Guidelines for Schools and Child Care Centres on

Communicable Diseases and Other Childhood Health Issues

This resource is intended to provide school principals, teachers, directors of child care centres (CCCs) and health care professionals with guidelines on communicable disease prevention and control in schools and CCCs.

Any child who is ill and unable to participate fully in regular activities should be cared for at home.

Ottawa Public Health recommends that individuals who may have been exposed to a communicable disease and have specific health concerns, such as and immunosuppression, be assessed by a health care professional.

Proper hand hygiene is the most effective way to prevent the spread of communicable diseases.

May 2017

CRITERIA FOR REPORTING OUTBREAKS TO OTTAWA PUBLIC HEALTH

For reporting of gastroenteritis outbreaks, see page 5.

For reporting of respiratory infection outbreaks, see page 11.

Schools must report when they have greater than 10% absenteeism due to similar symptoms in the school on the same day OR a sudden or unusual increase in absenteeism due to similar symptoms in students/staff in a class or school on the same day.

Child care centres must report when they have 10% or more children/staff ill with similar symptoms or absent on the same day.

Report all outbreaks immediately to the Outbreak Reporting Line at 613-580-6744, ext 26325, Monday to Friday 8:30 a.m. to 4:30 p.m. or 3-1-1 after hours.

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Period of Reporting Disease Cause/Symptoms Transmission Incubation Exclusion Communicability Requirements Amebiasis Parasite. Fecal-oral route. Few days to several During the period that CCCs: exclude Report to 613-580-6744, Abdominal distension, Food and water months to years, most cysts are passed, which symptomatic cases ext. 24224 within 1 cramps, diarrhea or contaminated by an commonly 2 to 4 weeks. may continue for years. (children and staff, business day. constipation, and rarely infected food handler or including food handlers), fever or chills. May be fecal matter. May also be until 24 hours after symptom free. transmitted sexually by diarrhea resolves or until fecal-oral contact. 48 hours after completion of antibiotic treatment. Bite (Animal) or There is a risk of rabies Animal saliva introduced Rabies: Usually 3-8 Rabies: Rabid animals Not required. Report immediately to exposure to a potentially from the bites of bats, by a bite or scratch. weeks; rarely as short as are infectious from the 613-580-6744, ext. rabid animal (Rabies) cats, dogs, ferrets, 9 days or as long as 7 time the reaches 23806 during regular groundhogs, muskrats, years. the salivary glands and business hours or 3-1-1 racoons, skunks and up until death. Death after hours to begin other wild mammals. usually occurs within 1 rabies immunization, if Bites of gerbils, week of onset of clinical needed, and/or to hamsters, mice, moles, signs. quarantine the biting rabbits and squirrels do animal, if available. not have to be reported unless the animal’s behaviour was very abnormal. Bites and scratches from animals may also result in infection, especially to young children, if not treated promptly. Young children are more at risk to injury to their face and neck. Bite (Human) If the skin is broken, Contact of contaminated Depends on the disease. Depends on the disease. Not required. Not required unless there may be a risk of with a break in the either person is known to transmission of hepatitis skin or blood inside of be infected with , hepatitis C, and HIV the mouth. B, hepatitis C or HIV. from an infected person. If so, report immediately to 613-580-6744, ext. 12580 during regular business hours or 3-1-1 after hours.

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Period of Reporting Disease Cause/Symptoms Transmission Incubation Exclusion Communicability Requirements Campylobacter Bacteria. Ingestion of Ranges from 1 to 10 Several days to several CCCs: exclude Report to 613-580-6744, Diarrhea (may be undercooked meat or days; usually 2 to 5 weeks, as long as symptomatic cases ext. 24224 within 1 bloody), abdominal pain, poultry, unpasteurized days. bacteria is excreted in (children and staff business day. malaise, fever, nausea milk, contaminated food feces. Without treatment including food handlers), and vomiting – may be or water or by direct bacteria may be until symptom free for 24 mild to severe. contact with fecal excreted for 2 to 7 hours or 48 hours after material from infected weeks. completion of antibiotics animals (especially pets or antidiarrheal and farm animals). medications. Fungus. Person to person by Variable, 2 to 5 days for While lesions are Not required. Not required. (Thrush, Diaper ) Thrush: Thin white layer direct contact with the thrush in infants. present. Avoid sharing on tongue and inside of mouth, skin or bodily bottle nipples and For more information, cheeks. May cause secretions containing the soothers between visit caringforkids.cps.ca difficulty with feeding. fungus. children. 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. (Varicella) Virus. Person to person by 10 to 21 days; commonly As long as 5 days, but No exclusion, children Report, by mail or fax, Fever. Blister-like rash direct contact with virus 14 to 16 days. usually 1 to 2 days can return with rash. number of cases and occurs over 5 to 6 days. through droplet or before onset of rash, Contact with ages, using the Chicken Scabs form after the airborne spread of blister until all blisters are immunocompromised Pox Weekly Reporting blister stage. Rash fluid or respiratory crusted, usually about 5 individuals, pregnant Form, available online at usually appears first on secretions. Indirectly days after the onset of women, particularly OttawaPublicHealth.ca the body, face and scalp, through freshly rash. those in the third and then later spreads to contaminated objects trimester, or newborns the arms and legs. and surfaces. should be avoided. Children 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 blister.

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Period of Reporting Disease Cause/Symptoms Transmission Incubation Exclusion Communicability Requirements Cold Sores (Herpes) Virus. Person to person by 2 to 12 days. While sores are Not required. Not required. Small blisters appear direct contact with saliva. apparent, however, virus If child has severe sores and then burst to form a may be transmitted even with fever and/or For more information, crust. Sores are usually when no visible sores excessive drooling, visit caringforkids.cps.ca around the mouth but are present. consider exclusion until can be around the nose fever free and able to and eyes. With the first participate fully in regular infection, sores may be activities without accompanied by fever, excessive drool. flu-like illness, and painful irritation. Reactivation of infection is common. Conjunctivitis-Bacterial Bacteria. Person to person by 24 to 72 hours. For duration of infection Exclude until treated with Not required. (Pink Eye) Pink or red conjunctiva direct or indirect contact or until 24 hours of antibiotic drops or (the white of the eye) with eye secretions. antibiotic treatment is ointment for 24 hours. For more information, with thick or crusty white completed. visit caringforkids.cps.ca or yellow discharge (pus), occasionally accompanied by fever. Conjunctivitis-Viral Virus. Person to person by 12 hours to 12 days. For duration of infection. Not required if no eye Not required. (Pink Eye) Pink conjunctiva (the direct or indirect contact discharge. Otherwise, white of the eye) with a with eye secretions. children can return upon For more information, clear, watery eye approval by healthcare visit caringforkids.cps.ca discharge. Often occurs provider. at the same time as a cold. Coxsackie Virus Virus. Person to person by Usually 3 to 5 days. Most infectious during Not required. Not required. (Hand, Foot and Mouth Sudden onset of fever, direct contact with fluid the first week of illness Disease) sore throat, rash on from sores, respiratory while experiencing For more information, palms of hands, fingers, secretions and fecal-oral symptoms. Transmission visit caringforkids.cps.ca and on soles of feet with route. Although most via stools and throat or without painful sores common in young secretions may persist inside the mouth. Usually children, asymptomatic for several weeks. occurs in children, adults can also spread particularly in the infection. summer months. Cryptosporidiosis Parasite. Fecal-oral route, 1 to 12 days with an From onset of symptoms CCCs: exclude Report to 613-580-6744, Frequent watery diarrhea including person to average of 7 days. up to several weeks after symptomatic cases ext. 24224 within 1 with abdominal pain, person, animal to symptoms resolve. (children and staff, business day. 4

Period of Reporting Disease Cause/Symptoms Transmission Incubation Exclusion Communicability Requirements fatigue, vomiting, and person, waterborne including food handlers), weight loss. May be (recreational or drinking until 24 hours after symptom free, which can water) and foodborne diarrhea resolves. be a source of infection transmission. Cases are not to use for others. recreational waters for 2 weeks after symptoms resolve. Diarrhea See Gastroenteritis E. Coli 0157:H7 Bacteria. Contaminated water or 2 to 10 days, usually 3 to 1 week or less in adults, CCCs: exclude all cases Report immediately to (Verotoxin-producing Diarrhea (may be food (e.g., undercooked 4 days. but can be 3 weeks in (children and staff, 613-580-6744, ext. Escherichia coli) bloody), severe meat, especially one third of children. including food handlers) 24224 during regular abdominal cramps, hamburger and poultry, HUS typically develops 7 until 2 negative stool business hours or 3-1-1 vomiting, fatigue, unwashed raw fruits and days (up to 3 weeks) cultures are obtained, at after hours. malaise and dehydration. vegetables, after onset of diarrhea least 24 hours apart or Most individuals recover unpasteurized milk and until 48 hours after the without residual effects, apple juice/cider. Also by completion of antibiotics however complications direct contact with fecal and/or anti-diarrheal such as Hemolytic material from infected medications. Uremic Syndrome animals or persons. (HUS), a serious health condition, may occur in a small percentage of cases. Eye Infection See Conjunctivitis Fifth Disease See Gastroenteritis: outbreak Bacteria, virus or Depends on cause. Depends on cause. Depends on cause. Depends on cause, Report the following parasite. Usually fecal-oral route number of cases and immediately to Diarrhea, vomiting, loss or through contaminated source of infection. All 613-580-6744, ext. of appetite and/or food or water. outbreaks must be 26325 during regular abdominal pain with or discussed with Ottawa business hours or 3-1-1 without fever. Public Health. During an after hours: outbreak, persons with vomiting or diarrhea CCCs: should be excluded for An outbreak exists when until 48 hours symptom there are 3 or more free before returning to children and/or staff ill work or childcare. with gastroenteritis within a program, group, or entire centre in a 3-day period, even if symptoms 5

Period of Reporting Disease Cause/Symptoms Transmission Incubation Exclusion Communicability Requirements occurred at home.

Schools: An outbreak exists when there is a sudden or unusual increase in absenteeism due to similar symptoms in students/staff in a class or school in the same day OR >10% absenteeism due to similar symptoms in a school on the same day. Gastroenteritis: single Bacteria, virus or Depends on cause. Depends on cause. Depends on cause. Exclude until 24 hours Not required. case of unknown cause parasite. Usually fecal-oral route after diarrhea and Exception: bloody Diarrhea, vomiting, loss or through contaminated vomiting is resolved; diarrhea should always of appetite and/or food or water. unless symptoms can be be reported immediately abdominal pain with or explained by a non to 613-580-6744, ext. without fever. infectious reason. If 24224 during regular diarrhea recurs within 48 business hours or 3-1-1 hours, it is after hours.. recommended to be assessed by a health care provider to see if a stool specimen is needed. German See . Giardiasis Parasite. Fecal-oral route, most 3 to 25 days or longer, Can be excreted in stool CCCs: exclude Report to 613-580-6744, (Beaver Fever) Acute or chronic diarrhea commonly through the usually 7 to 10 days. for months. symptomatic cases ext. 24224 within 1 (stools may also be pale ingestion of (children and staff, business day. and/or greasy), contaminated water or including food handlers) abdominal cramps, by direct person to until 24 hours after bloating, dehydration, person contact. This may diarrhea resolves or 48 fatigue and weight loss. include sexual activities hours after stopping anti- May be symptom free. involving potential diarrheal medication. contact with feces. Cases are not to use recreational waters for 2 weeks after symptoms resolve. 6

Period of Reporting Disease Cause/Symptoms Transmission Incubation Exclusion Communicability Requirements Hand, Foot and Mouth See Coxsackie Virus. Disease Hepatitis A Virus. Fecal-oral route, either 15 to 50 days, average Most infectious 2 weeks Exclude until 14 days Report immediately to Fever, fatigue, nausea, by direct contact with an 28 to 30 days. prior to onset of after the onset of 613-580-6744, ext. jaundice (yellowing of infected person or symptoms and until 7 symptoms or 7 days 24224 during regular skin and/or eyes), indirectly through days after onset of after the onset of business hours or 3-1-1 abdominal discomfort, ingestion of jaundice jaundice, whichever is after hours. dark urine, clay coloured contaminated water or sooner. stools. May be symptom food. May also be free (especially children). spread by certain sexual activities involving contact with feces. Hepatitis . Person to person by 45 to 180 days, average Many weeks before Not required. Report to 613-580-6744, Loss of appetite, fatigue, direct contact with 60 to 90 days. onset of first symptoms ext. 12580 within 1 vague abdominal infected body fluids, and through the acute business day. discomfort, joint pain, including sexual contact. period of disease. Some fever and jaundice people become carriers (yellowing of skin and/or and remain infectious for eyes). May be symptom life. free. Hepatitis C Virus. Person to person 2 weeks to 6 months, From 1 or more weeks Not required. Report to 613-580-6744, Most cases are usually primarily through blood- commonly 6 to 9 weeks. before onset of ext. 12580 within 1 asymptomatic or have to-blood contact. symptoms; some business day. mild illness; vague persons may be abdominal discomfort, infectious for a longer nausea, vomiting, fatigue period of time. and jaundice (yellowing of skin and/or eyes). HIV/AIDS Virus. Person to person by Generally 1 to 3 months Begins early after onset Not required. Report to 613-580-6744, (Human Some cases will develop direct contact with body until HIV blood test is of infection and extends ext. 12580 within 1 Immunodeficiency Virus) a short term flu-like fluids (blood, breast milk, positive. throughout life. business day. illness several weeks sexual fluids). Communicability after infection. May lead decreased with use of to suppression of the Antiretroviral therapy immune system. (ART). Impetigo Bacteria. Person to person by Variable. From onset of rash until Exclude until 24 hours Not required. Infection of the skin direct and indirect Commonly 4 to 10 days. 24 hours of treatment after the initiation of caused by Streptococcus contact with fluid from with oral or topical antibiotic treatment. For more information, or Staphylococcus blisters. It is very antibiotics. Typically, Upon return, any visit caringforkids.cps.ca bacteria; can follow a infectious and should be until blisters have draining or open blisters 7

Period of Reporting Disease Cause/Symptoms Transmission Incubation Exclusion Communicability Requirements scrape or insect bite. treated at once. crusted over. must be covered with a Appears as a rash with a clean dry bandage. cluster of red bumps or blisters, which may ooze or form a honey-coloured crust. Influenza Virus. Person to person by 1 to 3 days. 24 hours prior to onset of Exclude for 5 days after Report to 613-580-6744 May include sudden direct contact or by symptoms lasting up to 7 the onset of symptoms ext. 26325 within 1 fever, cough, headache, indirect contact with days. OR until fever free and business day. muscle soreness, contaminated surfaces feeling better, whichever fatigue, runny nose, sore and objects. is shorter. throat. Children may also have nausea, vomiting and diarrhea. May also be symptom free. Lice (Pediculosis) Colonization of the hair Head lice are generally Lice undergo a life cycle Until treatment has been Exclude until the first of 2 Not required. and skin by a parasitic spread through direct of 3 stages (egg, nymph completed. treatments is completed. insect. Head lice feed on head to head contact and adult lice) which For more information, human blood. Itching with an infested person. ranges from days to visit caringforkids.cps.ca from lice bites is Transmission by sharing months. common. Adult lice or infested belongings such eggs (nits) can be seen as bedding, clothing or with the naked eye, often headwear may also behind the ears and near occur. the nape of the neck. Measles (Red Measles) Virus. Person to person by 7 to 21 days, usually 10 4 days before to 4 days Exclude for 4 days after Report immediately to Fever, runny nose, direct contact or by days. after the onset of rash. the onset of rash. 613-580-6744, ext. cough, drowsiness, airborne droplets. 24224 during regular irritability and red eyes. business hours or 3-1-1 Small white spots appear Highly infectious. after hours. on the inside of the mouth and throat. Then, 3 to 7 days after initial symptoms a red blotchy rash appears on the face and progresses down the body.

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Period of Reporting Disease Cause/Symptoms Transmission Incubation Exclusion Communicability Requirements Meningitis Bacteria or virus. Varies depending on Varies depending on Varies depending on Varies depending on Report immediately to Young children may cause of meningitis. cause of meningitis. cause of meningitis. cause of meningitis. 613-580-6744, ext. show a cluster of 24224 during regular symptoms such as business hours or 3-1-1 irritability, poor feeding, after hours. vomiting, fever, rash and excessive high-pitched crying. Older children and adults may experience severe persistent headache, vomiting and neck stiffness. Virus. Person to person by 7 days to 6 months. Unknown, but probably Not required however, Not required. (Non-Plantar ) Smooth, often shiny, direct skin to skin contact as long as warts persist. lesions or warts should pinkish-white bumps with or indirect contact, such be covered upon return For more information, sunken centre, most as sharing clothes or to CCC/school. visit caringforkids.cps.ca often on face, trunk, or towels. limbs of children. Can be found on genitalia. May cause itchiness. Mononucleosis Epstein-Barr Virus. Person to person by 4 to 6 weeks. Prolonged; may persist Not required. Not required. Fever, sore throat, direct contact with up to 1 year or more. swollen lymph nodes in respiratory secretions, neck, fatigue. saliva or indirectly through surfaces and items (such as toys) contaminated with infected saliva. Mumps Virus. Person to person by 12 to 25 days; average 7 days before to 5 days Exclude for 5 days from Report immediately to Fever, swelling and direct contact with 16 to 18 days. after symptoms develop. the onset of swelling. 613-580-6744, ext. tenderness of salivary respiratory secretions or 24224 during regular glands slightly above the saliva. business hours or 3-1-1 angle of the jaw, on 1 or after hours. both sides. Norovirus See Gastroenteritis: outbreaks Paratyphoid Fever Bacteria. Fecal-oral route, either 1 to 10 days. From onset of initial CCCs: exclude all cases Report immediately to (Salmonella Paratyphi) Fever, headache, by direct contact with an symptoms and up to 2 (children and staff, 613-580-6744, ext. malaise, anorexia, infected person or weeks after symptoms including food handlers), 24224 during regular 9

Period of Reporting Disease Cause/Symptoms Transmission Incubation Exclusion Communicability Requirements constipation (more indirectly through resolve. until 3 consecutive stool business hours or 3-1-1 common than diarrhea) ingestion of specimens are negative after hours. and possible rash on contaminated water or (collected 48 hours trunk. May be mild food. apart). Time frame for illness with low grade stool specimen collection fever or progress to may vary depending on more serious illness and antibiotic prescribed. multiple complications. Parvovirus B19 Virus. Person to person by 4 to 14 days; can be as Most infectious a few Not required since no Not required. (Fifth Disease; Mild fever and distinctive direct or indirect contact long as 21 days. days before the onset of longer infectious once infectiosum) “slapped cheek” facial with respiratory rash. rash appears. However, For more information, rash. After 1 to 4 days, a secretions. Can also be children who are febrile visit caringforkids.cps.ca red, lace-like rash spread from mother to should be excluded until appears on the arms and fetus. fever free and able to body and can last 1 to 3 participate in regular weeks. May be symptom programs. free. Infected children with sickle cell or other forms of chronic anemia and pregnant staff are advised to consult with their health care provider. Pertussis Bacteria. Person to person by 6 to 20 days, usually 9 to Until 3 weeks after onset Exclude for 3 weeks Report immediately to (Whooping cough) Repeated bouts of direct contact with 10 days of symptoms or until 5 after onset of cough or 613-580-6744, ext. violent coughing, which respiratory secretions. days of antibiotic until completion of 5 24224 during regular may end with a high- treatment is completed. days of antibiotic business hours or 3-1-1 pitched inspiratory treatment. after hours. whoop and/or vomiting. May last 1 to 2 months. Pink Eye See Conjunctivitis Pinworms Worm. Fecal-oral route or 1 to 2 months or longer. Until treatment is Exclude until treatment is Not required Itching around the anal indirectly through initiated. initiated. area. bedding, clothing, food For more information, or other articles visit caringforkids.cps.ca contaminated with parasitic eggs.

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Period of Reporting Disease Cause/Symptoms Transmission Incubation Exclusion Communicability Requirements Poisonous Plants Plant toxin. Depends on the plant. Depends on the plant. Depends on the plant. Not required. Not required. (Poison Ivy, Wild Some people develop a For more information, Parsnip) severe skin irritation from visit: contact with certain  Poison Ivy plants. Washing the canada.ca exposed area immediately decreases  Wild parsnip the severity of omafra.gov.on.ca symptoms. Respiratory Outbreak Bacteria or virus. Person to person by Varies according to Varies according to Exclude for 5 days after Report the following Runny or stuffy nose, direct or indirect contact cause. cause. the onset of symptoms immediately to sneezing, sore throat, with respiratory OR until fever free and 613-580-6744, ext. hoarseness or difficulty secretions. feeling better, whichever 26325 during regular swallowing, cough, fever, is shorter. business hours or 3-1-1 swollen or tender glands after hours: in the neck, fatigue, muscle aches, loss of CCCs: appetite and headache. A respiratory outbreak exists when there is 10% or more children and/or staff sick or absent with acute respiratory illness occurring on the same day within the facility.

Schools: A sudden or unusual increase in absenteeism due to illness with similar symptoms in students/staff in a class or school on the same day OR >10% absenteeism due to illness with similar symptoms in a school on the same day.

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Period of Reporting Disease Cause/Symptoms Transmission Incubation Exclusion Communicability Requirements Respiratory Syncytial Virus. Person to person by 2 to 8 days, usually 4 to Usually 3 to 8 days from Children should be Not required. Virus (RSV) Can cause colds, direct or indirect contact 6 days. onset of symptoms, but excluded from childcare Exception: see bronchiolitis, bronchitis, with respiratory may continue for as long until fever free and able respiratory outbreak croup, pneumonia, and secretions. as 3 to 4 weeks. to participate in regular ear infections. programs. Ringworm (Tinea) Fungus. Person to person by Usually 10 to 14 days As long as lesions are Exclude until treatment Not required. Flat, well defined, red, direct skin to skin contact present or until treatment has been initiated. circular patches with or indirectly from contact is initiated. For more information, scaly or crusted border with contaminated visit caringforkids.cps.ca on the skin or scalp. The objects or surfaces, patches are often itchy. especially items that have been contaminated with hair (hairbrushes, combs, etc). Virus. Person to person by 9 to 10 days. While symptoms are Not required. Not required. Sudden onset of fever direct contact with present. lasting 3-5 days, respiratory secretions. For more information, followed by fine, pink visit caringforkids.cps.ca rash on trunk and body. . Person to person by 14 to 21 days. About 1 week before to 7 Exclude for 7 days after Report immediately to (German Measles) Low-grade fever, direct contact with days after onset of rash. onset of the rash. 613-580-6744, ext. headache, malaise, respiratory secretions. 24224 during regular runny nose, red eyes, Highly infectious. business hours or 3-1-1 enlarged tender neck after hours. nodes. Rash starts on the face, spreads in 24 hours and lasts 3 days. Salmonella Bacteria. Contaminated food or 6 to 72 hours, usually 12 Up to several weeks or CCCs: exclude Report to 613-580-6744, Symptoms include water (e.g., poultry, to 36 hours. months after onset of symptomatic cases ext. 24224 within 1 Salmonella paratyphi sudden onset of frozen processed symptoms. Children (children and staff, business day. (See Paratyphoid Fever) headache, fever, chicken products, raw under 5 may shed the including food handlers) abdominal pain, milk and milk products, bacteria in their stool for until symptom free for 24 Salmonella Typhi diarrhea, nausea and raw or undercooked longer periods. hours or 48 hours after (See Typhoid Fever) sometimes vomiting. meats and eggs, raw stopping anti-diarrheal unwashed fruits and medication. vegetables). Pets, farm animals and reptiles through direct contact and contact with their environment. 12

Period of Reporting Disease Cause/Symptoms Transmission Incubation Exclusion Communicability Requirements Infants and children under 5 are at higher risk of serious infection when in contact with reptiles, amphibians, ferrets, live poultry (including chicks and hatchlings) and farm animals. It is not recommended that these animals visit CCCs with children under 5. Scabies Caused by a mite Prolonged direct skin to 2 to 6 weeks. From onset of symptoms Exclude until the day Not required. burrowing under the skin contact or indirect until treated. Mites and after treatment is skin. contact by sharing eggs must be destroyed completed. For more information, Rash appears as bumps, clothes or towels with an to stop transmission. visit caringforkids.cps.ca patches or tiny red lines, actively infected person. This may require multiple usually between fingers treatments. and toes, and in skin folds. Intense itching, especially at night. See Streptococcal Infection. Shigella Bacteria. Primarily spread person 1 to 3 days; may range From onset of symptoms CCCs: exclude all cases Report immediately to Diarrhea (may be to person through fecal- from 12 hours to 1 week until bacteria is no longer (children and staff, 613-580-6744, ext. bloody), fever, nausea, oral route, either by depending on the strain. in stools (about 4 including food handlers) 24224 during regular vomiting, abdominal direct contact with an weeks). Use of until 1 stool sample or business hours or 3-1-1 cramps. Carriers of infected person or antibiotics may shorten rectal swab, collected 24 after hours. shigella who have no indirect contact with this time frame. hours after symptoms symptoms may also contaminated surfaces, have resolved or 48 spread infection. water or food handled by hours after antibiotics an infected person. May completed, is negative. also be spread sexually through certain sexual activities where fecal contact may occur. Poor personal hygiene also increases the risk of transmission as the only significant reservoir for shigella is humans. 13

Period of Reporting Disease Cause/Symptoms Transmission Incubation Exclusion Communicability Requirements (Herpes Zoster) Virus. Shingles occur in people 10 to 21 days; commonly Until blisters are crusted Not required. Not required. Reactivation of dormant who have already had 14 to 16 days. over. varicella (chickenpox) chickenpox. You cannot For more information, infection in the nerve transmit shingles; visit caringforkids.cps.ca endings. Characterized however, it is possible to by pain and a blistering get chickenpox from rash usually localized to someone with shingles one area of the body. through direct contact with the fluid in the blisters. Streptococcal Infection Bacteria. Direct or indirect contact Usually 1 to 3 days. From onset of symptoms Exclude until 24 hours Not required. (Strep throat, Scarlet Strep throat: Very sore with respiratory until 24 hours after after treatment is fever) and red throat, fever. secretions. antibiotic treatment initiated. For more information, Scarlet fever: High initiated. 10 to 21 days if visit caringforkids.cps.ca fever, vomiting, untreated. "sandpaper" skin rash, "strawberry tongue", red cheeks and whiteness around mouth. During recovery, skin on hands and feet may peel. Streptococcal Infection Necrotizing fasciitis: Direct or indirect contact Usually 1 to 3 days. From onset of symptoms Exclude until 24 hours Report immediately to (Invasive Group A Strep) Fever, localised redness, with respiratory until 24 hours after after treatment is 613-580-6744, ext. swelling, blister secretions or with antibiotic treatment initiated. 24224 during regular formation, and intense discharge from wounds. initiated. business hours or 3-1-1 pain. Redness spreads after hours. very quickly. Toxic Shock Syndrome: Sudden onset of high fever, vomiting, diarrhea, rash, muscle pains, and shock. Can be fatal. (TB) Mycobacterium If TB disease is in the Several weeks to years Varies. OPH manages all cases Report within 1 business tuberculosis. lungs: person to person for someone to develop of TB disease and day to 613-580-6744, If TB disease is in the via airborne bacteria. TB disease. notifies schools and ext. 24224. lungs: cough, loss of If TB disease is outside CCCs if exclusion is weight, fever, night of the lungs: not required. sweats, fatigue. contagious. If TB disease is outside 14

Period of Reporting Disease Cause/Symptoms Transmission Incubation Exclusion Communicability Requirements of the lungs: symptoms vary depending on where the disease is located. Typhoid fever Bacteria. Fecal-oral route. From 3 days to over 60 Variable, weeks to CCCs: exclude all cases Report immediately to (Salmonella Typhi) Low grade fever, Contact with feces and days; usual range is 8 to months. Infected (children and staff, 613-580-6744, ext. headache, malaise, urine of infected persons 14 days. persons may become including food handlers) 24224 during regular myalgia, dry cough, loss and carriers of the carriers and continue to until 3 consecutive stool business hours or 3-1-1 of appetite, nausea, and bacteria. Common spread infection and/or specimens are negative. after hours. abdominal discomfort. sources include relapse with symptoms Time frame for collection Rose spots on trunk may ingestion of varies depending on be seen. Constipation is contaminated water, antibiotic therapy used. more common than shellfish (particularly diarrhea in adults but oysters), milk, ice cream, diarrhea is more raw fruit and vegetables common in children. grown in fields fertilized Carriers of typhoid fever with fecal matter or who have no symptoms consumed in areas with may also spread poor sanitation. infection. Whooping Cough See Pertussis. Yersinia Bacteria. Fecal-oral route. 3 to 7 days, usually Usually 2 to 3 weeks. CCCs: exclude all cases Report within 1 business In small children, fever Direct contact with under 11 days. (children and staff, day to 613-580-6744, and diarrhea (may infected people or including food handlers) ext. 24224. contain blood and animals (such as until 24 hours after mucus). In adults and puppies or kittens) or diarrhea resolves, or 48 older children, may have indirect contact with hours after completion of abdominal pain similar to contaminated food and antibiotic therapy or anti- appendicitis with fever. water. Raw pork and diarrheal medications. Rarely, a rash may be pork products are known present. sources of infection.

This resource was produced by the Communicable Disease Control and Outbreak Management Program of Ottawa Public Health. References 1. Ontario Public Health Standards, Infectious Diseases Protocol, (2016): Appendix A and B 2. Control of Communicable Diseases Manual, 20th edition David L. Heymann 3. The Red Book, 30th edition American Academy of Pediatrics 4. Guidance Document for the Management of Animals in Child Care Centres, (2016)

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