It is not transmitted by the fecal-oral route.
Minimum Control Measures
Communicable period: An infected person can spread the virus for several weeks before symptoms appear and as long as the person is ill. Persons who develop lifelong infections ("carriers") may spread the virus for their entire lives.
Control: A child infected with hepatitis B should be under the care of a physician. Although the infected child does not need to be excluded for the entire period of the infection, physician approval is needed for the child to return to day care. If a child is unusually ill or exhibiting aggressive behaviors such as biting then exclusion may be necessary. Children who are chronic carriers do not need to be excluded as long as they do not display unusually aggressive behaviors (biting) that may place other children at risk. It is recommended for all household contacts of a hepatitis B case to be immunized.
Hepatitis B is a vaccine-preventable disease. Vaccination is recommended for all infants. The first dose is recommended to be given at birth. The second dose should be given between 1 and 2 months of age. The third dose should be given at 6 months of age (or at least 24 weeks). Hepatitis B is required for kindergarten and for 7th grade entry.
Other Information
Use barrier methods such as gloves to prevent contact with body fluids. For further information, see "Body Substance Precautions" below. There is no specific treatment for infection with the hepatitis B virus so prevention is extremely important.
*Report this illness to your local health department. Also report any pattern of illness which is unusual or an increased number of illnesses/cases. For more information contact your local health department.
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HEPATITIS C*
Incubation, Signs, and Symptoms
Incubation Period: Average is 6 to 9 weeks with a range of 2 weeks to 6 months.
Signs and Symptoms: The signs and symptoms of hepatitis C virus infection are normally not distinguishable from those of hepatitis A or B. Symptoms in a new infection tend to mild and most infected children do not have symptoms. If symptoms are present they usually develop slowly and include loss of appetite, stomach pain, nausea, and vomiting. Jaundice (yellowing of the skin and whites of the eyes) only occurs in 25% of patients. Most children with long term Hepatitis C infection do not have symptoms. Individuals that do not have symptoms can spread the disease.
Methods of Transmission
Hepatitis C may be spread by the following ways: 1) by direct contact with infected blood and body fluids 2) through sexual activity (only 10% of hepatitis C infections are transmitted through sexual activity) , 3) an infected mother may transmit the virus to her baby during birth (in utero transmission is rare, accounting for only 5% of perinatal infections) and 4) by using contaminated sharps or needles. Approximately 40% of the hepatitis C infections have no known exposure. It is unlikely, but hepatitis C may be transmitted by biting if skin is broken. It is not transmitted fecal-orally.
Minimum Control Measures
Communicable Period: An infected person can spread the virus for several weeks before symptoms appear. Persons who develop lifelong infections ("carriers"), may spread the virus for their entire lives.
Control: A child infected with hepatitis C should be under the care of a physician. Although the infected child does not need to be excluded for the entire period of the infection, if a child is unusually ill or exhibiting aggressive behaviors such as biting then exclusion may be necessary. Children who are chronic carriers do not need to be excluded as long as they do not display unusually aggressive behaviors (biting) that may place other children at risk.
There is no vaccine available for hepatitis C.
Other Information
Use barrier methods such as gloves to prevent contact with blood and other body fluids. For further information, see "Body Substance Precautions" below.
*Report this illness to your local health department. Also report any pattern of illness which is unusual or an increased number of illnesses/cases. For more information contact your local health department.
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HERPES SIMPLEX VIRUS (HSV)
Incubation, Signs and Symptoms
Incubation Period: 2-14 days.
Signs and Symptoms: Herpes is caused by one of two viruses: herpes simplex type 1 (HSV1) and herpes simplex type 2 (HSV2). Herpes is a common infection that causes "cold sores" or "fever blisters"on the mouth or face (known as oral herpes or HSV1) and similar symptoms in the genital region (known as genital herpes or HSV2). Primary infection is usually without symptoms when it occurs in early childhood. In newborns, congenital infection produces a spectrum of diseases ranging from localized skin lesions to severe symptoms involving the whole body.
Methods of Transmission
Herpes is transmitted by direct skin-to-skin contact, directly from the site of infection to the site of contact. For example, if you have a cold sore and kiss someone, the virus can infect the other person's mouth. Herpes can also be spread sexually when there are no visible signs or symptoms. Both types may be transmitted to various sites by oral-genital, oral-anal, or anal-genital contact.
Any genital sores should be reported to the Child Abuse Hotline (number below).
Minimum Control Measures
Communicable Period: The virus can be present for weeks and is most communicable when lesions are blister-like. The infected person may shed the virus when asymptomatic (without any symptoms) for both types of the virus.
Control: Excluding a child with HSV is not appropriate. HSV is very prevalent in the community. The oral type of Herpes (HSV1) may commonly be transmitted in families. If a child is symptomatic, exclusion may only be necessary if the child feels very uncomfortable. Care should be taken to disinfect objects placed in children's mouths before they are used by other children in the center. Good hand washing practices are essential when children or staff are infected with HSV.
If the child has gingivostomatitis (open blisters on gums and inside of the mouth) and cannot control oral secretions or has biting behaviors, the child should be EXCLUDED until the condition is resolved.
Other Information
Caregivers with HSV lesions should take special care with hygiene measures, such as handwashing. The person with HSV lesions should not kiss children/infants.
Any person suspecting child abuse or neglect, including sexual or physical abuse, must report it to the Child Abuse Hotline. In the Salt Lake area call 538-4377. In other areas of Utah call 1 (800) 678-9399.
A confidential investigation will be conducted to ensure that the child is not endangered. Information must be handled in strictest confidence in order to safeguard the privacy of the individual.
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HUMAN IMMUNODEFICIENCY VIRUS*
ACQUIRED IMMUNODEFICIENCY SYNDROME
HIV/AIDS
Incubation, Signs and Symptoms
Incubation Period: Window period of 6-12 weeks, an infected person will usually test negative during this time. The latency period includes the window period and can last 7-12 years. Generally, a person will test positive after the first 6-12 weeks; symptoms may not appear for 7-12 years.
Signs and Symptoms: HIV disease starts with infection by the human immunodeficiency virus (HIV). The virus attacks and suppresses the immune system so that opportunistic infections and cancers can affect the body. During the latency period a person may show no identifiable signs or symptoms. Some general symptoms of HIV disease may include prolonged fever, night sweats, persistent swollen lymph nodes, chronic diarrhea, and unexplained weight loss.
Methods of Transmission
HIV is transmitted in three ways: 1) through sexual intercourse with an infected person; 2) through contact with infected blood or body fluids to a mucous membrane or open or broken skin; and 3) from an infected mother to her child through pregnancy, birth or breast-feeding. Articles contaminated with blood or infected body fluids may also transmit HIV; for example, sharing needles. The major body fluids that are implicated in the transmission of HIV are blood, semen, vaginal/cervical secretions and breastmilk. HIV cannot be transmitted through sweat, tears, saliva, urine or feces unless blood is visibly present. However, it is important to use barrier precautions such as gloves for all body fluids because other diseases may be transmitted by these fluids.
Minimum Control Measures
Communicable Period: From the moment a person is infected, he or she becomes infectious for life and can transmit the virus to others.
Control: Children with HIV infection should not be excluded from school for the protection of other children or personnel, and disclosure of infection should not be required. Use barrier methods such as gloves to avoid contact with blood or body fluids. Wear disposable gloves when taking care of injuries. Wash hands thoroughly after removing the gloves.
Other Information
HIV is primarily a sexually transmitted disease. However, there are individuals who have been infected in other ways; such as through occupational exposure, I.V. drug use, or through birth to an infected mother. Infectious fluids can enter the body through chapped, broken or non-intact skin, needlesticks, or splashes to the mucous membranes of the eyes, nose or mouth. It is essential to follow Body Substance Precautions at all times. This means utilizing barrier methods, such as gloves, if contact with any body fluid is anticipated.
*Report this illness to your local health department. Also report any pattern of illness which is unusual or an increased number of illnesses/cases. For more information contact your local health department.
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IMPETIGO
Incubation, Signs and Symptoms
Incubation Period: 1-10 days, occasionally longer or indefinite.
Signs and Symptoms: Blister-like lesions on the skin which later ooze and develop into crusted sores. They appear in an irregular pattern. The sores may spread into a red, oozy rash that gets a clear or honey-colored crust. Itching is common.
Methods of Transmission
Direct contact with draining sores. Contaminated hands are the most frequent method for spreading infection. Often, tiny breaks in the skin allow bacteria in to cause infection. Some people carry the bacteria and can easily infect others when the skin is broken. Impetigo can be caused by staphylococcal or streptococcal bacteria.
Minimum Control Measures
Communicable Period: As long as sores continue to weep or drain.
Control: EXCLUDE from attendance until 24 hours after antibiotic treatment has been started, until sores are dried, or until sores can be covered with a bandage.
Other Information
Early detection and adequate treatment are important in preventing spread. Medical treatment is necessary. Oral antibiotics are preferred treatment for multiple lesions. Any person with lesions should avoid contact with newborn babies. The infected individual should use separate disposable towels and washcloths. Place dressings in a disposable bag and immediately put in the garbage. Staphylococcal infections are reportable to the local health department by number only.
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INFLUENZA*
(flu)
Incubation, Signs and Symptoms
Incubation Period: Usually 2 days, but can vary from 1-4 days.
Signs and Symptoms: Sudden onset of an acute viral disease with symptoms of fever, chills, headache, sore muscles, and a general feeling of being unwell. Associated with runny nose, sore throat, and cough. Cough is often severe and lasts longer than other symptoms which generally subside in 2-7 days. Nausea, vomiting and diarrhea may occur in children.
Methods of Transmission
Direct contact with respiratory secretions or droplets from an infected person. Indirect contact with articles freshly soiled by discharges from an infected person. The virus is excreted in discharges from the nose and throat and can live in dried mucus for several hours.
Minimum Control Measures
Communicable Period: Probably 3-5 days after onset of symptoms; can be up to 7 days after the onset of symptoms in younger children.
Control: EXCLUDE child who has fever or feels unwell. Otherwise, exclusion is not generally practical. Antiviral medications, if given within 2 days of illness onset to otherwise healthy individuals, can reduce the duration of uncomplicated influenza illness.
Influenza is generally more severe in very young children who have had noprior exposure. Influenza can also be severe in elderly populations. Sometimes influenza resembles a cold or other respiratory virus.
Because young, otherwise healthy children are at increased risk for influenza-related hospitalizations, it is recommended that children aged six months through 5 years receive influenza vaccination. It is also recommended that household contacts (anyone who spends a significant amount of time in the home) and out-of-home caregivers of children 6 months through 59 months (or 5 years) receive influenza vaccination. Annual immunizations are effective in preventing infections. Health care providers may prescribe antiviral medications for exposed individuals to reduce influenza transmission. Individuals exposed to influenza should consult with their health care provider.
Other Information
Children must not be given aspirin or salicylate-containing compounds because administration of these products increases the risks of subsequent Reye syndrome. Acetaminophen may be used for fever control. Reye syndrome is a rare but life-threatening illness. Early signs and symptoms are vomiting and confusion. Medical care should be sought immediately if Reye syndrome is suspected.
*Report the number of diagnosed cases to your local health department. Also report any pattern of illness which is unusual or an increased number of illnesses/cases.
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MEASLES*
(rubeola, hard measles, red measles)
Incubation, Signs and Symptoms
Incubation Period: 7-18 days from exposure to onset of fever, generally 10 days; about 14 days until rash appears.
Signs and Symptoms: The first symptoms of measles resemble a cold with cough, fever of 101°F or greater, runny nose, and/or red, watery eyes. A red, blotchy rash follows a few days later around the ears and hairline and spreads to cover the face, spreading to the trunk and arms by the second day. The fever usually disappears 1 or 2 days after the rash. The rash turns from pink to reddish brown and lasts about 5 days. Peeling of the skin is common. The disease is more severe in infants and adults than in children.
Methods of Transmission
Direct contact with secretions of nose and throat from an infected person. Can be spread by airborne droplet or by articles freshly soiled with respiratory secretions from an infected person. Measles is a highly contagious disease, but can be prevented through proper immunization.
Minimum Control Measures
Communicable Period: 1-2 days before the onset of cold-like symptoms, 4-5 days before the onset of the rash to 4 days after the rash appears; measles is most infectious just before rash appears. Communicability is minimal after the second day of the rash.
Control: EXCLUDE from attendance for at least 4 days after the rash appears. During an outbreak, susceptible persons should be excluded from attendance until they are immunized or until two weeks after the rash onset of the last case of measles. Standard control measures for measles suggest that the measles vaccine will protect exposed persons in some cases if given within 72 hours of exposure. Immune globulin can be given to prevent or modify measles in a susceptible person within 6 days of exposure.
Other Information
All children attending Utah schools and early childhood programs are required by law to be immunized between the ages of 12-15 months and again between 4-6 years. Two doses of measles are required for school attendance for grades kindergarten through twelve. Measles is a vaccine-preventable disease.
*Notify the local health department immediately if a case occurs in the center or school.
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MENINGITIS
(bacterial meningitis, Neisseria meningitidis, Haemophilus influenzae)
Incubation, Signs and Symptoms
Incubation Period: Usually 1-4 days.
Signs and Symptoms: The symptoms appear suddenly with onset of fever, chills, intense headache, nausea, vomiting, stiff neck, and sometimes rash. Behavioral changes may occur, including irritability or sluggishness. The disease may progress to seizures and a coma.
Signs and symptoms of meningitis are a medical emergency. Medical attention must be received immediately. Although anyone can get the disease, it appears most frequently in those less than five years of age. In some instances, it is important to treat household and day care contacts as soon as possible with preventive drugs, preferably within 24 hours. Contact the local health department immediately.
Methods of Transmission
Direct contact with droplets and secretions from the nose and throat of an infected person. Infected people are usually symptomatic, but some people may carry the organisms without having any symptoms
Minimum Control Measures
Communicable Period: Patients are considered infectious for as long as the bacteria are present in the nose and throat and after antibiotics are started: 24 hours for N. meningitidis, 24-48 hours for H. influenzae, and upon doctor’s determination for Streptococcal pneumoniae meningitis.
Control: EXCLUDE patients from attendance until adequately treated. May return to center when child feels well enough and when a physician determines that the child is no longer infectious. Antibiotic therapy for contacts may be indicated, contact public health immediately to assure that contacts receive prophylaxis.
There are vaccines available that can help protect against the various causes of bacterial meningitis.
For young children: Haemophilus influenzae type b (Hib)vaccine is recommended for all children beginning at 2 months of age. All children attending early childhood programs are required by law to receive Hib vaccine It is recommended that children be immunized at 2, 4, 6, and 12-15 months. The number of doses required depends on the age of the child at vaccination, previous number of doses received and the brand of vaccine used. The Hib vaccine is not required and is not recommended for children over 60 months (5 years).There is a vaccine available to protect against N. meningitidis for children over the age of 11. Parents/guardians should consult with their child’s health care provider about the feasibility of receiving this immunization.
Other Information
*Notify the health department immediately if a case occurs. Careful observation of exposed household, school or child care center contacts is essential. Exposed individuals who develop a fever should receive prompt medical evaluation. Household and close day care contacts need to receive antibiotics.
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MUMPS*
Incubation, Signs and Symptoms
Incubation Period: 14-25 days, commonly 16-18 days.
Signs and Symptoms: Usually fever, often with headache, chills, and discomfort, usually followed by painful swelling or tenderness under the jaw or in front of the ear.
Methods of Transmission
By droplet spread or direct contact with saliva from an infected person. The virus is also found in urine.
Minimum Control Measures
Communicable Period: 7 days before onset of swelling and up to 9 days after swelling occurs. Maximum infectiousness occurs between 2 days before to 4 days after the onset of illness.
Control: EXCLUDE from attendance for at least 9 days after swelling first occurs or until swelling is gone.
Other Information
All children 12 months of age and older attending Utah schools or early childhood programs are required by law to receive one dose of mumps vaccine for attendance. Mumps vaccine is recommended to be given between the ages of 12-15 months. Mumps is a vaccine-preventable disease.
The disease may have serious complications. Mumps infection during the first trimester of pregnancy may increase the rate of spontaneous abortion.
Adults born before 1957 are considered immune even if they did not have the disease or the vaccine as a child.
*Report the number of diagnosed cases to your local health department. Also report any pattern of illness which is unusual or an increased number of illnesses/cases.
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PINK-EYE
(conjunctivitis)
Incubation, Signs and Symptoms
Incubation Period: Viral: varies from 12 hours to 12 days. Bacterial: 24-72 hours.
Signs and Symptoms: Redness of eye(s), watery, white or yellow discharge from the eye, matted eyelashes, burning or itching eyes.
Methods of Transmission
Contact with discharges from the eyes or upper respiratory tract of an infected person. Eyes can become infected from contaminated fingers, clothing and other articles, including shared towels or eye makeup.
Minimum Control Measures
Communicable Period: During the course of active infection. Bacterial: May last from 2-3 days to 2-3 weeks. Viral: up to 2-3 weeks.
Control: Isolate child with eye discharge. EXCLUDE the child from attendance until examined by a physician and the child is approved for readmission. For bacterial infections, this is normally 24 hours after treatment is started by the physician. Conjunctivitis caused by viruses is not shortened by antibiotic treatment and may be contagious until the watery, white or yellow discharge has ceased. Exclusion for long periods is often impractical.
Thorough handwashing and disinfection of contaminated articles will help to prevent spread. Eliminate shared articles, such as common towels. Do not share eye makeup or eye drops.
Other Information
Distinguishing between viral and bacterial conjunctivitis requires costly laboratory tests. Many physicians treat all cases with antibiotics in order to prevent serious complications.
Encourage children not to rub their eyes. Exclusion of the child with pink-eye and good handwashing practices help to prevent the spread in day care situations.
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PINWORMS
(enterobiasis)
Incubation, Signs and Symptoms
Incubation Period: 1-2 months or longer.
Signs and Symptoms: Tiny parasitic worms that live in the lower intestine. Symptoms include anal itching with disturbed sleep, irritability, and local irritation due to scratching. Some individuals may not have any symptoms. The female worms resemble short white threads. They lay their microscopic eggs around the anus at night. Itching might be more intense at night. Pinworm infections are common in school-age children. Pinworms do not cause bed-wetting or teeth grinding.
Methods of Transmission
Direct transfer of eggs from anus to mouth. Eggs may get on hands from articles contaminated with eggs of the parasite, such as clothing, toys or bedding. Pinworms from animals cannot be transmitted to people.
Minimum Control Measures
Communicable Period: As long as the worms/eggs are present. Eggs remain infective in an outdoor environment for about 2 – 3 weeks.
Control: The child should receive medical attention. Utah child care rules require EXCLUSION of the child until after the first treatment. Proper handwashing is necessary before eating and after toilet use. Reinfection is common. Thoroughly clean the bathroom and vacuum the house or facility. Change bed linens and bath towels.
Other Information
Close contacts, such as siblings, should be checked and treated if necessary. Linens, clothing and bedding should not be shared and should be washed frequently. Pinworm infection may be present without symptoms.
Keep fingernails trimmed short. Discourage nail biting. Showers in the morning are preferred to baths.
Consult the local health department for help in controlling outbreaks of the disease within the center. Make sure children wash their hands after each toilet use and before meals.
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RINGWORM OF THE SCALP, SKIN OR FEET
(dermatophytosis, tinea, athlete's foot)
Incubation, Signs and Symptoms
Incubation Period: Scalp: Usually 10-14 days; Skin: Usually 4-10 days; Feet: Unknown.
Signs and Symptoms:
Beard and Scalp: Scaly patches of temporary baldness. Infected hairs are brittle and break easily. Infection may be unapparent.
Skin: Reddish, flat, inflamed ringlike rash that may itch or burn. May be dry and scaly, moist, or crusted.
Feet: Scaling or cracking of the skin, especially between the toes, or blisters containing a thin, watery fluid. Itching is common. Infection is rare among younger children. Also called athlete's foot. Infection may be unapparent. Repeat attacks and chronic infection common.
Methods of Transmission
Directly by contact with an infected person or animal (skin to skin or skin to fur). Indirectly by contact with articles such as seats, combs, clothing or hats, and surfaces contaminated, such as floors, benches, shower stalls or similar areas by such infected person or animal.
Minimum Control Measures
Communicable Period: As long as the rash or lesions are present, or the fungus persists on contaminated materials.
Control: EXCLUDE the child until medical treatment begins. Eliminate activities which involve skin to skin contact until fungus is completely gone. Prevent children from sharing brushes, combs, ribbons or other hair accessories. Refer people with a suspicious rash for a medical evaluation with diagnosis and treatment immediately.
Other Information
Preventive measures include not sharing personal items such as hair care articles and clothing. Personal hygiene is important--skin areas should be dried thoroughly after washing. All day care and household contacts, pets and farm animals should be inspected and treated if infected. Do not share brushes or combs with pets. Public facilities such as locker rooms and pools should not be used when infected with ringworm. Wash and disinfect bathroom surfaces and toys daily. Use disposable tissues and towels for wiping and washing children. Never use the same towel or tissue on more than one child.
Notify parents and staff if more than one person in the program develops ringworm for early detection of other cases.
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ROSEOLA
(exanthem subitum or human herpesvirus 6)
Incubation, Signs and Symptoms
Incubation Period: About 9-10 days, with a range of 5-15 days.
Signs and Symptoms: Sudden onset of a high fever, over 103°F, sometimes as high as 106°F that lasts 3-7 days and then quickly disappears. After fever subsides, a rash appears. The rash consists of small, separate rose-pink spots that begin on the chest and abdomen that may last a few hours or up to a few days. Most cases are in children 6 months to 4 years old. In some cases rash may not occur.
Methods of Transmission
Unknown. Humans are the only known host.
Minimum Control Measures
Communicable Period: Unknown. Humans are the only known host.
Control: EXCLUDE a child with fever. A child with rash and no fever may return to day care.
Other Information
Usually occurs in children under 4 years of age, most commonly around or before age 2. Immunity follows illness. Caused by the human herpesvirus-6 (HHV-6) or a virus similar to HHV-6. Unrecognized infections can occur.
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RUBELLA*
(German measles)
Incubation, Signs and Symptoms
Incubation Period: 14-21 days, usually 14-17 days.
Signs and Symptoms: A skin rash lasting 1-3 days may or may not occur. If a rash occurs, it begins on the face. Mild fever, usually less than 101 F; can include cold symptoms such as runny nose, cough, etc. Lymph nodes at back of head, behind ear, and along back of neck often are enlarged. Young children may be asymptomatic (without symptoms).
Methods of Transmission
Direct contact from an infected person or indirectly by contact with articles freshly soiled by respiratory secretions from an infected person. The virus is excreted in discharges from nose, throat and urine.
Minimum Control Measures
Communicable Period: Communicable from 1 week before and at least 4 days after the onset of the rash.
Control: EXCLUDE the child from attendance for 7 days after the onset of rash. Infants born with congenital rubella syndrome should be evaluated before being admitted to the center as they may shed virus over a prolonged period after birth. Patients with congenital rubella in childcare should be considered contagious until they are at least one year old, unless nasopharyngeal and urine cultures are repeatedly negative for rubella virus.
Other Information
All children 12 months of age and older attending Utah schools and early childhood programs are required by law to receive one dose of rubella vaccine for attendance. Rubella is recommended to be given between the ages of 12-15 months. Rubella is a vaccine-preventable disease.
The disease, while mild in children, is very serious for unborn babies if it is contracted by a pregnant woman. Pregnant women, whether or not immunized, should immediately consult their physicians if they have been exposed to rubella.
*Report this illness to your local health department. Also report any pattern of illness which is unusual or an increased number of illnesses/cases.
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SCABIES
Incubation, Signs and Symptoms
Incubation Period: 2-6 weeks before itching begins in a person with no previous exposure. Persons with prior exposure develop symptoms within 1-4 days.
Signs and Symptoms: Scabies is a skin infestation caused by microscopic parasites called mites. The mites burrow under the skin creating small raised areas of skin containing fluid or tiny paths under the skin. These burrows resemble wavy lines and appear frequently on finger webs or on the inside of the wrists and elbows. A rash may occur anywhere on the body, regardless of the area of infestation. Itching is intense, especially at night.
Methods of Transmission
Direct skin-to-skin contact with an infested person. Less commonly, transmission occurs through contact with contaminated clothing, bedding, or other articles.
Minimum Control Measures
Communicable Period: From the time of infestation until after mites and eggs are destroyed which ordinarily occurs after 1 or occasionally 2 courses of treatment 1 week apart. Generally, a person is treated on the first day. On the second day a bath or shower is taken and all linens, underclothes and bedding are changed. Carpets and furniture should be vacuumed. It should be noted that sometimes itching will persist for 1-2 weeks after treatment. This should not be taken as a sign that treatment failed. Overtreating should be avoided because the medication can be toxic. Follow the directions on the package exactly.
Control: Diagnosis of scabies should be confirmed by a physician. If a single case has been confirmed, EXCLUDE the child from attendance until the day after treatment is started. Individuals who have had direct contact with the infested child, including family members, should be evaluated and, if necessary, treated.
A child with rash and fever or a behavior change, such as itching, must be EXCLUDED from the day care setting.
Other Information
A single infestation in a family is uncommon. Bedding and clothing worn next to the skin during 72 hours prior to treatment should be laundered on the hot cycle. Store difficult to wash items in closed plastic bags for 5 days. Disinfection of the general environment is not necessary.
Consult the local health department for help in controlling outbreaks of this disease. Also report any pattern of illness which is unusual or an increased number or illnesses/cases.
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SEXUALLY TRANSMITTED DISEASES*
(gonorrhea, syphilis, chlamydia)
Incubation, Signs and Symptoms
Incubation Period:
Gonorrhea: 2-7 days, sometimes longer.
Syphilis: 10 days - 3 months, usually 3 weeks.
Chlamydia: 7-14 days or longer.
Signs and Symptoms:
Gonorrhea: In symptomatic males, a pus-colored discharge drains from the penis within an average period of 3-5 days. Although often asymptomatic in females, common symptoms may include burning, vaginal discharge and itching.
Syphilis: A tiny, painless ulcer develops at the site where the microorganism enters the body. A painless, firm lymph node commonly follows. Generalized secondary eruption occurs with mild symptoms including a rash, sore throat and weight loss.
Chlamydia: In males, symptoms include discharge, burning during urination and urethral itching. In females, discharge, itching and inflammation may occur in the genital tract and may result in permanent damage to the reproductive system. Asymptomatic infections may occur in both males and females.
Methods of Transmission
Gonorrhea: Direct contact with the discharge of mucous membranes of an infected person; almost always from sexual contact.
Syphilis: Direct contact with the secretions from the ulcers; almost always during sexual contact.
Chlamydia: Direct contact by sexual intercourseor other sexual contact.
Minimum Control Measures
Communicable Period:
Gonorrhea: may extend for months in untreated individuals who might be asymptomatic; ends within hours of appropriate drug therapy.
Syphilis: variable and indefinite during primary and secondary stages. Adequate bicillin therapy ends communicability within 24-48 hours.
Chlamydia: unknown; thought to be until treatment is completed.
Control: There is no reason to exclude a child with a sexually transmitted disease.
Other Information
Any person suspecting child abuse or neglect, including sexual or physical abuse, must report it to the Child Abuse Hotline. In the Salt Lake area call 538-4377. In other areas of Utah call 1 (800) 678-9399. A confidential investigation will be conducted to ensure that the child is not endangered. Information must be handled in strictest confidence in order to safeguard the privacy of the individual.
*Report this illness to your local health department. Also report any pattern of illness which is unusual or an increased number of illnesses/cases.
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SHIGELLOSIS*
(bacillary dysentery)
Incubation, Signs and Symptoms
Incubation Period: 12-96 hours, usually 1-3 days.
Signs and Symptoms: Watery diarrhea with fever, nausea, vomiting, cramps and sometimes spasms of the rectum. Diarrhea may contain blood, mucus and pus. Mild or asymptomatic cases can occur.
Methods of Transmission
Directly or indirectly from a patient or carrier through the fecal-oral route. The disease spreads from an infected person who fails to properly wash hands after defecation and from contaminated hands, objects or foods. Ingestion of a few organisms may result in an infection.
Minimum Control Measures
Communicable Period: Variable; as long as the organism is excreted in the stool, normally 4 weeks after illness. Asymptomatic carriers may transmit infection. Rarely, the carrier state may persist for months.
Control: EXCLUDE children and staff with diarrhea. Proper handwashing after using the bathroom or changing diapers is necessary. Persons preparing food must not change diapered children in day care setting.
Other Information
All persons in high risk occupations (day care, patient care or food handling) should be excluded until 2 negative stool cultures are taken 24 hours or more apart. Samples must be taken 48 hours following the last dose of antibiotic therapy.
*Report this illness to your local health department. Also, report any pattern of illness which is unusual or in increased numbers.
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SORE THROAT OR TONSILLITIS
The most frequent causes of sore throats and tonsillitis are the same viruses that cause colds. Whether or not to exclude a child can be a difficult decision. A general guideline is to exclude if symptoms resemble those of a strep throat.
|
Probably not Strep Throat |
Possible Strep Throat |
Fever |
absent or mild |
mild to high |
Appearance |
generalized redness |
pus spots on back of throat and tonsils |
Onset |
usually slow, accompanied by cold symptoms |
usually rapid (within hours) |
Exclusion |
most children don't need to be excluded unless having a fever or feeling unwell |
EXCLUDE until negative strep screen or on antibiotics for 24 hours |
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STREP THROAT AND SCARLET FEVER
Incubation, Signs and Symptoms
Incubation Period: 1-3 days, rarely longer.
Signs and Symptoms:
Strep Throat: Fever, sore and red throat, pus spots on the back of the throat, tender and swollen lymph nodes in the neck.
Scarlet Fever: Includes all symptoms that occur with strep throat, as well as strawberry tongue and rash on the skin and inside the mouth. High fever, nausea, and vomiting may occur. The rash on the skin is normally easily felt but not seen. The tongue is usually white before the appearance of the strawberry tongue.
Methods of Transmission
Direct or intimate contact with an infected person or carrier. Rarely, by contaminated objects or hands. Outbreaks of strep throat may follow ingestion of contaminated foods, such as milk, egg salad or deviled eggs.
Minimum Control Measures
Communicable Period: With antibiotic treatment, communicability is eliminated within 24 hours. Variable for untreated cases. Can spread through mild, unrecognized cases.
Control: EXCLUDE from attendance until 24 hours after antibiotic treatment is started. Cultures should be obtained from persons with symptoms who have had contact with the diagnosed individual.
Other Information
Medical attention is essential. Untreated children may develop severe complications, including rheumatic fever and glomerulonephritis (kidney disease).
Consult the local health department for help in controlling outbreaks of this disease. Also report any pattern of illness which is unusual or an increased number of illnesses/cases.
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THRUSH
(candidiasis, yeast infection, moniliasis)
Incubation,
Signs and Symptoms
Incubation
Period: Variable,
but 2-5 days for thrush in infants.
Signs and Symptoms: Infection of the skin,
mouth, or tongue that appears as white spots which cannot
be scraped off without causing bleeding. May also occur
in folds of the skin in diapered areas and is a common
cause of diaper rash.
Methods
of Transmission
Direct
contact with secretions or excretions of mouth, skin,
vagina, or feces from patients or carriers. From mother
to baby during birth. Infection may also happen as part
of normal body function. The fungus is often part of
normal body flora that sometimes becomes a symptomatic
infection.
Minimum
Control Measures
Communicable
Period: Presumably
for as long as lesions are present.
Control: It
is not necessary to exclude the child from attendance.
Meticulous handwashing and disinfection of contaminated
articles (such as nipples, pacifiers, etc.) is necessary
to prevent spread. Medication is usually needed to shorten
duration of infection.
Other
Information
Wet
diapers facilitate the spread of candidiasis; keeping
children in dry diapers is very important in prevention
of the disease. Children should be thoroughly cleaned
and dried before fresh diapers are applied. Persons
who have been on extended antibiotic therapy or who
are immunocompromised may be at increased risk.
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VIRAL MENINGITIS*
(aseptic meningitis)
Incubation,
Signs and Symptoms
Incubation
Period: 2-21 days,
depending on causative agent.
Signs and Symptoms: Acute disease with
sudden onset of fever, intense headache, nausea, vomiting,
and stiff neck. Behavioral changes may occur, including
irritability or sluggishness. A rash may or may not
be present.
Methods
of Transmission
Varies
with causative agent. Enteroviruses, a common cause
of viral meningitis, are transmitted by the fecal-oral
route (ingesting very tiny amounts of fecal material
from an infected person through contaminated hands or
objects). May also spread by airborne droplets from
respiratory secretions.
Minimum
Control Measures
Communicable
Period: Varies
with specific infectious agent.
Control: A
child with fever who feels unwell should be EXCLUDED
from attendance. A child with viral meningitis should
be under a physician's care.
Since the virus may be excreted in feces for several
weeks, proper handwashing is essential before handling
or eating foods, after using the bathroom, assisting
a child in the bathroom, or changing a diaper.
Other
Information
A medical
evaluation is necessary to determine whether meningitis
is viral or bacterial because the symptoms are essentially
the same. Viral meningitis is a less serious disease
than bacterial meningitis, except in young infants who
may suffer severe consequences. Medical care is necessary.
*Report this illness to your local health department. Also report any pattern of illness which is unusual
or an increased number of illnesses/cases.
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WHOOPING COUGH*
(pertussis)
Incubation, Signs and Symptoms
Incubation
Period: 7-10 days
commonly, with a range of 4-21 days.
Signs and Symptoms: Begins with cold symptoms
such as a runny nose and an irritating cough that gradually
worsens into severe coughing attacks (paroxysms) within
1-2 weeks. Violent spells of coughing frequently end
with vomiting. Some cases can be severe, resulting in
pneumonia or neurological symptoms. Can last for 1-2
months or longer. Young infants and adults often do
not have typical whoop. Mild cases are sometimes missed.
Methods of Transmission
Airborne
droplet or direct contact with the respiratory secretions
from an infected person.
Minimum Control Measures
Communicable
Period: Highly
communicable in early stage and up to 2 weeks after
the onset of violent coughing. Antibiotics shorten communicable
period to 5 days after treatment is started.
Control: EXCLUDE
from attendance until 5 days after start of antibiotic
therapy or until symptoms are no longer present. Exposure to children especially incompletely immunized
children should be observed for respiratory tract symptoms
for 20 days after last exposure. Symptomatic children
with a cough should be excluded until they are evaluated
by a physician. Those diagnosed as having pertussis
should not return to school until five days after starting
antibiotics. Chemoprophylaxis should be considered for
adult staff with close or extensive contact. Adult staff
members should also be observed for respiratory tract
symptoms, be tested if symptoms develop, and start antibiotic
therapy if cough develops within 20 days of exposure.
Other Information
Immunizations
should begin at 2 months of age and be received again
at 4 months, 6 months, 15-18 months and 4-6 years. Children
attending schools early childhood programs are required by law to be adequately immunized for their age.
Pertussis is a vaccine-preventable disease.
Serious complications of pertussis include bronchopneumonia
and occasionally neurological symptoms. Accelerated
schedule for booster vaccines and antibiotic therapy
may be recommended for exposed individuals.
*Report this illness to your local health department
immediately by telephone. Also report any pattern
of illness which is unusual or an increased number of
illnesses/cases.
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