Deschutes County Health Services COMMUNICABLE DISEASE EXCLUSION GUIDELINES FOR SCHOOLS AND CHILD CARE SETTINGS

Symptoms requiring exclusion of a child from school or childcare setting until either diagnosed and cleared by a licensed health care provider or recovery. FEVER: ANY fever greater than 100.5 F., may return when temperature decreases without use of fever-reducing medicine. VOMITTING: > 2 in the preceding 24 hours, unless determined to be from non-communicable conditions. May return when resolved. DIARRHEA: 3 or more watery or loose stools in 24 hours. May return when resolved for 24 hours. STIFF NECK: or headache with accompanying fever. May return after resolution of symptoms or diagnosis made and clearance given. RASHES: ANY new onset of rash if accompanied by fever; may return after rash resolves or if clearance given by health care providers. SKIN LESIONS: Drainage that cannot be contained within a bandage. JAUNDICE: Yellowing of eyes or skin. May return after diagnosis from physician and clearance given. BEHAVIOR CHANGE: Such as new onset of irritability, lethargy or somnolence. COUGH /SOB: Persistent cough with or without fever, serious sustained coughing, shortness of breath, or difficulty breathing. SYMPTOMS or complaints that prevent the student from active participation in usual school activities, or student requiring more care than the school staff can safely provide.

Inform local county health department, (LHD), of all diseases listed as reportable. The local county health department should be consulted regarding any written communication that may be developed to inform parents/guardians about disease outbreaks, risk to students, families, and staff and/or control measures specific to an outbreak.

DISEASE / CONDITION EXCLUDE SYMPTOMS TRANSMISSION PREVENTION RECOMMENDED SCHOOL COMMON NAME RESTRICTION INCUBATION PRECAUTIONARY CONTROL MEASURES MEDICAL TERMINOLOGY REPORT COMMUNICABILITY MEASURES ABSCESSES / BOILS EXCLUDE: For open Open, pimple-like sores Direct contact with Cover wounds. No foodservice duties while lesions are DRAINING WOUNDS draining wounds, that are swollen, infectious bodily fluids. present. tender; may be crusted Proper handwashing. STAPH SKIN INFECTION RESTRICTION: MAY or draining pus. Indirect contact with Good personal hygiene. INCLUDING MRSA ATTEND: articles contaminated with If drainage can be drainage. Proper handwashing contained within bandage; Communicable as long as or lesion is dry and sores are open, draining and crusted without drainage. untreated REPORT: NO AIDS / HIV EXCLUDE: NO HIV infection in Bloodborne Pathogen Children infected with Standard Precautions while dealing children is a broad Sexual contact, mucous HIV are at an increased with blood or body fluids. ACQUIRED IMMUNE RESTRICTION: NO spectrum of disease membrane contact with risk of experiencing DEFICIENCY SYNDROME REPORT: YES HCP and clinical course. blood or other body fluids severe complications from Report all exposures of body fluid

should report NOT AIDS represents the with high titers of HIV, infections such as contact to broken skin / mucous

school nurse to LHD most severe end of the percutaneous (needles or varicella, tuberculosis, membranes to Risk Management. In the absence of blood clinical spectrum of other sharp instruments), measles, CMV and herpes exposure, HIV infection is not this disease. and mother-to-infant. simplex virus. See: “Guidelines for Schools with acquired through the types of contact that usually occur in a Schools should develop Children who have bloodborne school setting; including Communicable lifetime; procedures for notifying infections” – Oregon Health Division. contact with saliva or tears. With changing infectivity parents of communicable Hence, children with HIV based on viral load. diseases such as varicella infection should not be and measles. excluded from school for the protection of others. AAP-Redbook 2006, p.396

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DISEASE / CONDITION EXCLUDE SYMPTOMS TRANSMISSION PREVENTION RECOMMENDED SCHOOL COMMON NAME RESTRICTION INCUBATION PRECAUTIONARY CONTROL MEASURES MEDICAL TERMINOLOGY REPORT COMMUNICABILITY MEASURES ATHLETE’S FOOT EXCLUDE: NO Scaling, cracking skin Direct contact with lesions Proper foot hygiene. Routine disinfection of school showers between toes with Clean, dry feet and socks. and floors with approved antifungal TINEA PEDIS RESTRICTION: NO burning and itching. Indirect contact with agents. Fungal infection of the feet. REPORT: NO Similar in nature to Tinea Blistering with thin contaminated articles Use of drying absorbent corporis (ringworm of skin). watery fluid. (shower and gym floors). antifungal powders. Recommend use of thongs in showers.

Communicable until treated Use own towels and Prohibit walking barefoot, sharing of with antifungal medications. socks. towels, socks or shoes. CHICKEN POX Rash is a thin-walled, easily ruptured, blister-like Direct contact with Vaccine recommended to The vaccine is 95% effective in VARICELLA rash, or red rash usually beginning on trunk; blisters infectious body fluids, individuals 12 months preventing MODERATE to SEVERE Primary infection results in scab over. Heaviest on trunk. drainage from blisters. and older. DISEASE, but only 70% to 85% a generalized rash. Indirect contact with items effective in preventing MILD to EXCLUDE: YES, contaminated with secretion. Good Handwashing MODERATE disease. See Also SHINGLES Airborne Chickenpox may Avoid touching sores. The recurrent infection with CASE: until a minimum of 5 days after first vesicles be transmitted through nasal Cases of varicella may occur in some the virus is called shingles. (pox) appear, or until all pox are dry. Whichever secretions. Cover mouth and nose vaccinated persons following exposure occurs last. when coughing, or to wild-type virus. This is called The virus is believed to have Incubation 14-16 days sneezing. breakthrough infection. Breakthrough a short survival time outside CONTACTS: In an outbreak situation consultation range 10-21 days. infection is varicella to wild-type the infected host. Humans with LHD for exclusion. Teachers of young varicella zoster virus and usually are the only source for this Communicable for 5 days children and women of results in mild illness. Nonetheless, before rash until at least 5 childbearing age should breakthrough varicella is contagious disease. REPORT: YES, for outbreak situations. days after rash appears. know their immune and can lead to transmission of virus CDC Pink book status or be immunized. to those unvaccinated and at risk for www.cdc.gov/nip/diseases/varicella/ complications, such as adults,

immunocompromised individuals, and pregnant women.

1%-4% of vaccines may have a varicella-like illness, with fewer than 10 lesions post-vaccination.

CMV EXCLUDE: NO Asymptomatic Direct contact with mucous Good handwashing, Standard Precautions when dealing infections are common. membranes, saliva. personal hygiene. with body fluids CYTOMEGALOVIRUS RESTRICTION: NO A mononucleosis-like Vertical from mother to REPORT: NO Caused by a human herpes illness with fever may fetus/infant. Cover mouth and nose Women of childbearing age or virus. Most severe form of occur. Incubation variable, 3 weeks when coughing, or immunocompromised individuals the disease affects to 3 months following blood sneezing. should consult with personal physician perinatally infected infants, transfusion, longer for saliva, regarding risks while caring for premature infants, and the household or vertical No food sharing. children identified as carriers of CMV. immunocompromised. transmission. AAP-Redbook 2006, p332 Communicable Virus Most children will be asymptomatic secreted in saliva/urine for and undiagnosed. many months, and may persist for years.

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DISEASE / CONDITION EXCLUDE SYMPTOMS TRANSMISSION PREVENTION RECOMMENDED SCHOOL COMMON NAME RESTRICTION INCUBATION PRECAUTIONARY CONTROL MEASURES MEDICAL TERMINOLOGY REPORT COMMUNICABILITY MEASURES COLD SORES EXCLUDE: NO Blister-like sores Direct Contact from sores to Good Handwashing Avoid contact sports while blisters are erupting around mucous membranes such as Avoid touching sores present. E.g. wrestling, rugby. HERPES SIMPLEX RESTRICTION: YES mouth. kissing, or to abraded skin Avoid sharing lip balms, Oral HSV infections are Limit PE activities that such as contact sports such lipsticks, etc. DO NOT share sports bottles. common among children. would involve physical as wrestling. Most are asymptomatic, contact if active lesions Incubation 2 – 12 days Limit/restrict P.E. Appropriate cleaning of wrestling mats with shedding of the virus cannot be covered. Communicable most activities that would at least daily and preferably between in saliva in the absence of REPORT: NO clinical disease. infectious during blister involve contact while matches. (Bleach ¼ cup to 1 gallon phase, can be spread at blisters are present. water) AAP Redbook other times. COMMON COLDS - RTI EXCLUDE: if fever is Runny nose and watery Direct contact with nose Cover mouth and nose Practice good personal hygiene. RESPIRATORY TRACT present. May return when eyes, cough, sneezing, and throat secretions when coughing and INFECTIONS fever resolves. possible sore throat, Airborne droplets. sneezing. Cover mouth and nose when coughing, chills, general malaise Indirect contact with sneezing. RHINOVIRUSES RESTRICTION: Consider contaminated articles. Good Handwashing. ADENOVIRUSES if number of cases in Fever uncommon. Incubation 12-72 hours, 48 Encourage good hand washing. school exceeds expected. CORONAVIRUSES hours common. Antibiotics NOT indicated REPORT: NO Communicable 1 day before Make tissues available to students. onset of symptoms until 5 days after. CROUP EXCLUDE: NO The classic sign of Same as for colds, flu, and Cover mouth and nose Practice good personal hygiene. croup is a loud, harsh, bronchitis when coughing and BRONCHIOLITIS RESTRICTION: NO CAUSED BY VIRUSES, barking cough — sneezing. Cover mouth and nose when coughing, REPORT: NO which often comes in Antibiotics NOT indicated. sneezing. ADENOVIRUSES, RSV, bursts at night. Your Good Handwashing. PARAINFLUENZAE, child's breathing may Encourage good hand washing. be labored or noisy. Make tissues available to students. DIARRHEAL DISEASES EXCLUDE: Exclude all 3 or more loose, watery Fecal-Oral. Contaminated Good handwashing NO cafeteria duty / food handling children with acute stools within 24 hours. hand-to-mouth contact. especially after toileting. vomiting or diarrhea Cramps, chills, Related to poor hygiene. Enforce handwashing routines in all NOROVIRUS OUTBREAK weakness, dizziness, Common source outbreaks NO food handling. foodservice areas. RESTRICTION: YES New onset of vomitting and abdominal pain. have been related to infected NO foodservice work until and/or diarrhea in foodservice workers, NO food sharing. Handwashing after diapering or diarrhea resolved for 72 numbers greater than contaminated food or water. assisting with toileting of children. hours. expected. Incubation variable NO cafeteria duties. REPORT: Cluster illnesses. depending on organism No home-prepared, unpackaged food In outbreak situations, Communicable variable from home shall be shared duration of exclusion will depending on organism be pathogen dependant. DIPHTHERIA EXCLUDE: YES exclude Respiratory diphtheria Airborne droplet direct or Vaccine recommended to Diphtheria is vaccine preventable. Presents as a sore CORYNEBACTERIUM from school or child care indirect contact with infected individuals at 2, 4, 6, 16- All children should be vaccinated. throat with low-grade respiratory secretions 18 months and boosters. DIPHTHERIAE facilities until two cultures fever and an adherent Incubation 2-4 days with a Part of the DTP and Td Notify local health department for Diphtheria is rare in the from both throat and nose membrane of the range of 1 -10 days and Dt vaccines. assistance with investigation and United States. In 1993 and taken ≥24 hours apart, tonsils, pharynx, or Communicable contagious protection of identified contacts. 1994, more than 50,000 and ≥24 hours after nose. It is toxin- for up to two weeks, but Avoid touching sores. cases were reported during cessation of antimicrobial producing strains of seldom more than four Attendance of students exempted from a serious outbreak of therapy are negative for Corynebacterium weeks. If the patient is Cover mouth and nose immunization because of medical or diphtheria in countries of diphtheria bacilli. diphtheriae treated with appropriate when coughing, or religious exemptions, should be the former Soviet Union. REPORT: YES. Cutaneous Diphtheria antibiotics, the contagious sneezing. discussed with local health department Notify LHD immediately. A wound infection may period can be limited to less have patches of a than four days sticky, gray material. 2018-19 School and Childcare Guidelines - 3 -

DISEASE / CONDITION EXCLUDE SYMPTOMS TRANSMISSION PREVENTION RECOMMENDED SCHOOL COMMON NAME RESTRICTION INCUBATION PRECAUTIONARY CONTROL MEASURES MEDICAL TERMINOLOGY REPORT COMMUNICABILITY MEASURES FIFTH DISEASE EXCLUDE: NO Bright red cheeks, No longer contagious after Good handwashing. Exposed pregnant women should blotchy “lace-like” rash appears. consult with their physician. PARVOVIRUS B19 RESTRICTION: NONE appearing rash on Cover mouth and nose REPORT : OUTBREAKS extremities that fades Airborne droplet direct or when coughing/sneezing. Exposed immunocompromised and recurs. Runny indirect contact with infected individuals should consult with their nose, loss of appetite, respiratory secretions physician. low-grade fever, and/or Incubation 4 – 20 days. sore throat. Communicable Greatest before onset of rash. FLU EXCLUDE: for fever over Acute onset of fever, Airborne droplet direct or Good handwashing. Encourage vaccine for high risk INFLUENZA 101.5 F or persistent chills, headache, indirect contact with infected persons. cough muscle aches, cough, respiratory secretions. Cover mouth and nose and sore throat. Incubation 24 – 72 hours when coughing/sneezing. Good personal hygiene. Communicable 3 – 5 days RESTRICTION : NO before onset of symptoms,

and up to 7 days following REPORT: YES for illness. Control of Outbreak situations Communicable Diseases HAND, FOOT & MOUTH EXCLUDE: NO Sudden onset of fever, Direct contact with Good handwashing. Standard Precautions COXSACKIEVIRUSES sore throat, and lesions infectious body fluids, (nose in mouth, blisters on and throat discharges, feces). Enteroviruses may survive on RESTRICTION: YES for palms, fingers, and Incubation 3 – 6 days environmental surfaces for periods long open draining lesions or feet. Communicable during acute enough to allow transmission from drooling in childcare or stage of illness and viral fomites*. daycare settings. shed for weeks in stool. * (an object capable of transmitting infectious REPORT: NO organisms from one individual to another)

HEAD LICE EXCLUDE: PER local Itching of scalp, Direct contact with infested Treat hair with medicated Refer to school head lice policy PEDICULOSIS school district policy. observations of lice, person. shampoo and remove all and or nits (small Indirect contact with nits. Screen siblings, friends, classmates grayish-brown eggs) in infested articles. (hats, RESTRICTION: Readmit the hair or hair shaft. helmets, combs, brushes) Check household Recommend washing clothes, hats, Adult head lice cannot with statement from Incubation 7-14 days members for lice / nits scarves, and bedding in very hot water, survive for more than 48 parent/guardian that Communicable as long as and vacuuming carpets. Wash combs hours apart from the human recognized treatment has eggs and/or lice remains on Do not share headgear, and brushes in hot water or send host.” begun. Per school policy. the infested person. combs, or brushes. through dishwasher cycle. The ABC’s of Safe and Healthy Childcare - CDC REPORT: NO Flea bombs are NOT recommended for HEPATITIS A EXCLUDE: YES - for Acute onset of fever, Fecal-Oral Contaminated Hepatitis A vaccine Enforce handwashing protocols for ALL HEPATITIS A VIRUS daycare and special malaise, anorexia, hand-to-mouth contact. and/or Immune globulin. foodservice workers. Schoolroom exposure settings and in general nausea, right upper Related to poor hygiene. generally does not pose an until one-week after onset quadrant pain and Common source outbreaks Good handwashing. Vaccine recommended for children appreciable risk of infection of symptoms. May attend later jaundice (yellow have been related to infected living in US communities with and IG administration is not with LHD permission. color to skin and eyes), foodservice workers, NO food service / consistently high hepatitis A rates. dark urine, or clay- contaminated food or water. cafeteria work until indicated when a single RESTRICTION: YES colored stool. Incubation 28-30days cleared. Notify local health department for case occurs. However, IG NO Foodservice work range 15 – 50 days assistance with investigation and may be considered if until cleared by Health Depending on age child Communicable for 2 weeks No sharing of food or protection of identified contacts. transmission within the Officer, may return with may be asymptomatic before symptoms until 2 drink. school setting is clearance by LHD to mild symptoms. weeks after symptoms No home-prepared, unpackaged food documented. AAP-Redbook 2006 p 335 appear. from home shall be shared. REPORT: YES

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DISEASE / CONDITION EXCLUDE SYMPTOMS TRANSMISSION PREVENTION RECOMMENDED SCHOOL COMMON NAME RESTRICTION INCUBATION PRECAUTIONARY CONTROL MEASURES MEDICAL TERMINOLOGY REPORT COMMUNICABILITY MEASURES HEPATITIS B EXCLUDE: NO Only about 10% of Bloodborne Pathogen Do not share personal Hepatitis B is vaccine preventable. children who become Exposure to blood, semen, items (toothbrushes, All children should be vaccinated HEPATITIS B VIRUS In general, unless in acute infected with HBV are vaginal secretion into pierced earrings, etc.). with 3 doses of hepatitis B vaccine. stage with restrictable symptomatic. bloodstream or under skin. symptoms i.e. jaundice, Hepatitis B is an infection of Contact sports (football / Use caution in accident / Standard Precautions while dealing and may return when the liver caused by the Symptoms are similar wrestling) may pose a risk if blood situations. with blood or body fluids. Clean up cleared by LHD. hepatitis B virus. The virus to hepatitis A. Fever, exposed to blood or other blood spills immediately. is completely different from RESTRICTION: See malaise, anorexia, potentially infectious body Vaccinate all children. hepatitis A and/or school guidelines for nausea, right upper fluids. Require parents to submit up-to-date Hepatitis C. children with bloodborne quadrant pain and Incubation 45 –180 days immunization records. infectons. later jaundice (yellow Communicable Variable color to skin and eyes), Report all exposures of body fluid REPORT: YES dark urine, or clay- contact to broken skin/ mucous colored stool. membranes to Risk Management. HEPATITIS C EXCLUDE: NO In an acute illness, Bloodborne Pathogen Do not share personal Clean up blood spills immediately. symptoms are similar HCV is primarily parenterally items (toothbrushes, HEPATITIS C VIRUS RESTRICTION: See to hepatitis A. Fever, transmitted. Sexual pierced earrings, etc.). Standard Precautions while dealing Hepatitis C is an infection of school guidelines for malaise, anorexia, transmission has been with blood or body fluids. the liver caused by the children with bloodborne nausea, right upper documented to occur but is Use caution in accident hepatitis C virus. The virus infections. is completely different from quadrant pain and far less efficient or frequent or blood situations. Report all exposures of body fluid hepatitis A or hepatitis B later jaundice (yellow than the parenteral route. contact to broken skin/ mucous REPORT: NO color to skin and eyes), membranes to Risk Management. dark urine, or clay- Incubation 7 – 9 weeks colored stool. Range 2 – 24 weeks. Communicable from one or more weeks before symptoms and can be indefinite. IMPETIGO EXCLUDE: YES, Skin lesions, (often Direct contact with Cover wounds. No foodservice duties while lesions are STAPH OR STREP SKIN All open wounds must be around the mouth and infectious drainage from present. nose) honey-colored wounds. Skin to skin. Proper handwashing. INFECTION covered by a bandage until crusts, itchy, Good personal hygiene. dry and no longer draining. May return after sometimes purulent. Indirect contact with Avoid touching lesions. 24 hours of appropriate Usually not painful, articles contaminated with Proper handwashing. antibiotics. but spread may be drainage. No sharing personal AAP Redbook 2006 p. 612 rapid. Incubation Variable, usually items when lesions 4 – 10 days. present. Communicable as long as RESTRICTION : YES, sores are open and draining, No contact sports NO sport activities until or until 24 hours of (wrestling) with open lesions healed. appropriate antibiotic lesions. REPORT: OUTBREAKS treatment.

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DISEASE / CONDITION EXCLUDE SYMPTOMS TRANSMISSION PREVENTION RECOMMENDED SCHOOL COMMON NAME RESTRICTION INCUBATION PRECAUTIONARY CONTROL MEASURES MEDICAL TERMINOLOGY REPORT COMMUNICABILITY MEASURES MEASLES EXCLUDE: YES, may Acute onset of fever, Airborne / Droplet spread, Vaccine recommended to Measles is vaccine preventable. RUBEOLA return 5 days after rash. runny nose, reddened, direct contact with nasal or individuals 12 months All children should be vaccinated. light-sensitive eyes a throat secretions of infected and older. very harsh cough, person, and direct contact Unimmunized students exempted from REPORT: YES. “Hard Measles”, followed by a red- with contaminated articles. Good Handwashing. immunization because of medical or “10-day measles” Notify LHD immediately. brown blotchy rash. religious exemptions, if not immunized

(Starts at hairline and Incubation 10 –14 days with Avoid touching sores. within 72 hours of exposure, should be HIGHLY CONTAGIOUIS EXCLUSION – spread down). range of 7 – 18 days. Usually excluded until at least 21 days after the Contacts: YES, IF 14 days until rash develops. Cover mouth and nose onset of rash in the last case of The hallmarks of when coughing, or measles. Oregon Health Division, INDEX CASE IS LAB Measles are: Communicable 1 day before sneezing. 10/2007. Measles guidelines. CONFIRMED  Cough the prodrome period (about 4 Any unimmunized child or  Coryza days before rash onset) until Notify local health department for adult should be offered  Conjunctivitis 4 days after appearance of assistance with investigation and immunization within 72  Koplik spots - rash. protection of identified contacts. hours or excluded from White spots in facility until 21 days after mouth. the last case of measles occurs in facility. MENINGITIS, EXCLUDE: YES, until Acute bacterial disease Airborne / Droplet spread, Vaccine available for Notify local health department for of sudden onset of with nasal or throat certain strains, (A,C,Y, assistance with investigation and BACTERIAL cleared by local health fever, intense secretions of infected person. and W-135) and not protection of identified contacts. NEISSERIA MENINGITIDIS department. headache, nausea effective for the B-strain. often with vomiting, Incubation 3 – 4 days with Recommended for certain No sharing food, drink or eating RESTRICTION: NO stiff neck and range of 2 – 10 days. populations. utensils. Meningococcal Disease frequently a (tiny Assist LHD with investigation and REPORT: YES bruise-like) petechial Communicable In general Good Handwashing assessment of contacts. Antibiotics rash. until 24 hours of appropriate given to contacts after investigation by antibiotic therapy. Cover mouth and nose the LHD. Letters to parents as defined when coughing, sneezing. by LHD. MENINGITIS, EXCLUDE: only for health Acute onset of fever, “The viruses that cause viral No specific treatment for Encourage good handwashing and VIRAL reasons, not typically severe headache, stiff meningitis are contagious. viral meningitis. personal hygiene. neck, bright lights hurt However, most infected ASEPTIC MENINGITIS spread person to person. the eyes, drowsiness or persons either have no Most persons will recover Cover mouth when coughing and Meningitides are illnesses in confusion, and nausea symptoms or develop only a completely. sneezing. RESTRICTION: NO which there is inflammation and vomiting. cold or rash with low-grade Doctors prescribe

of the tissues that cover the fever. Typically less than 1 medicine to relieve fever Careful disposal of used tissues. brain and spinal cord. Viral REPORT: Not required, Often the symptoms out of every 1000 persons and headache. (aseptic) meningitis, which is but recommended for of bacterial and viral infected [with viruses] the most common type, is assistance with rumor meningitis are the actually develop meningitis. Good handwashing and caused by an infection with control or education same. For this Therefore, if you are around personal hygiene. one of several types of assistance. reason, if you think a someone who has viral viruses. CDC website child has meningitis, meningitis, you have a Cover mouth and nose seek medical moderate chance of when coughing and Often these occur seasonally attention becoming infected, [with the sneezing. in the late summer and immediately. virus] but a very small early fall. chance of developing meningitis.” CDC website

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DISEASE / CONDITION EXCLUDE SYMPTOMS TRANSMISSION PREVENTION RECOMMENDED SCHOOL COMMON NAME RESTRICTION INCUBATION PRECAUTIONARY CONTROL MEASURES MEDICAL TERMINOLOGY REPORT COMMUNICABILITY MEASURES MOLLUSCUM EXCLUDE: NO Small white, pink, or Direct Contact: The virus Once someone has the Molluscum contagiosum is not harmful flesh-colored raised that causes Molluscum is virus, the bumps can and should not prevent a child from CONTAGIOSUM RESTRICTION: NO bumps or growths with spread from person to spread to other parts of attending day care or school. “DIMPLE WARTS” REPORT: NO a dimple or pit in the person by touching the their body by touching or Bumps not covered by clothing should Molluscum contagiosum is NOTIFY OTHERS: NO center. The bumps may affected skin. scratching a bump and be covered with a watertight bandage. caused by a virus and appear anywhere on then touching another Change the bandage daily or when usually causes a mild skin the body, alone or in Indirect Contact: The virus part of the body. obviously soiled. disease. The virus affects groups. They are may also be spread by Molluscum can be spread only the outer (epithelial) usually painless, touching a surface with the from one person to Although the virus might be spread by layer of skin and does not although they may be virus on it, such as a towel, another by sexual sharing swimming pools, baths, circulate throughout the itchy, red, swollen clothing, or toys. contact. saunas, or other wet and warm body in healthy people. and/or sore. environments, this has not been Molluscum usually proven. Researchers who have disappears within 6 to 12 investigated this idea think it is more months without treatment likely the virus is spread by sharing and without leaving scars. towels and other items around a pool Some growths may remain or sauna than through water. for up to 4 years. MONONUCLEOSIS EXCLUDE: NO Fever, sore throat, Direct contact with Rest and restriction of No sharing of eating or drinking EPSTEIN-BARR VIRUS swollen neck glands, infectious body fluid (saliva). athletic activities are utensils. fatigue, abdominal strongly advised. RESTRICTION: Contact pain, headache, The virus is viable outside the Good handwashing and personal sports should be avoided occasionally jaundice. body for several hours, but hygiene. until fully recovered. the role of fomites in transmission is unknown. Contact sports should be avoided until AAP Redbook 2006 p.286 fully recovered. REPORT: NO Incubation: 30 – 50 days Communicable – May be weeks to months. MUMPS EXCLUDE: YES, until 9 Swelling of one or more Direct contact with Vaccine preventable. During outbreak, students without days after swelling. of the salivary glands, infectious saliva and vaccine history shall be excluded, and usually the parotid respiratory tract secretions. Good handwashing and can be readmitted after immunization. glands. personal hygiene. RESTRICTION: NO Airborne droplets. Students exempted from immunization

Orchitis, swelling of the Cover mouth and nose because of medical or religious REPORT: YES testicles, is a common Incubation: 16-18 days when coughing and exemptions, should be excluded until complication after range 12-25 sneezing. at least 26 days after the onset of puberty, but sterility mumps in the last person with mumps rarely occurs. Communicable: 6-7 days in the affected school. AAP Redbook 2006 p 465 before onset; until 9 days AAP Redbook 2006 p 468 after symptoms. MRSA AND STAPH SKIN Clnicially Staph and MRSA skin infections are indistinguishable. Use the following infection control precautions for staph skin infections: INFECTIONS:  Wear gloves and practice Universal Precautions if examining lesions. Gloves should be removed after use, and handwashing performed before touching non-contaminated items and environmental surfaces and before tending to another student. SEE SKIN INFECTIONS OR  Follow routine procedures for cleaning the environment. In general, use routine procedures with a freshly prepared solution of commercially available IMPETIGO cleaner such as detergent, disinfectant-detergent or chemical germicide.  Students and staff with a MRSA infection can attend school regularly as long as the wound is covered and they are receiving proper treatment.  Any open wounds should be covered with a clean, dry dressing http://www.cdc.gov/Features/MRSainSchools/

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DISEASE / CONDITION EXCLUDE SYMPTOMS TRANSMISSION PREVENTION RECOMMENDED SCHOOL COMMON NAME RESTRICTION INCUBATION PRECAUTIONARY CONTROL MEASURES MEDICAL TERMINOLOGY REPORT COMMUNICABILITY MEASURES PERTUSSIS EXCLUDE: YES: Cold-like symptoms Airborne: Directly or Vaccine preventable. Following exposure to pertussis, with persistent indirectly by droplet spread. students and teachers should be WHOOPING COUGH Students and/or staff with irritating chronic Direct: By contact with Good handwashing and observed for 21days for any new cough www.pertussis.com pertussis should be cough. Whooping contaminated items. personal hygiene. lasting greater than 7 days, or A good primer on pertussis excluded until either: cough gets its name Incubation: 7-10 days with presenting with a paroxysmal (sudden, sounds and coughing. 5 days of appropriate from the whooping range of 5 –20 days. Cover mouth and nose spasmodic) cough. Persons with above Audio file. antibiotic treatment or for sound the child makes Communicable: Just before when coughing and respiratory symptoms should be 21 days after onset of when trying to breath the cold-like state until 3 sneezing. referred to physician pending cough if not treated with after a coughing spell. weeks after the paroxysmal evaluation and treatment. antibiotics. state in untreated cases. Preventative antibiotics

will be considered based RESTRICTION: NO upon epidemiological REPORT: YES investigation of close contacts. PINK EYE EXCLUDE: NO Red, tearing, irritated Direct or indirect contact Avoid sharing personal eyes. Light sensitivity, with eye discharge, or with articles (makeup) CONJUNCTIVITIS RESTRICTION: NO eyelids puffy. Thick contaminated articles. Can be bacterial, viral or REPORT: NO allergic reaction as discharge. Incubation: 24 – 72 hours Discard eye makeup causation. Communicable: 6 days following illness before onset until 9 days Avoid rubbing eyes. after symptoms begun. PINWORMS EXCLUDE: In daycare Intense rectal itching, Fecal-oral direct transfer of Daily bathing and clean In settings with young children, wash Increases at night. eggs by hand to mouth. undergarments. toys in sanitizing cleaner. PARASITIC WORMS settings, until 24 hours after treatment and seen Irritation from Contact with contaminated Good handwashing and by physician. scratching. Irritability. clothing and bedding. hygiene. No home-prepared, unpackaged food Eggs can survive up to 2 Clean undergarments from home shall be shared. RESTRICTION: NO weeks away from human and bedding. REPORT: NO host. Wash under fingernails, Incubation: 2 –6 weeks and keep nails trimmed Communicable: 2 – 8 weeks short. unless reinfected. POISON OAK, IVY EXCLUDE: NO Localized irritation, Itchy rash caused by either Avoid poison ivy plants. DO NOT burn the offending plant. The skin lesions, and touching the plant’s shiny Careful washing of smoke can cause inhalation reactions. CONTACT DERMATITIS RESTRICTION: NO burning, watery (oily) leaves, or by touching affected area with soap Poison Oak/ivy/sumac rash REPORT: NO is not contagious. It is a blisters. something the urushiol sap and water to remove all localized allergic reaction to has touched. irritant sap. the plant oils. Plants, such as Minimize scratching the poison ivy, oak, or sumac, all Prompt removal of Itching can be immediate rash, which can lead to produce a colorless, odorless irritating sap/oil off of or take up to several days secondary skin sap, called urushiol. The skin clothing and skin is to develop. infections. rash is a reaction to this sap important. producing a burning, blistering rash.

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DISEASE / CONDITION EXCLUDE SYMPTOMS TRANSMISSION PREVENTION RECOMMENDED SCHOOL COMMON NAME RESTRICTION INCUBATION PRECAUTIONARY CONTROL MEASURES MEDICAL TERMINOLOGY REPORT COMMUNICABILITY MEASURES RINGWORM, HEAD- EXCLUDE: NO. Patchy areas of Direct contact with Good handwashing Hats or caps are not recommended dandruff-like scaling infectious areas No sharing of personal Shaving head NOT recommended TINEA CAPITIS RESTRICTION: NO with mild to extensive Incubation: 10-14 days items especially combs, Not a worm but a fungal REPORT: NO infection of the scalp. hair loss. May have Communicable until treated brushes, etc. round area of “stubs” with appropriate Pets may be carriers. of broken hair. RINGWORM, SKIN – EXCLUDE: NO Ring-shaped red sores Direct contact with Good handwashing Special attention to cleaning and with blistered or scaly infectious areas. No sharing of personal disinfecting gym/locker areas with TINEA CORPORIS RESTRICTION: YES, borders. Itching is Incubation: 4 –10 days items especially combs, approved anti-fungal agent. A fungal infection on the NO sport activities until common. Communicable until treated brushes, etc. skin. In a circular pattern lesions healed.. hence, the term “ringworm”. with appropriate antifungal Pets may be carriers. Restriction of P.E. sport activities until REPORT: NO medications. lesions disappear. RUBELLA EXCLUDE: Slight fever, mild runny Droplet /Airborne route. Vaccine recommended to Women of childbearing age with nose, conjunctivitis, individuals 12 months contact to children should know their GERMAN MEASLES Cases: YES, until 7 days headache, fatigue, Direct contact with nasal and older. immune status to rubella. 3-DAY MEASLES after rash onset. aches, red eyes, and a discharges. Rubella is not usually a AAP Redbook. pinkish rash that Good handwashing and Rubella is vaccine preventable. serious illness in children, EXCLUSION – starts at face and Incubation: 14-23 days, personal hygiene. All children should be vaccinated. but can be very serious if a spread rapidly to trunk average 18 days pregnant woman becomes Contacts: YES, IF and limbs (fades in 3 Cover mouth and nose During an outbreak, unimmunized infected. INDEX CASE IS LAB days). Occasionally Communicable: very when coughing and students, who continue to be exempted CONFIRMED swollen glands in back contagious 1 week before sneezing. from immunization because of medical Any unimmunized child or of head and neck. and up to 7 days after rash or religious exemptions, if not adult should be offered occurs. Studies demonstrate immunized within 72 hours of immunization within 72 presence of virus in exposure, should be excluded until at hours or excluded from nasopharygeal secretions least 3 weeks after the onset of rash in facility until 21 days after from 7 days before to 14 the last case of rubella. the last case of rubella days after onset of rash. AAP Redbook 2006 and ABCs of occurs in facility. childcare settings, CDC. REPORT: YES SCABIES EXCLUDE: YES, until Intense itching, raised, Transmission: Direct skin Avoid sharing clothes and Observe close contacts for itching and SARCOPTES SCABIEI treated. red, small sores. to skin contact. personal items. scratching. Commons on hands, Caused by small mite RESTRICTION: NO especially finger Incubation: Variable. Wash personal items. Because mites can survive only briefly (sarcoptes scabiei) that REPORT: NO burrows under skin leaving webbing and skin Several days to weeks. off the human body, you can only get small red or dark lines. folds. Itching severe, Treat with anti parasitic scabies from direct bodily contact with worse at night. Not Communicable: Until lotion and clean clothing another person or by sharing an usually on face. treated and bedding. infested person’s clothes. SHINGLES EXCLUDE:. Exclude ONLY Shingles is usually Direct contact with Vaccine recommended to Recommend Varicella vaccine for all HERPES ZOSTER VARICELLA if lesions cannot be localized to rash on infectious body fluids, individuals 12 months susceptible school-age children. Check

SEE ALSO CHICKEN POX covered. abdomen. drainage from blisters. and older. with requirements for specific ages.

Reactivation of dormant RESTRICTION: YES The pain associated Good Handwashing herpes zoster varicella NO sport activities until with the lesions is out Avoid touching sores. (Shingles) results in lesions healed. localized rash. of proportion to the size of the lesions. Cover mouth and nose when coughing, or sneezing.

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DISEASE / CONDITION EXCLUDE SYMPTOMS TRANSMISSION PREVENTION RECOMMENDED SCHOOL COMMON NAME RESTRICTION INCUBATION PRECAUTIONARY CONTROL MEASURES MEDICAL TERMINOLOGY REPORT COMMUNICABILITY MEASURES STREP THROAT AND EXCLUDE: YES, CDC Fever nausea, sore Direct contact with large Good handwashing and Encourage good handwashing and throat, and headache. respiratory droplets. personal hygiene. personal hygiene. STREPTOCOCCAL recommends 24 hours of Swollen tonsils occur Indirect contact with SCARLET FEVER/SCARLETINA antibiotics and until resolution of fever. in 50-90% of cases. contact with respiratory Cover mouth and nose Cover mouth when coughing and Most common illnesses Scarlet Fever is a form secretions or infected skin when coughing and sneezing. RESTRICTION: YES associated with Group A- of Strep disease that lesions. sneezing. NO Foodservice while ill. Beta hemolytic streptococci involves a fine Incubation: 12 – 96 hours Careful disposal of used tissues. are pharyngitis (sore throat) REPORT: NO “sandpaper-like” rash Take antibiotics as and impetigo, (skin that blanches with Communicable: with directed. eruptions). Scarlet fever is pressure. Not usually appropriate antibiotics – the presentation of a on face. 24hrs generalized rash associated Without treatment 10-21 with Streptococcal organism. days. TUBERCULOSIS, TB EXCLUDE: Active TB Some children will be Airborne: Droplet spread Good handwashing and personal hygiene. M. TUBERCULOSIS until non-infectious asymptomatic. through coughing, sneezing, (pulmonary and laryngeal) Some of the symptoms singing, and yelling. Cover mouth and nose when coughing and sneezing. a child might have are: TB INFECTION OR “LTBI” cough, fatigue, weight Incubation: Variable Report any case or suspected case of TB to the local health (LATENT TB INFECTION) RESTRICTION: NO loss, growth delay, Communicable: As long as department. A positive skin test but no disease. Not a contagious fever, night sweats, organisms are being state. REPORT: YES chest pain, hoarseness, discharged through cough or and in later stages, respiratory secretions. Core Curriculum on Tuberculosis – What the Clinician Should Know ACTIVE TB, TB DISEASE: hemoptysis (coughing Specific drug treatment CDC ed. 2000 Symptomatic and contagious up blood), enlarged reduces communicability until treated (if laryngeal or cervical lymph nodes. within weeks. pulmonary TB).

DOT: Directly Observed Therapy. A medical provider observes patient taking the medication PPDs: No longer required for school entry. to improve compliance.

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BIBLIOGRAPHY

Oregon Administrative Rules (OARS) - INVESTIGATION AND CONTROL OF DISEASES: GENERAL POWERS AND RESPONSIBILITIES Including imposition and removal of worksite, child care and school restrictions Chapter 333, Division 19 - Health Services. http://www.oregon.gov/oha/PH/DiseasesConditions/communicabledisease/reportingcommunicabledisease/pages/rules.aspx

American Academy of Pediatrics, Committee on Infectious Diseases. 2015 Red Book Report of the Committee on Infectious Diseases. 30th ed. Elk Grove Village, IL. http://aapredbook.aappublications.org/current.shtml

Heymann, MD ed., Control of Communicable Diseases Manual. Official report of the American Public Health Association, 20th ed. 2004. Washington, DC. https://www.apha.org/ccdm

CDC Centers for Disease Control and Prevention, Division of Tuberculosis Elimination, Core Curriculum on Tuberculosis – What the Clinician Should Know, 6th Ed. 2013, Atlanta, GA http://www.cdc.gov/tb/pubs/corecurr/default.htm

Hambrosky J, Kroger A, Wolfe S, eds. CDC Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preventable Diseases. “The Pink Book”, 13th Ed. 2015, Atlanta, GA. https://www.cdc.gov/vaccines/pubs/pinkbook/chapters.html

Steele, R., ed. A Clinical Manual of Pediatric Infectious Disease. Appleton Clinical Manuals, Norwalk, CT

Oregon Department of Health and Human Services, ACD, Acute and Communicable disease section, 2008. OAR 581-022-0705 (excerpted) http://www.ode.state.or.us/groups/supportstaff/hklb/schoolnurses/commdisease.pdf

Centers for Disease Control and Prevention, 2017. http://www.CDC.gov

Reviewed and approved by Richard Fawcett, MD

Deschutes County Health Officer

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