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Home , Airborne transmission, Incubation period, Infectious period

Nevada Division of Public and Behavioral Health, Office of Public Health Informatics and 4150 Technology Way, Carson City, Nevada 89706 Main: (775) 684-5911 After Hours, Emergency Only: (775) 400-0333 Email: [email protected] Website: http://health.nv.gov/Epidemiology.htm

DISEASE INCUBATION MODE OF PERIOD OF CONTROL PUBLIC HEALTH PERIOD COMMUNICABILITY MEASURES RESPONSE AIDS/HIV* HIV : 14 Person-to-person by Persons with HIV should be considered Education of those who are infected, and Patient interview by Public Health days (1) sexual contact, infectious for life. Risk of transmission those who are at risk of becoming infected (PH). Education and counseling in AIDS (Stage 3 HIV (2) exposure to blood, may be higher in first months after about how to prevent transmission of HIV conjunction with HIV testing. Referral Infection): 7 to 10 years (3) mother to infant during pregnancy or at time infection. (i.e., safer sexual practices, stop injecting of sexual and needle sharing partners (when HIV infection of birth, or via breast feeding. drug use and needle sharing, etc). for testing, counseling, and untreated) treatment. Campylobacter* 1-10 days, average 2-5 days By ingestion of contaminated food – particularly Throughout course of ; usually Always wash hands thoroughly after bowel Education on prevention of spread, undercooked poultry, water, or unpasteurized several days to up to seven weeks. movements or diapering, before eating and including avoiding cross milk; from contact with infected animals or preparing food. Exclude symptomatic contamination of foods by washing persons by fecal-oral route. persons from food-handling and child care cutting boards and other food until diarrhea had ceased. Avoid preparation items between raw unpasteurized milk and unpasteurized dairy poultry or meats and other food products. Thoroughly cook all meat, products such as vegetables. especially poultry. : Varicella 10-21 days, average 14-16 Person-to-person by droplet or airborne spread As long as 5, but usually 1-2 days Exclude from school or child care and avoid Recommend for all days of respiratory secretions; direct contact with before onset of rash until all blisters contact with susceptible persons until appropriate susceptible persons. drainage from blisters or indirectly through have crusted. blisters are crusted. articles contaminated by secretions from Exposed susceptible people eligible for blisters. should receive vaccine within 3-5 days to protect from their recent exposure. * 1-3 weeks; often Contact with infected person through sexual Duration of infection. Reinfection is Examine and treat all persons with sexual For higher priority cases, patient , especially in activity; neonatal by contact with common if partners are not treated in contact that occurred within the last 60 days, interview with PH and notification of females birth canal. a timely manner. Without treatment, regardless of their test results. Annual sexual contacts for referral to medical infection may persist indefinitely, screening for sexually active females aged < care. Education on abstinence, leading to infections of the upper 25 or at high risk. monogamy and use of barrier reproductive tract and other serious, protection such as latex condoms. long-term complications in both females and males. Conjunctivitis, with a 24-72 hours Contact with discharges from the eyes, nose, or During the course of active infection. Persons should not attend school or child Education of family and classmates fever and behavioral throat of infected people, from contaminated care during the acute stage. on prevention of spread by practicing change, purulence or fingers, clothing, and other articles. good hand washing and not sharing hemorrhage towels or other items soiled with discharge from eyes or nose. Enterohemorrhagic 2-10 days, average 3-4 days Ingestion of contaminated foods, directly from Duration of excretion of the Exclude from high-risk settings (food- Patient interview and contact Esherichia coli Includes person-to-person by fecal-oral route, or contact in the stool, which is usually 1 week or handling, patient care, child care) until 2 investigation by PH. If high-risk E. coli O157:H7 and with infected animals. Linked to eating under- less in adults but 3 weeks in 1 out of 3 negative stool cultures taken 24 hours of setting involved, contact the Nevada other Shinga toxin cooked, contaminated ground beef, children. more apart and no sooner than 48 hours Division of Public and Behavioral producing E. coli* unpasteurized milk and juices. following discontinuation of . Health (DPBH). Education on Symptomatic contacts should be excluded importance of hand washing and from high-risk settings until 2 negative stool proper disposal of feces and diapers. cultures are obtained. , 4-20 days Contact with infected Greatest before onset of rash. Probably Frequent hand washing. Cover nose and Student, teacher, and family Human parvovirus respiratory secretions; also not communicable after onset of rash. mouth with disposable tissue when coughing education about hand washing and B19 infection, from mother to fetus; and People with aplastic crisis are and sneezing and proper disposal of tissue. standard precautions. Susceptible Erythema by transfusion of blood and communicable up to 1 week after Or cough and into your upper arm. women who are pregnant or who infectiosum blood products. onset of symptoms. Do not share eating utensils. Exclusion is not might become pregnant, and have necessary. continued close contact to people with infection should consult with their healthcare

provider. Giardia* 3-25 days or longer, Person-to-person spread b fecal-oral route, Entire period of infection, often Exclude symptomatic persons from food Education on prevention of spread to average 7-10 days especially in child care centers. Rarely by months. handling and child care until effective families, teachers and classmates. ingestion of contaminated food or water, or by treatment has been initiated and diarrhea Surveillance for additional cases. contact with infected animals. has ceased. Good hand washing by staff and child after bowel movements or diapering, and before eating or preparing food. * 2-5 days, sometimes Contact with infected person through sexual Duration of infection. Re- infection is Examine and treat all persons with sexual For higher priority cases, patient longer; often asymptomatic activity; neonatal infections by contact with common if partners are not treated in contact that occurred within the last 60 days, interview by PH and notification of especially in females birth canal. a timely manner. Without treatment, regardless of their test results. Annual sexual contacts for referral to medical infection may persist indefinitely, screening for sexually active women age <25 care. Education on abstinence, leading to infections of the upper or at high risk. monogamy and use of barrier reproductive tract and other serious, protection such as latex condoms. long-term complications in both females and males. Hand, foot, and 3-5 days Direct contact with nose and throat discharges During acute stage of illness, perhaps Prompt hand washing after handling Education of families, teachers, and mouth disease: and feces of infected people and by droplet longer; persist in stool for discharges, feces, and soiled articles. Wash classmates about proper hand Coxsackievirus spread. several weeks. or discard articles soiled with nose and washing. (Not related to throat discharges. Cover nose and mouth animal foot and mouth with disposable tissue when coughing and disease) sneezing and proper disposal of tissue. Or cough and sneeze into your upper arm. Exclusion may not prevent additional cases as is excreted after symptoms are gone. ** 15-50 days, average 28-30 Person-to-person spread by fecal-oral route; Approximately 2 weeks before and 1 Hand washing. Exclude from high-risk Immediate patient interview and days ingestion of contaminated food or water, or week after onset of jaundice. situations (food handling, child care, and assessment by PH. Contact sharing of drug paraphernalia. patient care) for 1 week after onset of investigation. Counseling. If case is in jaundice. Give household, child care and high-risk situation, contact DPBH other intimate contacts immune globulin (IG) immediately. Recommend 0.02ml/kg body weight and or vaccine within vaccination to appropriate 14 days of last exposure. susceptible persons. Hepatitis B* 45-180 days, average 60-90 Sexual, IV drug use, close household contact, Blood and other body fluids are Follow Standard and Blood Borne Pathogen Patient interview and assessment by days perinatal mother-to-infant. Rarely occupational infectious during late incubation Precautions. Cover open cuts and sores. PH. Contact investigation. Counseling. percutaneous or mucus membrane exposure to period, clinical disease, and for variable Wear gloves when in contact with blood or Education on prevention of further blood, saliva or semen period after recovery (as long as HBsAg body fluids. Immediate cleanup of objects spread and hepatitis B. Screen all positive). Chronic carriers are contaminated with blood or body fluid. For women during each pregnancy. infectious for life. blood or needle exposure to known HBsAg Recommend vaccination to positive persons, and not vaccinated, appropriate susceptible persons, hepatitis B immune globulin (HBIG) 0.06 including all infants. mg/kg body weight within 24 hours (no later than 72 hours for perinatal exposure, 7 days for percutaneous exposure, or 14 days for sexual exposure) and HBV vaccine given at 0,1, and 6 months if not previously vaccinated. : Variable and indefinite. Direct contact with purulent drainage from Until all lesions are healed. Avoid contact with purulent drainage from Education on prevention of spread Staphylococcal Average 4-10 days infected lesion lesions. Cover lesions when attending school and hand washing. disease or child care.

Influenza (Flu) 1-4 days, average 2 days Contact with droplets from the nose and throat One day before symptoms occur and Vaccination. Stay home while ill. Wash hands Education on prevention of spread. of an infected person who is coughing or up to 7-10 days after symptoms begin. often with soap and water. Cover nose and Recommend annual vaccination for sneezing. mouth with disposable tissue when coughing all appropriate persons. and sneezing or cough and sneeze into your that is known or suspected to be of a upper arm. Avoid close contact with ill viral strain that the Centers for individuals. Antiviral drugs, as prescribed. Disease Control and Prevention or the World Health Organization has determined poses a risk of a national or global is reportable immediately to DPBH. Lice, head Varies with stage of Direct contact with an Until nymphs or adult lice and their There is no need for child to be sent home Counseling. Education on appropriate louse/lice at exposure. infested person such as eggs (nits on hair shaft) have been from school or child care the day of control measures. If there are barriers head to head contact; less destroyed through treatment. diagnosis. Allow to return after initial for getting treatment, contact PH. frequently by contact with treatment. A "no-nit" policy is not contaminated personal recommended. A second treatment in 10 articles. Most children catch lice from exposure days. On days 3-9 and 12-14 shampoo, in the community, not in their school. condition and wet-comb hair using a fine- tooth comb before rinsing off conditioner. Launder clothing and bedding using hot water and dryer. Check family members and close contacts for infestation. :** About 10 days. Rash usually Airborne by a fine mist caused when an 4 days before rash appears to 4 days Exclude from school and child care for 4 days Contact DPBH immediately. IgM is Rubeola, appears about 14 days infectious person coughs, or after onset of rash. after appearance of rash. Vaccinate necessary to confirm diagnosis. Hard measles, after exposure but can be talks. This stays suspended in the air for up to 3 appropriate susceptible contacts as soon as Patient interview and contact Red measles as long as 19-21 days. Fever hours. possible but within 72 hours of last investigation by PH. Institute onset, 7-18 days. exposure. IG for appropriate susceptible outbreak control measures. contacts such as pregnant women as soon as Recommend immunization with MMR possible but must be within 6 days of last to all appropriate susceptible exposure. persons. Methicillin-resistant After colonization, disease Direct person-to-person contact is the primary Variable: as long as organisms are Cover open cuts and sores. Good hand Educating health care providers, Staphylococcus may not occur until several method of transmission. At least 1 in 3 infected present in the body substances (i.e., washing. Cover nose and mouth with family, and contacts about MRSA and aureus months later, or more persons are infected by spread from one part of weeping wounds, nasal discharges). disposable tissue when coughing and the importance of hand washing and (MRSA) commonly, never. their body to another. Infection is much less Spread much less likely from colonized sneezing with proper disposal of tissue. standard precautions. likely in healthy persons. persons. Or cough and sneeze into your upper arm. Treatment of MRSA infections, if indicated. MRSA is not grounds for exclusion from child care, school or nursing home. Mononucleosis 4-6 weeks Person-to-person by oral-pharyngeal route, via Prolonged pharyngeal excretion may Avoid contact with saliva. Good hand Education of students on prevention Epstein-Barr virus saliva. persist for months after infection. washing, disinfection of articles soiled with of spread. (EBV) nose and throat discharges, proper disposal of tissues, cover nose and mouth with disposable tissue when coughing and sneezing or cough and sneeze into your upper arm. * 12-25 days, average 16-18 Droplet or direct contact with saliva and by 3 days before to 4 days after day of Exclusion from school and child care through Recommend immunization with MMR days airborne droplet route. symptom onset or until symptoms 5 days after onset or until symptoms have to all appropriate susceptible resolve, whichever is longer. resolved, whichever is longer. Vaccination is persons. indicated for unimmunized contacts but may not provide protection for this exposure.

Neisseria meningitidis 2-10 days, average 3-4 days Direct contact including droplet spread and Until organisms no longer present in Respiratory until appropriate Contact DPBH immediately. Patient invasive disease:*** discharges from nose and throat during discharges from nose and throat. for 24 hours. Chemoprophylaxis interview and contact investigation. Meningococcal (which often is asymptomatic). Persons are non-infectious 24 hours for close contacts. Vaccination in limited Recommend immunization to after effective antibiotics are started. situations. Infected person should receive appropriate susceptible persons. rifampin prior to discharge if neither 3rd generation cephalosporin nor ciprofloxacin was given as treatment. Pertussis:** 6-20 days, average 9-10 Person-to-person by breathing in respiratory During catarrhal period until 3 weeks Infected person and symptomatic contacts Interview investigation by PH. days droplets. after onset of cough. Not infectious should be excluded from school until at least Recommend immunization for after 5 days of appropriate antibiotics. 5 days of appropriate antibiotics have been appropriate susceptible persons. completed or have coughed for 21 days. Course of appropriate antibiotics for all household and other close contacts. 12-50 hours, average 24-48 Person-to-person and fecal oral transmission. Communicable during acute stage of Exclude ill food handlers, healthcare Education on prevention of spread. Viral diarrhea hours Ingestion of ready to eat food, such as salads, disease and up to 48 hours after providers and child care staff and attendees sandwiches, ice, cookies, and fruit that are diarrhea stops. from work and child care for 48 hours after handled by infected persons; poorly cooked diarrhea and vomiting stops; everyone else, shellfish. 24 hours. Ringworm (Tinea 4-10 days Direct contact with lesions or indirect contact As long as lesions are present and Exclude from gymnasium, swimming pools, Education to families and patients on corporisbody) with contaminated surfaces or with infected viable spores persist on contaminated and contact sports. Wash gym mats with prevention of spread. animals materials. detergent solution and sanitize with fungicidal agent between uses. Launder clothes using hot water and dryer. Respiratory 2-8 days, average 4-6 days Droplet spread through coughing and sneezing About I day prior to, and throughout, Good hand washing. Cover nose and mouth Education to families, teachers, and syncytial virus or contact with nasal or oral secretions, or with illness. with disposable tissue when coughing and classmates on prevention of spread (RSV) articles contaminated with respiratory sneezing and proper disposal of tissue. Or by hand washing, proper use and discharges. cough and sneeze into your upper arm. disposal of tissues. Exclusion from school or child care will probably not decrease transmission. * * 14-21 days, average 14-17 Person-to-person by droplets and discharges About 7 days before and at least 4 days Exclude children from school and adults from IgM is necessary to confirm diagnosis. (German measles) days from nose and throat and via articles after rash appears. Infants with work for 7 days after onset of rash. Pregnant Contact investigation by PH. contaminated by secretions. congenital rubella syndrome may shed contacts should be serologically tested for Recommend immunization with MMR virus for months after birth via urine or susceptibility and advised according to for all appropriate susceptible pharyngeal secretions. results. persons. * 6-72 hours, average 12-36 Ingestion of contaminated food (commonly Variable: usually several days to several Exclude symptomatic persons from food Patient interview, assessment, and hours. (Up to 16 days has eggs, poultry, and meat); contact with infected weeks. A temporary carrier state may handling, patient care, and child care until contact investigation by PH. been documented.) animals or person-to-person spread by fecal- continue for months, especially in diarrhea has ceased. Thorough hand washing Education on prevention of spread. oral route. infants but transmission from carriers by staff and child after bowel movements or Advise no reptiles in classrooms, child is very uncommon. diapering, and before eating or preparing care or in homes with children < 5 food. years of age or with immunocompromised people. Scabies 2-6 weeks for first Prolonged direct contact with an infected Until mites and their eggs have been Exclude infested children from school and Education on appropriate control exposure. 1-4 days after re- person, sexual contact. Less frequently destroyed through treatment. child care until after first treatment. Treat all measures. exposure indirectly, by immediate contact with close, intimate (skin to skin) contacts contaminated personal articles including household members and sexual contacts. Launder bedding and clothing used by infected person within the 72 hours before treatment with hot water and dryer. Shigella* 12-96 hours, average 1-3 During acute infection and up to 4 weeks after During acute infection and up to 4 Same as E. coli O157:H7. Same as E. coli O157:H7. days onset of illness. weeks after onset of illness.

Shingles Varicella (chickenpox) virus Person-to-person by direct contact with While drainage from blisters is present. Cover lesions. No exclusion from school or Education on prevention of spread. (Herpes zoster) lies dormant in someone drainage from blisters. Only infectious to childcare if blisters can be covered. Recommend immunization for who has had chickenpox. persons who have not had chickenpox or appropriate persons. Reactivation of virus. chickenpox vaccine. Susceptible contacts get chicken pox, not shingles. Streptococcal 1-3 days Person-to-person by direct or intimate contact 10-21 days in untreated cases: until 24 Exclude from school until 24 hours after start Education on prevention of spread. infections with an infected person (case or carrier); rarely hours after start of appropriate of appropriate antibiotic therapy (usually (Strep throat, by contaminated articles, food or water. therapy. penicillin). Antibiotic prophylaxis of high-risk ) persons, i.e.; those with a history of rheumatic fever. Symptomatic contacts should be tested. Cover nose and mouth with disposable tissue when coughing or sneezing and proper disposal of tissue. Or cough and sneeze into your upper arm. * (TB) 2-10 weeks after exposure of tuberculosis Probably not communicable after 2-4 If communicable, exclude from school and Patient interview and contact (pulmonary and for skin test (PPD) in droplet nuclei from infectious person. weeks on effective drug regimen. work until patient meets criteria for non- investigation and follow-up by PH. laryngeal) conversion. 5-10% of Prolonged close contact usually needed for Extra-pulmonary TB is not infectiousness. Evaluate contacts with Directly observed therapy (DOT) by persons with latent TB spread. communicable. significant exposure. Prophylactic therapy or PH. PH give personnel infection (+ skin test but treatment as indicated. recommendations on return to clear chest x-ray) go on to community. Must still be reported develop disease in their even if suspect case. lifetime. Vancomycin-resistant Unknown due to carrier Same as MRSA and from contaminated Same as MRSA. Same as MRSA plus thorough environmental As above with MRSA plus the Enterococci (VRE) state. equipment or environment. cleaning. importance of keeping the environment clean.

Public Health Reporting * Disease is reportable the next work day to Nevada Division of Public and Behavioral Health (DPBH), Office of Public Health Informatics and Epidemiology - 775-684-5911 ** Disease is IMMEDIATELY reportable to DPBH (After Hours Emergency Duty Officer 775-400-0333) *** Disease is reportable within 24 hours regardless of whether or not that falls on a work day

Contact public health of any suspected outbreak. Immediately report any disease when there is reasonable suspicion that it may be the result of a deliberate act such as terrorism.

Why should I report? When should I report? What should be reported? Who should I report to? Reporting of cases of infectious Most disease reports should be Disease or suspected disease, patient's full Reports should be sent to the is important in the planning and submitted within five (5) working days of name, address, telephone number, date of local health agency (county or evaluation of disease prevention and diagnosis, treatment, or detection. birth (if known), sex, race (if known), state health department) by control programs, in the assurance of However, some conditions must be occupation (if known), employer (if known), telephone, email or fax. appropriate medical therapy, and in the reported within 24 hours or only during date of disease onset, date of diagnosis, health detection of common-source outbreaks. outbreaks. Care provider's name & contact information (and any other information required by health department).

All reported information is confidential.

Physicians, veterinarians, dentists, chiropractors, registered nurses, directors of medical facilities, medical laboratories and blood banks are required to report all cases, suspect cases and carriers within 24 hours. The following individuals should also report: school authorities, college administrators, directors of child care facilities, nursing homes and correctional institutions.

For more information on reportable diseases, see Nevada Revised Statue (NRS) Chapter 441A (http://leg.state.nv.us/nrs/NRS-441A.html) and Nevada Administrative Code Chapter 441 A.

Carson City Health & Human Services Southern Nevada Health District Washoe County Health District (Carson City, Lyon County, and Douglas 330 S. Valley View Blvd. 1001 E. Ninth St., Building B County) Las Vegas, NV 89107 P. O. Box 11130 900 East Long St. http://www.southernnevadahealthdistrict.org/ Reno, Nevada 89520-0027 Carson City, NV 89706 http://www.co.washoe.nv.us/health http://www.carson-city.nv.us Phone: (702) 759-1000 (24 hours) Confidential Fax: (702) 759-1414 Phone: (775) 328-2447 (24 hours) Phone: (775) 887-2190 Report Online: http://www.southernnevadahealthdistrict.org/diseasereports/disease_form.php Confidential Fax: (775) 328-3764 After-Hours Phone: (775) 887-2008 Confidential E-mail: [email protected] Confidential Fax (775) 887-2138

REMEMBER: HANDWASHING IS THE MOST IMPORTANT ACT A PERSON CAN DO TO PREVENT TRANSMISSION OF DISEASE!

This document has been adapted from the “Epidemiology of Common Communicable Diseases” courtesy of The Center for Acute Disease Epidemiology at the Iowa Department of Public Health.