GUIDE TO INFECTIOUS DISEASES FOR SCHOOLS AND DAY CARE CENTERS docx

Varicella INCUBATION AND SYMPTOMS Infectious Agent: Varicella - Zoster Virus herpesvirus 3 Incubation: 2-3 weeks, usually 13-17 days; may be prolonged after passive immunization against

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GUIDE TO

INFECTIOUS DISEASES

FOR SCHOOLS AND

DAY CARE CENTERS

Allegheny County Health Department

Divisions of Infectious Diseases

Phone (412) 578-8060

TABLE OF CONTENTS CHICKENPOX 1 COMMON COLD 1-2 CONJUNCTIVITIS 2 CROUP 3 DIARRHEAL DISEASES

CAMPYLOBACTERIOSIS 3-4 GIARDIASIS 4 SALMONELLOSIS 5 SHIGELLOSIS 5-6 YERSINIOSIS 6 FIFTH DISEASE 7 FLU 7-8 GERMAN MEASLES 8-9 HAND, FOOT AND MOUTH DISEASE 9 HEAD AND BODY LICE 9-10 HEPATITIS A 10-11 HEPATITIS B 11-12 IMPETIGO 12 MEASLES 12-13 MENINGITIS (BACTERIAL) 13-14 MENINGITIS (ASEPTIC-VIRAL) 14 MONONUCLEOSIS 15 MUMPS 15-16 RINGWORM 16 SCABIES 17 SCARLET FEVER 17-18 THRUSH 18 TUBERCULOSIS 19 WHOOPING COUGH (PERTUSSIS) 19-20 WORMS 20-21 SEXUALLY TRANSMITTED DISEASES

GONORRHEA 21-22 CHLAMYDIA 22-23 SYPHILIS 23-24

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(Varicella) INCUBATION AND SYMPTOMS

Infectious Agent: Varicella - Zoster Virus (herpesvirus 3)

Incubation: 2-3 weeks, usually 13-17 days; may be prolonged after

passive immunization against varicella and in the immunodeficient

Symptoms: Sudden onset of slight fever, skin rash consisting of small

blisters which leave scabs Eruptions occur in crops Pimples, blisters and

scabs may all be present at the same time

METHODS OF SPREAD

Direct contact with or droplet/airborne spread of respiratory secretions of

an infected person

MINIMUM CONTROL MEASURES

Period of Communicability: As long as 4 days, but usually 1-2 days

before onset of rash/blisters, and until all vesicles are dry

Control: Exclude from school/center for 6 days from the last crop of

vesicles, or until vesicles become dry

Concurrent Disinfection: Disinfect articles soiled by discharge from the

nose and throat, and from lesions

OTHER INFORMATION

Children with leukemia or otherwise immunocompromised are at increased

risk for complications

COMMON COLD

INCUBATION AND SYMPTOMS

Incubation: 12-72 hours, usually 48 hours.

Symptoms: Irritated throat, watery discharge from nose and eyes,

sneezing, chills and general body discomfort

Direct contact with an infected person, or indirectly by contact with articles freshly soiled by discharge from nose and throat of the infected person

Period of Communicability: Usually 24 hours before onset of symptoms

and until 5 days after onset

Control: Exclude from school/center until child is able to resume normal

activities

CONJUNCTIVITIS

(Pink Eye) INCUBATION AND SYMPTOMS

Infectious Agents: Haemophilus influenzae, Streptococcus

pneumoniae, et al

Incubation: Usually 24-72 hours.

Symptoms: Eyes are red, watery, itchy and sensitive to light; eyelids are

frequently swollen

Direct contact with eye and upper respiratory tract discharges of infected persons, or indirectly by contact with contaminated articles of person infected, including eye makeup applicators and multiple dose eye medication droppers

Period of Communicability: Duration of active infection.

Control: Exclude from school/center until 24 hours after start of

appropriate treatment, or until physician certifies as non-infectious

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INCUBATION & SYMPTOMS

Incubation: Variable, depending upon causative agent.

Symptoms: Acute respiratory infection which involves the larynx, trachea

and bronchi, and causes severe respiratory distress

Direct contact with an infected person, or indirectly by contact with articles

freshly soiled by discharge from nose and throat of the infected person

Period of Communicability: Duration of active disease.

Control: Exclude from school/center until symptoms are gone or

physician authorizes return

Medical attention may be necessary

DIARRHEAL DISEASES

This Section has been prepared for the most common diarrheal diseases If your

school/center is experiencing an outbreak of diarrhea, please contact the Health

Department while waiting for a confirmation of a specific disease

NOTE: The Health Department is to be notified immediately of any person in

the school/center diagnosed with any of the following diseases:

PROPER HANDWASHING IS THE MOST EFFECTIVE MEANS OF PREVENTING

THE SPREAD OF DIARRHEAL DISEASES.

CAMPYLOBACTERIOSIS

Infectious Agents: Campylobacter jejuni, et al

Incubation: Usually 3-5 days, with a range of 1-10 days.

Symptoms: Diarrhea, abdominal pain, fever, nausea, vomiting, and a

general feeling of sickness

-3-METHOD OF SPREAD

By ingestion of the organism in food or in unpasteurized milk or water; from contact with infected pets (especially puppies and kittens) or farm animals Person-to-person transmission has been reported in day care when children are in diapers (i.e., incontinent of stool)

Period of Communicability: Throughout the course of infection, usually

from several days to several weeks Individuals not treated with antibiotics excrete the organism for as long as 2-7 weeks

Control: Children attending or employees associated with day care,

pre-school, Headstart or nurseries may not attend the center if they are

symptomatic To minimize the risk of transmission, emphasize thorough handwashing by children and staff before eating and after toilet use and diaper changes Persons handling and preparing food should give particular attention to handwashing.

GIARDIASIS

Infectious Agent: Giardia lamblia Incubation: 5-25 days or longer; median 7-10 days.

Symptoms: It is common not to have symptoms However, symptoms

may include chronic diarrhea, abdominal cramps, bloating, frequent loose, pale and greasy stools, fatigue and weight loss

METHOD OF SPREAD

Person-to-person transmission occurs via the fecal/oral route May also be spread by ingestion of water or food contaminated with feces

Period of Communicability: Entire period of infection.

Control: Children or employees associated with day care, pre-school,

Headstart, or nurseries may not attend the center if they are symptomatic

To minimize the risk of transmission, emphasize thorough handwashing

by children and staff before eating and after toilet use and diaper changes

Persons handling and preparing food should give particular attention

to handwashing.

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Infectious Agent: Salmonella enteritidis, S typhimurium, et al

Incubation: 6-72 hours, usually 12-36 hours.

Symptoms: Sudden onset of headache, abdominal pain, diarrhea, nausea,

and sometimes vomiting Dehydration, especially among infants, may be

severe Fever is almost always present

Exposure to feces of infected animals, including household pets; ingestion

of contaminated food or water, undercooked foods, or improperly stored

foods Likelihood of transmission from person to person is greatest when

diarrhea is present This occurs chiefly in very young children (i.e., less

than 1 year)

Period of Communicability: Throughout the course of infection;

extremely variable, usually several days to several weeks (Temporary

carrier state occasionally continues for months, especially in infants.)

Headstart or nurseries may not attend the center if they are symptomatic

To minimize the risk of spread, emphasize thorough handwashing by

children and staff before eating and after toilet use and diaper changes

to handwashing.

SHIGELLOSIS

Infectious Agent: genus Shigella

Incubation: 12-96 hours (usually 1-3 days), and up to one week for S.

dysenteriae 1

Symptoms: Characterized by diarrhea, fever and nausea, sometimes

vomiting and cramps

METHOD OF SPREAD

Person-to-person contact either by direct or indirect transmission Individuals most responsible for the spread of disease are those who fail to thoroughly wash hands and under fingernails after bathroom use They may then spread infection to others directly by physical contact or indirectly by contaminating food Flies may transfer the organism onto a non-refrigerated or improperly covered food item

Period of Communicability: Entire period of infection Individuals

without symptoms may transmit the disease

Headstart or nurseries may not attend the center until they have been cleared by the Health Department To minimize the risk of spread,

emphasize thorough handwashing by children and staff before eating and after toilet use and diaper changes Persons handling and preparing food should give particular attention to handwashing.

YERSINIOSIS

Infectious Agent: genus Yersinia Incubation: Usually 3-7 days, generally under 10 days.

Symptoms: Acute, watery diarrhea (especially in young children), fever,

headache, pharyngitis, anorexia, vomiting

Method of Spread: Eating and drinking food and/or water that has been

contaminated with feces, or by contact with infected persons or animals

Period of Communicability: At least as long as symptoms are present,

usually 2-3 weeks Untreated cases may excrete the organism for 2-3 months

Headstart or nurseries may not attend the center if they are symptomatic

To minimize the risk of spread, emphasize thorough handwashing by

children and staff before eating and after toilet use and diaper changes

to handwashing.

END OF DIARRHEAL DISEASES

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FIFTH DISEASE

(Erythema Infectiosum) INCUBATION & SYMPTOMS

Infectious Agent: Parvovirus B19

Incubation: Variable; from 4-20 days until development of rash.

Symptoms: Characteristic is a striking erythema of the cheeks

(slapped-face appearance), followed in 1-4 days by a lace-like rash on trunk and

extremities which fades but may reappear Differentiation from rubella and

scarlet fever is often necessary

Contact with infected respiratory secretions

Period of Communicability: Greatest before onset of rash, probably not

communicable after onset of rash

Control: Children with Fifth Disease do NOT need to be excluded from

school since they are not contagious once the rash occurs

Concurrent Disinfection: Routine handwashing and proper disposal of

tissues used while sneezing, coughing and nose blowing are indicated to

reduce the spread of Fifth Disease

FLU

(Influenza) INCUBATION & SYMPTOMS

Infectious Agents: Influenza virus types A, B and C

Incubation: Short, usually 1-5 days.

Symptoms: Abrupt onset of fever, chills, headache and sore muscles.

Runny nose, sore throat and cough are common Nausea, vomiting and/or

diarrhea may occur, particularly in children

Direct contact with an infected person through droplet spread of nose and throat secretions; primarily spread among crowded populations in enclosed spaces Rarely, influenza may be transmitted by air-borne particles

Period of Communicability: Probably 3-5 days from clinical onset in

adults; up to 7 days in young children

Control: Exclude from school/center until symptoms are gone OTHER INFORMATION

Routine immunization is NOT recommended for children.

GERMAN MEASLES

(Rubella) INCUBATION & SYMPTOMS

Infectious Agent: genus Rubivirus Incubation: 16-18 days, with a range of 14-23 days.

Symptoms: Skin rash and mild fever Glands at back of head behind ear

and along back of neck are often enlarged Up to half the infections occur without evident rash

Infection is by droplet spread, contact with nasopharyngeal secretions, or direct contact with infected person

Period of Communicability: Highly communicable from a few days

before to at least 4 days after the onset of rash

Control: Exclude from school/center for at least 4 days after the onset of

rash

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Suspected cases should be reported by phone to the Health Department

Immunization of all children attending school is required by law While

mild in children, the disease when contracted by a pregnant woman

may cause serious consequences to the unborn child.

HAND, FOOT AND MOUTH DISEASE

(HFMD) INCUBATION & SYMPTOMS

Infectious Agent: primarily, coxsackievirus A-16 (CA16); also,

enterovirus 71 (EV71)

Incubation: Usually 3-7 days

Symptoms: Generally, mild fever, malaise, mouth ulcers and a

rash, often blisters, located on palms, soles and buttocks Fever begins first, then 1-2 days later mouth ulcers and rash appear

Direct person to person contact with nose and throat secretions and feces

of infected people

Period of Communicability: At the time of acute illness phase The

viruses may persist in feces for several weeks

Control: Enteric precautions should be observed and good personal

hygiene, including thorough handwashing practiced Disinfect

contaminated surfaces and wash soiled clothing Exclude from school if ill

HEAD AND BODY LICE

(Pediculosis capitas) (Pediculosis corpora) INCUBATION & SYMPTOMS

Infectious Agents: Pediculosis capitis, P humanus

Incubation: The eggs of lice may hatch in one week and sexual maturity

is reached approximately 8-10 days after hatching

Symptoms: Irritation and itching of scalp or body; presence of small light

grey insects and/or their eggs (nits) which are attached to the base of the hairs

Direct contact with an infected person and indirect contact with their

personal belongings, especially clothing and headgear.

Period of Communicability: While lice or nits remain alive on the infested

person or in clothing

Control: Exclude from school/center until adequately treated and until

judged noninfectious by the child's physician or by the school/center nurse

When a student is found with head lice, all family members should be

inspected and treated All students in infested classrooms should be inspected and those infested should be excluded.

HEPATITIS A

(HAV) INCUBATION & SYMPTOMS

Infectious Agent: hepatitis A virus Incubation: 15-50 days, average 28-30 days.

Symptoms: Usually abrupt onset with loss of appetite, fever, abdominal

pain, nausea and fatigue Jaundice may follow in a few days

Person to person contact by fecal/oral route: ingestion of feces-contaminated water and food

Period of Communicability: Most highly communicable during the last

half of incubation period and continuing for a few days after onset of jaundice Most cases are probably noninfectious after the 1st week of jaundice

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Control: For proven hepatitis A, enteric precautions should be observed:

emphasize thorough handwashing for children and staff before eating and

after toilet use and diaper changes Exclusion from school/center is

decided on a case by case basis Food handlers with known or

suspected hepatitis A may not work with food until a physician clears

the person for work.

Consult the Health Department for assistance and guidance in controlling

the disease within the school/center

HEPATITIS B

(HBV) INCUBATION & SYMPTOMS

Infectious Agent: hepatitis B virus

Incubation: 45-180 days, average 60-90 days.

Symptoms: Onset is gradual, with loss of appetite, vague abdominal

discomfort, nausea, vomiting, joint aches and rash May progress to

jaundice Fever may be mild or absent Some infected persons may be

asymptomatic

The virus is found in almost all body secretions; however, only blood and

blood products, saliva, semen, and vaginal fluids have been shown to be

infectious Transmission occurs through contaminated needles, (i.e IV, IM,

subcutaneous or intradermal use, including accidental needle sticks);

sexual exposure (either homosexual or heterosexual); perinatally; and

occasionally by sharing razors or toothbrushes with an infected person

Fecal/oral transmission has not been demonstrated

Period of Communicability: Highly communicable many weeks before

the onset of first symptoms and remains infectious through the acute

clinical course of the disease A person who is a chronic carrier may

remain infectious for life

Control: Educate about transmission methods Infected persons should

be under a physician's care

IMPETIGO

Infectious Agent: Staphylococcus aureus; Group A Streptococcus Incubation: Staphylococcus aureus: commonly 4-10 days, can be

variable and indefinite

Streptococcus: 1-3 days

Symptoms: Blister-like lesions which later develop into pustules of

irregular shape

Direct contact with draining sores or soiled bandages Stress good

personal hygiene, emphasizing thorough handwashing.

Period of Communicability: From onset of symptoms until sores are

healed

Control: Exclude from school/center until sores are no longer draining and

the child is judged noninfectious by the nurse or the child's physician

Early detection and adequate treatment are important in preventing spread Infected individuals should use separate towels and wash cloths; sores should be bandaged and dressings should be disposed of as any infectious material

MEASLES

(Rubeola) INCUBATION & SYMPTOMS

Infectious Agent: Measles virus Incubation: 7-18 days, usually 10 days.

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Symptoms: Acute, highly communicable disease with fever, cough, runny

eyes and nose, followed by a dark red elevated rash that occurs in patches

Direct contact with secretions of nose and throat of infected persons;

indirectly airborne and by articles freshly soiled with secretions of nose and

throat

Period of Communicability: From slightly before the onset of symptoms

to 4 days after rash appears

Control: Exclude from school/center until at least 4 days after the rash

appears

Suspected cases should be reported by phone to the Health Department

Immunization of all children attending school is required by law Notify the

Health Department if a case occurs in the school/center Measles is one of

the most readily transmitted communicable diseases

MENINGITIS

(Bacterial) INCUBATION & SYMPTOMS

Infectious Agent: Meningococcal meningitis, Haemophilus influenzae.

Incubation: 2-10 days, commonly 2-4 days (Haemophilus influenzae 2-4

days; Meningococcal meningitis 3-4 days)

Symptoms: Acute disease with sudden onset of fever, intense headache,

nausea, forceful vomiting, stiff neck and, frequently, a petechial rash

Behavioral changes may occur, including irritability or sluggishness

Direct contact with secretions of nose and throat of infected persons or

carriers

Period of Communicability: Up to 24 hours after initiation of antibiotic

therapy Penicillin does not eradicate organisms from nasopharynx

Control: Exclude from school/center until adequately treated Student must be under a physician's care.

Notify the Health Department immediately if a case occurs in the school Household and nursery school contacts may need to receive antibiotic

therapy Classroom contacts are usually NOT candidates for antibiotic

therapy

MENINGITIS

(Aseptic-Viral) INCUBATION & SYMPTOMS

Infectious Agent: Wide variety of infectious viruses Incubation: Varies with causative agent.

Symptoms: Common, acute disease with sudden onset of fever, intense

headache, nausea, forceful vomiting, stiff neck Behavioral changes may occur, including irritability or sluggishness

Varies with causative agent

Period of Communicability: Varies with causative agent.

Control: Exclude from school/center until child's physician certifies able

to return

Aseptic meningitis is generally a less serious disease than bacterial meningitis

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Infectious Agent: Epstein-Barr virus

Incubation: 4-6 weeks.

Symptoms: Fever, sore throat, swollen lymph glands.

Direct contact with saliva of infected person

Use of hygienic measures, especially thorough handwashing Student

may return to school/center when well enough to resume normal activities

MUMPS

Infectious Agent: Mumps virus

Incubation: 12-25 days, commonly 18 days.

Symptoms: Fever followed by painful swelling of salivary glands (under

the jaw or in front of the ear)

By droplet spread and by direct contact with saliva of infected person

Period of Communicability: 6-7 days before onset of swelling and up to

9 days after swelling occurs

Control: Exclude from school/center until swelling is gone, or until 9 days

from onset of swelling

Immunization of all children attending school is required by law Notify the Health Department if a case occurs in the school/center The disease may have serious complications in adults

RINGWORM

(Scalp, Skin and Feet) INCUBATION & SYMPTOMS

Infectious Agents: Microsporum; Trichophyton;

Epidermophyton/Floccosum

Incubation: Scalp and beard 10-14 days; body 4-10 days; nails and feet

unknown

Symptoms: Scalp: Scaly patches of temporary baldness Infected hairs

are brittle and break easily

Skin: Flat, inflamed ringlike sores that may itch or burn Feet: Scaling or cracking of the skin especially between the toes,

or blisters containing a thin watery fluid

Directly by contact with infected persons or animals or indirectly by contact with articles and surfaces contaminated by infected persons or animals

Period of Communicability: As long as lesions are present.

Control: Skin and Scalp: Infected persons should be excluded from

school/center until judged noninfectious by the nurse or the child's physician

OTHER INFORMATION:

Preventive measures are largely hygienic All household contacts, pets, and farm animals should be examined and treated if infected Scalp ringworm is seldom, if ever, found in adults

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Infectious Agent: Sarcoptes scabiei, a mite

Incubation: Symptoms occur 2-6 weeks after first infestation; symptoms

associated with reinfestation may occur in 1-4 days

Symptoms: Small raised areas of skin containing fluid, or tiny burrows

under the skin (line-like), that appear frequently on finger webs, in the folds

of wrists, elbows, armpits, thighs and belt line Itching is intense, especially

at night

Direct skin to skin contact and, to a limited extent, from undergarments or

bedding freshly contaminated by infected persons.

Period of Communicability: Until student and household contacts have

been adequately treated (usually one course of treatment, occasionally two,

a week apart)

Control: Exclude from school/center until student and household contacts

have been treated adequately (single infection in a family is uncommon)

SCARLET FEVER

(Streptococcal) INCUBATION & SYMPTOMS

Infectious Agent: Streptococcus pyogenes

Incubation: Short, usually 1-3 days, rarely longer.

Symptoms: Strep Throat: Fever, sore and inflamed throat, pus spots on

the back of the throat, tender and swollen glands of the neck

There may be a minimum of symptoms

Scarlet Fever: All symptoms that occur with strep throat as

well as strawberry tongue and body rash High fever, nausea and vomiting may occur

Direct or intimate contact with infected person or carrier, rarely by casual contact through transfer by objects or hands Explosive outbreaks of strep throat may follow drinking contaminated milk or eating contaminated food

Period of Communicability: With adequate treatment, communicability

is eliminated within 24 hours

Control: Exclude from school/center until 24 hours after treatment is

started

Early diagnosis and medical treatment are essential for the prevention of serious complications

THRUSH

(Candidiasis) INCUBATION & SYMPTOMS

Infectious Agent: Candida albicans Incubation: Variable, but 2-5 days in infants.

Symptoms: Infection of the mouth or tongue that appears as a

yellowish-white coating Other organs of the body may be involved

Direct contact with secretions or excretions from infected areas

Period of Communicability: Presumably for as long as lesions are visible Control: While it is not necessary to exclude the child from school/center,

precautions should be taken in order to prevent contamination of toys and other objects

Tiêu đề	Guide to Infectious Diseases for Schools and Day Care Centers
Trường học	Allegheny County Health Department
Chuyên ngành	Infectious Diseases
Thể loại	Hướng dẫn
Thành phố	Pittsburgh

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