INFECTIOUS DISEASE GUIDELINES FOR SCHOOLS AND CHILD CARE FACILITIES

Transcription

1 INFECTIOUS DISEASE GUIDELINES FOR SCHOOLS AND CHILD CARE FACILITIES GREY BRUCE HEALTH UNIT (519) Fax: (519) The following information is intended to provide guidance on how to manage infectious diseases in schools or child care facilities. Any child who is ill and unable to participate fully in regular activities should be cared for at home. August, 2016 version

2 GREY BRUCE HEALTH UNIT INFECTIOUS DISEASE GUIDELINES FOR SCHOOLS AND CHILD CARE FACILITIES Disease Cause/Symptoms Transmission Incubation ing of Amebiasis Parasite Most infections are asymptomatic Symptoms may include abdominal cramps, diarrhea (possibly bloody) or constipation Few days to several months or years (usually 2-4 weeks) During the period that cysts are passed, which may continue for years Exclude symptomatic cases (attendees and staff, including food handlers) until 24 hours after diarrhea resolves or for 48 hours after completion of antibiotic treatment Bite (Animal) There is 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. Contact with saliva of infected animals through bites, scratches, or contact with mucus membranes or open skin Depends on many factors Usually 3-8 weeks (rarely as short as 9 days or as long as 7 years) Rabid animals are infectious from the time the virus reaches salivary glands and up until death No exclusion to begin risk assessment for rabies immunization and/or quarantine of the biting animal Bite (Human) If the skin is broken, there is 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 and many factors Depends on the disease and many factors No exclusion Parent advised to consult with health care provider if skin is broken as result of bite Page 1

3 ing of Campylobacter enteritis Diarrhea (possibly bloody), abdominal pain, fever, nausea, and vomiting. Animal-to-person spread can occur 1-10 days (usually 2-5 days) Throughout course of infection (as long as organisms are being excreted) (usually 2-7 weeks) Exclude symptomatic cases (attendees and staff, including food handlers) until symptom free for 24 hours, or 48 hours after completion of antibiotic medications. Candidiasis (Thrush, Diaper Rash) Fungus Thrush: whitish-grey patches on the inside of the cheek, roof of the mouth or on the tongue. direct contact of secretions or excretions Variable 2-5 days for thrush in infants While lesions are present Diaper rash: usually very red, with small red spots close to larger, defined patches. Chickenpox (Varicella) Rash usually starts as red spots, turns into fluidfilled blisters that crust over within a few days. Rash may be very itchy; new spots continue to appear over the next 2-3 days. Can be accompanied by a high fever and severe rash. Person-to-person through droplet or airborne spread of fluid from blisters or respiratory secretions; or indirectly by objects contaminated by the fluid from blisters Scabs are not infectious days (usually days) As long as 5 days but usually 1-2 days before onset of rash and until all lesions are crusted (usually about 5 days after rash onset) No fever and well enough to participate in normal activities, regardless of the state of the rash. Parents and staff should be notified, particularly those of immunocompromised children, in addition to pregnant staff. the number of cases and ages of children on a weekly basis Page 2

4 ing of Cold Sores (Herpes) Small clear blisters usually on the face or lips. Sores crust and heal within a few days. May have simple cold sore, many painful ulcers in the mouth with a high fever or be asymptomatic. Usually lasts for a week or more. direct contact with cold sores or saliva days 2 to 7 weeks after first infection Recurrent infections: less than 5 days Children who have extensive mouth lesions and are drooling should be excluded until they can eat comfortably and are well enough to participate in all program activities. Conjunctivitis See Pink Eye Cryptosporidiosis Parasite Diarrhea, can be watery or profuse, preceded by anorexia and vomiting in children. Animal-to-person spread can occur 1-12 days (average of 7 days) Up to several weeks after symptoms resolve Exclude food handlers, daycare staff and attendees who are symptomatic until 24 hours after cessation of symptoms. Avoid using public recreational waters such as swimming pools and splash pads for 2 weeks after symptoms have resolved. Cyclosporiasis Parasite Profuse, watery diarrhea. Nausea, vomiting, anorexia, weight loss, abdominal bloating or cramping and prolonged fatigue can also occur. Diarrhea can alternate with constipation days (average of 7 days) Upon resolution of symptoms (mean duration of shedding is 23 days) Exclude symptomatic food handlers, day care staff and attendees until symptom free for 24 hours, OR symptom free for 48 hours after discontinuing use of anti-diarrheal medication. Page 3

5 ing of Diarrhea (Single case unknown cause) A change in bowel movements (increased number and change in consistency to watery or unformed) Various causes. May be due to dietary changes or other causes unrelated to infection., or Parasite Depends on specific agent transmitted Depends on specific agent transmitted Depends on specific agent transmitted Exclude day care staff and attendees if: their stool cannot be contained in a diaper or a toilet-trained child cannot control bowel movements, OR if there are signs of infection (fever, vomiting, blood or mucus in the stool). unless part of an outbreak (see Gastroenteritis) Escherichia coli (E. coli) infection (Verotoxigenic Escherichia coli - VTEC) Bloody or non-bloody diarrhea, abdominal cramping, and vomiting. Person-to-person spread by direct or indirect contact Animal-to-person spread can occur 2-10 days (median of 3-4 days) Variable. As long as organisms are excreted Can be 3 weeks in one third of children 1 week or less in adults Exclude symptomatic food handlers, day care staff and attendees until the provision of 2 consecutive negative stool specimens or rectal swabs taken at least 24 hours apart, and at least 48 hours after the completion of antibiotic and/or antidiarrheal therapy medications, if these medications have been used. School children: Exclude until stools are formed Page 4

6 ing of Fever If accompanied by diarrhea or vomiting, see Diarrhea, Gastroenteritis, Hepatitis or Meningitis. If accompanied by a rash, see Chickenpox, Hand Foot & Mouth Disease, Impetigo, Measles, Meningitis, Fifth Disease, Roseola, Rubella, or Streptococcal Infection. If accompanied by cough, sore throat or runny nose, see Influenza, Mononucleosis, Pertussis, Strep throat, or Tuberculosis. Fifth Disease (Slapped Cheek Syndrome, Parvovirus B19) Very red rash on cheeks. After 1-4 days, a red, lace-like rash develops on torso and arms, then over rest of the body. May have a low grade fever, general malaise or mild cold before rash breaks out. direct or indirect contact secretions Can be transmitted from susceptible mother to fetus 4-14 days (can be as long as 20 days) Several days before onset of rash Infected children with sickle cell or certain chronic forms of anaemia and pregnant women should see a healthcare provider. Page 5

7 ing of Gastroenteritis ( Outbreaksunknown cause) 3 or more cases in the same class or program within a 4 day period Gastroenteritis definition: 2 or more loose/watery bowel movements in a 24 hour period or 2 or more episodes of vomiting in a 24 hour period or 1 episode of loose/watery bowel movement and 1 episode of vomiting in a 24 hour period, or Parasite Vomiting, diarrhea, abdominal pain, headache, and fever. Depends on specific agent transmitted Primarily through: Person-to-person spread by direct or indirect contact Depends on specific agent transmitted Depends on specific agent transmitted Exclude symptomatic cases (attendees and staff, including food handlers) until symptom free for 48 hours ing and consultation with Public is required; exclusion policies may change depending on factors of the outbreak German Measles See Rubella Giardiasis (Beaver Fever) Parasite Diarrhea (pale, greasy stools), abdominal cramps, bloating, and weight loss. Some infections are asymptomatic. Ingestion of water Person-to-person spread by direct or indirect contact 3-25 days or longer (median of 7-10 days) As long as cysts are excreted in stool Exclude symptomatic food handlers, day care staff and attendees until symptom free for 24 hours, OR symptom free for 48 hours after discontinuing use of anti-diarrheal medication. should not use recreational water venues such as swimming pools, lakes and rivers for 2 weeks after symptoms resolve. Page 6

8 ing of Hand, Foot & Mouth Disease (Coxsackie) Fever, headache, sore throat and mouth, loss of appetite, lack of energy and a characteristic rash. direct or indirect contact secretions or faeces Usually 3-5 days During the acute stage of the illness may remain in stool for 4 weeks after onset of illness Red spots, often with small blisters on top, appear on the hands and feet and sometimes elsewhere on the body. Small, painful ulcers may develop in the mouth. Head Lice (Pediculosis) Insects Itchy scalp Nits on hair shaft or live lice Direct head to head contact or occasionally by sharing items, such as hats, combs, brushes, or pillows Lice do not fly or hop. They crawl very quickly Eggs hatch in 7-10 days Egg to egg cycle averages 3 weeks As long as eggs or lice remain alive on person Persons with head lice should be treated. Family members should be examined and treated at the same time if infested Hepatitis A Fever, tiredness, loss of appetite, nausea, abdominal pain, and jaundice (yellowing of skin). Younger children often asymptomatic. Person-to-person spread by direct or indirect contact days (average of days) 2 weeks prior to symptoms until 1 week after the onset of jaundice Prolonged viral excretion (up to 6 months) may occur in infants and children Schools: Child Care Facilities: Exclude cases such as food handler, child care staff and attendees for 14 days after onset of symptoms, or 7 days after onset of jaundice, whichever comes earlier. Page 7

9 ing of Hepatitis B Fever, tiredness, loss of appetite, nausea, abdominal pain, and jaundice (yellowing of skin). Many cases are asymptomatic. Through contact of infected blood and bloody fluids, semen, vaginal fluid and saliva with nonintact skin or mucous membrane(s) (eyes, nose and mouth) For example: unprotected sexual intercourse, sharing of needles during injection drug use, bites that break the skin Usually days (average days) Weeks before onset of symptoms through the acute period of disease Some become carriers and remain contagious for life Hepatitis C Loss of appetite, abdominal pain, nausea, vomiting and tiredness. Most cases are asymptomatic. Through blood to blood contact For example: injection drug use, blood transfusions prior to 1990, needle stick injuries, un-sterile tattooing/piercing, contaminated toothbrushes, razors, nail clippers 2 weeks to 6 months (average 6-9 weeks) From one or more weeks before onset of symptoms (most people are probably infectious indefinitely) HIV / 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 severe infections and death Through contact with blood (e.g. needle sharing in injection drug users, un-sterile tattooing or body piercing), unprotected sexual intercourse or from mother to fetus Variable (usually 1-3 months) Begins early after onset of infection and extends throughout life Page 8

10 ing of Impetigo (Streptococcus or Staphylococcus) Fluid-filled blisters, usually around the mouth or nose but may occur elsewhere. Blisters may break, ooze, and become covered by an itchy honey coloured crust. touch or contact with shared objects (e.g. towels, wash cloths) Variable (Strep, usually 1-3 days; Staph, usually 4-10 days) As long as lesions drain. If Group A Streptococcus until 24 hours after first dose of an appropriate antibiotic. Ensure any lesions are covered with clean dry bandage (exclude if draining lesions cannot be kept covered). Children with impetigo caused by Group A Streptococcus should be exluded until antibiotic treatment has been given for 24 hours and they are well enough to participate comfortably in all activities. Influenza (A, B, C) High fever, headache, muscle aches, weakness, runny nose, sore throat, cough. Children may also have nausea, vomiting, diarrhea direct and indirect contact secretions and/or contaminated hands or objects Usually 1-3 days May be infectious during the 24 hours prior to onset of symptoms and up to 7 days after (can be prolonged in young children) Exclude until well enough to participate in all program activities. Measles (Rubeola, Red Measles) Fever, runny nose, cough, drowsiness, irritability and red eyes. Small white spots appear on inside of the mouth and throat. 3-7 days after the start of symptoms a red, blotchy rash appears on face and progresses down the body. airborne droplets and close personal contact or direct contact with respiratory secretions Very contagious About 10 days (7-18 days for fever onset) (usually 14 days until rash appears) Usually 4 days before the rash until 4 days after the onset of rash Exclude until 4 days after onset of rash. Consultation with Public is required regarding exclusion of susceptible persons Page 9

11 ing of Meningitis (any kind) or Sudden onset of high fever, severe headache, stiff neck, vomiting, confusion, seizures, drowsiness, and skin rash Depends on infectious agent Depends on specific agent transmitted Depends on specific agent transmitted Consult with Public Newborns and infants may not have all the classic symptoms above. May be irritable, refuse meals, have unusual sleep patterns and constant crying Mononucleosis Fever, sore throat, swelling of lymph nodes around neck and fatigue direct or indirect contact secretions or direct contact of saliva 4-6 weeks Prolonged (may persist a year or more) Mumps Fever, swelling and tenderness of salivary glands at the jaw line, on one or both sides of the face direct or indirect contact secretions or direct contact of saliva days (average days) 7 days before until 9 days after symptoms develop (most contagious 2 days before until 4 days after onset of illness) Exclude case for 5 days after swelling onset (day 1 is onset) Consultation with Public is required regarding exclusion of susceptible persons Non-plantar Warts (Molluscum contagiosum) Tiny pinpoints on skin turn into pinkish-white bumps that are smooth and shiny, have a dip in the middle and a milkywhite cheesy material inside Direct contact with the skin of an infected person Estimated to be 1 week to 6 months Unknown, but probably as long as lesions persist Page 10

12 ing of Pink Eye (Conjunctivitis l) Purulent conjunctivitis. Pink or red eyeball (the white of the eye) with white or yellow discharge (pus), matted or red eyelids and eye pain. Direct or indirect contact with eye secretions hours For duration of infection or until 24 hours after antibiotics started (as prescribed by a health care provider) Antibacterial overthe-counter drops are not adequate treatment for bacterial conjunctivitis Child with pinkeye should be excluded until they have been seen by a healthcare provider. If deemed bacterial, the child can return after an antibiotic has been started. Pink Eye (Conjunctivitis Viral or Allergic) or Allergic reaction Non-purulent conjunctivitis. Eyeball (the white of the eye) is pink or red, discharge is clear and watery, mild or no pain. Direct or indirect contact with eye secretions 12 hours to 12 days As long as there is discharge. Child with pinkeye should be excluded until they have been seen by a healthcare provider. If deemed viral, the child can return, as long as no other symptoms are present (i.e. fever, behavioural change). Pinworms Worm Itching around the anus. If infection is severe, disturbed sleep and irritability Directly through scratching itchy area which transfers eggs to own or another s mouth; or, indirectly through contaminated hands or objects, bedding 2-6 weeks During incubation period, until worms no longer present Eggs remain infective in an indoor environment for about 2 weeks Page 11

13 ing of Poison Ivy Plant Resin (sap) Rash, develops into blisters with severe itching. Rash is linear (sometimes resembles insect bites). Develops into blisters with severe itching where skin was exposed. Takes about 10 days to heal Contact with any part of the plant (direct skin contact or through items that have come in contact with plant) hours Washing the exposed area with soap and cold water decreases the severity of symptoms Spread by exposure to plant, not rash/blisters Respiratory Syncytial (RSV) Resembles common cold with cough, runny nose, fever, decrease in appetite, irritability. Some children (most often very young infants) have difficulty breathing/and or wheezing. direct and indirect contact secretions and/or contaminated hands or objects 2-8 days During the acute stage of the illness Children are known to shed virus for long periods (up to weeks) even after clinical recovery Ringworm (Tinea) Fungus Rash that may be ringshaped, with a raised edge. May be dry and scaly or moist and crusted. Often itchy. Direct contact with skin and lesions of infected people, or indirect contact with contaminated objects and surfaces Usually 4-10 days (10-14 days for scalp) As long as lesions are present Exclude until first treatment has been applied Roseola High fever and cranky for several (3-5) days followed by a rash of small red spots on face and body. direct or indirect contact secretions or direct contact of saliva 5-15 days Unknown Probably before rash appears Page 12

14 ing of Rubella (German Measles) Low fever, runny nose, enlarged glands in neck and behind ears, fine pale red rash spreading from behind the ears to the face, then downward. May have tender joints. direct or indirect contact secretions days For about 1 week before and at least 4 days after onset of rash (sometimes 5-7 days after onset of rash) Very contagious Exclude for 7 days after rash onset Pregnant or unimmunized individuals should consult with their healthcare provider Salmonellosis Headache, fever, abdominal pain, diarrhea, nausea and sometimes vomiting. Person-to-person spread by direct or indirect contact Animal-to-person spread can occur 6-72 hours (usually hours) As long as organisms are excreted A temporary carrier state occasionally continues for months (especially in infants). Exclude symptomatic individuals from food handling, and from attending or working in day nurseries, until symptom free for 24 hours, or symptom free for 48 hours after discontinuing use of anti-diarrheal medication. Scabies Parasite Very itchy and red rash. Itchiness usually worse at night. Rash usually appears between fingers, in the groin area, between toes and around the wrists or elbows. Direct contact with skin of infected people, or indirect contact with contaminated objects and surfaces 2-6 weeks 1-4 days in persons previously infested Until mites and eggs are destroyed by treatment. Exclude until first treatment has been applied In children under 2, rash may appear on head, face, neck, chest, abdomen and back as white, curvy, thread-like lines, tiny red bumps or scratch marks. Scarlet Fever See Streptococcal Infection Page 13

15 ing of Shigellosis Watery, loose stools, fever, nausea and vomiting Person-to-person spread by direct or indirect contact hours (usually 1-3 days) As long as organisms are excreted Exclude symptomatic food handlers, day care staff and attendees until a negative stool sample or rectal swab collected at least 24 hours after cessation of symptoms OR 48 hours after completion of antibiotic therapy. School children: Exclude until stools are formed Strep Throat See Streptococcal Infection Streptococcal Infection (Strep Throat, Scarlet Fever) Strep Throat: Fever, sore throat, swollen tender neck glands, swollen tonsils and loss of appetite. direct or indirect contact secretions and/or contaminated hands or objects Usually 1-3 days From onset of symptoms until 24 hours after treatment initiated Up to days if untreated Exclude until 24 hours after treatment initiated Scarlet Fever: Red rash that looks like a sunburn and feels like sandpaper (most often begins on chest and stomach). When rash fades, skin on hands and feet may start to peel. Fever, nausea and vomiting, sore throat, red swollen lips, strawberry tongue, flushed cheeks and pale area around mouth. Page 14

16 ing of Streptococcal Infection (Invasive Group A Strep) Symptoms may be vague and include pain of unusual severity, swelling, fever, chills, influenza-like symptoms, generalized muscle aches, generalized macular rash, bullae (a form of blisters), nausea, vomiting, diarrhea, malaise or joint pain large respiratory droplets or direct contact with saliva of infected persons or carriers Casual contact rarely leads to infection Usually 1-3 days Untreated, uncomplicated cases: days Untreated, complicated cases: weeks to months Treated: within 24 hours of treatment Exclude until 24 hours after treatment initiated Child should be in the hospital Immediately consult with Public Necrotizing Fasciitis: fever, and a red painful swelling of tissue, which spreads rapidly (up to 2.5 cm/hour) Toxic Shock Syndrome: symptoms above plus low blood pressure, adult respiratory distress syndrome, renal impairment (kidneys stop functioning properly), rapid onset of shock and multi organ failure Streptococcus pneumoniae, Invasive Pneumococcal disease refers to a variety of infections caused by Streptococcus pneumoniae bacteria (including pneumonia and meningitis) direct or indirect contact secretions and/or contaminated hands or objects Not well determined. May be as short as 1-3 days Presumably until discharges of nose and mouth no longer contain virulent pneumococci in significant numbers Dependent on type of infection Exclude if child is ill and not well enough to participate in activities Symptoms of pneumonia may include fever, cough, rapid breathing and grunting. Page 15

17 ing of Tuberculosis Pulmonary (lung) TB: persistent cough (lasts more than 3 weeks), sputum production, chest pain, shortness of breath, fever, chills and night sweats In the lungs or airways: respiratory secretions Outside of the lungs or airways: Not generally contagious Several weeks to years for symptom onset In children under 5 years old the risk of active disease is greater Tuberculosis is contagious only if in the lungs or airways Laboratory tests are needed to identify if or how contagious someone is Consult with Public Other locations: Varies depending on location (e.g. lymph nodes, bones, kidneys, joints, larynx, inner ear, skin, intestines, and others) Until 2-4 weeks after start of treatment for active disease Whooping Cough (Pertussis) Runny nose and cough; attacks of coughing become increasingly frequent and severe (characteristic gasping breath, at end of cough spell - high pitched whoop ). Gagging and vomiting may occur after coughing. direct or indirect contact secretions or direct contact of saliva 5-21 days (usually 7-10 days) From the onset of the cough until: a) 3 weeks after onset of coughing spells (or whooping) or b) 5 days after starting proper antibiotic treatment Exclude until 5 days after antibiotic treatment initiated If no treatment is given, until 21 days post cough onset Yersiniosis Fever, diarrhea (often contains blood and mucus) and right sided abdominal pain Person-to-person spread by direct or indirect contact Animal-to-person spread can occur 3-7 days (usually less than 11 days) As long as symptoms persist (usually 2-3 weeks) If untreated, may shed for up to 2-3 months. Exclude symptomatic food handlers, day care staff and attendees until symptom free for 24 hours, or 48 hours after completion of antibiotic or anti-diarrheal medications. Version: August 2016 Page 16

18 References: Canadian Paediatric Society. (2015). Well beings: a guide to health in child care. 3 rd Edition revised. Center for Disease Control. (2012). Fifth Disease. Retrieved August 25, 2016, from Canada. (2013). Poison Ivy. Retrieved from Heymann D, editor. American Public Association. (2015). Control of Communicable Diseases Manual. 20 th Edition. Ministry of and Long-Term Care. (2013). Ontario Public Standards. Infectious Diseases Protocol. Appendix A: Disease-Specific Chapters. Retrieved from Public Agency of Canada. (2011). Respiratory Syncytial. Retrieved August 25, 2016, from Royal Children s Hospital. (2010). Roseola infantum. Retrieved August 25, 2016, from Page 17