Managing infections

Refer to this document for information on managing infections in children. Requirements for reporting vary across Canada. Find out which infections are reportable in your province/ territory by contacting your local public health unit.

Reporting and Illness Transmission Signs/symptoms Infectious period Exclusion notifi cation

Viral respiratory infections Viruses include: Viruses in the Common cold: Depends on Common cold: No. respiratory syncytial nose and throat Runny nose, cough, the virus but usually No, unless the child is virus, parainfl uenza spread by: direct sneezing, sore throat, 3 to 8 days (longer too ill to participate in virus, infl uenza, contact with headache, possibly for children with a all program activities. adenovirus, respiratory secretions fever. weakened immune rhinovirus, or contaminated system). Bronchiolitis, No, unless coronavirus, hands, indirect Bronchiolitis: croup, infl uenza, you suspect metapneumovirus. contact with toys, Cough, laboured Most infectious pneumonia: an outbreak. tissues, or other breathing, wheezing, while symptoms are Yes, until the child See page 175 for objects contaminated fever. present. is well enough to additional information. with respiratory participate in all secretions, or Croup: Hoarseness, program activities. droplets from barking cough, rapid, coughs and sneezes. laboured or noisy breathing, fever.

Infl uenza: Fever, chills, cough, headache and muscle pains.

Pneumonia: Fever, cough, rapid or laboured breathing, poor skin colour. Bacterial Bacteria usually Fever, cough, rapid or Usually not Yes, until the child No, unless pneumonia present in the nose laboured breathing, considered is well enough to pneumococcus and throat and can poor skin colour. contagious. participate in all or Haemophilus See pages 206, cause disease if they program activities. infl uenzae type B is 209 for additional get into the lungs. isolated during blood information. testing.

Gastrointestinal infections Can be viral or Germs in stool spread by: direct contact (hand to mouth), or indirect contact with toys, other objects or surfaces bacterial. See page contaminated with stool. 186 for additional information. Campylobacter Bacteria usually Fever, diarrhea (often Bacteria excreted in Yes, if a child’s diarrhea Yes, by the testing ingested in with blood and/or stool for 2 to can’t be contained in laboratory. contaminated food or mucus in stool), 3 weeks. a diaper, or a toilet- (e.g., improperly cramps. trained child can’t Contact your local cooked poultry, Most contagious control his bowel public health unit if a unpasteurized milk) during the acute movements. child at your facility or water. illness. is diagnosed with Campylobacter Person-to-person gastroenteritis. spread by direct or indirect contact with stool can occur, especially among young children.

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Content from Well Beings: A Guide to Health in Child Care. For more information, visit www.cps.ca. Managing infections

Reporting and Illness Transmission Signs/symptoms Infectious period Exclusion notifi cation Clostridium diffi cile Bacteria are normally Diarrhea (sometimes Infectious as long as Yes, if a child’s diarrhea No. (C. diffi cile) found in soil and in with blood and/ diarrhea lasts. can’t be contained in the intestinal tract. or mucus in stool), a diaper, or a toilet- Antibiotic treatment cramps, fever. trained child can’t permits overgrowth control his bowel of C. diffi cile in the Most children under 1 movements. gut and may trigger year of age have no disease. symptoms, and most older children have a Person-to-person very mild illness. spread by direct or indirect contact with stool can occur. Escherichia Bacteria usually Starts as non-bloody Bacteria excreted Yes, until diarrhea Yes, by the testing coli O157 ingested in diarrhea, usually in stool for about a subsides and 2 stool laboratory. (E. coli) contaminated food progressing to visibly week. cultures (taken when (e.g., poultry, beef, bloody stools, with the child is no longer Contact your local milk, unpasteurized severe abdominal Infectious as long as receiving antibiotics) public health unit apple juice, raw pain. diarrhea lasts. test negative. if a child in your vegetables), or facility is diagnosed water contaminated with E. coli 0157 with animal or human gastroenteritis. feces.

Also spread from person to person by direct or indirect contact with stool. Giardia Parasites in the stool Watery diarrhea, Infectious as long Yes, until diarrhea Yes, by the testing are spread from recurrent abdominal as cysts are in the subsides. laboratory. See page 187 for person to person by pain. stool, which can be additional information. direct or indirect for months. Contact your local contact with stool Some children public health unit or are ingested in experience chronic if a child at your contaminated food diarrhea with foul- facility is diagnosed or water. smelling stools, a with Giardia distended stomach gastroenteritis. and weight loss. In the case of an outbreak, authorities Many infected children may screen and/or have no symptoms. treat all children and staff , with or without symptoms. Rotavirus Viruses in the stool High fever, vomiting, Infectious just Yes, if a child’s diarrhea No. spread easily from followed within 12 to before onset of can’t be contained in See page 186 for person to person by: 24 hours by profuse, symptoms and as a diaper or a toilet- Contact your local additional information. watery diarrhea. long as 3 weeks trained child can’t public health unit Direct or indirect later. control her bowel if you suspect an contact with stool movements. outbreak (i.e., 2 to 3 and contaminated or more children have objects/surfaces. diarrhea within 48 hours). Salmonella typhi Bacteria in the stool Diarrhea, cramps, Infectious as long as Yes, until diarrhea Yes, by the treating (gastroenteritis or are spread from fever. bacteria are in the subsides and 3 stool physician and testing typhoid fever) person to person by stool, which can be cultures (taken when laboratory. direct or indirect for many weeks. the child is no longer contact with stool, receiving antibiotics) Inform your local or are ingested in test negative. public health unit contaminated food. immediately if a child or adult at your facility is diagnosed with S. typhi infection. Stool cultures for other children and staff may be required.

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Content from Well Beings: A Guide to Health in Child Care. For more information, visit www.cps.ca. Managing infections

Reporting and Illness Transmission Signs/symptoms Infectious period Exclusion notifi cation Salmonella Bacteria are Diarrhea, cramps, Infectious as long as Yes, until the child Yes, by the testing gastroenteritis usually ingested in fever. bacteria are in the is well enough to laboratory. (non-typhi) contaminated food stool, which can be participate in all (e.g., meat, poultry, many weeks. program activities. Contact your local eggs, unpasteurized public health unit dairy products, if a child at your vegetables and fruit). facility is diagnosed with Salmonella Person-to-person gastroenteritis. spread may occur from direct or indirect contact with stool.

Reptiles and amphibians are also sources of infection. Shigella Bacteria in stool Watery diarrhea, Infectious as long as Yes, until diarrhea Yes, by the testing gastroenteritis spread from person with or without blood bacteria are in the subsides and 2 stool laboratory. to person by direct and/or mucus, fever, stool, which can be cultures (taken when or indirect contact cramps. up to 4 weeks. the child is no longer Contact your local with stool. receiving antibiotics) public health unit test negative. if a child at your facility is diagnosed with Shigella gastroenteritis. Other children, staff or household contacts with symptoms may need testing. Yersinia Bacteria are ingested Fever, diarrhea (often Infectious as long as Yes, if a child’s diarrhea Yes, by the testing gastroenteritis in contaminated with blood and/or bacteria are in the can’t be contained in laboratory. food (e.g., raw or mucus in stool). stool, which can be a diaper, or a toilet- undercooked pork, for up to 2 to trained child can’t Contact your unpasteurized milk) 3 weeks. control his bowel public health unit or water. movements. if a child at your facility is diagnosed Person-to-person with Yersinia spread is rare. gastroenteritis.

Other illnesses Chickenpox Viruses in the throat Fever and itchy rash. Infectious for 2 days No. Children with mild Yes, in some (varicella) and from skin lesions Crops of small red before rash starts chickenpox can attend jurisdictions, by the spread easily from spots turn into fl uid- until all blisters have child care regardless of treating physician and For more information person to person fi lled blisters that crusted over and the state of their rash, testing laboratory. and important through the air, crust over within a dried (usually about as long as they feel well requirements, and can travel large few days and become 5 days after start of enough to participate in Contact your local see pages 198–99 and distances. itchy. rash). all program activities. public health unit if 375. there is an outbreak Viruses in skin lesions at your facility. Non- spread by contact immune children and with fl uid from staff may need to see blisters. a doctor right away. Preventive treatment Virus persists in the (vaccine or immune body for life and may globulin) may be recur as shingles. needed. Viruses can spread by contact with Notify all shingles if lesions parents and staff are not covered. immediately.

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Content from Well Beings: A Guide to Health in Child Care. For more information, visit www.cps.ca. Managing infections

Reporting and Illness Transmission Signs/symptoms Infectious period Exclusion notifi cation Cold sores Viruses spread from Range from no Infectious for at No, for a child with No. (herpes simplex type person to person by symptoms to a simple least a week during simple cold sores. 1 virus) direct contact of cold sore or many the fi rst infection. mucous membranes painful ulcers in the Yes, for a child with See page 193 for (mouth, nose, eyes) mouth and a high Recurrences are mouth ulcers who is additional information. with cold sores or fever. less contagious for a drooling, until she is saliva. shorter time. well enough to eat and participate comfortably Virus persists in the in all program activities. body for life and infections may recur. Conjunctivitis Bacterial or viral. Scratchy, painful or Bacterial: Yes, until seen by a No. (pinkeye) Germs spread itchy red eyes, light Infectious until 24 doctor. easily by: direct sensitivity, tearing hours of appropriate Contact your local See page 180 for and indirect with purulent (pus) or antibiotic treatment If bacterial, child public health unit additional information. contact with mucousy discharge. received. can return to the if you suspect an eye secretions, program after starting outbreak (2 or more or droplets from Viral: Infectious as appropriate antibiotic children in one room coughs and sneezes long as there is eye treatment. have red eyes with when associated with discharge. watery discharge). a respiratory virus. If viral, child can return with doctor’s approval. It can also be caused by an allergy or No need to eye irritation, which exclude if there is no usually does not eye discharge, unless cause discharge. there is an outbreak. Cytomegalovirus Viruses in saliva Children usually have Infectious as long as No. No. (CMV infection) and urine spread by no symptoms. virus is in the urine direct contact. and saliva, which See pages 184 and Can infect a fetus if can be for months 380 for additional Virus persists in the the mother is infected in many healthy information. body for life and or re-exposed during infants. infections may recur. pregnancy. Group A Some strains of Toxic shock Infectious until 24 Yes. A child can return Yes, by the treating Streptococcus (GAS) GAS cause invasive syndome: Fever, hours of appropriate to the program once physician and testing invasive diseases disease. Bacteria dizziness, confusion antibiotic treatment she has received at laboratory. (e.g., toxic shock spread from person and abdominal pain. received. least 24 hours of syndrome, necrotizing to person by: appropriate antibiotic Notify your local fasciitis [fl esh-eating direct contact Necrotizing therapy, and a doctor public health unit disease]) with skin lesions, fasciitis: Fever, has determined she immediately if a or respiratory severe, painful is recovered and well child or adult at For more information droplets. localized swelling, and enough to participate in your facility is and important a rapidly spreading all program activities. diagnosed with requirements, Children are at red rash. invasive GAS. see page 211. highest risk of Antibiotic treatment infection within may be required 2 weeks of having for all exposed chickenpox. contacts, especially if chickenpox is also present.

Inform public health authorities if a child or staff member in your program has had a non-invasive GAS infection (e.g., impetigo or pharyngytis) or chickenpox within the previous 2 weeks.

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Content from Well Beings: A Guide to Health in Child Care. For more information, visit www.cps.ca. Managing infections

Reporting and Illness Transmission Signs/symptoms Infectious period Exclusion notifi cation Haemophilus Bacteria in mouth and Causes fever Infectious Yes. A child can return Yes, by the treating infl uenzae nose are spread by: and pneumonia, until at least 24 to the program once physician and testing type b (Hib) disease direct contact and meningitis, hours of appropriate she has received at laboratory. respiratory droplets. epiglottitis, blood, antibiotic therapy least 24 hours of Inform your local For more information bone and joint received. appropriate antibiotic public health unit and important Does not spread infections. Symptoms therapy and a doctor immediately if a requirements, easily, and requires develop rapidly. has determined child at your center see page 206. prolonged close she is well enough is diagnosed with contact. to participate in all a Hib infection. program activities. Antibiotic treatment or vaccine may be required for exposed children.

Notify all parents. Hand-foot-and- Intestinal viruses Fever, headache, sore Virus in saliva for a Yes. Children should No. mouth disease spread from person throat, small, painful few days only but stay home from school to person by: direct mouth ulcers and a can remain in stool and child care if they See page 200 for or indirect contact rash (small red spots for 4 weeks after have symptoms. additional information. with stool or saliva. or small blisters), onset of illness. usually on the hands and feet. Head lice Spread from person Itchy scalp. Infectious as long as No. Exclusion is No. to person by: direct left untreated. ineff ective and See pages 191–92 for contact (head to unnecessary. Contact your local additional information. head), or public health unit indirect contact for guidance if an (e.g., shared outbreak cannot be hats, hairbrushes, controlled. headphones). Hepatitis A virus Virus in stool spreads Tea-coloured urine, Most infectious 1 Yes, for 1 week after Yes, by the treating (HAV) from person to jaundice and fever. to 2 weeks before onset of illness physician and testing person by: direct Most young children onset of illness until (unless all other laboratory. For more information or indirect contact do not get sick but 1 week after onset children and staff have Inform your local and important with stool, or can still spread the of jaundice. received preventive public health unit requirements, contaminated food virus to others. treatment). immediately if a see pages 189–90 or water. child or adult at and 380–81. Older children and your facility is adults are more likely diagnosed with to have symptoms. HAV.

Contacts may need vaccine and/or immune globulin.

Notify all parents and staff . Hepatitis B virus Virus in blood and Young children almost Infectious as long No. A child with HBV Yes, by the treating (HBV) other body fl uids always have no as the virus is in can participate in all physician and testing (e.g., saliva, genital symptoms. the blood and body program activities, laboratory. For more information secretions). Mainly fl uids. unless there are and important transmitted through Older children and medical or behavioural Contact your local requirements, sexual intercourse, adults may have May persist for life, risk factors (e.g., public health unit see pages from mother to fever, fatigue, especially in infants biting). about any bite that 212–14 and newborn, by sharing jaundice. infected at birth. breaks the skin. 377–78. contaminated Blood tests may be injection equipment required. or by transfusion of unscreened blood.

May be transmitted if an open cut or the mucous membranes (eyes, nose or mouth) are exposed to blood.

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Content from Well Beings: A Guide to Health in Child Care. For more information, visit www.cps.ca. Managing infections

Reporting and Illness Transmission Signs/symptoms Infectious period Exclusion notifi cation Hepatitis C virus Virus in blood. Young children almost Infectious as long No. A child with HCV Yes, by the treating (HCV) Mainly transmitted always have no as the virus is in the can participate in all physician and testing from mother to symptoms. blood. program activities. laboratory For more information newborn. Also by and important sharing contaminated Older children and May persist for life. Contact your local requirements, injection equipment adults may have public health unit see pages 216 or by transfusion fever, fatigue, about any bite that and 378. of unscreened blood. jaundice. breaks the skin. Blood tests may be May be transmitted required. if an open cut or the mucous membranes (eyes, nose or mouth) are exposed to blood. Human immuno- Virus in blood, genital Children usually have Infectious as long No. A child with HIV Yes, by the treating defi ciency virus secretions and breast no symptoms. as the virus is in can participate in all physician and testing (HIV) milk. Children usually the blood and body program activities. laboratory. acquire HIV from If AIDS develops, fl uids, presumably For more information their mothers before, they may have for life. Contact your local and important during or after birth persistent thrush, public health unit requirements, (by breastfeeding). Candida dermatitis, about any bite that see pages 215–16 Otherwise, chronic diarrhea, and breaks the skin. and 378–79. transmitted through be unable to gain Blood tests may be sexual intercourse, by weight. required. sharing contaminated injection equipment or by transfusion of unscreened blood.

May be transmitted if an open cut or the mucous membranes (eyes, nose or mouth) are exposed to a large amount of blood. Impetigo Caused by Group Fluid-fi lled blisters, Infectious until Yes, if draining lesions No (but community- A Streptococcus usually around the lesions have dried cannot be kept covered. associated methicillin- For more information or Staphylococcus mouth or nose, but up. If Group A For Group A resistant S. aureus and important aureus bacteria. may occur elsewhere. Streptococcus, Streptococcus [CA-MRSA] is requirements, Both spread from Blisters break, ooze, until 24 hours infections, until reportable by the see pages 194–95. person to person by: and form a honey- after fi rst dose of 24 hours of appropriate testing laboratory in direct contact (e.g., coloured crust. an appropriate antibiotic treatment some jurisdictions). by touching skin antibiotic. received. lesions), or indirect Contact your local contact (e.g., via public health unit for contaminated bed advice if you suspect linens or clothing). an outbreak (e.g., more than one child in the same room has impetigo within a month).

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Content from Well Beings: A Guide to Health in Child Care. For more information, visit www.cps.ca. Managing infections

Reporting and Illness Transmission Signs/symptoms Infectious period Exclusion notifi cation Measles Viruses in respiratory High fever, cough, Highly infectious Yes. A child with Yes, by the treating secretions spread runny nose and red from 3 to 5 days measles cannot return physician and testing For more information easily from person eyes 2 to 4 days before and up to to child care until at laboratory. and important to person through before a rash appears, 4 days after the rash least 4 days after onset requirements, the air. fi rst on the face, then appears. of rash. Measles exposure see pages 200–01 over entire body. is a medical and 377. Non-immune children emergency. and staff must be Notify your local excluded for 2 weeks public health unit after the onset of rash immediately if a in the child diagnosed child or adult at with measles, unless your facility is they have been diagnosed with vaccinated within measles. 72 hours of fi rst exposure. Exposed susceptible children and staff may require vaccine within 72 hours of the fi rst contact or immune globulin within 6 days of exposure.

Notify all staff and parents immediately. Meningitis Not all forms of Bacterial: Fever, Bacterial meningitis Yes. A child can return Bacterial meningitis: (bacterial or meningitis are lethargy, headache, is infectious until 24 to the program once Yes, by the treating enteroviral) contagious. extreme irritability, hours of appropriate she has received at physician and testing vomiting, stiff neck, antibiotic therapy least 24 hours of laboratory. For more information Bacterial: See seizures, a bulging received. appropriate antibiotic and important Meningococcal fontanel in babies therapy, and a doctor Notify your local requirements, disease and under 18 months old. Enteroviruses are has determined she has public health unit see pages 204–06. Haemophilus Usually progresses found in saliva for recovered and feels well immediately if infl uenzae type b rapidly. Child may only a few days but enough to participate in a child or adult disease. have a rapidly can remain in stool all program activities. at your facility spreading, bruise-like for 4 weeks after is diagnosed Enteroviruses in rash. onset of illness. with bacterial saliva and stool are meningitis. Antibiotic spread by direct or Viral: Usually milder, treatment or vaccine indirect contact. often fever and may be mandated for irritability only. some or all exposed children and staff .

Notify all parents and staff immediately. Meningococcal Meningococcus Usually causes Infectious until Yes. A child can return Yes, by the treating disease is a bacterium sepsis or meningitis, after 24 hours to child care once he physician and testing found in the mouth with high fever and of appropriate has received at least laboratory. For more information and respiratory rapid progression to antibiotic treatment 24 hours of appropriate Inform your local and important secretions. Does not shock (decreased received. antibiotic therapy, and a public health unit requirements, spread easily but responsiveness, poor doctor has determined immediately if a see pages 207–09. can be transmitted skin colour). Child he has recovered and child or adult at by: close, direct may have a distinctive feels well enough your facility is contact (e.g. rash that starts as to participate in all diagnosed with with saliva), or small red spots but program activities. meningococcal respiratory rapidly progresses disease. Public droplets. to large red-purple health authorities bruises. may mandate antibiotic treatment and/or vaccination for exposed children and staff .

Notify all parents and staff immediately.

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Content from Well Beings: A Guide to Health in Child Care. For more information, visit www.cps.ca. Managing infections

Reporting and Illness Transmission Signs/symptoms Infectious period Exclusion notifi cation Molluscum Virus spreads from Smooth, shiny Unknown. No. No. contagiosum person to person by pinkish-white bumps direct (skin-to- with a dip in the Molluscum See page 197 for skin) contact with middle and a cheesy disappears after additional information. lesions, or indirect material inside, several months contact (e.g., anywhere on the without treatment. with bed linens body. contaminated with material from the lesions).

Not very contagious. Mumps Virus in saliva and Fever, swollen glands Infectious from Yes, for 5 days after Yes, by treating respiratory secretions at the jaw line or on 2 days before onset onset of swelling. physician and testing For more information spreads easily from the face, headache. of swelling until laboratory. and important person to person 9 days after. Public health authorities requirements, by: direct contact may exclude non- Notify your local see pages 184 (e.g. kissing), immune children or public health unit and 376–77. or respiratory staff for at least immediately if droplets. 26 days after symptom a child or adult onset in the last person at your facility with mumps in a child is diagnosed care setting. with mumps. The authorities may mandate vaccination for non-immune contacts. Otitis media (middle Viral or bacterial, Earache, irritability, Non-contagious. No, unless child is No. ear infections) usually a complication possibly fl uid draining too ill to participate in of from ears. Child may program activities. See page 178 for the common cold. have fever or cold additional information. symptoms. Non-contagious. Parvovirus B19 Virus in respiratory Red rash on the Infectious for No. Once rash appears, No. infection (fi fth secretions spreads cheeks followed by several days before a child is no longer disease, erythema by: direct contact, a lace-like rash on the rash, and non- contagious. Notify all parents and infectiosum, or and (possibly) the torso and arms infectious once rash staff . “slapped cheek” respiratory that spreads to the appears. syndrome) droplets. rest of the body. Advise exposed Sometimes preceded pregnant staff and For more information Can also be by a low fever or parents to contact and important transmitted from cold symptoms 7 to their doctor. requirements, mother to child 10 days before rash see pages 201–02 before birth. appears. and 379–80. Pertussis (whooping Bacteria in respiratory Runny nose, Infectious for up to Not routine but Yes, by the treating cough) secretions spread frequent and severe 3 weeks from onset exclusion may be physician and testing easily from person to coughing spells, of illness if not mandated by public laboratory. For more information person by droplets sometimes followed treated, and for health authorities, and important from coughs and by a whooping sound, 5 days if appropriate especially if people at Inform your local requirements, sneezes. gagging or vomiting. antibiotic treatment high risk are present. public health unit see pages 182–83 Babies may have is received. immediately if a and 379. serious diffi culty Exclude until 5 days child or adult at breathing. of appropriate antibiotic your facility is treatment received or diagnosed with for 3 weeks from onset pertussis. Antibiotic of illness, if not treated. treatment and/or vaccination may be mandated.

Notify all parents and staff immediately.

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Content from Well Beings: A Guide to Health in Child Care. For more information, visit www.cps.ca. Managing infections

Reporting and Illness Transmission Signs/symptoms Infectious period Exclusion notifi cation Pinworms Worm eggs spread Anal itching, disturbed Infectious as long as No. Contact your local by: direct contact sleep, irritability. eggs are being laid public health unit if an See pages 190–91 for (e.g., contaminated on skin. Eggs are infestation persists. additional information. fi ngers), or indirect infective for 2 to Treating all household contact (e.g., 3 weeks indoors. members and close contaminated bed contacts may be linens, clothing, toys). needed. Pneumococcal Bacteria are normally Usually an ear or Not usually No, for minor illness Yes (for invasive disease found in the nose and sinus infection considered (e.g., otitis, sinusitis). pneumococcal throat and usually do following a cold. infectious. Probably infections only), See pages 209–10 for not cause infection. not transmissible A child with serious by the treating additional information. Invasive infections after 24 hours illness can return physician and testing Possible person- include fever of appropriate to child care once a laboratory. to-person spread and pneumonia, antibiotic therapy. doctor has determined by: close, direct meningitis, blood, he is well enough contact with bone and joint to participate in all mouth secretions infections. Symptoms program activities. (e.g., kissing), develop rapidly. or respiratory droplets. Ringworm Fungus spreads from Ring-shaped itchy, Transmissible as Yes, until the fi rst No. person to person by: scaly lesions on scalp, long as rash is treatment has been See pages 195–96 for direct contact (skin- body or feet (athlete’s untreated and/or applied. additional information. to-skin), and indirect foot). Bald spots on uncovered. contact (e.g., shared the scalp. combs, unwashed clothes, or shower or pool surfaces).

Also acquired from pets, especially cats. Roseola Virus probably High fever and Infectious while No. A child with roseola No. spreads from person crankiness for 3 to symptoms are can continue to attend See page 203 for to person by direct 5 days. When the present. child care as long as additional information. contact with saliva. fever subsides, a rash she is well enough Often found in saliva of small red spots to participate in all of people with no appears on the face program activities. symptoms. and body, lasting a few hours to 2 days. Rubella Virus spreads from Mild in children, with Infectious from Yes, for 7 days Yes, by the treating (German measles) person to person low fever, swollen 7 days before to after the rash is physician and testing by: direct contact glands in the neck 7 days after the fi rst noticed. laboratory. For more information with nose/ and behind the ears, rash appears. Rubella exposure and important mouth secretions, and a rash with is a medical requirements, or respiratory small red spots. emergency. see pages 203–04 droplets. More severe in Notify your local and 376. adults. If acquired public health unit in pregnancy, may immediately if a seriously aff ect the child or adult at fetus. your facility is diagnosed with rubella. Non-immune children and staff may need immunization.

Notify all parents and staff immediately.

Advise pregnant staff and parents who aren’t sure of their immune status to see their doctor.

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Content from Well Beings: A Guide to Health in Child Care. For more information, visit www.cps.ca. Managing infections

Reporting and Illness Transmission Signs/symptoms Infectious period Exclusion notifi cation

Scabies Mites spread from Itchy red rash, usually Transmissible as Yes, until the fi rst No. Contact your person to person by between fi ngers and long as infestation is treatment has been local public health See pages 192–93 for direct (prolonged, toes, or the wrists untreated. applied. unit for guidance if an additional information. close and intimate) or in the groin, with outbreak cannot be contact. thread-like lines and controlled. scratch marks. May be elsewhere on the body in children under 2 years of age. Streptococcal Bacteria in throat Sore throat, fever, Infectious from Yes. A child can return Scarlet fever is pharyngitis (strep spread from person swollen tender neck onset of illness to the program once he reportable by the throat) and scarlet to person by: direct glands. until 24 hours has received at least treating physician in fever contact with saliva, of appropriate 24 hours of appropriate some jurisdictions. or respiratory Scarlet fever is strep antibiotic treatment antibiotic treatment, See pages 181–82 for droplets. throat with a red received. and the child is well Contact your public additional information. sunburn-like rash enough to participate in health unit if you covering the entire all program activities. suspect an outbreak body. at your facility (more than 2 cases in a month). Thrush and Candida Fungus is normally Thrush presents as Usually not spread No. No. diaper rash present in the body whitish-gray patches from person to without causing on the inside of the person. Make sure bottle See pages 196–97 for illness, and rarely cheek or on the nipples and soothers additional information. spreads from person tongue. aren’t shared between to person. children. Candida diaper rash Thrush can be is a painful bright-red transmitted to an rash in the deepest infant by contact with creases of a baby’s contaminated bottle groin, on the buttocks nipples or soothers. or in moist neck folds. Tuberculosis (TB) Bacteria from the For infectious TB: If infectious TB: As If infectious TB: Yes, for Yes, by the treating lungs spread fever, cough, diffi culty long as bacteria are at least 2 weeks after physician and testing For more information through the air in breathing. in the respiratory starting appropriate laboratory. and important particles produced secretions. antibiotic treatment, requirements, by coughing. Young children rarely and until the treating Notify your local see pages 210–11 have infectious TB. physician or local public public health unit and 381. health unit states that a immediately if a child or staff member is child or adult at no longer infectious. your facility is diagnosed with TB.

Exposed children and adults may need testing and antibiotic treatment.

Notify all parents and staff immediately.

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© Canadian Paediatric Society, 2015. Reprinted from Well Beings: A Guide to Health in Child Care (3rd revised edition). May be reproduced for educational purposes and for use in child care settings. For more information on this topic, consult Well Beings: A Guide to Health in Child Care. Purchase this book at www.cps.ca.