IS YOUR CHILD WELL ENOUGH TO GO TO SCHOOL

IS YOUR CHILD WELL ENOUGH TO GO TO SCHOOL Certain symptoms in children may suggest the presence of a communicable disease. Regular attendance at school is very important to your child s success in school. However, to prevent the spread of disease in school, children must not attend school if they are communicable. Children with the following symptoms/conditions may be communicable and must be excluded from school (must not attend school) until the symptoms have subsided, the recommended treatment has been initiated and the exclusion time has passed: If your child has had a fever of 100 degrees Fahrenheit or higher, he/she must stay home until 24 hours after the temperature returns to normal without the use of fever-reducing medication like Tylenol or Ibuprofen. Do not give your child Tylenol or Ibuprofen and then send him/her to school for temperatures over 99 degrees Fahrenheit. If your child has vomited or had diarrhea, he/she must stay home until 24 hours after the last episode of vomiting or diarrhea. If your child has been diagnosed with strep throat, impetigo, ringworm or scabies; he/she must stay home until at least 24 hours after treatment has been initiated (he/she may not return sooner than 24 hours after treatment has been initiated even if he/she has received 3 doses of medication). If your child has lice, he/she must stay home until treatment has been competed and all lice are dead. If your child has a rash that is associated with a fever or other symptoms, that may be diseaserelated or that you do not know the cause of; review the enclosed information and consult with your family physician before sending him/her to school. We need to ensure it is not a communicable rash (e.g. chicken pox, shingles, measles, roseola, rubella or scarlet fever) before your child comes/returns to school. If your child has one of the childhood illnesses outlined in the enclosed information; review the information, act accordingly and consult your family physician or the school nurse if you have questions before sending him/her school. If your child has one of the conditions outlined above or is too ill to attend school, please call the school attendance line to report the illness and your child s absence. Please also send a note with your child, documenting the reason for his/her absence, upon his/her return to school. If your child develops one of the symptoms outlined above or in the enclosed information while in school, he/she will be sent home from school and must not return to school until the symptoms have subsided, the recommended treatment has been initiated and the exclusion time has passed. If your child returns to school with continued symptoms, before the recommended treatment has been initiated and/or before the exclusion time has passed, he/she will again be sent home from school. Please be sure to provide your child s school with your home, work and cell phone numbers and the phone number for an emergency contact available during the school day (in case you cannot be reached at home or work or on your cell phone), so we can contact you in the event your child becomes ill or is injured in school. If you have any questions regarding this information or your child s illness, please do not hesitate to contact me at 763-497-6520 or the Health Assistant in your child s school. Julie Winkelman School Nurse 1/5/10

Disease (Agent) Common Cold (many different viruses) Strep Throat (Streptococcus Scarlet Fever (Streptococcus Pertussis/ Whooping Cough (Bordetella pertussis) Influenza (Influenza virus) Symptoms Acute upper respiratory signs; including watery eyes, sneezing, runny nose, coughing, and general feeling of illness. Fever, sore throat, swollen glands, headache, nausea and vomiting. Strep throat plus high fever diffuse pinkishred rash and red tongue. Initially symptoms like those of the common cold (see page 1). After 1-2 weeks, persistent cough in explosive bursts, sometimes ending with a high pitched whoop and vomiting. Chills, body ache, headache, fever and sore throat; followed by cough, runny nose and possibly stomach ache. Incubation period 12 hours - 3 days 1-3 days 3-5 days 7-10 days 24-72 hours Mode of Transmission & Communicability objects contaminated with nose or throat discharges of infected persons. Communicable 24 hours before onset of symptoms and for 5 days after nasal involvement. The bacteria is spread directly by objects contaminated with nose or throat discharges of infected persons. Communicable from 24 hours before onset of symptoms and 24-48 hours after treatment is started. The bacteria is spread by direct contact with infected persons or with objects freshly soiled with discharges from their noses, throats or lesions. Contagious until all lesions have healed or the person has been treated with an antibiotic for at least a full 24 hours. The bacteria is spread by droplets expelled from sneezing or coughing of infected persons. Communicable until 3 weeks after the cough begins without antibiotic treatment and for 5 days with antibiotic treatment. The virus is spread by droplets expelled from sneezing or coughing of infected persons. Communicable 24 hours before onset of symptoms and until all symptoms subside. Vaccines reduce the incidence of infection. School Action - No restriction unless the child has a fever or is not able to participate in regular school activities. - If the child has a fever, exclude from school until 24 hours after the temperature returns to normal and the child is able to participate in regular school activities. at least a full 24 hours after treatment is initiated, the child is without fever for 24 hours and the child is clinically well. - For negative quick strep tests, recommend children remain out of school until the 24 hour throat culture results are available. at least a full 24 hours after treatment is initiated, the child is without fever and rash for 24 hours and the child is clinically well. on antibiotics for 5 days. health department - Ensure all children have completed their primary series of pertussis immunization. (DPT). 24 hours after temperature returns to normal, symptoms subside and the child is able to participate in regular school activities.

Mononucleosis (usually Epstein- Barr virus) Headache, fever, sore throat, tiredness, swollen lymph glands in the neck and generalized body weakness, achiness and sometimes a rash. Young adults may have jaundice (yellowing of the skin or eyes) and an enlarged spleen. 30-50 days in most cases The virus is spread by contact with an infected person s oropharynx (such as kissing). Communicable from many weeks to a year or more. 24 hours after temperature returns to normal. - If the spleen is enlarged students should avoid contact sports for 6 weeks or until healthcare provider has given approval for student to continue with the sport(s). Measles/Rubeola (Measles virus) Mumps/ Epidemic Parotitis (mumps virus) Rubella/German measles (rubella virus) Fever, watery eyes, runny nose, and cough. A red blotchy rash appears on the third to seventh day, beginning on the face, spreading down trunk and down the arms and legs. The rash usually lasts 4-7 days. Initially: chilling, headache, lack of appetite, low to moderate-grade fever and generalized body weakness and achiness. 12-24 hours later; swelling of the parotid (salivary) gland (located just below and in front of the ear), and sometimes nearby glands and tissue, and high fever. Fever, headache, runny nose, swollen lymph glands of the neck and generalized body weakness and achiness 1-5 days before the appearance of the rash. The rash is fine, pink, flat spots that pinpoint on the second day. 8-12 days 12-25 days, usually about 18 days. 14-21 days articles contaminated with nose or throat discharges of infected person. Communicable 3-5 days before the rash appears and until 4 days after the appearance of the rash. articles contaminated with nose or throat discharges from infected person. Communicable 7 days before swelling of the parotid gland and until the swelling resolves (usually 9 days). articles contaminated with nose or throat discharges of infected person. Communicable from 1 week before until 6 days after the appearance of the rash. 4 days after the rash appears. local health department - Ensure all children < 12 years have had 1 and all children > 12 years have had 2 measles immunizations. the swelling resolves or 9 days after the swelling begins. local health department - Ensure all children <12 years have had 1 and all children > 12 years have had 2 mumps immunizations. 7 days after the rash appears. local health department - Ensure all children <12 years have had 1 and all children > 12 years have had 2 Rubella immunizations.

Fifth Disease/ Erythema Infectiosum (Human paravirus B 19) Chicken Pox (Varicella Zoster) Shingles (Varicella zoster virus) Low grade fever, slight generalized body weakness and achiness and a slapped cheek appearance 1-2 days before the rash. The rash is small, flat or slightly raised pink spots, can be blotchy and appears on the extremities and trunk. Initially: mild headache, moderate fever, clear runny nose & generalized aching. Rash appears in stages: 1- Macule (flat, red spot) 2- Vesicle (fluid-filled, elevated lesion). 3- Crusting The rash usually appears first on the trunk and later on the face, neck, arms, and legs; and is associated with intense itching. Severe pain, itching and numbness along certain nerve pathways, commonly around the midline or on the face. About 1-3 days later a red rash appears. Soon after, clusters of blisters appear in crops, usually on one side of the body and closer together than chicken pox. Shingles usually occurs in older adults, but can occur in children, especially if the child had then chicken pox disease before 1 year of age. 4-21 days 14-21 days None (After a person has chicken pox, the virus can remain inactive in the body and later cause shingles) objects contaminated with nose or throat discharges of infected person. Most contagious before the beginning of the rash. The virus is spread by direct contact with discharges from the infected person s nose, mouth, skin, and mucous membrane. Children on immunosuppressive drugs have a higher risk of contracting chicken pox. Communicable 1-2 days before onset of symptoms until all of the vesicles have crusted. One episode or vaccination usually confers immunity; however, children who have received the varicella vaccine can still develop chicken pox (usually a milder case). The virus is spread by contact with the fluid from the blisters. Communicable until 1 week after the blisters appear. When people who have not had chicken pox are exposed to the shingles virus, they can develop chicken pox. Shingles does not spread from person to person. - Refer to medical diagnosis if questions remain regarding the cause of the rash. - If other rash-causing illnesses are ruled out, there is no need to exclude the child. all vesicles are dry and crusted (usually 10 days). - Treatment consists of frequent cleansing of the skin, over the counter medications for itching and Tylenol for fever and discomfort. - Contact your healthcare provider for secondary infection of the lesion or other complications. - If the sores can be covered by clothing or a bandage, no exclusion is needed. If the sores cannot be covered, exclude the child until the sores have crusted.

Ringworm (fungus) Scabies (Sarcoptes scabiei, a mite) Impetigo (Streptococcus and Staphlococcus Bacteria) Cold Sores (Herpes Simplex Virus Type 1) Pink Eye/ Conjunctivitis (bacteria, viruses, allergies, or chemicals.) Flat, spreading, ringshaped or irregular lesion on the skin. May have fluid-filled blisters and/or scaly borders. May be clear in the center and may become inflamed and crusted. Itching, scratch marks, or burrow marks. Common sites are thighs, beltline, wrists, elbows and webs of fingers. Scratching may cause secondary infections or rash. Fluid-filled blisters, rapidly covered with honey-colored crusts, often occurring on the nose, arms, legs or around the mouth. (May be confused with cold sores). Fluid-filled blisters usually on the lips, but may occur anywhere on the face or in mucous membranes. They usually crust and heal within a few days. (May be confused with Impetigo). May include redness, itching, pain, and eye discharge depending on the cause. Bacterial conjunctivitis can sometimes be distinguished from other forms of conjunctivitis by a more purulent (white or yellow) eye discharge (pus). 4-14 days 2 weeks- 6 weeks 1-10 days 2-14 days 1-3 days The fungus is spread by contact with lesions of infected persons, animals or contaminated objects. Communicable as long as the infected lesions are present. Communicability is greatly reduced once treatment has begun. The mite is transferred by prolonged direct contact with an infected person, and to a limited extent, undergarments or soiled sheets freshly contaminated by an infected person. Communicable from the time a person acquires the mites (before the rash appears) until 24 hours after treatment begins. The bacteria is spread by touching the fluid from the sores of infected persons or, rarely, by touching objects freshly soiled with discharges from their noses, throats or lesions. Communicable until all lesions have healed or the person has been treated with an antibiotic for at least a full 24 hours. The virus is transmitted by direct contact with the sores or saliva of infected persons. May be communicable as long as 7 weeks after lesions appear. Viruses and bacteria are spread with secretions from the eyes, nose and mouth of infected persons. Spread can also occur by sharing towels, washcloths, eye makeup, contact lens solution, etc. Communicability depends on the agent. 24 hours after treatment is initiated. Re-check the child every 2 weeks until cleared up. - No PE, swimming or other close contact activity until 72 hours after treatment is initiated. 24 hours after initiation of treatment. the child has been treated with an antibiotic for at least a full 24 hours. - Cover sores as a barrier to prevent spread until the sores have healed completely. - No restrictions. - If no pus, eye pain, or eye-lid redness; monitor. No treatment recommended or restrictions. - If fever, pus, eye pain or eye-lid redness present; refer for medical evaluation and treatment. - Children may return to school once treatment has started, unless they are unable to keep their hands away from their eyes.

Lice (Pediculosis humanus capitis, a louse) Reye s Syndrome Tuberculosis (Mycobacterium tuberculosis Hand, Foot, and Mouth Disease (Coxsackie virus) Infestation of the head hair or other parts of the body with lice and/or nits. Lice are 1/8 inch long, wingless, tan or reddish brown parasites. Nits are sacs of eggs and are small, plump and cream-colored when alive and flat and white when dead or empty. Nits are attached to the hair shaft close to the scalp, usually at the neckline and/or behind the ears, but can be anywhere. Scratching causes reddened, rash-like areas. Sudden onset of violent vomiting, mental confusion, extreme sleepiness, very fatigued, twitching or jerking movements, hostility and coma. Tiredness, weight loss, fever, and night sweats. When TB is in the lungs: cough, chest pain, and possibly coughing up blood. Sores occur toward the front of the mouth, on the sides of the tongue, inside the cheeks, and on the gums and may last 7-10 days. In most cases, sores can be found on the palms of the hands, the fingers, and the soles of the feet. A low-grade fever may last 1-2 days. Variable, the eggs hatch 7-10 days after they are laid. 1-7 days following viral infection (cold, flu, chicken pox) 2-12 weeks 3-6 days Lice are spread by direct contact with an infected person s head/hair or with objects that have come in contact with an infected person s head/hair within the past 7-10 days (such as combs, brushes, hair accessories, hats, clothing, bedding, pillows, stuffed animals, ect.). Live/crawling lice are communicable. Lice that hatch from live nits (7-10 days after they are laid) are communicable. Dead lice and dead nits are not communicable. Usually follows a viral infection. It is not contagious. The cause is unknown. There is no prevention. It requires immediate attention at onset of symptoms. It is most common in young children. The bacteria is spread by droplets expelled by coughing or sneezing of infected persons. Only TB of the lung is communicable; from onset of symptoms until adequate treatment, usually 1-3 weeks after treatment started. The virus is spread through contact with nose and throat discharge and stool of infected persons. Communicable 1-3 weeks after onset of illness. - If live lice are found, exclude from school until all lice are dead. Parents to institute treatment and remove all lice and nits from the child s head and objects the child has been in contact with. The school will check the child s hair on readmittance, in one week and again in 2 weeks. - If nits, but no lice; no restriction. Parents to remove all nits. The school will check the child s hair on readmittance, in one week and again in two weeks. - If one or more symptoms appear, call doctor immediately (child should be evaluated in emergency room). - Do not give aspirin. clinically well and released by physician. - Exclude children with TB of the lung until the physician states the child is no longer communicable. - Children with positive Mantoux tests, but without symptoms, refer for medical evaluation, do not exclude. local health department. - Exclude until temperature is normal for 24 hours and child is well enough to participate in normal activities.

Lyme Disease Meningococcal Disease (Neisseria meningitidis Early symptoms include an expanding rash (> 2 inches) which resembles a bulls-eye, occurring first at the site of the bite and may occur elsewhere on the body. Symptoms such as fever, malaise, fatigue, headache, stiff neck or muscle aches may be present. Later symptoms can affect the joints, nervous system and heart. Bacteremia- sudden onset of fever, chills, tiredness, sometimes a rash. Meningitis-fever, vomiting, headache, stiff neck, extreme sleepiness, confusion, irritability, lack of appetite, sometimes a rash or seizures. 7-14 days, from the time a person is exposed until early symptoms develop 1-10 days, usually less than 4 days. The Lyme disease bacteria is spread through the bite of an infected deer tick. The tick must be attached and feeding for at least one or two days before transmission can occur. Not all deer ticks carry the bacteria. Lyme disease is not contagious. The bacteria is spread through direct contact with secretions of the nose and mouth of an infected person; more common in households, childcare settings, or schools where there is close prolonged physical contact (e.g., through kissing, sharing food, beverages or toothbrushes). Antibiotics to prevent meningitis are recommended for: Household contacts of the person with meningitis, overnight visitors, or people who had contact with the secretions of the infected person through kissing, by sharing food, beverages, chapstick or toothbrushes. - Check ticks removed. The deer tick is brown and red in color and slightly smaller than a sesame seed. They are ½ the size of a wood tick. evaluation and treatment if symptoms of Lyme disease are present. - Report to the local health department (as required by law). 24 hours after treatment is initiated child is without fever for 24 hours and the child is clinically well. - Report to local health department (required by law).