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Wisconsin Childhood Communicable Diseases Wall Chart

Wisconsin Childhood Communicable Diseases Wall Chart

WISCONSIN CHILDHOOD COMMUNICABLE DISEASES

Disease Name Time Period When Person is Spread by Criteria for Exclusion from School or Group Onsite Control and Prevention Measures Time from exposure to Contagious (AKA, causative agent) symptoms

Cold sores Direct contact with open sores , irritability, in mouth, on gums, lips, 2-7 weeks after symptoms appear, Exclude until fever-free, child able to control drooling,

( virus) or saliva 2 days to 2 weeks conjunctivitis, keratitis shedding possible without symptoms blisters resolved

Mononucleosis Person to person contact with Many months after ; excretion None, unless illness prevents participation; no contact saliva 30-50 days Fever, sore throat, swollen lymph nodes, of virus can occur intermittently for sports until spleen no longer enlarged (Mono, Epstein-Barr virus) For all diseases: Good handwashing and ; avoid R/V Inhalation of respiratory Fever, swelling and tenderness of parotid glands, Exclude for 5 days after swelling onset (day of swelling kissing, sharing drinks, or utensils, use proper disinfection droplets, direct contact with 12-25 days; headache, earache, painful swollen testicles, From 2 days before to 5 days after onset is day zero); exclude susceptible* contacts from of surfaces and toys (Mumps virus) saliva of infected person usually 16-18 days abdominal with swollen ovaries swelling day 12 through day 25 after exposure Mumps: Provide records for exposed Bacterial: red/pink itchy eye(s), green/yellow eye individuals to public officials Pink Eye None, unless fever, behavior change or unable to Direct or indirect contact with Variable depending on discharge While signs and symptoms are present avoid touching eyes; antibiotics not required for (Bacterial or viral conjunctivitis) eye discharge causative organism return Strep Throat: Avoid kissing, sharing drinks, or utensils; Viral: pink-swollen eye(s), light sensitivity exclude infected food handlers; minimize contact with respiratory and oral secretions Strep Throat and Contact with infectious Eye, Ear, Nose, and Throat and Nose, Ear, Eye, respiratory droplets and saliva, Sore throat, fever, headache, tender swollen lymph Until 24 hours after initiation of Exclude for 24 hours after initiation of appropriate (Streptococcal pharyngitis, Group A direct contact with mouth or 2-5 days nodes, decreased appetite, chills and sweats appropriate antibiotic treatment antibiotic and fever resolved Streptococcus) nose secretions

Influenza V Inhalation of respiratory droplets 1-4 days Fever, cough, nasal congestion, headache, body 1 day prior to and up to 5-7 days after Exclude until fever resolved for 24 hours (Flu, virus) aches, fatigue symptoms begin

For all diseases:

Pertussis R/V Early cold-like signs or symptoms, coughing Handwashing and good personal hygiene including covering Inhalation or direct contact of 5-21 days; progressing to severe, often with “whoop,” 7 days prior to and until 21 days after Exclude until after 5 days of appropriate antibiotic coughs and sneezes (Whooping cough, Bordetella onset of cough; or 5 days after start of treatment; if no antibiotic treatment, exclude 21 days respiratory secretions usually 7­10 days vomiting possible, absent or minimal fever, most treatment after cough onset pertussis) severe first 6 months after birth Pertussis: Refer symptomatic individuals to Direct or close contact with provider for evaluation

Respiratory Respiratory Syncytial virus respiratory droplets or direct contact of eye, nose, or mouth 2-8 days; Runny nose, cough, sneezing, wheezing, fever Duration of illness; usually -3 8 days Exclude until fever resolved for 24 hours Respiratory Syncytial Virus: Avoid sharing linens, toys (RSV) discharges, or contaminated usually 4-6 days surfaces

Diarrhea of unknown Usually fecal-oral Variable 3 or more loose stools in 24 hour period Variable Exclude until for 24 hours For all diseases: Good handwashing and hygiene; proper Gastroenteritis, Bacterial R Mild to severe that can be bloody, Exclude until asymptomatic for 24 hours disposal of dirty diapers; proper disinfection of changing  Campylobacter Fecal-oral: person-to-person, abdominal cramps, may include vomiting or fever, tables, toys, and food preparation areas; avoid potentially asymptomatic possible contaminated beverages, food, and water; divide food  Salmonella water, food 1-7 days; For high settings* Shiga toxin-producing E. coli While present in stool, weeks and Shigella require 2 consecutive negative fecal preparation and diapering responsibilities among staff  Shigella For bacteria other than Shigella: usually 2-5 days, varies Shiga toxin-producing E. coli can cause severe by bacteria kidney complications to months samples collected at least 24 hours apart and  E. coli O157:H7 and other animal-to-person, especially livestock, poultry, and pets obtained at least 48 hours after antimicrobial Shiga toxin-producing E. coli Salmonella can cause bloodstream and urinary completed; consult with local health department Diarrhea: 3 or more loose stools in a 24-hour period tract infections (STEC) Outbreaks of diarrhea in group settings are reportable to local health department non-bloody watery diarrhea, abdominal Cryptosporidium: up to 2 weeks, Gastroenteritis, ParasiticR Fecal-oral: water, person-to- Cryptosporidium: 3-14 days pain, fatigue, fever, and ; can months for immune-compromised; Exclude until asymptomatic for 24 hours; no  Cryptosporidium person, food, animal-to-person, have recurring symptoms most contagious during diarrhea phase swimming for 2 weeks after diarrhea resolves  Giardia especially calves Giardia: 1-3 weeks Gastroenteritis-Bacterial: Proper cooking/handling of Giardia can cause foul smelling stools Giardia: weeks to months and raw eggs; reptiles and live poultry should not be permitted in child care centers Gastroenteritis, Viral Fecal-oral: person-to-person, Acute onset vomiting and/or non-bloody diarrhea, While symptomatic up to 3 weeks after Exclude until asymptomatic for 24 hours with  Norovirus water, food, environmental 12-72 hours possible nausea, abdominal cramps, low-grade symptoms resolve; virus can be present rotavirus and 48 hours with norovirus C. difficile, Cryptosporidium, and Norovirus: -based  V surfaces fever, headache, malaise before onset of diarrhea Gastrointestinal Rotavirus hand hygiene products are not effective against these organisms; soap and water must be used 14 days before onset of symptoms to

Hepatitis AR/V Fecal-oral: close personal 15-50 days; average 28- Fever, anorexia, fatigue, jaundice, abdominal pain, 7-10 days after jaundice onset; Exclude for 14 days after onset of symptoms or 10 dark-brown urine; most children <6 years old not Hepatitis A: Consider Hep A for staff; exposed staff (Hepatitis A virus) contact, contaminated food 30 days jaundiced or symptomatic No jaundice: 10 days prior to 14 days days after onset of jaundice after onset of symptoms should not prepare meals for others

1-2 months or longer Pinworm infection While eggs are present, eggs can Pinworms: Frequent, good handwashing, particularly by Fecal-oral: directly or indirectly from time of of Anal and possibly vaginal itching remain infective 2-3 weeks in indoor None, unless has diarrhea (Enterobius vermicularis) from toys, bedding, eggs to adult worm infected child and staff assisting with toileting; keep reaching anal area environments fingernails clean and short; prevent fingers in mouth; bed linen and underclothing of infected child should be handled Variable; 5 days after difficile infection Mild to moderate disease: watery diarrhea, low- carefully, not shaken, and laundered promptly Fecal-oral: person-to-person, starting antibiotic grade fever, mild abdominal pain; recurrent or For the duration of the diarrheal illness Exclude until asymptomatic for 48 hours (CDI, C. diff) environmental surfaces treatment to 10 weeks following completion severe disease can occur

Fifth Disease Brief mild illness includes fever, fatigue, muscle Contact with respiratory Usually 4-14 days; aches, headache, followed by red “slapped-cheek” Onset of symptoms until appears None ( , secretions can be up to 21 days infectiosum) rash 1-3 weeks later

Hand-foot-and-mouth disease Contact with fecal, oral, or 3-6 days Fever, rash on hands, feet, or mouth, conjunctivitis, 1-2 weeks for respiratory secretions; None, unless fever present or child cannot maintain (Coxsackie virus) respiratory secretions sore throat, vomiting, diarrhea weeks to months for hygiene or avoid close contact with others Direct contact with or Small red pimples or fluid-filled blisters, crusted Until lesions are treated with antibiotics Exclude until after initiation of appropriate antibiotic For all diseases: Good handwashing and hygiene; proper (, Group A contaminated objects 4-10 days yellow scabs on face or body for at least 24 hours or crusting lesions treatment and lesions are covered or crusted disinfection of changing tables, surfaces, and toys Streptococcus) resolved 4-6 weeks after first , , and Varicella: Assess exposure Lice Exclude at end of program or school day until after risk to susceptible* and high risk* persons; provide Direct contact or contaminated infestation; Itching scalp, especially behind ears and back of While live lice present treatment or removal of live lice; immunization records of exposed individuals to public (Pediculosis) objects 1-6 weeks after neck; many children are asymptomatic “no-nit” policies are discouraged health officials; consultation with official subsequent infestations recommended Measles R/V 7-21 days; usually 10 Blotchy red rash at hairline or on face that extends 4 days prior to 4 days after rash appears Exclude for 4 days after rash onset; exposed Measles and Varicella: contacts without documented Inhalation or direct contact of days from exposure to over body, watery eyes, runny nose, high fever, dry susceptible* individual from day 7 through day 21 (Rubeola, measles virus) respiratory secretions immunity (2 doses of vaccine or laboratory proof of fever, 14 days to rash cough, diarrhea or ear infections following their earliest exposure immunity) should be vaccinated MRSA Person-to-person, contaminated Variable; usually 4-10 Duration of acute illness; if wound Exclude if drainage from lesions cannot be contained, Rubella: Exposed pregnant women should immediately (Methicillin-resistant objects days, can be up to Red, swollen, pus-filled lesions drainage present until lesions resolve contact their Staphylococcus aureus) several months Impetigo: Keep fingernails clean and short Skin: red, circular patches with raised edges, Ringworm Direct or indirect contact with Body/perianal/groin: center clearing, cracking/peeling of skin between Lice and : lesions or contaminated 4-10 days toes As long as lesions are present or until Exclude until treatment is initiated or lesions are (fungal infection, dermatophytosis, treatment begins covered  Avoid sharing and storing together personal items such Skin and Rash and Skin tinea) personal objects/surfaces Scalp: 10-14 days Scalp: dandruff-like scaling patchy areas with or as headgear, combs, clothing, and bedding without hair loss, redness Inhalation or direct contact of  Machine wash clothing, bedding, or cloth toys in water over 129°F and dry on hot setting; dry cleaning or respiratory droplets; most 3-7 days high fever followed by red, raised rash for storing clothing in plastic bags for 10 days is also (, children infected by age 4; 75% 9-10 days hours to several days, febrile seizures possible in Unknown Exclude until fever resolved effective in killing mites, lice, and nymphs subitum) of healthy adults shed virus in children < 4 years old saliva MRSA: Cover skin lesions, avoid contact with wound Low-grade fever, pinkish rash appearing first on drainage, proper disposal of dressings, no sharing of Inhalation of droplets, or direct face then spreading over body, enlarged lymph personal items, clean and disinfect athletic equipment Rubella R/V Exclude until 7 days after rash onset; exposed contact of nose or throat 14-21 days; glands behind ears, transient joint aches/pain in 7 days before until 7 days after rash susceptible* individual from day 7 through day 21 between uses, wash and dry laundry on “hot” setting () secretions; from usually 16-18 days older children and adults onset mother to fetus across placenta following earliest exposure Ringworm: Avoid direct contact, avoid sharing combs, Many children have minimal symptoms brushes, hats, clothing, towels; proper disinfection of surfaces and toys with a fungicidal agent Scabies 2-6 weeks; usually 4-6 Person-to-person, contaminated weeks; 1-4 days if Intense itching (especially at night), red bumps or Until mites and eggs are destroyed, Exclude until treatment is complete (Sarcoptes scabiei, mite infestation) bedding, towels, clothing blisters most commonly found on skin folds usually after initial topical treatment Scabies: Itching may continue for several weeks following previously infected treatment, and is not indicator of treatment failure Exclude if rash cannot be covered or doubt child’s Shingles Direct contact with fluid None: Reactivated Red bumps and blisters that may be itchy or ability to comply with keeping rash covered until Usually 7-10 days; until blisters crust (Herpes zoster, varicella-zoster to only those susceptible to painful, usually in narrow area on half of body, can over blisters crust over; exclusion of exposed susceptible* virus) chickenpox cause fever, chills, headache, upset stomach usually not mandated, families should be notified of risk

Varicella R/V Inhalation or direct contact of 2 days prior to rash onset to 5 days after Exclude until lesions have dried and crusted; exclusion respiratory secretions, skin 10-21 days; Generalized rapidly progressing itchy rash, blisters rash resolves or until lesions crusted of exposed susceptible* usually not mandated, (Chickenpox, varicella-zoster virus) lesions, or contaminated objects usually 14-16 days that crust, mild fever, malaise over families should be notified of risk For all diseases: Good handwashing and hygiene; cover Hib R/V Usually short, 2-4 days coughs and sneezes; avoid direct saliva contact and sharing (Haemophilus influenzae type b) drinks, utensils, and water bottles

May include: sudden onset of fever, headache, stiff Hib bacteria: Ensure of contacts under age 4 are Meningococcal disease R/V Direct contact with oral and 2-10 days; neck, nausea, vomiting 7 days prior to onset until 24 hours after Exclude for at least 24 hours after appropriate up-to-date after exposure or treated with antibiotics (Neisseria meningitidis) respiratory secretions usually 3-4 days Rash and photophobia also common with N. treatment begins antibiotic treatment begins meningitidis Meningococcal meningitis: Direct saliva contacts should Pneumococcal disease R/V receive antibiotic treatment immediately Usually short, 1-4 days (Streptococcus pneumonia) Pneumococcal meningitis: Treatment of contacts not

necessary and not beneficial Meningitis Viral meningitis: Proper disinfection of surfaces such as Viral Meningitis Contact with droplets from nose, 3-6 days May include: sudden onset of fever, headache, stiff From day before illness up to 2 weeks Exclude until fever resolved for 24 hours changing tables with soap, water, and bleach-containing (Usually enterovirus) eyes, or mouth neck, nausea, vomiting after onset solution; treatment of contacts not necessary, no specific treatment Chlamydia R

(Chlamydia trachomatis) Neonatal conjunctivitis, pneumonia, genital tract Sexual contact, infants at 2-14 days or longer for infections, purulent discharge from urethra/cervix, Until 2 weeks after treatment begins or None Gonorrhea R delivery, eye mucus/discharge chlamydia ectopic , PID, may be asymptomatic months if untreated (Neisseria gonorrhea) Herpes Simplex Oral and sexual contact, infants 2-12 days Blisters on/around genitals, rectum, mouth; may 2-7 weeks after primary infection; None () at delivery recur intermittent shedding without sores For all diseases: Prevent others from touching lesions and HPV V discharge; maintain good hand and personal hygiene Sexual contact or contact with 3 months to several Flat/raised skin , cauliflower-like warts in Unknown None (Human papillomavirus) cutaneous warts years anogenital area

Syphilis R : painless genital , rash on palms (Treponema pallidum) Sexual contact, contact with 10-90 days for syphilis, or soles of feet, generalized body rash, oral/genital 1-2 weeks after treatment initiated or or secretion, syphilis can mucus membrane lesions; months to years if untreated None Sexually Transmitted Diseases Transmitted Sexually Chancroid R infect unborn babies 3-5 days for chancroid Chancroid: painful genital ulcers, tender glands (Haemophilus ducreyi)

For more information, contact R = Reportable to State and local health departments V = Vaccine available to prevent illness Developed and produced by the Bureau of Communicable Diseases and Emergency Response Division of Public Health your local health department. *Susceptible/At Risk = Persons not immunized, with compromised immune systems, or pregnant * High Risk Settings = Health care, child care, food service State of Wisconsin, Department of Health Services

Three Key Criteria for Exclusion: Most childhood illnesses do not require exclusion. /teacher should determine if the illness 1) prevents child from participating comfortably in activities, 2) results in need for care that is greater than staff can provide without compromising health and safety of other children, or 3) poses risk of spread. If any of these criteria are met, child should be excluded regardless of the type of illness. References:

American Academy of Pediatrics, Red Book: 2012 Report of the Committee on Infectious Diseases; 2012. This chart of selected communicable diseases information is meant only as a guide to answer questions frequently asked of persons who have American Academy of Pediatrics, Managing Infectious Diseases in Child Care and Schools, 3nd Edition; 2013. responsibility for groups of children in day care centers, schools, summer camps, or other similar situations. The chart is not meant to be an all-inclusive list of significant diseases, or be a comprehensive guide to all the information about each disease. More specific information about these or other American Public Health Association, Control of Communicable Diseases Manual, 19th Edition; 2008.

diseases may be obtained from your local public health agency or at: http://www.dhs.wisconsin.gov/communicable/index.htm. P-44397 (Rev. 05/2014)

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