Communicable Disease Control Measures

COMMUNICABLE DISEASE CONTROL MEASURES

The school nurse shall recommend to the principal that he exclude any youngster who, in her opinion, should be home for his welfare or continues to be a source of infection to others.

“Sick Children” are not to attend school. It is recommended that a student remain home at least 24 hours after his temperature has returned to normal. The following are medical policies for Communicable Disease Control in the Fairfield school system.

Disease

Chickenpox/Shingles The Varicella Zoster virus (VZV) causes chickenpox (varicella), a vaccine preventable generalized rash illness that is spread by coughing, sneezing or direct contact. VZV also causes shingles (herpes zoster), a localized rash in a person who has already had chickenpox, and is spread through direct contact with the shingles rash and through the air. A child with chickenpox, with or without a history of varicella vaccination, may return to school on the sixth day after appearance of the first eruption if well. Immunocompromised and other children with a prolonged course should be excluded for the duration of vesicular eruption.

Persons with non-disseminated zoster (shingles) should consult with their physician regarding the use of anti-viral medication. Student/staff may return to school as long as the area with lesions is covered. Instruct student/staff to wash hands well after contact with lesions. If lesions cannot be completely covered, student/staff may attend school when the rash is crusted over and dry.

Chickenpox disease in schools must be reported to the State and local health departments. When a case is reported at school, the nurse will complete the Varicella Case Report Form. Obtain the required information from the child’s parent or from the staff member who has chickenpox. Contact the physician if there is information which the parent or staff member is unable to provide which may be available from the physician, e.g., date of VZV vaccination. Fax the form to the State of CT Dept. of Public Health (fax #860- 509-7945) or mail it to the address at the bottom of the form. Also, fax or mail the form to the local health department in the town in which the child or staff member resides. For those who are Fairfield residents, forms may be sent inter-office from public schools to the Health Department, Sullivan Independence Hall. For non-public schools, forms may be mailed to Town of Fairfield Health Department, Sullivan Independence Hall, 725 Old Post Road, Fairfield, CT 06824. Alternatively, fax form to the Fairfield Health Department, fax #256-3080.

Parent/Staff Notification When the first case of chickenpox or shingles is reported during the school year, notify all parents of students in the school as well as all staff members. Use Health Department letter and CT Department of Public Health fact sheet for notification.

Re-notification is required, subsequently, for 3 or more cases in a 3 week period.

-Immunocompromised Children A written plan for notifying parents of immunocompromised children of cases of Chickenpox/shingles shall be established by the school nurse in collaboration with the child’s health care provider and parent. This plan shall include a requirement for written physician instruction regarding school attendance in these circumstances.

Chronic Infectious Disease (including, but not limited to, Acquired Immune Deficiency Syndrome, Hepatitis B, Tuberculosis) - See Fairfield Board of Education Policy).

Conjunctivitis Exclude until treatment has been initiated by the physician and symptoms have subsided. Nurse should see student upon reentry into school. If purulent drainage is still present, the child should not be readmitted to school. In elementary schools, when three or more cases occur in any one classroom in a one-week period, notify parents of children in that class. In all schools, when cases occur in 3% or more of the school population in a two-week period, notify all parents in the school. (Use Health Department letter for parental notification).

Coxsackievirus Child may attend school if afebrile and feeling well. Instruct student to wash hands well (Hand, Foot, after using the bathroom. Instruct staff who diaper or provide toileting assistance to a & Mouth child with Coxsackievirus to wash hands well and to use good hygienic practices for Disease) diaper changes.

Cryptosporidiosis May return to school once diarrhea has stopped. When a case is identified in a food handler, that person shall not resume food handling duties until approved to do so by the Director of Health.

Escherichia coli (E. coli) diarrhea – May return to school when diarrhea resolves and test results from 2 consecutive stool cultures taken 24 hours apart are negative for the E. coli bacteria that caused the illness. When a case is identified in a food handler, that person shall not resume food handling duties until approved to do so by the Director of Health.

Fifth Disease Description of Fifth Disease rash: On the face, this rash is intensely red with a “slapped (Erythema cheek” appearance and circumoral pallor. A symmetric maculopapular, lace-like rash Infectiosum) can also be noted on the arms, moving caudally to involve the trunk, buttocks, and thighs. The rash can recur and fluctuate in intensity with environmental changes, such as temperature and exposure to sunlight for weeks and sometimes months. May attend school unless fever is present. Notify school staff re: possible adverse effects of exposure during pregnancy. Include fact sheet from the CDC with the letter. (See Manual.) Notify parents of those with certain blood dyscrasias ie., sickle cell as per plan. Notification of school staff once made need not be repeated within 21 days.

Giardiasis May return to school once diarrhea has resolved.

Haemophilus For proven haemophilus influenza type b, may reenter per written doctor’s Influenza type b instructions 48 hours or more after starting antibiotic therapy. Refer preschool- aged children and household contacts for possible chemoprophylaxis. Household and preschool-aged contacts developing signs of illness, especially fever, should seek prompt medical evaluation.

Hepatitis A Exclude for one week after onset of illness. May then reenter with note from MD. Refer close contacts to their physician for consideration of IG administration. School room exposure generally does not pose a significant risk of infection and IG is not indicated. However, prophylaxis of school contacts with IG or vaccine may be considered when transmission within the school setting is documented.

Also, when a case is identified in a student or employee in a preschool class or a class in which children are not toilet trained, IG prophylaxis of staff and children in the class may be needed. In these circumstances, the School Medical Advisor and Director of Health will be consulted.

When a case is identified in a food handler, that person shall not resume food handling duties until approved to do so by the Director of Health.

Head Lice See Policy and Procedure: Pediculosis Capitis (Head Lice) in Communicable (Head Lice) Disease section of this manual.

Hepatitis B May attend school per written doctor’s instructions. Refer household contacts, and sexual contacts if known, to physician for possible prophylaxis.

Hepatitis C See Chronic Infectious Disease-42.5. May attend school per written doctor’s instruction.

Herpes Students with open oozing skin sores that cannot be covered should not attend school Simplex until lesions are not draining. Children who typically put their fingers in Infection their mouth, or children who are drooling or have biting behavior, may return to school when mouth lesions are crusted over. Students with herpetic whitlow should be permitted to attend school if lesions are covered. Staff who may come in contact with lesions on student, e.g., during diapering, should wear gloves and use good hand washing technique.

Impetigo Exclude until at least 24 hours after beginning antimicrobial therapy. Moist lesions must be covered.

Influenza - May attend school if feeling well, no fever is present, and cough is not severe. Criteria for exclusion from school will be those set forth by the School Medical Advisor and Director of Health in the event of a widespread influenza outbreak or influenza pandemic.

Measles Exclude student a minimum of 4 days after appearance of rash and until well. Siblings may come to school if adequately immunized.

Meningitis, Viral May reenter per doctor’s instructions. Written physician permission is not required to reenter school.

Meningococcal Infections May reenter per doctor’s instructions. Refer household and close contacts (Meningococcal) to physician for antibiotic prophylaxis as soon as possible, preferably (Meningitis) within 24 hours of diagnosis of the primary case. Prophylaxis is also (Meningococcemia) warranted for persons who have had contact with the patient’s oral secretions through persons who have had contact with the patient’s oral secretions through kissing or sharing of food or beverages or eating utensils.

Preschool classmates/playmates of the patient should be referred for prophylaxis as well.

Older children and adults who attend the patient’s school should be advised to consult their physician promptly should they develop febrile illness within 10 days of exposure.

Parent notification that one or more cases are known or suspected shall be made upon recommendation of the State of CT Department of Public Health or School Medical Advisor.

Methicillin-resistant Staphylococcus Aureus (MRSA) – The most frequent manifestation of Community associated MRSA infestations is skin and soft tissue infection but invasive disease and pneumonia also occur. Report any case of MRSA to the Nursing Supervisor immediately. Recommendations for school attendance and participation in school activities will be made on a case by case basis by the Nursing Supervisor in consultation with the School Medical Advisor. Instruct the affected student in hand washing techniques and good hygiene practices.

Molluscum Contagiosum No restriction for school attendance.

Mononucleosis May re-enter per doctor’s instruction. Written physician permission is not required to re-enter school.

Mumps Exclude student until 5 days after onset of parotid gland swelling and until well. Siblings may come to school if adequately immunized.

Pertussis Exclude for 21 days from paroxysmal cough onset if student is not on erythromycin therapy or (Whooping other recommended drug therapy.. Alternatively, may re-enter with a note from the doctor 5 days cough) after initiation of erythromycin therapy or other recommended drug therapy. Siblings may attend school if they have been adequately immunized and have received the recommended erythromycin therapy or other recommended drug therapy. Refer household and other close contacts to physician for immunization and/or chemoprophylaxis. Persons who have been in contact with an infected individual should be monitored closely for respiratory symptoms for 20 days after last contact with the infected individual.

Pinworms No restriction for school attendance. (Enterobiasis)

Ringworm of the Scalp Exclude child until under medical treatment. Refer household contacts to (Tinea Capitis) physician to rule out infections. Advise parents that pets, especially dogs and cats, may be possible sources of infection.

In elementary schools, when two or more cases occur in any one classroom in a two-week period, notify parents of children in that class. In all schools, when cases occur in 1% or more of the school population in a four-week period, notify all parents in the school. (Use Health Department letter for parental notification.)

Ringworm of Exclude child until under medical treatment. Refer household and other close the Body contacts to physician to rule out infection. Advise parents that pets may be a (Tinea Corporis) possible source of infection.

While undergoing treatment, infected children should be excluded from swimming pools, gymnasiums (unless lesions are covered), and other activities likely to lead to the exposure of others.

Rubella Exclude student a minimum of 7 days after onset of rash and until well. (German Measles) Siblings may come to school if adequately immunized. Remind school staff and family about dangers of exposure during pregnancy.

Salmonella Salmonella typhi – May return to school after three negative stool cultures have been obtained, stool is contained in toilet or diaper, and fever, nausea, and vomiting have subsided.

Other salmonella species – May return to school when stool is contained in toilet or diaper, and fever, nausea, and vomiting have subsided For all Salmonella species, when a case is identified in a food handler, that person shall not resume food handling duties until approved to do so by the Director of Health.

Scabies Any child with scabies must be excluded until the day after treatment has been completed. After such treatment he may return to school even though the scars remain on his body. Refer family and close contacts for possible prophylactic treatment.

Scarlet Fever Exclude student a minimum of 7 days if not under treatment or for 24 hours Scarletina after institution of antibiotic therapy. In elementary schools, when 3 or more cases occur Strep Throat in any one classroom in a one-week period, notify parents of children in that class. In all schools, when cases occur in 3% or more of the school population in a two-week period, notify all parents in the school. (Use Health Department letter for parental notification).

Severe Acute Respiratory Syndrome (SARS) Suspect, probable, or confirmed cases shall be excluded for a minimum of 10 days after resolution of fever, provided respiratory symptoms are absent or improving. Readmission to school requires written approval of the patient’s private physician and approval of the School Medical Advisor and Director of Health.

Household and other close contacts may attend school in the absence of fever or respiratory symptoms and should seek immediate medical evaluation should these develop within 10 days of the last exposure. Students and school staff who are household or other close contacts of a SARS patient should be assessed daily for fever or respiratory symptoms by the school nurse for 10 days after the last exposure before attending class or beginning work.

Parent notification that one or more cases of SARS are suspected or known shall be made upon recommendation of the State of Connecticut Department of Public Health or School Medical Advisor.

This policy shall be revised in accordance with changes in recommendations or guidance from the CDC (Centers for Disease Control) and/or State of Connecticut Department of Public Health.

Sexually Transmitted Diseases Refer for prompt medical assessment any student having symptoms suggestive of a sexually transmitted disease (STD), and for immediate medical assessment when having symptoms suggestive of pelvic inflammatory disease (PID).

a. Share available community resources if not linked with health care provider. b. Assist student, as pertinent, in making medical appointment. c. Encourage concurrent assessment and treatment of sexual partner(s) should STD be confirmed. d. Encourage student to notify parent of current symptoms. e. Advise student of any need to share life-threatening observations with parent. - Reinforce with student that no etiologic factors will be divulged. f. Encourage sexually active students to have routine medical assessment due to increased risk for asymptomatic STD/reproductive concerns. Advise parent of symptoms whenever assessing life-threatening symptoms. g. Recommend immediate medical assessment. h. Share observations only; do not divulge suspected etiology.

For Contact of Known STD:

1. Assure confidentiality and facilitate communication. 2. Encourage student to share anxieties/feelings and offer support as appropriate. 3. Encourage prompt medical assessment. a. Share available community resources if not linked with health care provider.

Shigella – May return to school when treatment is complete, test results from 2 stool cultures taken 24 hours apart are negative, and stool is contained in the toilet. For children who are diapered, diarrhea must be resolved before child may return to school. When a case is identified in a food handler, that person shall not resume food handling duties until approved to do so by the Director of Health.

Tuberculosis Exclude until effective chemotherapy has been instituted based on clinical, Disease bacteriologic, and roentgenographic signs. Attendance requires written approval of student’s physician and approval of School Medical Advisor and Director of Health. Student must remain compliant with chemotherapy regime to continue school attendance.

Tuberculosis Infection Students with a positive tuberculin skin test who also have symptoms suggestive of tuberculosis disease must be excluded and evaluated by a physician.

Students with a positive tuberculin skin test who do not have symptoms suggestive of tuberculosis disease may attend school but should be referred for medical evaluation. Such students shall obtain medical evaluation within two weeks in order to remain in school.

Upper Respiratory Infection (common cold) May attend school unless cough is severe or fever is present.

Vaccinia may attend school if afebrile if lesions are covered and affected individual is able to refrain from touching lesions. Encourage good hand-washing practices.

Other Infectious Diseases Control measures for infectious diseases not listed above will be determined with the advice of the School Medical Advisor, Director of Health, Nursing Supervisor, and State of CT. Department of Health Services as indicated.

Outbreak Control Measures for control of outbreaks of any communicable disease will be undertaken with the advice of the School Medical Advisor, Director of Health, Nursing Supervisor, and State of CT. Department of Health Services as indicated.

SHM Vol II. Section 2. Communicable Disease A.Communicable Disease Control Measures rev. 12/08/08, 12/01/16, 1/22/2020