A Guide to Common Infections

DISEASE HOW IT IS SYMPTOMS WHEN IS IT WHEN TO REPORT TO SPREAD AND SIGNS CONTAGIOUS EXCLUDE FROM PUBLIC SCHOOL HEALTH

Respiratory Infections Do not give ASA; acetylsalicylic acid (Aspirin)

Common Cold Spreads person to person via Runny nose, sneezing, One day before to five Do not exclude unless too ill Not reportable to Health droplets; indirect spread via sore throat, cough, days after onset. to take part in the activities. Unit. contaminated hands, objects, decreased appetite. Fever Frequent hand washing surfaces. Almost always with some colds. is important. viral.

Ear Infections Complication of cold. Earache or irritability, fever Not infectious. Do not exclude unless too ill Not reportable to Health (Otitis Media) and cold symptoms. to take part in the activities. Unit.

Influenza Virus spreads through air in Sudden onset of fever, Before symptoms have Exclude until well enough to Report to Health Unit. enclosed spaces, by direct chills, headache, developed until 5-7 participate. Usually 5-7 Influenza can result in contact with respiratory generalized aches and days after onset of days. serious complications secretions or indirectly by pains, loss of appetite, symptoms. for the elderly and those contact with contaminated cough. Weakness and with chronic health hands, objects, surfaces. cough can last several problems. Incubation period 1-3 days. days to weeks.

Strep Throat Bacteria spreads person to Fever, sore throat. General Until 24 hours after Exclude until 24 hours after Not reportable to Health Scarlet Fever person through respiratory discomfort and tender treatment begun. If the start of antibiotics. Unit. droplets or direct contact glands on the neck. untreated 10-21 days. with a symptomatic person or Sandpaper-like rash on asymptomatic carrier. Rarely neck, chest, in folds of spread indirectly through axilla, elbow, groin, and contaminated surfaces. inner surface of the thighs. Incubation period 1-3 days. Face looks flushed.

Whooping Cough Bacteria which is spread from Begins as cold with runny From onset of runny Exclude until 5 days after Report to Health Unit. (Pertussis) person to person by nose and cough. Cough nose until 3 weeks start of antibiotics or 3 Parents and staff should respiratory droplets, and gets gradually worse and after onset of weeks from onset of be notified. direct contact with respiratory occurs in spasms, paroxysmal cough paroxysmal or ‘whooping’ secretions. Rarely, through characterized by with whooping (if not cough if no treatment is indirect contact with inspiratory ‘whoop’. treated with given. Contacts may need surfaces. Fever uncommon. antibiotics). antibiotics or vaccine. Very infectious. Incubation period 6-20 days.

Gastrointestinal Infections Do not give Aspirin

Campylobacter Bacteria excreted in stool. Fever, vomiting, diarrhea, For duration of Exclude until diarrhea is Report to Health Unit. Can be found in poultry, beef, blood in stool, abdominal diarrhea. If untreated, gone and symptom free for unpasteurized milk or other cramps, and malaise. can shed bacteria in 24 hours. food. Contaminated water stool for 2-7 weeks. may be source of infection. Infected pets and farm animals may also be a source. Incubation period 1- 10 days.

Cryptosporidosis Parasite excreted in stool of Watery, non-bloody From onset of diarrhea Exclude until diarrhea is Report to Health Unit. infected persons and diarrhea, abdominal until several weeks gone and no other Immunocompromised animals. Spreads person to cramps and sometimes after symptoms symptoms for 24 hours. people are at risk of person and through fever, loss of appetite, resolve. serious complications. contaminated food or water. nausea and vomiting. Incubation period 2-14 days, Fever and vomiting are average 7 days. common in children. Symptoms may last 1-2 weeks or as long as a month. Symptoms can come and go over time.

DISEASE HOW IT IS SPREAD SYMPTOMS WHEN IS IT WHEN TO EXCLUDE WHEN TO REPORT AND SIGNS CONTAGIOUS FROM SCHOOL TO PUBLIC HEALTH

Diarrhea Germs are spread through Increase in frequency of For duration of Exclude children until Report to Health Unit the stool of infected persons. stools and/or change to diarrhea. diarrhea is gone or outbreaks of 2 or more Spread directly from person unformed, loose, or watery physician determines child children having diarrhea to person; indirectly from stool. Fever, loss of is not infectious. Notify occurring within 48 hands of staff and children, appetite, nausea, vomiting, parents at once if any of hours, also any case of objects, surfaces, food, or abdominal pain, mucus or the following are present: 2 bloody or diagnosed water contaminated with blood in stool may also or more episodes of bacterial diarrhea. germs (young children occur. Diarrhea may be diarrhea or diarrhea with frequently put fingers and dangerous in infants and fever over 39oC (102oF); objects in mouth). young children because repeated vomiting; the loss of fluid may cause dehydration; blood or dehydration. mucus in stool.

Escherichia coli Spreads through food or Mild diarrhea to blood in For duration of the Exclude until no diarrhea Report to Health Unit. (E. coli 0157:H7) water contaminated with stool, abdominal cramps, diarrhea. or other symptoms for 24 human or animal feces. Generally, no fever hours. Person to person spread is present. found in families, child care centres, and custodial institutions. Incubation period 2 to 8 days. Usually 3-4 days.

Giardia Parasite in stool of infected Most children have no Often months. Exclude until treated and Report to Health Unit. persons. Spreads person to symptoms. May have no diarrhea for 24 hours. person. Common in child diarrhea, loss of appetite, care settings. Incubation bloating, abdominal period 3 - 25 days or longer. cramps, pale and greasy Average 7-10 days. foul smelling stools, excessive gas, fatigue, weight loss.

Hepatitis A Virus excreted in stool of Most children have no 2 weeks before to 1 Exclude for 1 week Report to Health Unit. infected persons. Spreads symptoms. May have week after onset of after onset of jaundice (or Vaccination is available person to person by the fecal- fever, loss of appetite, jaundice. illness if no jaundice is for susceptible contacts. oral route; may also be nausea, abdominal present). spread in contaminated food discomfort, followed in a or water. Incubation period few days by jaundice 15-50 days. (yellow colour in skin and eyes).

Norwalk Virus Virus excreted in stool or Diarrhea and vomiting During acute stage of Exclude until 48 hours Report outbreaks to the Norwalk-like vomit of infected persons. accompanied by illness and up to 48 after diarrhea and vomiting Health Unit. Virus Spreads person to person abdominal cramps, hours after the have stopped. through the fecal-oral route. headache, malaise, diarrhea has stopped. Vomiting can cause the virus myalgia, low grade fever. to become aersolized and Symptoms persist for 24- infect food, water and 48 hours. surfaces. Incubation period 1-2 days.

Rotavirus Germ is excreted in stool of Fever and vomiting During the acute stage Exclude until 48 hours Report outbreaks to infected persons and spreads precede watery diarrhea. of illness through to after diarrhea and vomiting Health Unit. person to person through the Dehydration may occur the 8th day of infection. have stopped. Emphasize proper fecal-oral route. May also rapidly. handwashing. spread via contact and Symptoms usually last for through respiratory 4 –6 days. secretions. Incubation period is 1- 3 days.

Salmonella Acquired mainly from Sudden onset of headache, While having diarrhea. Exclude until 24 hours Report to Health Unit. contaminated food, including abdominal pain, diarrhea Can be several days to after diarrhea has stopped. Treatment is usually not eggs and egg products, beef, and nausea. Sometimes several weeks. indicated. poultry, unpasteurized milk, vomiting is present. Fever Excellent hand hygiene is and produce. Incubation is common. important. period 6-72 hours. Average is Anorexia and diarrhea tend 12–36 hours. to persist for several days.

Shigella Bacteria excreted in stool of Diarrhea, fever, blood For duration of Exclude until diarrhea is Report to Health Unit. infected persons. Spreads and/or mucus in stool, diarrhea. Highly gone and no other Emphasize proper person to person by indirect abdominal cramps. infectious. symptoms for 24 hours. handwashing. or direct fecal-oral Symptoms usually last 48– If untreated up to 4 transmission. Also spread in 72 hours. weeks. Asymptomatic contaminated food, water or carriers may transmit milk. Flies can be vectors. infection. The carrier Incubation period 1-7 days. state may persist for months.

DISEASE HOW IT IS SPREAD SYMPTOMS WHEN IS IT WHEN TO EXCLUDE WHEN TO REPORT AND SIGNS CONTAGIOUS FROM SCHOOL TO PUBLIC HEALTH

Skin and Scalp Infections (Refer to School Board policy for Head Lice) Do Not give Asprin

Chickenpox Spreads person to person by Sudden onset of mild Up to 5 days before Return to school or Report to Health Unit. (Varicella) direct contact, droplet or fever. Small red pimples onset of rash and childcare as soon as child Vaccine availabe. airborne spread of fluid from which develop into lasting until lesions is well enough to Staff and parents should vessicles or secretions of the blisters, then become have crusted (about 5 participate normally in all be notified. Susceptible respiratory tract. Indirectly encrusted. Occurs in days). actvities (regardless of the pregnant staff will need to through articles freshly soiled successive crops, and state of the rash). seek medical care with secretions from vessicles. tends to affect face, hands, promptly. Very infectious. May develop neck and extremities. following contact with person having shingles. Incubation period 14-21 days. Shingles Return to school or Reactivation of chickenpox. A rash, often with blisters, Up to one week after childcare as soon as child Not reportable. If a person who has never had that may be painful, the rash develops. No is well enough to May seek guidance from chickenpox touches the rash of usually on one side of the longer infectious once participate normally in all Public Health, as vaccine a person with shingles, they body. all the blisters have activities (regardless of the for chickenpox is may develop chickenpox. crusted. state of the rash). Where available for susceptible possible, the rash should contacts. be kept covered.

Herpes Simplex Virus spreads person to Many infections occur For several weeks Exclude if too ill to Not reportable to Health (Cold Sores) person by direct contact with without any symptoms. during initial infection participate. Avoid direct Unit. saliva and infected sores. May cause high fever, and intermittently contact with lesions or many painful ulcers in and thereafter especially cold sores. around mouth. May recur when cold sores as cold sores. return.

Impetigo Bacteria spreads person to Pustules or crusted rash From onset of rash Exclude until antibiotic Not reportable to Health person by direct contact. on face or exposed parts until 1 day after start of treatment has been taken Unit. Caused by same bacteria that of body (arms and/or legs). treatment with for 1 full day. causes strep throat. antibiotics. Depending on type of Ringworm Spread by direct or indirect ringworm, may cause While lesions are Exclusion is not required. Not reportable to Health contact with lesions of infected circular lesions on skin or visible. Treatment is important. Unit. persons or animals. Indirectly scalp. Lesions may have Avoid contact sports until through contaminated floors, slightly raised, red edges cleared by a physician to shower stalls and benches. and may be dry and scaly. return to sports. Incubation period 4-14 days Other types of ringworm depending on type of may affect the skin ringworm. between the toes (Athletes Foot) or the nails.

Scabies Mites spread person to person Very itchy rash. Usually Until mites and eggs Exclude until 24 hours Not reportable to Health by prolonged direct close appears on fingers, are destroyed by after treatment is first Unit. contact. Incubation period 2-6 elbows, armpits and treatment. Usually applied. weeks in persons without abdomen. after 1 or occasionally previous exposure. 1-4 weeks after 2 courses of in those previously exposed. treatment a week apart.

Other Infections Do not give Aspirin

Cocksackie A Virus spreads person to Fever, headache, sore Communicable during Do not exclude unless too Not reportable to the (Hand/Foot/ person through direct contact throat, lack of energy. acute stage of illness; ill to participate. Health Unit. Mouth Disease) with nose and throat Small painful ulcers in can continue to discharges and faeces of mouth. Rash consists of transmit virus in stools infected people or by red spots often topped by for weeks. aersolized droplets. small blisters on hands Most common in Incubation period 3-5 days. and feet. summer and fall.

Conjunctivitis Bacteria spreads person to Redness, swelling, itching, For duration of Exclude if yellowish Not reportable to Health (Pinkeye) person by contact with pain, discharge from eye. infection or until discharge present and Unit. secretions from eye or After sleep the discharge 24 hours after then until the antibiotics respiratory secretions. Indirect forms dry, yellowish crusts treatment has started. have been taken or through contaminated clothing on eyelashes. dropped into eyes for one and other articles. Incubation full day. period usually 24-72 hours.

Fifth Disease Virus mainly spreads from Usually afebrile, very red Greatest before onset Do not exclude if well Not reportable to Health person to person through rash begins on cheeks of rash. Probably not enough to take part in Unit. contact with respiratory (slapped face appearance) communicable after activities. In consultation with secretions. Incubation period followed by a lace-like rash onset of rash. Public Health, notify is 4-20 days to development of on the trunk and pregnant teachers and rash. extremities which fades parents who may have but may come and go for 1 had exposure. to 3 weeks.

DISEASE HOW IT IS SPREAD SYMPTOMS WHEN IS IT WHEN TO EXCLUDE WHEN TO REPORT AND SIGNS CONTAGIOUS FROM SCHOOL TO PUBLIC HEALTH

Hepatitis B Virus found in blood, semen Lack of appetite, nausea, From weeks before No exclusion required. Report to Health Unit. and vaginal fluids. Can be vomiting, tiredness, onset to months or Immediately report any spread by unprotected sex, abdominal pain and/or years after recovery bites that cause bleeding. blood contact, bites, and from yellowing of the skin from acute illness. Hepatitis B vaccine mother to baby at birth. (jaundice). May be infectious for and/or immune globulin May be asymptomatic. life. may be indicated for close contacts under special circumstances.

Measles Virus in respiratory Fever, cough, runny nose, From about 4 days Exclude until at least 4 Report to Health Unit at (Red Measles) secretions. Spreads person to inflamed eyes, followed by before onset of rash days after onset of rash. once. person through the air or direct rash. Rash is until 4 days after onset Immediate reporting is contact with nasal or throat characterized by large red of rash. essential in limiting secretions. spots which often join outbreaks of measles. Highly infectious. together, starts on face Incubation period 7-18 days. and spreads rapidly over body.

Meningitis Spreads from person to person A severe headache, For bacterial For bacterial meningitis, Report to Health Unit through direct contact with sudden onset of fever, meningitis, exclude until 24 hours after immediately. nose and throat secretions. vomiting, stiff neck and communicable until 24 the start of antibiotics. Seek emergency care Can be viral or bacterial. sensitivity to light. May hours after the start of immediately. Incubation period is 1 – 10 develop a red pin-point antibiotics. For viral meningitis, In some circumstances, days. rash. exclude until well enough close contacts may Can be life threatening to participate. require antibiotics or infection. vaccine. Asymptomatic carrier state exists in 5 –10% of the population.

Mumps Virus spreads person to Typically involves swelling From 7 days before to Exclude for 9 days after Report to Health Unit. person by droplets and of the salivary glands. The 9 days after onset of onset of swelling. through the air. Also spread virus can also affect other swelling. by direct contact with the parts of the body. Most infectious 2 days saliva of infected persons. About 1/3 of infections do before to 5 days after Incubation period is usually 15- not involve facial swelling, onset of swelling. 18 days. but instead show signs of respiratory infection.

Roseola Spread of human herpesvirus 6 Starts with fever. Several Unknown. Do not exclude unless too Not reportable to the (Sixth Disease) is not clearly understood. days later small red spots If the virus becomes ill to participate. Health Unit. Common in children 6-24 appear on face and body. latent may be months of age. Incubation Rash lasts 3-5 days. In communicable for life. period is about 10 days. some children, high fever Difficult to diagnose may be the only symptom. until rash appears.

Rubella Spreads from person to person Many children infected 7 days before until at Exclude for 7 days after Report to Health Unit. (German when nose and mouth have no signs of illness or least 4 days after onset onset of rash. Susceptible pregnant Measles) secretions from the ill person rash. of rash. staff should seek medical enter the nose, mouth or eyes May have mild fever, sore care promptly. of another person. throat, swollen glands in There is risk of severe damage neck and behind the ears, to the fetus if a pregnant which is followed in 5-10 woman gets rubella during the days by a rash. first half of the pregnancy. Incubation period 14-21 days. The rash starts on the face and becomes generalized in 24 hours. It lasts about 3 days.

Sources: 1) American Academy of Pediatrics. (2006). Red Book 2006:Report of the committee on infectious diseases. (25th ed). American Academy of Pediatrics: Elk Grove Village, IL. 2) Heyman, D (2004). Control of Communicable Diseases Manual. (18th ed). American Public Health Association: Washington.

EHU 585 (Feb/09)

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