Guidelines for Communicable Disease and Other Childhood Health Issues for Schools and Child Care Facilities (CCF)

Transcription

1 Guidelines for Communicable Disease and Other Childhood Health Issues for Schools and Child Care Facilities (CCF) These guidelines are intended to provide principals, teachers, and directors of CCF and health professionals with guidance on communicable disease prevention and control. Any child who is too ill to participate fully in regular activities should be cared for at home. February 2007 OTTAWA PUBLIC HEALTH COMMUNICABLE DISEASE PROGRAM ext

2 Amebiasis Bite (Animal) Bite (Human) Campylobacter Candidiasis (Thrush, Diaper Rash) Parasite. Abdominal distention and cramps, diarrhea or constipation, and rarely fever or chills. May be symptom free. 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. Feeding squirrels is a form of provocation. If the skin is broken, there may be a risk of transmission of hepatitis B, hepatitis C, and HIV from an infected person. Diarrhea, abdominal pain, fever, nausea and vomiting. Stools may contain blood. Fungus. Thrush: Thin white layer on tongue and inside of cheeks. May cause difficulty in feeding, or may be symptom-free. 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. Food and water contaminated by an infected food handler or sewage. Animal saliva introduced by a bite or scratch. Contact of contaminated blood with a break in the skin or blood inside of the mouth. Ingestion of undercooked meat (especially poultry), unpasteurized milk and contaminated water, or by direct contact with fecal material from infected animals or people. Person-to-person by direct contact, or during childbirth. Candida organism normally present on skin, so one can become autoinfected. Few days to several months, commonly 2 to 4 weeks. Depends on the cause. Depends on the cause. Until treated. Depends on the cause. Depends on the cause. 1 to 10 Up to several weeks after beginning of symptoms, or until treated. Variable, 2 to 5 days for thrush in infants. While lesions are present. formed and anti-parasite treatment is complete. formed. ext (3-1-1 after hours) in order to begin rabies immunization if needed and/or to quarantine the biting animal if available. Not required unless the biting or bitten child is known to be infected with hepatitis B, hepatitis C or HIV. If so, report , ext , Page 2

3 Chickenpox (Varicella) Cold Sores (Herpes) Conjunctivitis- Bacterial (Pink Eye) Fever. Blister-like rash occurs in successive crops. Scabs form after the blister stage. "Spots" usually appear first on the body, face and scalp, then later spread to the arms and legs. Small blisters appear and then burst to form a crust. Sores are usually around the mouth but can be around the nose and eyes area. With the first infection, sores may be accompanied by fever, flu-like illness, and painful irritation. Pink or red conjunctiva (the white of the eye) with thick or crusty white or yellow discharge (pus), occasionally accompanied by fever. Person-to-person by: 1) respiratory secretions, or 2) direct skin contact with fluid from blisters or objects and surfaces contaminated by the fluid from the blisters. Person-to-person by saliva. Hand hygiene is important in preventing transmission. Person-to-person: by direct or indirect contact with eye secretions. Hand hygiene is important in preventing transmission. 10 to 21 days; commonly 14 to 16 1 to 4 days before to 5 days after onset of rash. Low infectiousness after 1 or 2 days of rash. 2 to 12 While sores are apparent, however, virus may be transmitted even when no visible lesions are present. 24 to 72 hours. For duration of infection or until 24 hours of antibiotic treatment. Exclude until well enough to participate in regular activities. Children can return with rash. Children who are immunosuppressed or on cancer treatment may need to be excluded (consult with Ottawa Public Health at ext ). Child 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 lesion, or 3) the child is not his or herself. If it is the first episode (severe symptoms): exclude only if child is drooling, until lesions are crusted over. If diagnosed to be bacterial or possibly bacterial exclude until treated with antibiotic drops or ointment for 24 hours. For staff cases the director/principal should reinforce hand hygiene procedures. number of cases and ages by mail or fax to on a weekly basis. See Chicken Pox reporting form (call ext for copy of form). Page 3

4 Conjunctivitis- Viral (Pink Eye) Coxsackie Virus (Hand, Foot and Mouth Disease) Crabs (Genital Lice) Cryptosporidiosis Non-purulent conjunctivitis (viral or allergic): Pink conjunctiva (the white of the eye) with a clear, watery eye discharge often accompanied by 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. Acute self-limited viral infection. Usually in children, particularly in the summer months. Small grey-brown insects and white eggs (nits) attached to pubic hairs. May spread to other areas where there are hairs: head, eyebrows, underarms, etc. Cause intense itching and skin redness Parasite. Frequent, non-bloody, watery diarrhea, abdominal cramps, fatigue, vomiting, anorexia, and weight loss. Fever and vomiting are relatively common among children. May be symptom free. Diarrhea See Gastroenteritis. Escherichia Coli 0157:H7 (E coli) Eye Infection See Conjunctivitis. Severe abdominal cramps; watery, possibly bloody diarrhea; fever; nausea and vomiting. Fifth Disease See Parvovirus B19. Person-to-person: by direct or indirect contact with eye secretions. Hand hygiene is important in preventing transmission. secretions and fecal-oral route. Lesions themselves do not spread infection. Person-to-person by direct skin-toskin contact (sexually) or indirect contact through bedding, clothing, and towels Fecal-oral, including person-toperson, animal-to-person, waterborne and foodborne transmission. Undercooked meat (especially hamburger) and poultry Salami Raw vegetables (e.g. sprouts) and fruits Unpasteurized milk and apple juice/cider Contaminated water 12 hours to 12 Usually 3 to 6 For duration of infection. During the acute stage of the illness. Transmission via stools may persist for several weeks. 6 to 10 As long as lice or eggs remain alive on hair (until treated). 1 to 12 days with an average of about 7 1 to 8 days, usually 3 to 4 From onset of symptoms and for several weeks after symptoms resolve. 1 week or less in adults, but 3 weeks in one third of children. No need to exclude, but encourage frequent hand hygiene. Until stools are formed. Cases are not to use recreational waters for 2 weeks after symptoms resolve. formed. Children under 6 attending school or a CCF: Exclude until 2 negative stool cultures, at least 24 hours apart. Note: Antibiotics are not recommended for this infection. ext. Page 4

5 Gastroenteritis: Institutional Outbreaks (for a school: 3 cases or more in the same class within 48 hours of each other, for a CCF: 2 cases or more in the same group within 48 hours of each other). Gastroenteritis Single Case Genital Herpes Bacteria, viruses or parasites. Nausea, vomiting, diarrhea, abdominal pain, headache, fever. Bacteria, viruses or parasites. See Amebiasis, Campylobacter, Escherichia coli, Giardiasis, Norovirus, Salmonella, Shigella, or Yersinia. 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. Depends on cause. Usually fecal-oral route or through food and water contaminated with bacteria, virus or parasites. Depends on cause. Usually fecal-oral route or through food and water contaminated with bacteria, viruses or parasites Depends on cause. Depends on cause. Depends on cause. Depends on cause. Sexually (skin-to-skin). 2 to 12 Usually while sores are apparent but virus may be transmitted even when no visible lesions are present. Depends on cause, number of cases and source of infection. All outbreaks must be discussed with Ottawa Public Health. formed. If recurrence within 48 hours, recommend to parent/guardian that child be seen 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. For Amebiasis, Campylobacter, Escherichia coli O157:H7, Giardiasis, Norovirus, Salmonella, Shigella or Yersinia see specific exclusion criteria. ext (3-1-1 after Not required unless part of an outbreak (see above). Page 5

6 German Measles See Rubella. Giardiasis (Beaver Fever) Parasite. Diarrhea, abdominal cramps, bloating, weight loss. May be symptom free. Water and food contaminated by infected food handler or sewage. Lake and river water. 3 to 25 days or longer, usually 7 to 10 Entire period of infection, often months, or until treated. formed. Hand, Foot and Mouth Disease See Coxsackie Head Lice (Pediculosis) See section on head lice in the Growing Healthy Manual or the Reference Guide for School Staff or call Ottawa Public Health Information at Hepatitis A Fever, tiredness, nausea, jaundice (yellowing of skin), abdominal discomfort, dark urine, clay coloured stools. May be symptom free. Food (e.g. shellfish and raw produce) and water contaminated by infected food handler or sewage. 15 to 50 days, average 28 to 30 1 to 2 weeks prior to symptoms to 1 week after the onset of symptoms. Exclude for 7 days after onset of jaundice or illness. ext. Hepatitis B Same symptoms as hepatitis A. Through contact with blood and bloody fluids, semen, vaginal fluid and saliva with non-intact skin or mucous membrane (eyes, nose and mouth). For example: unprotected sexual intercourse, sharing of needles in injection drug use, bites that break the skin. 45 to 180 days, average 60 to 90 From weeks before onset of symptoms to months or years after end of symptoms. Some become carriers and remain contagious for life. Child care facilities: Special circumstances may apply depending on child's behaviour. All cases are to be discussed with Ottawa Public Health at to within one working day. Hepatitis C Same symptoms as hepatitis A and B. Through contact with blood, needle sharing by injection drug users, nonsterile tattooing or body piercing, sharing contaminated razors or toothbrushes, receiving blood products prior to There is no evidence of transmission through sharing of eating and drinking utensils or through blood touching intact skin. 2 weeks to 6 months, most common 6 to 9 weeks. From one or more weeks before onset of first symptoms to the end of symptoms; persists indefinitely in carriers (90% of those infected). Child care facilities: Special circumstances may apply depending on child's behaviour. All cases are to be discussed with Ottawa Public Health at to within one working day. HIV (Human Immunodeficiency Virus) / AIDS Many will develop a short-term flu-like illness several weeks to months after infection; after several years, damage to the immune and other systems lead to Through contact with blood (needle sharing in injection drug users, nonsterile tattooing or body piercing), unprotected sexual intercourse, or Generally 4 to 12 weeks until HIV blood test is positive. Generally begins early after onset of infection and extends throughout to within one working day. Page 6

7 Impetigo Influenza Lice (Pediculosis) Measles (Red Measles) Meningitis Molluscum Contagiosum (Non-Plantar Warts) Mononucleosis severe infections and death. from mother to fetus. life. Infection of the skin caused by Streptococcus or Staphylococcus bacteria. It often follows 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 be covered by a honey-coloured crust. It is very contagious and should be treated at once. Infection of the airways caused by the influenza A or B virus leading to fever, headache, muscle soreness, runny nose, sore throat, and cough. See head lice. Fever ( 38.3 C), cough, pink eyes sensitive to light, runny nose (symptoms of a cold), dusky-red blotchy rash on 3rd to 4th day after onset of symptoms spreading downwards from face, and sometimes white spots in mouth. Bacteria or virus. Young children may show a cluster of symptoms such as irritability, poor feeding, vomiting, fever and excessive high-pitched crying. Older children and adults may experience severe persistent headache, 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. Usually symptom-free, but may cause itchiness. Epstein-Barr virus. Fever, sore throat, swelling of glands around neck area, fatigue Person-to-person by direct contact with sores or from asymptomatic carriers. Hand hygiene is important in preventing transmission. Person to person by respiratory secretions or direct contact with secretions. secretions or direct contact with secretions. Very contagious. Varies depending on cause of meningitis. Often is person-to-person by respiratory secretions. Person-to-person through direct skinto-skin contact or indirect contact (by sharing clothes or at swimming pools), or sexually. Hand hygiene is important in preventing transmission. secretions. Variable. Commonly 1 to 10 From onset of rash until 24 hours of treatment with oral or topical antibiotics if lesions are few and small. 1 to 3 From onset of symptoms up to 7 days in young children. 10 days (range of 7 to 18 days) for fever and 14 days for rash. Varies depending on cause of meningitis. 1 to 7 weeks, but can be as long as 6 months. 1 to 2 days before the onset of symptoms until 4 days after the appearance of the rash. Varies depending on cause of meningitis. Unknown, but probably as long as lesions persist. 30 to 50 days Up to 1 year or more. Exclude until sores are completely scabbed over or for at least 24 hours following initiation of antibiotic treatment. Exclude until 4 days after the appearance of the rash. Exclude exposed susceptible persons for 18 days after last contact with an infectious case. All cases must be discussed with Ottawa Public Health. ext. ext. Page 7

8 Mumps Norovirus (Norwalk-like Virus) Outbreaks (any kind, except for gastroenteritis or diarrhea) Parvovirus B19 (Fifth Disease; Erythema infectiosum, Slapped Cheeks Syndrome ) Pertussis (Whooping cough) Fever, swelling and tenderness of salivary glands slightly above the angle of the jaw. Acute onset of nausea, vomiting (especially in children), abdominal cramps and/or diarrhea (especially in adults). May have headache, fever, chills and muscle pain. 15% or more people sick with similar symptoms or absent at the same time. For gastroenteritis or diarrhea, need 2-3 or more cases in the same CCF or class (see Gastroenteritis: Institutional Outbreak). For measles, mumps, parvovirus, pertussis, and rubella, see specific reporting criteria. Mild fever and distinctive slapped cheeks 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 coughs, which may end with a crowing or high-pitched whoop and vomiting. May last 6-10 weeks. Occurs mainly in pre-school children but can occur in adolescents and adults. secretions or contact with saliva. Fecal-oral route; contact with vomitus; contaminated water, ice or food (clams, oysters; salad ingredients, fruit and other uncooked foods contaminated by sick food handler) 12 to 25 days; usually 16 to 18 4 to 77 hours (often 24 to 48 hours) 7 days before to 9 days after swelling; most contagious 48 hours before until 5 days after onset of illness. During acute stage of illness and up to 48 hours after last episode of vomiting or diarrhea Exclude for 9 days from the onset of swelling, unless the illness is very mild. Exclude exposed, susceptible persons for 25 days after last contact with an infectious case. Exclude until 48 hours after last episode of vomiting or diarrhea ext. Not required unless part of an outbreak. See Gastroenteritis: Institutional Outbreaks Varies. Varies. Varies. Varies. ext (3-1-1 after secretions and mother to fetus. secretions. 4 to 14 days; can be as long as 21 6 to 21 days, usually 7 to 10 days One week before onset of rash until onset of rash. Children with chronic anemia may be contagious for up to 1 week after onset of rash. From the onset of the cough until: 1) 3 weeks after onset of paroxysms or whooping; or 2) 5 days after starting appropriate antibiotic treatment. Not required since no longer infectious once rash appears. Infected children with sickle cell or other forms of chronic anemia should see a physician and may need to be excluded. Pregnant personnel are advised to consult with their physician. Exclude until 5 days after beginning of antibiotic treatment, or, until 3 weeks have passed since onset of illness. immediately if 2 or more physician diagnosed cases occur in the same CCF or school within 3 weeks, to ext Page 8

9 Pink Eye See Conjunctivitis. Pinworms Poison Ivy Respiratory Syncytial Virus (RSV) Ringworm (Tinea) Roseola Rubella (German Measles) Worm. Itching around the anal area. Irritability. Plant toxin. Not contagious. Redness and blisters in linear pattern, where skin was exposed. Very itchy. Can cause colds, bronchiolitis, bronchitis, croup, pneumonia, and ear infections. Most common in 0-2 years old. Fungus. Flat, well demarcated, 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 Following break of fever, a fine, pink rash appears on trunk and body. Mild fever, runny nose, enlarged tender neck nodes, fine pale red rash spreading from behind the ears to the face, then downward. May have tender joints. Often difficult to diagnose. Pinworm eggs transmit to others by fecal-oral route or contaminated bedding, food or clothing. Direct skin contact with any part of the plant. Person-to-person through respiratory droplets or contact with secretions. Can be spread by contaminated toys and other surfaces. Person-to-person by direct contact: skin-to-skin. Indirect spread by contaminated hands, objects and surfaces. Person-to-person. Not well understood. May be saliva. secretions. Very contagious. 2 to 8 weeks. During incubation period, until treatment is initiated. Symptoms appear after a few minutes to several Washing the exposed area immediately decreases the severity of symptoms. 2 to 8 days, usually 4 to 6 10 to 14 days for scalp; 4 to 10 days for other areas. 5 to 15 days, usually 10 From 14 to 21 days, usually 16 to 18 Not contagious after the toxin has been washed off from the skin or clothing. The blister liquid is not contagious. From a few days before the appearance of symptoms for up to 4 weeks. For duration of illness or until treatment is initiated. Exclude until treatment initiated. Unknown. For about 1 week before the rash starts until 7 days after the onset of the rash. Exclude for 7 days after onset of the rash. Exclude exposed, susceptible persons for 21 days after contact with an infectious case. ext. Page 9

10 Salmonella Diarrhea, nausea, vomiting, headache, abdominal pain, fever, lack of appetite. May be symptom free. Undercooked meat (especially poultry). Raw or undercooked eggs (cook until yolks and whites are firm). Raw sprouts. Vegetables and fruit, (e.g. melons), contaminated with animal feces. Unpasteurized milk, cheese, juice and cider. 6 to 72 hours, usually 12 to 36 hours. Several weeks to months after beginning of symptoms. formed. For children under 6 attending school or a CCF with salmonella typhi or paratyphi, exclusion is required until 3 negative stool cultures. Contaminated water. Contact with reptiles (turtles, lizards and snakes), rodents, domestic and farm animals. Food from street vendors in developing countries (for Salmonella typhi). Scabies Caused by a mite burrowing under the skin. Rash appears as bumps, patches or tiny red lines, usually between fingers and toes and in skin folds. Intense itching, especially at night. Person-to-person by direct skin-toskin contact or indirectly by sharing of clothes or towels. 2 to 6 weeks. 1 to 4 days in persons previously infested. From beginning of the incubation period until treated. Exclude until treatment has been completed. If part of an outbreak ( 15% of children in class affected): report ext Scarlet Fever See Streptococcal Infection. Shigella Watery diarrhea, which may contain blood, fever, nausea, vomiting, abdominal cramps. May be symptom free. Food and water contaminated by infected food handler, sewage, raw vegetables, egg salads. 1 to 6 days; usually 1 to 3 As long as present in the stool: 1 week if treated, up to 4 weeks if not. formed. For children under 6 attending school or a CCF: Exclude until diarrhea is gone and two cultures at least 24 hours apart are negative. The child must not have been on antibiotics for at least 48 hours before taking the first sample. ext. Page 10

11 Shingles (Herpes Zoster) Reactivation of latent varicella (chickenpox) infection in the nerve endings. Blister-like lesions may appear in irregular crops along nerve pathways, sometimes accompanied by pain localized to the area. It is only possible to get chickenpox from someone with shingles through direct contact with vesicle fluid of the patient with shingles. 10 to 21 days; commonly 14 to 16 One week after the appearance of lesions. 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. During convalescence, skin on hands and feet may peel. secretions. 1 to 5 From onset of symptoms until 24 hours after beginning of treatment. Up to 10 to 21 days if untreated. Exclude until 24 hours after treatment begun. Child must be well enough to participate in activities before returning. If in an outbreak situation ( 15% of children in class affected) report , ext Streptococcal Infection (Invasive Group A Strep) Necrotizing fasciitis: Fever, localised redness, swelling, blister formation, and intense pain. Redness spreads very quickly (up to 3 cm/hour). Can arise from infected chickenpox lesions. secretions, through direct and indirect contact. Up to 10 Unknown. Same as above. Child should be in hospital. ext. Toxic Shock Syndrome: Sudden onset of high fever, vomiting, diarrhea, rash, muscle pains, and shock. Can be fatal. Tuberculosis Mycobacterium tuberculosis. In the lungs or airways (pharynx, larynx): Cough producing sputum, lasting over 2 weeks. Loss of weight, fever, night sweats, fatigue. Outside of the lungs or airways: It varies depending on where the disease is located, for e.g., lymph nodes, bones, kidneys and meninges. In the lungs or airways: Person-to-person via airborne bacteria. Outside of the lungs or airways: Tuberculosis is not contagious outside the lungs or airways. 2 to 12 weeks for the tuberculin skin test to show exposure to tuberculosis. Several weeks to years for someone to develop disease. In children 18 years of age and under, the incubation period tends to be shortest and the complications greatest. Tuberculosis can be contagious only if it is in the lungs or airways. Laboratory tests are needed to identify if or how contagious someone is. Each case to be discussed with Ottawa Public Health. Page 11

12 Typhoid fever See Salmonella Whooping Cough See Pertussis. Yersinia Watery diarrhea, fever, headache. Undercooked pork and beef. Food and water contaminated by infected food handler or sewage. Unpasteurized milk, contaminated water. 3 to 7 days, usually under 10 For 2 to 3 months or until treated with antibiotics. formed. Contact with infected pets, e.g.: dogs, cats, rodents or birds. Page 12