Disease Clusters & Non-Reportable Conditions in Schools

Transcription

1 Disease Clusters & Non-Reportable Conditions in Schools Michael O. Vernon, DrPH Director, Communicable Disease Control Cook County Department of Public Health May 4, 2012

2 Disclosures 1. I did not chose this topic 2. I have very strong opinions 2

3 USING THE AUDIENCE RESPONSE SYSTEM Press the number on the keypad that corresponds to your choice. It is not necessary to wait for the clock to begin before entering your choice. You do not need to aim the keypad in any particular direction. Your selection can be changed by pressing another button on the keypad (as long as the timer has not run out). All responses are anonymous. Please remember to leave your keypad at the end of the session (they are of no use to you outside of this room). Thank you for your cooperation. 3

4 Practice Question: If you could be an ice cream flavor, what would it be? 1. Tutti Frutti 2. Cherry Garcia 3. Chocolate Therapy 4. Chunky Monkey (banana, fudge, walnuts) 5. Jamaican Me Crazy (pineapple, passion fruit)

5 Scenario #1 Parent of a 6 th Grade student informs the school nurse that a boil on the child s right leg is due to an infection with Methicillin Resistant Staphylococcus aureus (MRSA). 5

6 What should you do with a case of MRSA? 1. Restrict attendance until wound has healed 2. Restrict participation in PE only 3. Notify parents of all 6 th Grade students 4. #2 and #3 only 5. None of the above 6

7 Students with MRSA infection whose wounds are covered with clean, dry, intact bandages should not be restricted from school Exclusion is generally reserved for persons with wound drainage that cannot be contained with a clean, dry dressing taped on all 4 sides Do not allow student athletes with draining wounds to participate in practices, games, or P.E. classes that involve contact with others until the wound has stopped draining 7

8 Should a single case of MRSA be reported to CCDPH? 1. Yes 2. No 8

9 CA-MRSA Cluster 2 or more cases within 14 days Lab confirmed Epidemiologically-linked (by contact or association) Reportable to LHD within 24 hours (New Rule) Complete cluster investigation/report form LHD may request information on individual cases 9

10 Scenario #2 Website posting from a school nurse: I have a student with head lice. My questions are: 1. Is head lice reportable? 2. Must we check the entire school? 10

11 What is the appropriate response to a case of head lice? 1. Call parent to pick up child immediately 2. Arrange for screening of all students 3. Notify CCDPH 4. Notify parent at end of school day 5. Send letters to parents of entire school body 11

12 Head lice can be a nuisance; they do not spread disease. A person with head lice is said to be infested, not infected. Students diagnosed with live head lice do not need to be sent home early from school. They can go home at the end of the day, be treated, and return to class after appropriate treatment. Notify parents when infestation is confined to a specific classroom, widespread, or transmission is ongoing. Mass notifications should be avoided. Teach importance of not sharing combs, brushes, hats and coats. Store coats, hats, scarves, etc., separately. 12

13 March 2012: Scenario #3 Nurse from an elementary school reported 50 of 585 students (8.5%) absent from school mostly due to fever and/or cough, sore throat, and runny nose. Highest absenteeism rates in 1 st grade; 29/99 (29%). 13

14 How should you respond to multiple cases of flu in your school? 1. Inform parents to keep sick children home until fever-free for 24 hrs 2. No action necessary until absenteeism reaches 50% or greater 3. Require doctors note for return to school 4. Order school closure for sanitation 14

15 Send home students with symptoms of acute respiratory infection (fever > 100 degrees and cough or sore throat) Spike in absenteeism due to influenza-like illness (ILI) should be used to reinforce key messages with students, parents, and teachers -- e.g., hygiene and staying home when ill Instruct parents to keep sick children home, for 24 hours after resolution of fever without use of fever-reducing medications Control measures include: covering mouth and nose to cough or sneeze, discarding used tissues, washing hands frequently, using alcohol-based hand rubs, routine environmental cleaning Report to LHD 15

16 CCDPH Weekly Influenza Surveillance Report: Week 10: March 11-17,

17 Reporting Form 17

18 You can get Influenza from the flu vaccine. 1. True 2. False 18 18

19 Everyone over the age of 6 months should receive Influenza vaccine on an annual basis. 1. True 2. False 19

20 Scenario #4 Parent of 2 y.o. attending a child care center (CCC) calls CCDPH to report diagnosis of scabies in the infant. CCDPH calls the CCC and learns that there are 9 children and 2 teachers with skin rashes. 20

21 What should the CCC have done? 1. Notify CCDPH 2. Restrict all students and teachers with rash to a single classroom 3. Use pesticide spray or fog to disinfect the school 21

22 Report cluster of 2 or more cases to CCDPH. Scabies is an infestation of the skin with microscopic mites, Sarcoptes scabei. Spread by direct, prolonged, skin-to-skin contact; quick handshake or hug will not spread infestation. FDA-approved creams and lotions are available by prescription for treatment of cases and household contacts. Exclude cases from school until day after first treatment. Conduct routine environmental cleaning. 22

23 Scenario #5 Coach from a high school calls CCDPH to report 6 cases of ringworm on the boys wrestling team. 23

24 What is the cause of ringworm? 1. Worm 2. Tick 3. Fungus 4. Parasite 24

25 Ringworm infection is not caused by a worm but by a fungus. Spread by contact with infected skin or contaminated clothing, towels, bedding. Teach good hygiene, showering, clean clothes, handwashing. Conduct regular cleaning of surfaces including mats. Teach importance of not sharing combs, brushes, hats and coats. Store coats, hats, scarves, etc., separately. 25

26 Scenario #6 Channel 5 news reporter calls CCDPH to inquire into an outbreak of bedbugs at a local elementary school. CCDPH calls the school and learns that bedbugs were discovered in a storage closet in the kindergarten classroom. 26

27 How should you respond to this situation? 1. Send out a press release 2. Immediately dismiss the kindergarten class 3. Close the school for cleaning & disinfection 4. Call CCDPH 5. Call in a licensed pest control professional 27

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29 Bedbugs feed on blood; are not known to transmit diseases; assemble in cracks and crevices. Consult a licensed pest management professional for identification, inspection and treatment of infested areas. Consider isolating backpacks in tightly sealed plastic containers or bags to reduce potential for dispersal. Notify parents of children in affected classrooms and provide basic information identification, preferred hiding places, and strategies for elimination (vacuuming, steam cleaning, laundering). Mass notifications should be avoided. 29

30 Evaluation of Today's Presentation