Guidelines for Schools and Child Care Facilities on Communicable Diseases and Other Childhood Health Issues

Transcription

1 Guidelines for Schools and Child Care Facilities on Communicable Diseases and Other Childhood Health Issues This resource is intended to provide school principals, teachers, directors of child care facilities (CCFs) and health care professionals with guidelines on communicable disease prevention and control in schools and CCFs. Any child who is ill and unable to participate fully in regular activities should be cared for at home. Individuals who may have been exposed to a communicable disease and have specific health concerns, such as pregnancy and immunosuppression, may need to be assessed by a health care professional. Proper hand hygiene is the most effective way to prevent the spread of communicable diseases. October 2011 ottawa.ca/health TTY:

2 CRITERIA FOR REPORTING OUTBREAKS TO OTTAWA PUBLIC HEALTH For reporting gastroenteritis outbreaks see page 5. For reporting of respiratory infection outbreaks see page 10. Schools must report when they have greater than 10% absenteeism due to similar symptoms in the school on the same day OR a sudden or unusual increase in absenteeism due to similar symptoms in students/staff in a class or school on the same day. Child care facilities must report when they have 15% or more attendees/staff ill with similar symptoms or absent on the same day. Report all outbreaks immediately to the Outbreak Line at , ext 26325, Monday to Friday 8:30 a.m. to 4:30 p.m. or

3 Amebiasis Disease Cause/Symptoms Transmission Incubation Period of Parasite. Abdominal distension and cramps, diarrhea or constipation, and rarely fever or chills. May be symptom free. Fecal-oral route. Food and water contaminated by an infected food handler or fecal matter. Few days to several months, commonly 2 to 4 weeks. During the period that cysts are passed, which may continue for years. CCFs: exclude symptomatic cases (attendees and staff, including food handlers), until 24 hours after diarrhea resolves or until 48 hours after completion of antibiotic treatment. Report to , ext within 1 Bite (Animal) There is a risk of rabies from the bites of bats, cats, dogs, ferrets, groundhogs, muskrats, racoons, skunks and other wild mammals. Bites of gerbils, hamsters, mice, moles, rabbits and squirrels do not have to be reported unless the animal s behaviour was very abnormal. Animal saliva introduced by a bite or scratch. Rabies: Usually 3-8 weeks; rarely as short as 9 days or as long as 7 years. Rabies: Rabid animals are infectious from the time the virus reaches the salivary glands and up until death. Death usually occurs within 1 week of onset of clinical signs during regular business hours or after hours to begin rabies immunization, if needed, and/or to quarantine the biting animal, if available. Bite (Human) If the skin is broken, there may be a risk of transmission of hepatitis B, hepatitis C, and HIV from an infected person. Contact of contaminated blood with a break in the skin or blood inside of the mouth. Depends on the disease. Depends on the disease. Not required unless either person is known to be infected with hepatitis B, hepatitis C or HIV. If so, report immediately to during regular business hours or Campylobacter Diarrhea, abdominal pain, malaise, fever, nausea and vomiting may be mild to severe. Stools may contain blood. Fecal-oral route. Ingestion of undercooked meat (especially poultry), unpasteurized milk and contaminated water or by direct contact with fecal material from infected animals or people. 1 to 10 days. Variable, as long as organisms are being excreted; usually 2 to 7 weeks. CCFs: exclude symptomatic cases (attendees and staff including food handlers), until symptom free for 24 hours. Report to , ext within 1 2

4 Candidiasis Disease Cause/Symptoms Transmission Incubation Period of (Thrush, Diaper Rash) Fungus. Thrush: Thin white layer on tongue and inside of cheeks. May cause difficulty with feeding. Diaper rash or other skin rash: Well demarcated, red rash with white flaky border, usually in skin folds. Painful when comes in contact with urine. contact. Variable, 2 to 5 days for thrush in infants. While lesions are present. Chickenpox (Varicella) Fever. Blister-like rash occurs over 5 to 6 days. Scabs form after the blister stage. Rash usually appears first on the body, face and scalp, and then later spreads to the arms and legs. contact with virus through droplet or airborne spread of blister fluid or respiratory secretions. Indirectly through freshly contaminated objects and surfaces. 2 to 3 weeks; commonly 14 to 16 days. As long as 5 days, but usually 1 to 2 days before onset of rash, until all blisters are crusted, usually about 5 days after the onset of rash. No exclusion, children can return with rash. Contact with immunocompromised individuals, susceptible pregnant women, particularly those in the third trimester, or newborns should be avoided. Children should be seen by a physician as soon as possible if: 1) fever (>38.3 C) lasts for more than 3 days or recurs, 2) redness, swelling, and severe pain develop around a blister. Report, by mail or fax, number of cases and ages, using the Chicken Pox Weekly Form, available online at ottawa.ca/health Cold Sores (Herpes) Small blisters appear and then burst to form a crust. Sores are usually around the mouth but can be around the nose and eyes. With the first infection, sores may be accompanied by fever, flu-like illness, and painful irritation. contact with saliva. 2 to 12 days. While sores are apparent, however, virus may be transmitted even when no visible sores are present. If it is the first episode and symptoms are severe, exclude only if child does not have control of oral secretions, until sores are crusted over. 3

5 Disease Cause/Symptoms Transmission Incubation Period of Conjunctivitis-Bacterial (Pink Eye) Pink or red conjunctiva (the white of the eye) with thick or crusty white or yellow discharge (pus), occasionally accompanied by fever. or indirect contact with eye secretions. 24 to 72 hours. For duration of infection or until 24 hours of antibiotic treatment is completed. Exclude until treated with antibiotic drops or ointment for 24 hours. Conjunctivitis-Viral (Pink Eye) Coxsackie Virus (Hand, Foot and Mouth Disease) Pink conjunctiva (the white of the eye) with a clear, watery eye discharge. Often occurs at the same time as a cold. Sudden onset of fever, sore throat. Rash on the palms of the hands, the fingers, and on the soles of the feet, and sores inside the mouth. Usually occurs in children, particularly in the summer months. or indirect contact with eye secretions. contact with respiratory secretions and fecal-oral route. Infection cannot be spread through contact with rash or sores. 12 hours to 12 days. For duration of infection. Usually 3 to 5 days. During the acute stage of the illness (while experiencing symptoms). Transmission via stools may persist for several weeks. Not required, but encourage frequent hand hygiene. Crabs (Genital Lice) Cryptosporidiosis Small grey-brown insects and white eggs (nits) attached to pubic hairs. May spread to other areas where there is hair (head, eyebrows, underarms). Intense itching and skin redness. Parasite. Frequent, non-bloody, watery diarrhea with abdominal cramps and pain, fatigue, vomiting, and weight loss. Loss of appetite and vomiting are relatively common among children. May be symptom free. skin to skin contact, sexual contact, or indirect contact with bedding, clothing, and towels. Fecal-oral route, including person to person, animal to person, waterborne (recreational or drinking water) and foodborne transmission. 6 to 10 days. As long as lice or eggs remain alive on hair; until treated. 1 to 12 days with an average of 7 days. From onset of symptoms up to several weeks after symptoms resolve. CCFs: exclude symptomatic cases (attendees and staff, including food handlers), until 24 hours after diarrhea resolves. Cases are not to use recreational waters for 2 weeks after symptoms resolve. Report to , ext within 1 4

6 Diarrhea E. Coli 0157:H7 Disease Cause/Symptoms Transmission Incubation Period of (Verotoxin-producing Escherichia coli) See Gastroenteritis. Bloody or non-bloody diarrhea, severe abdominal cramps, vomiting, fatigue, malaise and dehydration. Symptoms usually last fewer than 5 days. Eye Infection See Conjunctivitis. Fifth Disease See Parvovirus B19. Gastroenteritis: outbreak Bacteria, virus or CCFs: parasite. Defined as 3 or more Vomiting, diarrhea, cases in a specific class or abdominal pain, program within a 4 day headache, fever. period. A case must meet at least 1 of the following criteria: 2 or more episodes of loose/watery bowel movements (conforms to the shape of the container) within 24 hours, OR 2 or more episodes of vomiting within 24 hours, OR 1 episode of loose/watery bowel movements and 1 episode of vomiting within 24 hours. Fecal-oral route, mainly by ingestion of contaminated food: undercooked meat (especially hamburger) and poultry unwashed raw vegetables ( lettuce, spinach, sprouts) and fruits unpasteurized milk and apple juice/cider. Contaminated drinking or recreational water. Animal to person and person to person can occur. Depends on cause. Usually fecal-oral route or through food and water contaminated with bacteria, virus or parasite. 1 to 8 days, usually 3 to 4 days. 1 week or less in adults, but can be 3 weeks in one third of children. CCFs: exclude all cases (attendees and staff, including food handlers) until 2 negative stool cultures are obtained, at least 24 hours apart or until 48 hours after the completion of antibiotics. Depends on cause. Depends on cause. Depends on cause, number of cases and source of infection. All outbreaks must be discussed with Ottawa Public Health during regular during regular 5

7 Schools: Disease Cause/Symptoms Transmission Incubation Period of Defined as a sudden or unusual increase in absenteeism due to similar symptoms in students/staff in a class or school in the same day OR >10% absenteeism due to similar symptoms in a school in the same day. Gastroenteritis: single case of unknown cause A case is defined as having: 2 episodes of vomiting, OR 2 episodes of diarrhea, OR 1 episode of vomiting and 1 episode of diarrhea within 24 hours. Genital Herpes German Measles Giardiasis (Beaver Fever) Hand, Foot and Mouth Disease Bacteria, virus or parasite. Vomiting, diarrhea, abdominal pain, headache, fever. Painful sores on the skin around genitalia. With the first infection, sores may be accompanied by fever, flu-like symptoms and painful irritation. See Rubella. Parasite. Chronic diarrhea, abdominal cramps, bloating, dehydration, fatigue and weight loss. May be symptom free. See Coxsackie Depends on cause. Usually fecal-oral route or through food and water contaminated with bacteria, virus or parasite. Depends on cause. Depends on cause. Exclude until 24 hours after diarrhea is resolved. If diarrhea recurs within 48 hours, recommend to parent/guardian that child be assessed by a physician to see if a stool culture is needed. Exclude if vomiting 2 or more times in the previous 24 hours, unless the vomiting is determined to be caused by a non-communicable condition and the child is not in danger of dehydration. Sexual contact. 2 to 12 days. Usually while sores are apparent but virus may be transmitted even when no visible lesions are present. Fecal-oral route, most commonly through the ingestion of contaminated water or by direct person to person contact. 3 to 25 days or longer, usually 7 to 10 days. Can be excreted in stool for months. CCFs: exclude symptomatic cases (attendees and staff, including food handlers) until 24 hours after diarrhea resolves. Cases should not use swimming pools, lakes or rivers for 2 weeks once diarrhea has stopped. Exception: bloody diarrhea should always be reported. Report to , ext within 1 6

8 Disease Cause/Symptoms Transmission Incubation Period of Head Lice (Pediculosis) Colonization of the hair and skin by a parasitic insect. Head lice feed on human blood; itching from lice bites is common. Adult lice or eggs (nits) can be seen with the naked eye, often behind the ears and near the nape of the neck. Head lice are generally spread through direct head to head contact with an infested person; transmission by sharing bedding or clothing such as headwear is much less common. 7 to 12 days from the laying of eggs to the hatching of the first nymph. Until treatment has been completed. Exclude until the initial treatment is completed. Hepatitis A Fever, fatigue, nausea, jaundice (yellowing of skin), abdominal discomfort, dark urine, clay coloured stools. Fecal-oral route, either by direct contact with an infected person or indirectly through ingestion of contaminated water or foods. 15 to 50 days, average 28 to 30 days. Most infectious 2 weeks prior to and until 1 week after the onset of symptoms. Exclude until 1 week after onset of symptoms during regular May be symptom free. Hepatitis B Anorexia, fatigue, vague abdominal discomfort, joint pain, fever and jaundice. May be symptom free. contact with infected body fluids, including sexual contact. 45 to 180 days, average 60 to 90 days. Many weeks before onset of first symptoms and through the acute period of disease. Some people become carriers and remain contagious for life. Report to , ext within 1 Hepatitis C Most cases are usually asymptomatic or have mild illness; vague abdominal discomfort, nausea, vomiting and fatigue. Person to person primarily through blood-to-blood contact. 2 weeks to 6 months, commonly 6 to 9 weeks. From 1 or more weeks before onset of symptoms; most persons are probably infectious indefinitely. Report to , ext within 1 HIV/AIDS (Human Immunodeficiency Virus) Most cases will develop a short-term flu-like illness several weeks to months after infection. May lead to suppression of the immune system. contact with infected body fluids, including sexual contact. Generally 1 to 3 months until HIV blood test is positive. Begins early after onset of infection and extends throughout life. Report to , ext within 1 7

9 Impetigo Disease Cause/Symptoms Transmission Incubation Period of Infection of the skin caused by Streptococcus or Staphylococcus bacteria; can follow a scrape or insect bite. It usually appears on the face or exposed skin as a rash with a cluster of red bumps or blisters, which may ooze or form a honey-coloured crust. and indirect contact with fluid from blisters. It is very contagious and should be treated at once. Variable. Commonly 1 to 10 days. From onset of rash until 24 hours of treatment with oral or topical antibiotics. Exclude until 24 hours after the initiation of antibiotic treatment. Upon return, any draining or open blisters must be covered with a clean dry bandage. Influenza Lice (Pediculosis) Measles (Red Measles) Meningitis May include sudden fever, non-productive cough, headache, muscle soreness, fatigue, runny nose, sore throat. Children may also have nausea, vomiting and diarrhea. May also be asymptomatic. See head lice. Fever, runny nose, cough, drowsiness, irritability and red eyes. Small white spots appear on the inside of the mouth and throat. Then, 3 to 7 days after initial symptoms a red blotchy rash appears on the face and progresses down the body. Bacteria or virus. Young children may show a cluster of symptoms such as irritability, poor feeding, vomiting, fever, rash and excessive high-pitched crying. Older children and adults may experience severe persistent headache, contact or indirect contact with contaminated surfaces and objects. contact or by airborne droplets. Highly contagious. Varies depending on cause of meningitis. 1 to 3 days. 24 hours prior to onset of symptoms lasting up to 7 days. 7 to 21 days, usually 10 days. Varies depending on cause of meningitis. 4 days before to 4 days after the onset of rash. Varies depending on cause of meningitis. Exclude for 5 days after the onset of symptoms, or until fever free and feeling better, whichever is shorter. Exclude for 4 days after the onset of rash. Varies depending on cause of meningitis during regular during regular 8

10 Disease Cause/Symptoms Transmission Incubation Period of Molluscum Contagiosum (Non-Plantar Warts) Mononucleosis Mumps Norovirus Paratyphoid fever Parvovirus B19 (Fifth Disease; Erythema infectiosum) Pertussis (Whooping cough) vomiting and neck rigidity. Skin infection with small flesh-coloured or translucent bumps with sunken centre, most often on face, trunk, or limbs of children. Can be found on genitalia. May cause itchiness. Epstein-Barr Fever, sore throat, swollen lymph nodes in neck, fatigue. Fever, swelling and tenderness of salivary glands slightly above the angle of the jaw, on 1 or both sides. See Gastroenteritis: outbreaks Fever, headache, malaise, anorexia, infrequent stools and possible rash on trunk. Mild fever and distinctive slapped cheek facial rash. After 1-4 days, a red, lace-like rash appears on the arms and body and can last 1-3 weeks. May be symptom free. Repeated bouts of violent coughing, which may end with a highpitched inspiratory whoop and/or vomiting. May last 1 to 2 months. skin to skin contact or indirect contact, such as sharing clothes or towels. contact with saliva. contact with respiratory secretions or saliva. Fecal-oral route, either by direct contact with an infected person or indirectly through ingestion of contaminated water or foods. or indirect contact with respiratory secretions; mother to fetus. contact with respiratory secretions. 2 to 7 weeks, but can be as long as 6 months. Unknown, but probably as long as warts persist. 4 to 6 weeks. Prolonged; may persist up to 1 year or more. 14 to 25 days; average 16 to 18 days. 1to10 days. 4 to 14 days; can be as long as 21 days. 5 to 21 days, usually 7 to 10 days 7 days before to 9 days after symptoms develop. From onset of initial symptoms, and up to 2 weeks after. 1 week before onset of rash. Until 3 weeks after onset of symptoms or until 5 days of antibiotic treatment is completed. Exclude for 5 days from the onset of swelling. CCFs: exclude all cases (attendees and staff, including food handlers), until 3 consecutive stool specimens are negative. Not required since no longer infectious once rash appears. Infected children with sickle cell or other forms of chronic anemia and pregnant personnel are advised to consult with their health care provider. Exclude for 3 weeks after onset of cough or until completion of 5 days of antibiotic treatment. Report to , ext within during regular Report to , ext within 1 9

11 Pink Eye Pinworms Poison Ivy Disease Cause/Symptoms Transmission Incubation Period of Respiratory infection outbreak CCFs: A respiratory outbreak exists when there is 15% or more people (children and /or staff) sick or absent with acute respiratory illness occurring on the same day within the facility. Schools: A sudden or unusual increase in absenteeism due to illness with similar symptoms in students/staff in a class or school on the same day OR >10% absenteeism due to illness with similar symptoms in a school on the same day. Respiratory Syncytial Virus (RSV) See Conjunctivitis. Worm. Itching around the anal area. Plant toxin. Redness and blisters in linear pattern, where skin was exposed. Extremely itchy. Washing the exposed area immediately decreases the severity of symptoms. Bacteria or virus. Symptoms may include: Runny or stuffy nose or sneezing Sore throat, hoarseness or difficulty swallowing Dry cough Fever/abnormal temperature, chills may or may not be present Swollen or tender glands in the neck Fatigue Muscle aches Loss of appetite Headache. Can cause colds, bronchiolitis, bronchitis, croup, pneumonia, and ear infections. Most common in children < 2 years old Fecal-oral route or indirectly from contaminated items such as bedding, clothing, toilet seats or toys. Direct skin contact with any part of the plant. or indirect contact with respiratory secretions. or indirect contact with respiratory secretions. 1 to 2 months or longer. Until treatment is initiated. A few minutes to several days. Varies according to cause. 2 to 8 days, usually 4 to 6 days. Not contagious after the toxin has been washed from the skin or clothing. Varies according to cause. Usually 3 to 8 days from onset of symptoms, but may continue for as long as 3 to 4 weeks. Exclude until treatment is initiated. Exclude for 5 days after the onset of symptoms, or until fever free and feeling better, whichever is shorter during regular 10

12 Disease Cause/Symptoms Transmission Incubation Period of Ringworm (Tinea) Roseola Rubella (German Measles) Salmonella Salmonella paratyphi (See paratyphoid fever) Salmonella Typhi (See Typhoid fever). Fungus. Flat, well defined, red, circular patches with scaly or crusted border on the skin or scalp. The patches are often itchy. Sudden onset of fever lasting 3-5 days, followed by fine, pink rash on trunk and body. Low-grade fever, headache, malaise, runny nose, red eyes, enlarged tender neck nodes. Rash starts on the face, spreads in 24 hours and lasts 3 days. Symptoms include sudden onset of headache, fever, abdominal pain, diarrhea, nausea and sometimes vomiting. skin to skin contact or indirectly from contact with contaminated objects or surfaces. contact with respiratory secretions. contact with respiratory secretions. Highly contagious. Fecal-oral route, either by direct contact with an infected person or indirectly through ingestion of contaminated food. Pets (iguanas, turtles, sometimes cats and dogs) and farm animals are another common source of infection. 10 to 14 days for scalp; 4 to 10 days for other areas. As long as lesions are present or until treatment is initiated. 9 to 10 days. Unknown; probably communicable during the fever phase and before the rash appears. 14 to 21 days. About 1 week before to 7 days after onset of rash. 6 to 72 hours, usually 12 to 36 hours. Up to several weeks or months after onset of symptoms. Exclude until treatment has been initiated. Exclude for 7 days after onset of the rash. CCFs: exclude symptomatic cases (attendees and staff, including food handlers) until symptom free for 24 hours during regular Report to , ext within 1 Scabies Caused by a mite burrowing under the skin. Direct skin to skin contact or indirect contact by sharing clothes or towels. 2 to 6 weeks. From onset of symptoms until treated. Exclude until treatment has been completed. Rash appears as bumps, patches or tiny red lines, usually between fingers and toes, and in skin folds. Intense itching, especially at night. Scarlet Fever See Streptococcal Infection. 11

13 Shigella Disease Cause/Symptoms Transmission Incubation Period of Watery diarrhea or bloody diarrhea, fever, nausea, vomiting, abdominal cramps. May be symptom free. Fecal-oral route, either by direct contact with an infected person or indirect contact with contaminated surfaces, ingestion of contaminated water or food; or sexual contact. 1 to 3 days; may range from 12 hours to 1 week. 1 week if treated with antibiotics, up to 4 weeks if not. CCFs: exclude all cases (attendees and staff, including food handlers) until 2 consecutive stool samples or rectal swabs are negative during regular Shingles (Herpes Zoster) Reactivation of latent varicella (chickenpox) infection in the nerve endings. Characterized by pain and a blistering rash usually localized to one area of the body. Shingles occur in people who have already had chickenpox. You cannot transmit shingles; however, it is possible to get chickenpox from someone with shingles through direct contact with the fluid in the blisters. 2 to 3 weeks; commonly 14 to 16 days. Until blisters are crusted over. Streptococcal Infection (Strep throat, Scarlet fever) Strep Throat: Very sore and red throat, fever. Scarlet Fever: High fever, vomiting, "sandpaper" skin rash, "strawberry tongue", red cheeks and whiteness around mouth. Direct or indirect contact with respiratory secretions. Usually 1 to 3 days. From onset of symptoms until 24 hours after antibiotic treatment initiated. 10 to 21 days if untreated. Exclude until 24 hours after treatment is initiated. During convalescence, skin on hands and feet may peel. Streptococcal Infection (Invasive Group A Strep) Necrotizing fasciitis: Fever, localised redness, swelling, blister formation, and intense pain. Redness spreads very quickly. Toxic Shock Syndrome: Sudden onset of high fever, vomiting, diarrhea, rash, muscle pains, and shock. Direct or indirect contact with respiratory secretions or with discharge from wounds. Usually 1 to 3 days. From onset of symptoms until 24 hours after antibiotic treatment initiated. Exclude until 24 hours after treatment is initiated during regular Can be fatal. 12

14 Disease Cause/Symptoms Transmission Incubation Period of Tuberculosis (TB) Typhoid fever (Salmonella Typhi) Whooping Cough Yersinia Mycobacterium tuberculosis. If TB disease is in the lungs: cough, loss of weight, fever, night sweats, fatigue. If TB disease is outside of the lungs: symptoms vary depending on where the disease is located. Low grade fever, headache, malaise, myalgia, dry cough, anorexia, nausea, and abdominal discomfort. Constipation is more common than diarrhea in adults but diarrhea is more common in children. See Pertussis. Diarrhea, fever, abdominal pain, headache, and in some cases, a rash. If TB disease is in the lungs: person to person via airborne bacteria. If TB disease is outside of the lungs: not contagious. Fecal-oral route. Direct contact with contaminated water, shellfish, particularly oysters, milk, ice-cream, raw fruit and vegetables grown in fields fertilized with fecal matter. Fecal-oral route. Direct contact with infected people or animals such as puppies or kittens or indirect contact with contaminated food and water. Several weeks to years for someone to develop TB disease. From 3 days to over 60 days; usual range is 8-14 days. 3 to 7 days, usually under 10 days. Varies. Variable. Usually 1 to 2 weeks. Usually 2-3 weeks. OPH manages all cases of TB disease and notifies schools and CCFs if exclusion is required. CCFs: exclude all cases (attendees and staff, including food handlers) until 3 consecutive stool specimens are negative. CCFs: exclude all cases (attendees and staff, including food handlers) until 24 hours after diarrhea resolves, or 48 hours after completion of antibiotic therapy. Report within 1 business day to , ext during regular Report within 1 business day to , ext This resource was produced by the Communicable Disease Control and Outbreak Management Unit of Ottawa Public Health. References 1. Ontario Public Health Standards, Infectious Diseases Protocol, (2009): Appendix A and B 2. Control of Communicable Diseases Manual, 19 th edition David L. Heymann 3. The Red Book, 28 th edition American Academy of Pediatrics 13