Microorganism, Infectious Disease Table Winnipeg Regional Health Authority Acute Care Infection Prevention & Control Manual

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Microorganism, Clinical Infective Route of Incubation Period of Duration of Infectious Precautions Comments Presentation Material Transmission Period Communicability Precautions Disease Actinomycosis Cervicofacial, Routine Practices Variable Not person-to- Normal flora; infection usually secondary to trauma. (Actinomyces thoracic or person spp.) abdominal infection

Adenovirus Respiratory tract Droplet and Respiratory Large droplets; 1-10 days Shortly prior to Duration of Different strains responsible for respiratory and gastrointestinal disease. Respiratory infection Contact secretions Direct/indirect and until symptoms Patient should not share room with high-risk roommates. (pneumonia) contact symptoms cease strains Minimize exposure of immunocompromised patients, patients with chronic cardiac or lung disease, neonates. Symptoms may be prolonged in immunocompromised patients. Conjunctivitis Contact Eye discharge Direct/indirect 5-12 days Late in incubation Duration of contact period until 14 symptoms, up days after onset to 14 days Adenovirus Diarrhea Adult: Routine Feces Direct/indirect 3-10 days Until symptoms Duration of *Consider Contact Precautions for incontinent adults if stool cannot be contained or for adults Enteric strain Practices* contact cease symptoms with poor hygiene who contaminate their environment. Pediatric: (fecal/oral) **Pediatric precautions apply to children who are incontinent or unable to comply with Contact** hygiene. Refer to Specific Disease Protocol: Diarrhea – Viral Amebiasis Dysentery and Adult: Feces Direct/indirect 2-4 weeks Duration of cyst Duration of *Consider Contact Precautions for incontinent adults if stool cannot be contained or for adults (Entamoeba liver abscess Routine Practices contact excretion symptoms with poor hygiene who contaminate their environment. (fecal/oral) histolytica) Pediatric: **Pediatric precautions apply to children who are incontinent or unable to comply with hygiene. Contact** Refer to Specific Disease Protocol: Diarrhea – Viral. Anaplasmosis Tick-borne Reportable Disease: Reported by diagnosing healthcare provider. Contact Site Infection Control Professional (ICP). Anthrax Cutaneous Routine Practices 1-7 days; Not person-to- Acquired from contact with infected animals and animal products. (Bacillus Pulmonary may be up person Inhalation anthrax may occur as a result of occupational exposure to anthrax spores or as a anthracis) to 60 days result of bioterrorism. Decontamination and post exposure prophylaxis required for exposure to aerosols in laboratory exposures or biological terrorism. Reportable Disease: Contact Site ICP.

DATE ISSUED: February 1, 2006 Review by: November 2019 6.2.1 REVISION DATE: November 2016

Microorganism, Infectious Disease Table Winnipeg Regional Health Authority Acute Care Infection Prevention & Control Manual

Arthropod borne Encephalitis, fever, Routine Practices Blood, tissues Vector-borne 3-21 days Not person-to- *Over one hundred different viruses, most limited to specific geographic areas. virus* rash, arthralgia, (spread by (varies with person except In North America: West Nile is most common; others include California, St. Louis, Western (arboviruses) meningitis mosquitoes, different rarely by blood equine, Eastern equine, Powassan, Colorado tick, Snowshoe hare, Jamestown Canyon. ticks) arboviruses) transfusion or organ transplantation Ascariasis Usually Routine Practices Not person-to- Ova must hatch in soil to become infective. (Ascaris asymptomatic person lumbrioides) (roundworm) Aspergillosis Skin, lung, wound or Routine Practices Not person-to- Spores in dust; infections in immunocompromised patients may be associated with construction. (Aspergillus spp.) central nervous person system infection Avian influenza See influenza. Astrovirus Diarrhea Adult: Routine Feces Direct/indirect 3-4 days Duration of Duration of *Consider Contact Precautions for incontinent adults if stool cannot be contained or for adults Practices* contact symptoms symptoms with poor hygiene who contaminate their environment. Pediatric: (fecal/oral) **Pediatric precautions apply to children who are incontinent or unable to comply with hygiene. Contact** Refer to Specific Disease Protocol: Diarrhea – Viral. Babesiosis Adult: Routine Blood Tick-borne Not person-to- Reportable Disease: Reported by diagnosing healthcare provider. Practices person except Contact Site ICP. rarely by blood Pediatric: Contact transfusion from asymptomatic parasitaemic donors Bacillus cereus Food poisoning, Adult: Routine Foodborne Contaminated food, soil or dust. nausea, vomiting, Practices* *Consider Contact Precautions for incontinent adults if stool cannot be contained or for adults diarrhea, abdominal Pediatric: with poor hygiene who contaminate their environment. cramps Contact** **Pediatric precautions apply to children who are incontinent or unable to comply with hygiene.

DATE ISSUED: February 1, 2006 Review by: November 2019 6.2.2 REVISION DATE: November 2016

Microorganism, Infectious Disease Table Winnipeg Regional Health Authority Acute Care Infection Prevention & Control Manual

Microorganism, Clinical Infective Route of Incubation Period of Duration of Infectious Precautions Comments Presentation Material Transmission Period Communicability Precautions Disease Blastomycosis Pneumonia, skin Routine Practices Not person-to- Acquired from spores in soil. (Blastomyces lesions person dermatitidis) Bocavirus [5, 6] Cough, rhinorrhea, Droplet and Respiratory tract For duration of May cohort if infected with same virus. Respiratory tract fever Contact secretions and symptoms Patient should not share room with high-risk roommates. possibly stool Shedding of virus infection may occur after resolution of symptoms, particularly in immune- compromised hosts Botulism Flaccid paralysis; Routine Practices Food containing Foodborne Not person-to- *Food in which neurotoxin has formed usually due to inadequate heating during canning (Clostridium cranial nerve palsies neurotoxin* person Presents as flaccid paralysis, cranial nerve palsies. botulinum) Reportable Disease: Refer to WRHA Reporting of a Communicable Disease to Manitoba Health by Infection Prevention & Control in Hospitals Operational Directives.. Contact Site ICP. Brucellosis Systemic bacterial Routine Practices Weeks to Not transmitted Acquired from contact with infected animals or from contaminated food, mostly dairy products. (Brucella sp.) disease of acute or months person-to-person Brucella is hazardous to laboratory workers. Notify laboratory if diagnosis is suspected. insidious onset (rarely via banked Undulant, Malta or Prophylaxis required following laboratory exposure. spermatozoa and Mediterranean sexual contact) fever Draining lesions Minor: Routine Possibly direct Duration of *Major: Contact Precautions required only if wound drainage cannot be contained by dressings. Practices contact drainage Major: Contact* Burkholderia Exacerbation of Contact Until organism B. cepacia can result in respiratory tract colonization or infection in patients. cepacia [2, 6] chronic lung disease cleared as *Contact precautions if cystic fibrosis (CF) patients on unit. directed by ICP Avoid all interactions with CF patients. Caliciviruses See Noroviruses Campylobacter Gastroenteritis Adult: Routine Contaminated Direct/indirect 2-5 days Duration of Duration of *Consider contact Precautions for adults if stool cannot be contained or for adults with poor Practices* food contact excretion symptoms hygiene who contaminate their environment. Pediatric: Feces (fecal/oral) Person-to-person **Pediatric precautions apply to children who are incontinent or unable to comply with hygiene. Contact** uncommon Refer to Specific Disease Protocols – Diarrhea – Bacterial.

DATE ISSUED: February 1, 2006 Review by: November 2019 6.2.3 REVISION DATE: November 2016

Microorganism, Infectious Disease Table Winnipeg Regional Health Authority Acute Care Infection Prevention & Control Manual

Microorganism, Clinical Infective Route of Incubation Period of Duration of Infectious Precautions Comments Presentation Material Transmission Period Communicability Precautions Disease Candida auris1 – Contact Contact Site ICP. See AROs Refer to Global Emergence of Invasive MDR Yeast Candida auris Infections CDC. Candidiasis Many Routine Practices Normal flora. (Candida sp.) Cat Scratch Fever, Routine Practices 16-22 days Not person-to- Acquired from animals (cats and others). Disease lymphadenopathy person (Bartonella henselae) Chancroid Genital ulcers Routine Practices Sexual 3-5 days Until healed and as (Haemophilus transmission long as infectious Ducreyi) agent persists in the original lesion Chicken pox See Varicella. Chlamydia Urethritis, cervicitis, Routine Practices Conjunctival and Sexual Variable As long as Infections: pelvic inflammatory genital transmission organism present C. trachomatis disease; neonatal secretions Mother to child in sections conjunctivitis, infant at birth pneumonia; Trachoma: trachoma direct/indirect contact C. pneumoniae Pneumonia Routine Practices Respiratory Unknown Unknown Unknown Rare outbreaks of pneumonia in institutionalized populations. secretions C. psittaci Pneumonia, Routine Practices Infected birds 7-14 days Not person-to- Acquired by inhalation of desiccated droppings, secretions and dust of infected birds. (psittacosis, undifferentiated person ornithosis) fever Cholera Diarrhea Adult: Routine Feces Direct/indirect 2-3 days Duration of Duration of Reportable Disease: Refer to WRHA Reporting of a Communicable Disease to Manitoba Health by (Vibrio cholerae 01, Practices* contact shedding symptoms Infection Prevention & Control in Hospitals Operational Directives. 0139) Pediatric: (fecal/oral) *Consider Contact Precautions for adults if stool cannot be contained or for adults with poor Contact** hygiene who contaminate their environment. **Pediatric precautions apply to children who are incontinent or unable to comply with hygiene. Refer to Specific Disease Protocols: Diarrhea - Bacterial.

DATE ISSUED: February 1, 2006 Review by: November 2019 6.2.4 REVISION DATE: November 2016

Microorganism, Infectious Disease Table Winnipeg Regional Health Authority Acute Care Infection Prevention & Control Manual

Microorganism, Clinical Infective Route of Incubation Period of Duration of Infectious Precautions Comments Presentation Material Transmission Period Communicability Precautions Disease Clostridium difficile Diarrhea, pseudo- Contact Feces Direct/indirect Variable Duration of Until Bacterial spores persist in the environment. membranous colitis contact shedding asymptomatic for Consider increased environmental cleaning. (fecal/or oral) at least 48 hours Dedicate patient care equipment. Routine Practices are adequate for home care settings. Relapses are common. Refer to Specific Disease Protocol: Diarrhea – C. difficile. Clostridium Food poisoning Routine Practices Feces Direct/indirect 2-3 days Not person-to- perfringens contact person (fecal/oral) Gas gangrene, Routine Practices Variable Not person-to- Found in normal gut flora, soil, Infection related to devitalized tissue. abscesses, person myonecrosis

Coccidioido- Pneumonia, draining Routine Practices 1-4 weeks Not person-to- Acquired from spores in soil, dust in endemic areas. mycosis lesions person (Coccidioides immitis) Colorado tick fever Fever Routine Practices Tick-borne 3-6 days Not person-to- See Arbovirus person Congential rubella See Rubella Coronavirus – Common cold Droplet and Respiratory Direct/indirect 2-4 days Until symptoms Duration of May cohort if infected with same virus. other than MERS Contact secretions contact, cease symptoms Patient should not share room with high-risk roommates. CoV or SARS CoV Possible large Minimize exposure of immunocompromised patients, children with chronic cardiac or lung For MERS CoV: droplet disease, neonates. See Middle Eastern Respiratory Syndrome For SARS CoV: See Severe acute respiratory syndrome

DATE ISSUED: February 1, 2006 Review by: November 2019 6.2.5 REVISION DATE: November 2016

Microorganism, Infectious Disease Table Winnipeg Regional Health Authority Acute Care Infection Prevention & Control Manual

Microorganism, Clinical Infective Route of Incubation Period of Duration of Infectious Precautions Comments Presentation Material Transmission Period Communicability Precautions Disease Creutzfeldt-Jakob Chronic Routine Practices* Contaminated Reportable disease: Refer to WRHA Reporting of a Communicable Disease to Manitoba Health by Disease (CJD) encephalopathy neurosurgical Infection Prevention & Control in Hospitals Operational Directives. instruments; *Special Precautions for instruments contaminated with CSF or CNS tissues, neurosurgical tissue grafts procedures, autopsy and handling deceased body required. **Transmission has been from infected documented following human pituitary hormone therapy, human dura mater grafts, corneal donors grafts and linked to neurosurgical instruments. Refer to Specific Disease Protocols: CJD. Crimean-Congo See Viral Hemorrhagic Fevers. Fever Cryptococcosis Pneumonia, Routine Practices Unknown Not person-to- (Cryptococus meningitis, person neoformans) adenopathy Cryptosporidiosis Diarrhea Adult: Routine Feces Direct/indirect 1-12 days From onset of Duration of *Consider Contact Precautions for incontinent adults if stool cannot be contained or for adults (Cryptosporidium Practices* contact symptoms until symptoms with poor hygiene who contaminate their environment. parvum) Pediatric: (fecal/oral) several weeks after **Pediatric Precautions apply to children who are incontinent or unable to comply with hygiene resolution Contact** Refer to Specific Disease Protocol: Diarrhea – Other. Cysticercosis T.solium larval cysts Routine Practices Ova in feces Direct contact Months to While eggs present Transmissible only from humans with T.solium adult tapeworm in gastrointestinal tract (Taenia solium in various organs (fecal/oral) years in feces (autoinfection occurs). larvae) Cytomegalovirus Usually Routine Practices Saliva, genital Direct* Unknown Virus is excreted in Requires close direct personal contact for transmission. asymptomatic; secretions, urine, Sexual urine, saliva, congenital infection, breast milk, genital secretions, transmission Reassignment to prevent pregnant health care workers from contact with cytomegalovirus is not retinitis, transplanted breast milk for Vertical mother recommended.[4] mononucleosis, organs or stem many months; may to child in utero, pneumonia, cells, blood persist or be at birth or disseminated products episodic for life *Disease often reactivation rather than new infection. through breast infection in milk immunocompromise d host Transfusion Transplantation Dengue Fever, arthralgia, Routine Practices Mosquito- 3-14 days Not person-to- (arbovirus) rash borne person Dermatophytosis See Tinea spp.

DATE ISSUED: February 1, 2006 Review by: November 2019 6.2.6 REVISION DATE: November 2016

Microorganism, Infectious Disease Table Winnipeg Regional Health Authority Acute Care Infection Prevention & Control Manual

Microorganism, Clinical Infective Route of Incubation Period of Duration of Infectious Precautions Comments Presentation Material Transmission Period Communicability Precautions Disease Diphtheria Cutaneous Contact Lesion drainage Direct/indirect 2-5 days If untreated, 2 Until two *Cultures should be taken at least 24 hours apart and at least 24 hours after cessation of (Corynebacterium (characteristic contact weeks to several cultures* from antimicrobial therapy. Close contacts should be given antimicrobial prophylaxis diphtheria) ulcerative lesion) months skin lesions are Reportable Disease for all cases and contacts Contact Site ICP negative Diphtheria Pharyngeal Droplet Nasopharyngeal Large droplets 2-5 days If untreated, 2 Until 2 negative *Cultures should be taken at least 24 hours apart and at least 24 hours after cessation of (Corynebacterium (adherent grayish secretions weeks to several cultures*from antimicrobial therapy. Close contacts should be given antimicrobial prophylaxis. diphtheria) membrane) months nose AND throat Ebola See Viral hemorrhagic fever Echinococcosis Cysts in various Routine Practices Months to Not person-to- Acquired from contact with infected animals. (Hydatidosis) organisms years person (Echinococcus granulosis, E. multilocularis) Echovirus See Enterovirus.

Enterobiasis Perianal itching Routine Practices Ova in stool, Direct/indirect Life cycle As long as gravid *Direct transfer of infective eggs by hand from anus to mouth of the same or another person; (oxyuriasis, perianal region contact* requires 2-6 females discharge indirectly through clothing, bedding or other contaminated articles. pinworm) weeks eggs on perianal Close household contacts may need treatment. (Enterobius skin. Eggs remain vermicularis) infective indoors about 2 weeks. Enterococcus See Vancomycin-resistant enterococci. species (Vancomycin resistant only) Enteroviral Acute febrile Adult: Routine Feces, Direct/indirect 3-5 days Duration of *Consider Contact Precautions for incontinent adults if stool cannot be contained or for adults infections symptoms, aseptic Practices* respiratory contact symptoms; If with poor hygiene who contaminate their environment. Echovirus, meningitis Pediatric: secretions (fecal/oral) poliovirus, see **Pediatric Precautions apply to children who are incontinent or unable to comply with hygiene. Coxsackievirus A, encephalitis, Contact** poliomyelitis Coxsackievirus B, pharyngitis, Enterovirus herpangina, rash, pleurodynia, hand,

foot and mouth disease Poliovirus Conjunctivitis Contact Eye discharge Direct/indirect 1-3 days Duration of See poliomyelitis contact symptoms DATE ISSUED: February 1, 2006 Review by: November 2019 6.2.7 REVISION DATE: November 2016

Microorganism, Infectious Disease Table Winnipeg Regional Health Authority Acute Care Infection Prevention & Control Manual

Microorganism, Clinical Infective Route of Incubation Period of Duration of Infectious Precautions Comments Presentation Material Transmission Period Communicability Precautions Disease Epstein Barr virus Infectious Routine Practices Saliva, Direct 4-6 weeks Prolonged: mononucleosis transplanted oropharyngeal pharyngeal organs or stem route via saliva; excretion may be cells transplantation intermittent or persistent for years Erythema See Parvovirus B19. infectiosum Escherichia coli Diarrhea, food Adult: Routine Feces Direct/indirect 1-8 days Duration of Duration of *Consider Contact Precautions for incontinent adults if stool cannot be contained or for adults (enteropathogenic poisoning, hemolytic Practices* contact shedding symptoms with poor hygiene who contaminate their environment. strains) uremic syndrome Pediatric: (fecal/oral) If HUS: until 2 **Pediatric Precautions apply to children who are incontinent or unable to comply with hygiene. (HUS), thrombotic Foodborne Contact** stools negative for If HUS contact Site ICP. thrombocytopenic E.coli 0157:H7 or purpura 10 days from onset of diarrhea Fifth disease See Parvovirus.

German measles See Rubella Giardia Diarrhea Adult: Routine Feces Direct/indirect 3-25 days Enter period of Duration of *Consider Contact Precautions for incontinent adults if stool cannot be contained or for adults (Giardia lamblia) Practices* contact infection; often symptoms with poor hygiene who contaminate their environment. Pediatric: (fecal/oral) months **Pediatric Precautions apply to children who are incontinent or unable to comply with hygiene. Contact** Granuloma Painless genital ulcers,Routine Practices Sexual Unknown; Unknown; probably inguinale inguinal ulcers, transmission probably for the duration of (Donovanosis) nodules between 1-16 open lesions on the (Calymmato- weeks skin or mucous bacterium membranes granulomatis) Haemophilus Pneumonia, Adult: Routine Respiratory Large droplets, Variable Most infectious in Until 24 hours of Close contacts <48 months old and who are not immune may require chemoprophylaxis. influenza type b epiglottitis, Practices secretions direct contact the week prior to appropriate Reportable Disease if invasive disease for Haemophilus type-able organisms. (invasive infections) meningitis, onset of symptoms antimicrobial Contact Site ICP. bacteremia, septic and during therapy has been Pediatric: Droplet arthritis, cellulitis, symptoms until received osteomyelitis in a treated child

DATE ISSUED: February 1, 2006 Review by: November 2019 6.2.8 REVISION DATE: November 2016

Microorganism, Infectious Disease Table Winnipeg Regional Health Authority Acute Care Infection Prevention & Control Manual

Microorganism, Clinical Infective Route of Incubation Period of Duration of Infectious Precautions Comments Presentation Material Transmission Period Communicability Precautions Disease Hand, foot and See enteroviral infections. mouth disease Hansen’s Disease See Leprosy Hantavirus Fever, pneumonia Routine Practices Rodent excreta Presumed A few days to Not well defined, Infection acquired from rodents. (Hantavirus aerosol 6 weeks person-to-person is pulmonary transmission rare (documented syndrome) from rodent for S. American excreta strains) Helicobacter pylori Gastritis, duodenal Routine Practices Probable 5-10 days Unknown ulcer disease ingestion of organisms; presumed fecal-oral/oral- oral Hepatitis A, E Hepatitis, anicteric Adult: Routine Feces Direct/indirect A: 28-30 days A: Two weeks 1 week after *Consider Contact Precautions for incontinent adults if stool cannot be contained or for adults acute febrile Practices* contact E: 26-42 days before to1 week onset of jaundice: with poor hygiene who contaminate their environment. symptoms Pediatric: (fecal/oral) after onset of duration of **Pediatric Precautions apply to children who are incontinent or unable to comply with hygiene. jaundice; Shedding hospitalization if Contact** Post-exposure prophylaxis indicated for non-immune household contacts with significant is prolonged in the newborn exposure to hepatitis A if within 2 weeks of exposure. newborn Outbreaks of HAV in HCWs have been associated with eating and drinking in patient care areas. E: not known; at least 2 weeks before onset of symptoms Hepatitis B, C, D Hepatitis, often Routine Practices Blood, genital Mucosal or B: 2-3 months B: all persons who Follow the WRHA Post Exposure Prophylaxis Care Map/Blood & Body Fluid Exposure asymptomatic: secretions, and percutaneous C: 2 weeks to are HBsAg positive Management Policy. Report an exposure to infective material e.g., needle stick or blood cirrhosis, hepatic certain other exposure to 6 months are infectious; spill/splash immediately to Occupational and Environmental Safety and Health cancer body fluids infective body D: 2-8 weeks C: indefinite fluids: Sexual D: indefinite transmission: Vertical mother to child

DATE ISSUED: February 1, 2006 Review by: November 2019 6.2.9 REVISION DATE: November 2016

Microorganism, Infectious Disease Table Winnipeg Regional Health Authority Acute Care Infection Prevention & Control Manual

Microorganism, Clinical Infective Route of Incubation Period of Duration of Infectious Precautions Comments Presentation Material Transmission Period Communicability Precautions Disease Herpes simplex Encephalitis Adult: Routine virus Practices Pediatric: Contact Neonatal Contact Skin or mucosal Direct contact Birth to 6 Duration of Contact Precautions are also indicated for infants delivered vaginally (or by C-section if lesions; possibly weeks of age symptoms membranes have been ruptured more than 4-6 hours) to women with active genital HSV all body infections, until neonatal HSV infection has been ruled out. secretions and excretions Mucocutaneous: Contact Skin or mucosal Direct contact 2 days to 2 While lesions Until lesions are disseminated or lesions weeks present dry and crusted primary and Sexual extensive transmission (gingivostomatitis, Mother to child eczema herpeticum) at birth Recurrent Routine Practices Herpes zoster See Varicella zoster. Histoplasmosis Pneumonia, Routine Practices 3-17 days Not person-to- Acquired from spores in soil. (Histoplasma lymphadenopathy, person capsulatum) fever Hookworm Usually Routine Practices Percutaneous Few weeks to Not person-to- Larvae must hatch in soil to become infectious. (Necator asymptomatic Fecal/oral many months person americanus, Ancyclostoma duodenale) Human See Roseola herpesvirus 6 (HHV-6) Human Asymptomatic; Routine Practices Blood, genital Mucosal or Weeks to From onset of Continuous Immediately contact MOH or delegate if HCW has percutaneous, non-intact skin or mucous immunodeficiency multiple clinical secretions, percutaneous years infection membrane exposure. exposure to virus (HIV) presentations breast mild and Diagnosis of AIDS is a Reportable Disease: Refer to WRHA Reporting of a Communicable Disease infective body certain other to Manitoba Health by Infection Prevention & Control in Hospitals Operational Directives. fluids; Sexual body fluids Contact Site ICP. transmission; Vertical mother to child

DATE ISSUED: February 1, 2006 Review by: November 2019 6.2.10 REVISION DATE: November 2016

Microorganism, Infectious Disease Table Winnipeg Regional Health Authority Acute Care Infection Prevention & Control Manual

Microorganism, Clinical Infective Route of Incubation Period of Duration of Infectious Precautions Comments Presentation Material Transmission Period Communicability Precautions Disease Human meta- Respiratory tract Droplet and Respiratory Large droplets 3-5 days Duration of May cohort if infected with same virus. pneumovirus infection Contact secretions Direct/indirect symptoms contact Patient should not share room with high-risk roommates. Human T-cell Usually Routine Practices Breast milk, Vertical mother Weeks to Indefinite leukemia virus, asymptomatic, blood and to child; years human T- tropical spastic, certain other mucosal or lymphotrophic paraperisis body fluids percutaneous virus (HTLV-I, lymphoma exposure to HTLV-II) infective body fluids Infectious mononucleosis See Epstein-Bar Influenza Seasonal Respiratory tract Droplet and Respiratory Large droplets, 1-3 days Probably 3-5 days Duration of If private room is unavailable, consider cohorting patients during outbreaks. infection Contact secretions Direct/indirect from clinical onset symptoms Patient should not share room with high-risk roommates. contact in adults; up to 7 Consider anti-viral prophylaxis for exposed roommates. days in young children Refer to Specific Disease Protocol: Influenza (Seasonal). Pandemic Respiratory tract *Pandemic As seasonal As seasonal Unknown; Unknown, possibly Duration of Refer to Specific Disease Protocol: Pandemic Influenza. Novel influenza infection Influenza possibly 1-7 up to 7 days symptoms Viruses Precautions days Avian Respiratory tract Enhanced Droplet Excreta of sick For current information on Avian influenza see Human Health Issues Related to Domestic Avian H7N9 infection, and Contact birds, possibly Influenza in Canada, available at: http://www.phac-aspc.gc.ca/publicat/daio-enia/9-eng.php. conjunctivitis human respiratory tract secretions

Lassa fever See Viral hemorrhagic fever. Legionellosis Pneumonia, Routine Practices 2-10 days Not person-to- Acquired from contaminated water sources (inhalation not ingestion). (Legionella spp) Legionnaires’ person disease, Pontiac fever

DATE ISSUED: February 1, 2006 Review by: November 2019 6.2.11 REVISION DATE: November 2016

Microorganism, Infectious Disease Table Winnipeg Regional Health Authority Acute Care Infection Prevention & Control Manual

Microorganism, Clinical Infective Route of Incubation Period of Duration of Infectious Precautions Comments Presentation Material Transmission Period Communicability Precautions Disease Leprosy Chronic disease of Routine Practices Nasal secretions, Direct contact 9 months to Transmitted between persons only with very prolonged extensive close personal contact. (Hansen’s disease) skin, nerves, skin lesions 20 years Household contacts should be assessed and may be given prophylaxis. nasopharyngeal (Mycobacterium Reportable Disease: Refer to WRHA Reporting of a Communicable Disease to Manitoba Health by mucosa leprae) Infection Prevention & Control in Hospitals Operational Directives. Contact Site ICP. Leptospirosis Fever, jaundice, Routine Practices 2-30 days Direct person-to- Acquired from contact with animals and animal excretion. (Leptospira sp.) aseptic meningitis person transmission is rare

Lice (pediculosis) Scalp or body itch, Routine Practices Louse Head and body 6-10 days Until effective Until 24 hours Apply pediculicides as directed on label. If live lice found after therapy, repeat. Head itchy rash plus gloves for lice: treatment to kill after application Head lice: Wash headgear, combs, pillowcases, towels with hot water or dry clean or seal in Body direct patient Direct/indirect lice and ova of appropriate plastic bag and store for 10 days. Pubic (crab) contact only contact pediculicide; (Pediculus capitas, Body lice: as above, for all exposed clothing and bedding. Pubic lice: applied as Pediculus corporis, Refer to Specific Disease Protocol: Pediculosis. Usually sexual directed Pediculus contact humanus, Phthirus pubis) Listeriosis Fever, meningitis Routine Practices Listeria grows Foodborne Mean 21 days; Nosocomial outbreaks reported in newborn nurseries due to contaminated equipment or well at low (Listeria Congenital or Vertical mother 3-70 days materials. temperatures & monocytogenes) neonatal infection to child in utero following a can multiply in or at birth single exposure contaminated to an refrigerated implicated foods. food product Pregnant women and immune compromised people should avoid cheese made with unpasteurized milk; cold cuts & uncooked meat products, including hot dogs

DATE ISSUED: February 1, 2006 Review by: November 2019 6.2.12 REVISION DATE: November 2016

Microorganism, Infectious Disease Table Winnipeg Regional Health Authority Acute Care Infection Prevention & Control Manual

Microorganism, Clinical Infective Route of Incubation Period of Duration of Infectious Precautions Comments Presentation Material Transmission Period Communicability Precautions Disease Lyme disease Fever, arthritis, rash, Routine Practices Tick-borne To initial rash: Not person-to- Reportable Disease: Reported by diagnosing healthcare provider. (Borrelia meningitis 3-32 days; person Contact Site ICP. burgdorferi) mean 7-10

days Lymphocytic Aseptic meningitis Routine Practices Urine of rodents 6-12 days Not person-to- Acquired from contact with rodents. choriomeningitis person virus

Lymphogranuloma Genital ulcers, Routine Practices Sexually Range of 3-30 venereum (C. inguinal adenopathy transmitted days for a trachomatis primary lesion serovars L1, L2, L3) Malaria Fever Routine Practices Blood Mosquito-borne Variable; 9-14 Not normally Can be transmitted via blood transfusion. Rarely trans- (Plasmodium spp.) days for P. person-to-person placental from falciparum mother to fetus Blood transfusion Marburg virus See Viral haemorrhagic fever. Measles Fever, cough, Airborne Respiratory Airborne 7-18 days to 5 days before onset 4 days after start Reportable Disease: Refer to WRHA Reporting of a Communicable Disease to Manitoba Health by (Rubeola) coryza, secretions onset of fever; of rash (1-2 days of rash; duration Infection Prevention & Control in Hospitals Operational Directives. conjunctivitis, rarely as long before onset of of symptoms in Only immune HCWs, caretakers and visitors should enter the room. maculopapular skin as 21 days initial symptoms) immune N95 respirators required for non-immune persons who must enter. rash until 4 days after compromised Precautions should be taken with neonates born to mothers with measles infection at delivery. onset of rash patients Immunoprophylaxis is indicated for susceptible contacts. (longer in immune Refer to Specific Disease Protocol: Measles/Rubeola. compromised patients) Contact Site ICP. Susceptible contact Airborne Respiratory Airborne Potentially From 5 days after Only immune HCWs caretakers and visitors should enter the room. first exposure secretions communicable N95 respirators required for non-immune persons who must enter. during last 2 days through 21 days Precautions should be taken with neonates born to mothers with measles infection at delivery. of incubation after last period exposure Immunoprophylaxis is indicated for susceptible contacts. regardless of Refer to Specific Disease Protocol: Measles/Rubeola. post-exposure prophylaxis Contact Site ICP.

DATE ISSUED: February 1, 2006 Review by: November 2019 6.2.13 REVISION DATE: November 2016

Microorganism, Infectious Disease Table Winnipeg Regional Health Authority Acute Care Infection Prevention & Control Manual

Microorganism, Clinical Infective Route of Incubation Period of Duration of Infectious Precautions Comments Presentation Material Transmission Period Communicability Precautions Disease Melioidosis Pneumonia, fever Routine Practices Contaminated Variable Organism in soil in South-East Asia. (Pseudomonas soil Person-to-person has not been proven. pseudomallei) Meningococcus Rash (petechial/ Droplet Respiratory Large droplet, Usually 2-10 Until 24 hours of Close contacts may require chemoprophylaxis. (Neisseria purpuric) with fever secretions direct contact days effective Refer to Specific Disease Protocol: Meningitis – Meningococcal. meningitidis) Meningococcemia antimicrobial Reportable Disease if invasive. Refer to WRHA Reporting of a Communicable Disease to meningitis, therapy received Manitoba Health by Infection Prevention & Control in Hospitals Operational Directives. pneumonia Contact Site ICP. Methicillin See ARO. resistant S. aureus (MRSA) Middle Eastern Enhanced Droplet Respiratory Large droplet, 12 hours - 14 Not clearly Consult IP&C Contact Site ICP. Respiratory and Contact secretions Direct/indirect days; established; likely Refer to Managing MERS-CoV Presentations in WRHA Emergency Departments (June 11, 2015) Syndrome Precautions contact Most to extend from (MERS CoV)[3] common: onset of fever and 6 days until 10 days after fever resolves Molluscum Umbilicated papules Routine Practices Contents of Direct contact 2 weeks to 6 Unknown Requires close direct personal contact for transmission. contagiosum papules months Monkeypox Resembles small- *Contact, Droplet Lesions and Contact with *Contact: Until all Transmission in hospital settings is unlikely. See http://www.cdc.gov/ncidod/monkeypox. pox; and Airborne respiratory infected lesions crusted lymphadenopathy is secretions animals a more dominant Possible feature airborne transmission from animals to humans Mucormycosis Skin, wound, Routine Practices Fungal spores in Inhalation or Unknown Not person-to- Unknown Acquired from spores in dust, soil. (phycomycosis; rhinocerebral, dust and soil ingestion of person *Infections in immunocompromised patients. zygomycosis) pulmonary, fungal spores (Mucor, gastrointestinal Zygomycetes) disseminated infection * Mumps Swelling of salivary Droplet Saliva Large droplets, Usually 16-18 Viral excretion Droplet Precautions for exposed susceptible patients/health care workers should begin 10 days after first glands, orchitis, direct contact days; highest 2 days prior contact and continue through 26 days after last exposure. . Immune persons do not require PPE. meningitis range 12-25 to 5 days after Reportable Disease: Refer to WRHA Reporting of a Communicable Disease to Manitoba Health by Infection days onset of parotitis Prevention & Control in Hospitals Operational Directives. HCWs, roommates and visitors should be immune to mumps. Non-immune HCWs should not enter room if immune caregivers are available Refer to Mumps Protocol. Contact Site ICP.

DATE ISSUED: February 1, 2006 Review by: November 2019 6.2.14 REVISION DATE: November 2016

Microorganism, Infectious Disease Table Winnipeg Regional Health Authority Acute Care Infection Prevention & Control Manual

Microorganism, Clinical Infective Route of Incubation Period of Duration of Infectious Precautions Comments Presentation Material Transmission Period Communicability Precautions Disease Mycobacterium, Lymphadenitis; Routine Practices Unknown Not person-to- Acquired from soil, water, animal, reservoirs. non-tuberculosis pneumonia; person (atypical) disseminated disease in immune

compromised host Mycobacterium Confirmed or Airborne* Respiratory Airborne Weeks to While organisms Until deemed no Tuberculosis in young children is rarely transmissible; due to lack of cavitary disease and weak tuberculosis (also suspected secretions years are viable in longer infectious. cough. If confirmed TB, Mycobacterium respiratory sputum *If AGMP: see strategies to reduce aerosol generation. africanum, (including pleural, until 2 weeks of Reportable Disease: Refer to WRHA Reporting of a Communicable Disease to Manitoba Health by Mycobacterium laryngeal) effective therapy Infection Prevention & Control in Hospitals Operational Directives. bovis) is received & patient is clinically Contact Site Infection Control Professional (ICP). improving and has Refer to Specific Disease Protocol: Tuberculosis. 3 consecutive sputum smears negative for acid fast bacilli, collected 8 – 24 hours apart. If multi-drug resistant TB, until sputum culture negative Non-pulmonary: Routine Practices Aerosolized While viable Maintain Most patients with non-pulmonary disease alone are noncontagious; it is important to assess for precautions until meningitis, bone or wound drainage microorganism concurrent pulmonary tuberculosis. joint infection are in drainage drainage ceased *Airborne precautions if procedures which may aerosolize drainage are being performed. peritonitis, or there are 3 pericardial with no consecutive drainage negative acid fast bacilli smears of Non-pulmonary: Routine Practices drainage skin or soft tissue Airborne* draining lesions If multi-drug resistant TB, until culture negative PPD skin test Routine Practices Non positive with no communicable evidence of current pulmonary disease

DATE ISSUED: February 1, 2006 Review by: November 2019 6.2.15 REVISION DATE: November 2016

Microorganism, Infectious Disease Table Winnipeg Regional Health Authority Acute Care Infection Prevention & Control Manual

Microorganism, Clinical Infective Route of Incubation Period of Duration of Infectious Precautions Comments Presentation Material Transmission Period Communicability Precautions Disease Mycoplasma Pneumonia Droplet Respiratory Large droplets 1-4 weeks Unknown Duration of pneumonia secretions symptoms Neisseria Urethritis, cervicitis, Routine Practices Sexual 2-7 days May extend for gonorrhoeae pelvic inflammatory transmission, months if disease, arthritis, Mother to child untreated ophthalmia at birth Rarely: Effective treatment neonatorum, direct/indirect ends the conjunctivitis contact communicability Neisseria Rash (petechial/ Droplet Respiratory Large droplet, Usually 2-10 Until 24 hours of See Meningococcus. Close contacts may require chemoprophylaxis. meningitides purpuric) with fever secretions direct contact days effective Refer to Disease Specific Protocol: Meningitis – Meningococcal. Meningococcemia antimicrobial Reportable Disease if invasive. Refer to WRHA Reporting of a Communicable Disease to meningitis, therapy has been Manitoba Health by Infection Prevention & Control in Hospitals Operational Directives. pneumonia received Contact Site ICP. Nocardiosis Fever, pulmonary or Routine Practices Unknown Not person-to- Acquired from organisms in dust, soil. (Nocardia spp.) CNS infection or person disseminated disease Noroviruses Nausea, vomiting, Contact Feces Direct/indirect Usually 24-48 Duration of viral 48 hours after Special attention to cleaning. (Norwalk-life diarrhea contact hours; range shedding; usual 48 resolution of Usually outbreak associated. (fecal/oral) of 10-50 hours hrs. after diarrhea symptoms agents, Refer to Specific Disease Protocol: Diarrhea - Viral. Caliciviruses) resolves ORF (poxvirus) Skin lesions Routine Practices Generally 3-6 Not person-to- Acquired from infected animals. days person Parainfluenza virus Respiratory tract Droplet and Respiratory Large droplets, 2-6 days 1-3 weeks Duration of May cohort if infected with same virus. Minimize exposure of immunocompromised patients, Direct/indirect children with chronic cardiac or lung disease, neonates. infection Contact secretions symptoms contact Patient should not share room with high-risk roommates. Parvovirus B-19 Erythema Routine Practices: Respiratory Large droplets, 4-21 days to Fifth disease: no Aplastic or longer infectious Human parvovirus infectiosum (fifth Fifth disease secretions direct contact; onset of rash erythrocytic crisis: once rash appears disease) Vertical mother 7 days to fetus Aplastic crisis: Up Aplastic or Droplet: Aplastic Chronic infection to 1 week after erythrocytic crisis crisis or chronic in immune- onset of crisis infection in compromised Immune immune patient: duration compromised with compromised of hospitalization chronic infection: patient months to years

DATE ISSUED: February 1, 2006 Review by: November 2019 6.2.16 REVISION DATE: November 2016

Microorganism, Infectious Disease Table Winnipeg Regional Health Authority Acute Care Infection Prevention & Control Manual

Microorganism, Clinical Infective Route of Incubation Period of Duration of Infectious Precautions Comments Presentation Material Transmission Period Communicability Precautions Disease Pediculosis See lice. Pertussis Whooping cough, Droplet Respiratory Large droplets Average 9-10 To 3 weeks after To 3 weeks after Close contacts (household and HCWs) may need chemoprophylaxis and/or immunization. onset of (Bordetella non-specific secretions days; range 6- onset of paroxysms If HCWs immunization not up to date refer to OESH/delegate. respiratory tract 20 days if not treated paroxysms if not pertussis B. Reportable Disease: Refer to WRHA Reporting of a Communicable Disease to Manitoba Health by infection in infants, treated; or until 5 parapertussis) Infection Prevention & Control in Hospitals Operational Directives. adolescents and days of adults appropriate Contact Site Infection Control Professional (ICP) antimicrobial therapy received Pinworms See Enterobius vermiculoys. Plague Bubonic Routine Practices Fleas 1-7 days (Yersinia pestis) (lymphadenitis) Pneumonic (cough, Droplet Respiratory Large droplets 1-4 days Until 48 hours of Until 48 hours of Reportable Disease: Refer to WRHA Reporting of a Communicable Disease to Manitoba Health by fever, hemoptysis) secretions appropriate appropriate Infection Prevention & Control in Hospitals Operational Directives. antimicrobial antimicrobial Close contact and exposed HCWs may require prophylaxis; contact OESH. therapy received therapy received Pneumocystis Pneumonia in Routine Practices Unknown Unknown Ensure roommates are not immune compromised. jirovecii (carinii) immune compromised host Poliomyelitis Fever, aseptic Contact Feces, Direct/indirect 3-35 days Virus in the throat Until 6 weeks Most infectious during the days before and after onset of symptoms. Infantile paralysis meningitis, flaccid respiratory contact for approximately 1 from onset of Close contacts who are not immune should receive immunoprophylaxis. paralysis secretions week and in feces symptoms or until Reportable Disease: Refer to WRHA Reporting of a Communicable Disease to Manitoba Health for 3-6 weeks feces viral culture by Infection Prevention & Control in Hospitals Operational Directives. negative Contact Site ICP. Prion disease See CJD. Psittacosis See Chlamydia psittaci. Q Fever Pneumonia, fever Routine Practices Infected animals Direct contact 14-39 days Not person-to- Acquired from contact with infected animals or from ingestion of raw milk. with infected (Coxiella burnetii) unpasteurized person *Airborne precautions when performing autopsies on a patient that has died of Q fever. milk animals; raw *Airborne milk Airborne from aerosolized contaminated dust or during autopsies

DATE ISSUED: February 1, 2006 Review by: November 2019 6.2.17 REVISION DATE: November 2016

Microorganism, Infectious Disease Table Winnipeg Regional Health Authority Acute Care Infection Prevention & Control Manual

Microorganism, Clinical Infective Route of Incubation Period of Duration of Infectious Precautions Comments Presentation Material Transmission Period Communicability Precautions Disease Rabies Acute Routine Practices Saliva Mucosal or Usually 3-8 Person-to-person Acquired from contact with infected animals. encephalomyelitis percutaneous weeks, rarely transmission is Post-exposure prophylaxis is recommended for percutaneous or mucosal exposure to saliva of exposure to as short as 9 theoretically rabid animal or patient. saliva; corneal, days or as possible, but not Reportable Disease: Refer to WRHA Reporting of a Communicable Disease to Manitoba Health tissue & organ long as 7 years well documented. by Infection Prevention & Control in Hospitals Operational Directives. transplant Contact Site ICP. Rat Bite fever Fever, arthralgia Routine Practices Saliva of infected Rodent bite,A. A. monili- Not person-to- A. moniliformic: rats and other animals, contaminated milk. Actinobacillus rodents; ingestion of formis 3-10 person S. minus: rats, mice only. contaminated contaminated days, rarely (formerly milk milk longer S. minus Streptobacillus) 1-3 weeks moniliformis; Spirillum minus Relapsing fever Recurrent fevers Routine Practices Vector-borne Not person-to- Spread by ticks or lice. (Borellia person recurrentis, other Borellia species) Respiratory Respiratory tract Droplet and Respiratory Large droplets, 2-8 days Until symptoms Duration of May cohort if infected with same virus. syncytial virus infection, Contact secretions Direct/indirect cease symptoms Patient should not share room with high-risk roommates. (RSV) contact Rhinovirus Respiratory tract Contact and Respiratory Direct/indirect 2-3 days Until symptoms Duration of May cohort if infected with same virus. infection, common Droplet secretions contact, cease symptoms Patient should not share room with high-risk roommates. cold possibly large droplets Rickettsialpox Fever, rash Routine Practices Mite-borne 9-14 days Not person-to- Transmitted by mouse mites. Rickettsia akari person Ringworm See Tinea. Rocky Mountain Fever, petechial Routine Practices Tick-borne 3-14 days Not transmitted Spotted Fever rash, encephalitis from person-to- Rickettsia rickettsii person except rarely through transfusion Roseola infantum Rash, fever Routine Practices Saliva Direct Contact 10 days Unknown Transmission requires close direct personnel contact. (HHV-6)

DATE ISSUED: February 1, 2006 Review by: November 2019 6.2.18 REVISION DATE: November 2016

Microorganism, Infectious Disease Table Winnipeg Regional Health Authority Acute Care Infection Prevention & Control Manual

Microorganism, Clinical Infective Route of Incubation Period of Duration of Infectious Precautions Comments Presentation Material Transmission Period Communicability Precautions Disease Rotavirus Diarrhea Contact Feces Direct/indirect 1-3 days Duration of viral Duration of Refer to Specific Disease Protocol: Diarrhea - Viral. contact (fecal- shedding symptoms oral) Roundworm See Ascariasis. Rubella Fever, Droplet Respiratory Large droplets, 14-21 days For about 1 week Until 7 days after Contact Site ICP. Only immune HCWs, caretakers and visitors should enter the room. Acquired maculopapular rash secretions direct contact before and after onset of rash Pregnant HCWs should not care for rubella patients regardless of their immune status. HCWs, onset of rash roommates and caregivers should be immune to Rubella. Droplet precautions should be maintained for exposed susceptible patients for 7 days after first contact through to 21 days after last contact. Refer to Disease Specific Protocol: Rubella. Administer vaccine to exposed susceptible non-pregnant persons within 3 days of exposure. Exclude susceptible HCWs from duty from day 7 after first exposure to day 21 after last exposure, regardless of post-exposure vaccination. Reportable Disease: Refer to WRHA Reporting of a Communicable Disease to Manitoba Health by Infection Prevention & Control in Hospitals Operational Directives. Congenital rubella Droplet and Respiratory Direct/indirect Prolonged Until 1 year old, Refer to Specific Disease Protocols: Rubella. unless syndrome Contact secretions, urine contact; large shedding in Reportable Disease: Refer to WRHA Reporting of a Communicable Disease to Manitoba Health by nasopharyngeal Congenital droplets respiratory tract Infection Prevention & Control in Hospitals Operational Directives. and urine; can be and urine cultures Contact Site ICP. up to one year are negative after 3 months of age Rubeola See Measles. Salmonella spp. Diarrhea, enteric Adult: Routine Feces Direct/indirect 6-72 hours Variable Duration of *Consider Contact Precautions for incontinent adults if stool cannot be contained or for adults Practices* contact symptoms with poor hygiene who contaminate their environment. (including fever, typhoid fever, Pediatric: (fecal/oral) **Pediatric Precautions apply to children who are incontinent or unable to comply with hygiene. Salmonella typhi) food poisoning Contact** Food borne Refer to Disease Specific Protocol: Diarrhea – Bacterial. Scabies Itchy skin rash Contact Mite Direct/indirect Without Until mites and Until 24 hours Apply scabicide as directed on label. eggs destroyed by (Sarcoptes scabies) contact previous after initiation of Wash clothes and bedding in hot water, dry clean or seal in a plastic bag, and store for 1 week. exposure, 2-6 treatment, usually appropriate Household contact and exposed staff should be treated. weeks; 1-4 after 1/occasionally therapy. 2 treatment Refer to Specific Disease Protocol: Scabies. days after re- For Norwegian courses, 1 week exposure Scabies: Until skin apart. lesions have Norwegian Scabies: resolved and skin Until mites & eggs scrapings are destroyed by negative treatment Scarlet fever See Streptococcus, group A.

DATE ISSUED: February 1, 2006 Review by: November 2019 6.2.19 REVISION DATE: November 2016

Microorganism, Infectious Disease Table Winnipeg Regional Health Authority Acute Care Infection Prevention & Control Manual

Microorganism, Clinical Infective Route of Incubation Period of Duration of Infectious Precautions Comments Presentation Material Transmission Period Communicability Precautions Disease Schistosomiasis Diarrhea, fever, Routine Practices Not person-to- Contact with larvae in contaminated water. (bilharziasis) itchy rash, person (Schistoma spp.) hepatosplenomegaly hematuria Shigellosis Diarrhea Adult: Routine Feces Direct/indirect 1-3 days Usually 4 weeks if Duration of *Consider Contact Precautions for incontinent adults if stool cannot be contained or for adults Shigella spp. Practices* contact not treated symptoms with poor hygiene who contaminate their environment. Pediatric: (fecal/oral) **Pediatric Precautions apply to children who are incontinent or unable to comply with hygiene. Contact** Refer to Specific Disease Protocol: Diarrhea – Bacterial. Treatment with effective antimicrobial shortens period of infectivity. Shingles See varicella zoster. Severe Acute Malaise, myalgia, Contact and Respiratory Droplet, 3-10 days Not yet 10 days following *If AGMP: refer to Appendix A: Aerosol Generating Medical Procedures. Respiratory headache, fever, Droplet secretions, stool Direct/indirect determined; resolution of fever Single room; may cohort if infected with same virus. Syndrome (SARS) respiratory *AGMP contact suggested to be is respiratory Reportable Disease Refer to WRHA Reporting of a Communicable Disease to Manitoba Health by Coronavirus) symptoms (cough, less than 21 days symptoms have Infection Prevention & Control in Hospitals Operational Directives. increasing shortness Aerosols during also resolved Contact Site ICP. of breath), AGMP pneumonia, ARDS Smallpox Fever, Droplet, Contact Skin lesions, Airborne, direct 7-10 days Onset of mucosal Until all scabs Contact Site ICP. See Vaccinia for management of vaccinated persons. (Variola virus) vesicular/pustular in and Airborne oropharyngeal and indirect lesions, until all have crusted and HCW immunization stopped in 1977. Generalized appropriate secretions contact skin lesions have separated (3-4 Care should preferably be provided by immune HCWs. Non-vaccinated HCWs should not provide vaccinia, eczema epidemiologic crusted weeks) care if immune HCWs are available. vaccinatum context N95 respirator for all regardless of vaccination status. Reportable Disease: Refer to WRHA Reporting of a Communicable Disease to Manitoba Health by Infection Prevention & Control in Hospitals Operational Directives. Staphylococcus Skin (furuncles, Minor: Routine Drainage, pus Direct/indirect Variable As long as Until drainage *Major: drainage not contained by dressing. aureus impetigo) wound or Practices contact organism is in the resolved or If methicillin resistant, also see ARO. burn infection; exudates or contained by abscess; scalded skin Major: Contact* drainage dressings syndrome, osteomyelitis Endometritis Routine Practices Food poisoning Routine Practices Foodborne Pneumonia Adult: Routine Respiratory Large droplets, Variable Until 24 hours of Practices secretions direct contact appropriate Paediatric: Droplet antimicrobial therapy received Toxic shock Routine Practices Contact Site ICP. syndrome

DATE ISSUED: February 1, 2006 Review by: November 2019 6.2.20 REVISION DATE: November 2016

Microorganism, Infectious Disease Table Winnipeg Regional Health Authority Acute Care Infection Prevention & Control Manual

Microorganism, Clinical Infective Route of Incubation Period of Duration of Infectious Precautions Comments Presentation Material Transmission Period Communicability Precautions Disease Sporotrichosis Skin lesions, Routine Practices Variable Rarely transmitted Acquired from spores in soil, on vegetation. Sporothrix Schenkii disseminated person-to-person Streptobacillus See Rat-bite fever. moniliformis disease Streptococcus Pneumonia, Routine Practices Variable Normal flora. pneumoniae meningitis and other Streptococcus, Skin (e.g., erysipelas, Minor: Routine Drainage, pus Direct/indirect 1-3 days, As long as Until 24 hours of *Major = drainage not contained by dressings. Group A impetigo), wound or Practices contact rarely longer organism is in appropriate (Streptococcus burn infection Major: Contact* drainage antimicrobial pyogenes) therapy received Scarlet fever, Adult: Routine Respiratory Large droplets 2-5 days 10-21 days if not Until 24 hours of pharyngitis in Practices secretions treated appropriate children under 5 Pediatric: Contact antimicrobial years and Droplet therapy received GAS – Endometritis Routine Practices (puerperal fever) GAS – Toxic shock, Droplet and Respiratory Large droplets, Until 24 hours of invasive disease Contact secretions, direct or appropriate (including wound drainage indirect contact antimicrobial necrotizing fasciitis, therapy received myositis, meningitis, pneumonia) Streptococcus GB S Newborn Routine Practices Mother to child Early onset Normal flora. Group B sepsis, pneumonia, at birth 1-7 days of (Streptococcus meningitis age; late onset agalactiae 7 days to 3 months of age Strongyloides Usually Routine Practices Larvae in feces Unknown Rarely transmitted Infective larvae in soil. (Strongyloides asymptomatic. May person-to-person stercoralis) cause disseminated disease presenting as gram negative bacteremia meningitis in immune compromised patients

DATE ISSUED: February 1, 2006 Review by: November 2019 6.2.21 REVISION DATE: November 2016

Microorganism, Infectious Disease Table Winnipeg Regional Health Authority Acute Care Infection Prevention & Control Manual

Microorganism, Clinical Infective Route of Incubation Period of Duration of Infectious Precautions Comments Presentation Material Transmission Period Communicability Precautions Disease Syphilis Genital, skin or Routine Practices Genital Direct contact 10-90 days; When moist (Treponema mucosal lesions, *Gloves for direct secretions lesion with infectious usually 3 mucocutaneous pallidum) disseminated contact with skin exudates exudates or weeks lesions of primary disease, neurological lesions lesions; and secondary or cardiac disease; Sexual syphilis are present latent infection transmission, Intrauterine or intrapartum from mother to child Tapeworm Usually Routine Practices Larvae in food Foodborne Variable Not transmissible Consumption of larvae in raw or undercooked beef or pork or raw fish; larvae develop into adult Taenia saginata asymptomatic person-to-person tapeworms in gastrointestinal tract. Taenia solium Individuals with T. solium adult tapeworms may transmit cysticercosis to others. Diphyllobothrium latum Usually Routine Practices Ova in rodent or Direct contact 2-4 weeks While ova in feces Hymenolepsis nana asymptomatic human feces (fecal/oral) Tetanus Tetanus Routine Practices 1 day to Not person-to- Acquired from spores in soil which germinate in wounds, devitalized tissue. Clostridium tetani several person Reportable Disease: Refer to WRHA Reporting of a Communicable Disease to Manitoba Health by months Infection Prevention & Control in Hospitals Operational Directives. Contact Site ICP. Tinea Ringworm (skin, Routine Practices Organism in skin Direct skin-to Variable 4-14 While lesion May be acquired from animals, shared combs, brushes, clothing hats, sheets, shower stalls. (Dermatophytosis) beard, scalp, groin, or hair skin contact days present Trichophyton spp., perineal region); Microsporum spp. athletes foot; Malassezia furur pityriasis versicolor Toxic Shock See Staphylococcus aureus, Group A Streptococcus. Syndrome Toxocariasis Fever, wheeze, rash, Routine Practices Ova in dog/cat Unknown Not person-to- Acquired from contact with dogs, cats. (Toxocara canis, eosinophilia feces person Toxocara cati) Toxoplasmosis Asymptomatic, Routine Practices Ingestion Intrauterine 5-23 days Acquired to contact with infected felines or soil contaminated by felines, consumption of raw (Toxoplasma fever, lymph- contaminated transmission meat, contaminated raw vegetable or contaminated water. gondii) adenopathy; food or water; from mother to retinitis, encephalitis cat feces fetus; in immune- transplantation compromised host; of stem cells or congenital infection organs

DATE ISSUED: February 1, 2006 Review by: November 2019 6.2.22 REVISION DATE: November 2016

Microorganism, Infectious Disease Table Winnipeg Regional Health Authority Acute Care Infection Prevention & Control Manual

Microorganism, Clinical Infective Route of Incubation Period of Duration of Infectious Precautions Comments Presentation Material Transmission Period Communicability Precautions Disease Trachoma See Chlamydia trachomatis. Transmissible See Creutzfeld-Jacob disease. spongiform encephalopathy Trench fever Relapsing fevers, Routine Practices Feces of human Louse-borne 7-30 days Not person-to- (Bartonella rash body lice person in absence Quintana) of lice Trichinosis Fever, rash, diarrhea Routine Practices Infected meat Food-borne 5-45 days Not person-to- Acquired from consumption of infected meat. (Trichinella spiralis) person Trichomoniasis Vaginitis Routine Practices Sexually 4-20 days Duration of (Trichomonas transmitted infection vaginalis) Trichuriasis Abdominal pain Routine Practices Unknown Not person-to- Ova must hatch in soil to be infective. (whipworm) diarrhea person (Trichuris trichiura) Tuberculosis See Mycobacterium tuberculosis. Tularemia Fever, lymph- Routine Practices 1-14 days Not person-to- Acquired from contact with infected animals. (Francisella adenopathy person F. tularensis is hazardous to laboratory workers. Notify laboratory if diagnosis is suspected. tularensis) pneumonia Typhoid/ See Salmonella. paratyphoid fever Typhus fever Fever, rash Routine Practices Rat fleas Flea borne From 1-2 Not transmitted Endemic flea-borne weeks, person-to-person typus (Rickettsia commonly 12 prowazekii) days Epidemic Louse- Fever, rash Routine Practices Human body Louse borne 1-2 weeks Person-to-person through close personal contact, not transmitted in absence of louse. Borne Fever louse Vaccinia Range of adverse Airborne and Skin exudate Direct/indirect 3-5 days Until all skin lesions Until all skin Vaccinia may be spread by touching a vaccination site before it has healed or by touching reactions to smallpox Contact contact resolved and scabs lesions resolved bandages or clothing that may have been contaminated with live virus from the smallpox vaccine (e.g., separated and scabs vaccination site. eczema vaccination, separated Immunization of health care workers was stopped in 1977. generalized or progressive vaccinia, other) Vancomycin- Infection or Routine Infected or Direct/indirect Variable Duration of As directed by ICP resistant colonization of any colonized contact colonization enterococci (VRE) body site secretions, excretions

DATE ISSUED: February 1, 2006 Review by: November 2019 6.2.23 REVISION DATE: November 2016

Microorganism, Infectious Disease Table Winnipeg Regional Health Authority Acute Care Infection Prevention & Control Manual

Microorganism, Clinical Infective Route of Incubation Period of Duration of Infectious Precautions Comments Presentation Material Transmission Period Communicability Precautions Disease Vancomycin- Infection or Contact Infected or Direct/indirect Variable Duration of As directed by ICP Theoretical, to date not reported in Canada. resistant colonized colonization of any contact colonization Notify local public health authorities immediately. Staphylococcus body site secretions, aureus (VRSA) excretions Varicella-zoster Fever with vesicular Airborne and Skin lesions Airborne, 10-21 days 1-2 days before Until all lesions HCWs, roommates and caregivers should be immune to chickenpox. virus rash Contact drainage Direct/indirect rash and until skin have crusted and Susceptible high-risk contacts should receive varicella zoster immunoglobulin as soon as possible, lesions have dried latest within 96 hours of exposure. Varicella zoster immunoglobulin may extend the incubation Varicella respiratory contact; secretions crusted. May be period to 28 days. (chickenpox) prolonged in Newborns: Airborne precautions should be taken with neonates born to mothers with varicella immune- onset < 5 days before delivery. Prevent exposure of susceptible persons & immunosuppressed compromised patients. patients Refer to Specific Disease Protocol: Varicella Zoster Virus - Chickenpox Vesicular skin Airborne and Vesicle fluid, Airborne, Until all lesions Until all lesions HCWs, roommates and caregivers should be immune to chickenpox. Non-immune HCWs should Herpes Zoster lesions Contact respiratory Direct/indirect have crusted and have crusted and not enter room if immune caregivers are available. If non-immune persons enter room they must (shingles), secretions contact dried dried wear N95 respirator. disseminated Susceptible high-risk contacts should receive varicella zoster immunoglobulin as soon as possible, latest with 96 hours of exposure. Varicella zoster immunoglobulin may extend the incubation period to 28 days. Refer to Specific Disease Protocol: Varicella Zoster Virus - Shingles Vesicular skin Airborne and Vesicle fluid Direct/indirect Until all lesions Until 24 hours Localized zoster may disseminate in immunocompromised host if not treated. Herpes zoster lesions in Contact* contact, crusted and dried, after antiviral HCWs, roommates and caregivers should be immune to chickenpox. dermatomal airborne and disseminated therapy started; Susceptible high-risk contacts should receive varicella zoster immunoglobulin as soon as possible, Localized – distribution infection ruled out then per localized latest within 96 hours of exposure. Varicella zoster immunoglobulin may extend the incubation Immune zoster in normal period to 28 days. Refer to Specific Disease Protocol: Varicella Zoster Virus – Shingles. compromised host host *Consider contact and airborne for cases of extensive localized zoster that cannot be covered, in Vesicular skin Routine Practices Vesicle fluid Direct/indirect Until all lesions Until all lesions situations where there are varicella susceptible patients/HCWs. Normal Host lesions in Contact and contact, crusted and dried have crusted and Refer to Specific Disease Protocol: Varicella Zoster Virus – Shingles. dermatomal Airborne possibly dried distribution airborne Susceptible contact: Airborne Respiratory Airborne 10-21 days Potentially 8 days after first Airborne precautions should be taken with neonates born mothers with varicella onset <5 days

(No history of Varicella secretions communicable contact until 21 days before delivery. Varicella or herpes illness, immunization after last contact during last 2 days HCWs, roommates and caregivers should be immune to chickenpox. zoster contact* or VZV IgG antibodies with rash regardless of incubation Refer to Specific Disease Protocol: Varicella Zoster Virus. and exposed to a of post-exposure person with period. vaccination (28 days chickenpox or if given varicella disseminated zoster. zoster immunoglobulin)

DATE ISSUED: February 1, 2006 Review by: November 2019 6.2.24 REVISION DATE: November 2016

Microorganism, Infectious Disease Table Winnipeg Regional Health Authority Acute Care Infection Prevention & Control Manual

Vibrio parahaemo- Diarrhea, food Routine Practices Contaminated Foodborne Between 12 Refer to Specific Disease Protocol: Diarrhea – Bacterial. lyticus enteritis poisoning food, especially and 24 hours; seafood range from 4- 30 hours Vincent’s angina Routine Practices (trench mouth) Viral hemorrhagic Hemorrhagic fever Contact & Droplet Blood and Direct/indirect Lassa 1-3 Unknown, possibly Until symptoms Reportable Disease: Refer to WRHA Reporting of a Communicable Disease to Manitoba Health by Infection Prevention & Control in Hospitals Operational Directives. fevers and Airborne if bloody body contact Weeks several weeks resolve Local public health authorities should be notified immediately. Lassa, Marburg, pneumonia fluids, Possibly Contact Site ICP. Refer to: IP&C Ebola Virus Disease (EVD) Algorithm Crimean-Congo Contact and respiratory Airborne if Lassa virus may be Infection Prevention & Control Management of Ebola Virus Disease (EVD) in EVD – Designated In- viruses Droplet and secretions pneumonia excreted in urine Patient Areas Operational Directive Airborne and Ebola Lassa: also urine Ebola 2-21 Ebola Lassa: Sexual for 3-9 weeks after Infection Prevention & Control Management of Ebola Virus Disease (EVD) in NON EVD – Precautions days Ebola: also skin contact onset Designated In-Patient Areas Operational Directive. West Nile See Arboviruses. Whipworm See Trichuriasis. Whooping Cough See Pertussis. Yersinia Diarrhea, Adult: Routine Feces Direct/indirect 3-7 days, Duration of Duration of *Consider Contact Precautions for incontinent adults if stool cannot be contained or for adults enterocolitica; mesenteric adenitis Practices* contact generally excretion in stool symptoms with poor hygiene who contaminate their environment. Y. pseudo- Pediatric: (fecal/oral under 10 days **Pediatric Precautions apply to children who are incontinent or unable to comply with hygiene. tuberculosis Contact** foodborne) Yellow Fever [7] Fever, chills, severe Routine Practices Blood, tissues Vector-borne Typically 3–6 Not person-to- Also see Arboviruses. headache, back & (spread by days person except Reportable Disease: Refer to WRHA Reporting of a Communicable Disease to Manitoba Health by body aches, nausea, mosquitoes) rarely by blood Infection Prevention & Control in Hospitals Operational Directives. vomiting, fatigue, transfusion or Vaccine preventable. weakness, organ Endemic in tropical areas of Africa and Central and South America. Occasionally travelers who hemorrhagic fever transplantation visit yellow fever endemic countries may bring the disease to countries free from yellow fever. Zika Virus Routine Practices Vector-borne Primarily transmitted from the bite of an infected Aedes mosquito, commonly found in tropical (spread by and sub-tropical regions. mosquitoes) Zoster See Varicella (herpes zoster). Zygomycosis See Mucormycosis. (Phycomycosis) DATE ISSUED: February 1, 2006 Review by: November 2019 6.2.25 REVISION DATE: November 2016

Microorganism, Infectious Disease Table Winnipeg Regional Health Authority Acute Care Infection Prevention & Control Manual

Microorganism, Clinical Infective Route of Incubation Period of Duration of Infectious Precautions Comments Presentation Material Transmission Period Communicability Precautions Disease

References: 1. Emerging multidrug-resistant Candida auris: information on infection control practices. (2016, July 14) Provincial Infection Control Network of British Columbia. . Available at: https://www.picnet.ca/candida-auris-ipc-info/. 2. Infection Control and Hospital Epidemiology, Vol. 35, No. S1, Cystic Fibrosis Foundation Guideline (August 2014), pp. S1-S67. Available at: http://www.jstor.org/stable/10.1086/676882?seq=1#page_scan_tab_contents. 3. Infection Prevention and Control Guidance for Middle East Respiratory Syndrome Coronavirus (MERS-CoV) in Acute Care Settings. (2016, May 17). Public Health Agency of Canada. Available at: http://healthycanadians.gc.ca/publications/diseases-conditions-maladies-affections/accute-care-settings-middle-east-respiratory- syndrome-respiratoire-moyen-orient-etablissements-soins-actifs/index-eng.php#s2. 4. Prevention and Control of Occupational Infections in Health Care. CCDR volume 28S1. (2002, March). Public Health Agency of Canada. Available at: http://www.mtpinnacle.com/pdfs/cdc-infection-cont.pdf. 5. Red Book® 2015 Committee on Infectious Diseases; American Academy of Pediatrics; David W. Kimberlin, MD, FAAP; Michael T. Brady, MD, FAAP; Mary Anne Jackson, MD, FAAP; Sarah S. Long, MD, FAAP . Available at: http://redbook.solutions.aap.org/. 6. Routine Practices and Additional Precautions: Preventing the Transmission of Infection in Health Care. (2012 April). Manitoba Health. Available at: http://www.gov.mb.ca/health/publichealth/cdc/docs/ipc/rpap.pdf. 7. Yellow Fever Fact Sheet. (2015, August). Centers for Disease Control and Prevention CDCO). Available at: http://www.cdc.gov/yellowfever/symptoms/index.html.

DATE ISSUED: February 1, 2006 Review by: November 2019 6.2.26 REVISION DATE: November 2016