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Disease-Specific Information and Exclusion Guidelines

Disease-Specific Information and Exclusion Guidelines

Excerpted from: https://www.washtenaw.org/DocumentCenter/View/5326/Managing-Communicable--in-Schools-PDF?bidId=

Disease-Specific Information and Exclusion Guidelines Mode of Spread Symptoms Contagious Period Contacts Exclusions (subject to LHD approval) Campylobacteriosisⱡ Ingestion of under- (may be Average 2-5 days Throughout illness Exclude with first signs Exclude until diarrhea cooked meat, bloody), abdominal (range 1-10 days) (usually 1-2 weeks, but of illness; encourage has ceased for at least contaminated or , , up to 7 weeks without good hand hygiene 2 days; additional water, or raw milk treatment) restrictions may apply ** ⱡ Person-to-person by Fever, mild respiratory Average 14-16 days As long as 5 days, but Exclude contacts Cases: Until lesions (Varicella) direct contact, droplet symptoms, body rash (range 10-21 days) usually 1-2 days lacking documentation have crusted and no or airborne spread of of itchy, blister-like before onset of rash of until 21 new lesions for 24hr vesicle fluid, or lesions, usually and until all lesions days after last case (for non-crusting concentrated on the have crusted onset; consult LHD lesions: until lesions secretions face, scalp, trunk are fading and no new lesions appear) CMV Exposure to infectious None or “mono-like” 1 month may be shed for If pregnant, consult No exclusion () tissues, secretions, or 6 months to 2 years OB; contacts should necessary excretions not be excluded Common Airborne or contact Runny or stuffy nose, Variable, usually 1-3 24hrs before onset to Encourage No exclusion with respiratory slight fever, watery days up to 5 days after etiquette and good necessary secretions; person-to- eyes onset hand hygiene person or by touching contaminated surfaces Airborne or contact Barking cough, Variable based on Variable based on Encourage cough No exclusion with respiratory difficulty causative organism causative organism etiquette and good necessary secretions hand hygiene Diarrheal Illness Fecal-oral: person-to- Loose stools; potential Variable based on Variable based on Exclude with first signs Exclude until diarrhea (Unspecified) person, ingesting for fever, gas, causative organism causative organism of illness; encourage has ceased for 24h or contaminated food or abdominal cramps, good hand hygiene until medically cleared liquid, contact with , infected animals E. coli ⱡ Fecal-oral: person-to- Abdominal cramps, Variable, usually For duration of Exclude with first signs Medical clearance (Shiga - person, from diarrhea (may be 2-10 days diarrhea until stool of illness; encourage required; also, exclude producing) contaminated food or bloody), may include culture is negative good hand hygiene until diarrhea has liquids, contact with gas, nausea, fever or ceased for at least 2 infected animals vomiting days; additional restrictions may apply Fifth Disease Person-to-person; Fever, flushed, lacy Variable, usually 4-20 Most infectious before If pregnant, consult No exclusion (Erythema infectiosum) Contact with rash (“slapped cheek”) days 1-2 days prior to onset OB; encourage good necessary if rash is (Parvovirus B19) respiratory secretions hand hygiene; do not diagnosed as Fifth share eating utensils disease by a healthcare provider

Page 6 of 14 Disease Mode of Spread Symptoms Incubation Period Contagious Period Contacts Exclusions (subject to LHD approval) ** ⱡ Person-to-person Diarrhea, abdominal Average 7-10 days During active Encourage good hand Exclude until diarrhea of cysts cramps, bloating, (range 3-25+ days) hygiene has ceased for at least from infected feces; , weight loss, 2 days; may be contaminated water pale, greasy stools; relapsing; additional may be asymptomatic restrictions may apply Hand Foot and Contact with Sudden onset of fever, Average 3-5 days From 2-3 days before Exclude with first signs If secretions from Mouth Disease** respiratory secretions , cough, (range 2-14 days) onset and several days of illness; encourage blisters can be () or by feces from tiny blisters inside after onset; shed in cough etiquette and contained, no (Herpangina) infected person mouth, throat and on feces for weeks good hand hygiene exclusion required extremities Head lice Head-to-head contact Itching, especially 1-2 weeks Until lice and viable Avoid head-to-head Students with live lice (Pediculosis) with an infected nape of neck and eggs are destroyed, contact during play; may stay in school person and/or their behind ; scalp can which generally do not share personal until end of day; personal items such as become pink and dry; requires 1-2 shampoo items, such as hats, immediate treatment clothing or bedding patches may be rough treatments and nit combs; inspect close at home is advised; Head Lice Manual and flake off combing contacts frequently ** ⱡ Fecal-oral; person-to- Loss of appetite, Average 25-30 days 2 weeks before onset Immediately notify Exclude until at least 7 person or via nausea, fever, (range 15-50 days) of symptoms to 1 to 2 LHD regarding days after jaundice contaminated food or jaundice, abdominal weeks after onset evaluation and onset and medically water discomfort, diarrhea, treatment of close cleared; exclude from dark urine, fatigue contacts; encourage food handling for 14 good hand hygiene days after onset Herpes simplex I, II Infected secretions Tingling prior to fluid- 2-14 days As long as lesions are Encourage good hand No exclusion (cold sores / fever HSV I – filled blister(s) that present; may be hygiene and age- necessary blisters) HSV II – sexual recur in the same area intermittent shedding appropriate STD () (mouth, nose, while asymptomatic prevention; avoid genitals) blister secretions; do not share personal items Direct or indirect Lesions/blisters are Variable, usually 4-10 While sores are Encourage good hand Treatment may be (Impetigo contagiosa) contact with lesions generally found on the days, but can be as draining hygiene delayed until end of and their discharge mouth and nostrils; short as 1-3 days the day; if treatment occasionally near eyes started before next day’s return, no exclusion necessary; cover lesions *** Droplet; contact with High fever, fatigue, 1-4 days 1 day prior to onset of Exclude with first signs Exclude until 24hrs (influenza-like respiratory secretions cough, muscle aches, symptoms to 1 week of illness; encourage with no fever (without illness) or touching sore throat, , or more after onset cough etiquette and fever-reducing contaminated runny nose; rarely good hand hygiene ) and cough surfaces) vomiting or diarrhea has subsided

Page 7 of 14 Disease Mode of Spread Symptoms Incubation Period Contagious Period Contacts Exclusions (subject to LHD approval) ** ⱡ Contact with nasal or High fever, runny Average 10-12 days 4 days before to 4 Exclude contacts Cases: Exclude until 4 (Rubeola) throat secretions; nose, cough, red, (range 7-21 days) from days after rash onset lacking documentation days after rash onset airborne via sneezing watery eyes, followed exposure to fever of immunity until 21 (Hard/red measles) and coughing by rash on face, then onset days after last case spreading over body onset; consult LHD ** ⱡ Varies with causative Severe headache, stiff Varies with causative Varies with causative Encourage cough Exclude until medically (Aseptic/viral) agent: droplet or neck and back, agent agent, but generally 2- etiquette and good cleared fecal-oral route; may vomiting, fever, 14 days hand hygiene be complications of intolerance to light, another illness neurologic symptoms Meningitis** ⱡ Contact with saliva or Severe headache, Average 2-4 days Generally considered Immediately notify Medical clearance (Bacterial) nasal and throat fever, stiff neck or (range 1-10 days) no longer contagious LHD; encourage good required; exclude until (N. meningitis) secretions; spread by back, vomiting, after 24hrs of hand hygiene; do not 24 hrs after (H. influenzae) sneezing, coughing, irritability, intolerance antibiotic treatment share personal items antimicrobial and sharing beverages of light, neurologic and eating utensils treatment (S. pneumoniae) or utensils symptoms; rash Molloscum Transmitted by skin- Smooth, firm, flesh- Usually between 2 and Unknown but likely as Do not share personal No exclusion contagiosum to-skin contact and colored papules 7 weeks long as lesions persist items necessary through handling (bumps) with an contaminated objects indented center Mononucleosis Person-to-person via Fever, sore throat, 30-50 days Prolonged, possibly Do not share personal Exclude until able to saliva fatigue, swollen lymph longer than 1 year items tolerate activity; nodes, enlarged exclude from contact spleen sports until recovered MRSA** Transmitted by skin- Fever may be present; Varies As long as lesions are Encourage good hand No exclusion if wound (Methicillin-resistant to-skin contact and commonly a lesion; draining; MRSA is hygiene; do not share is covered and Staphylococcus contact with surfaces may resemble a spider frequently found in personal items, drainage contained; aureus) that have contacted bite and be swollen, many environments; including but not no exclusion from infection site drainage painful with drainage; handwashing is the limited to towels, swimming if wound is a non-symptomatic best way to avoid washcloths, clothing covered with carrier state is possible infection and uniforms waterproof bandage ** ⱡ Airborne or direct Swelling of 1 or more Average 16-18 days Up to 7 days prior to Exclude contacts Cases: Exclude until 5 contact with saliva salivary glands (usually (range 12-25 days) and 8 days after lacking documentation days after onset of parotid); , fever, parotitis onset of immunity until 25 salivary gland swelling headache are possible days after last case onset; consult LHD *** Food, water, surfaces Nausea, vomiting, Average 24-48hrs Usually from onset Encourage good hand Exclude until illness (viral ) contaminated with diarrhea, abdominal (range: 12-72hrs) until 2-3 days after hygiene; contact LHD has ceased for at least vomit or feces, pain for 12-72hrs; recovery; typically, for environmental 2 days; exclude from person-to-person, possibly low-grade virus is no longer shed cleaning food handling for 3 aerosolized vomit fever, chills, headache after 10 days recommendations days after recovery Page 8 of 14 Disease Mode of Spread Symptoms Incubation Period Contagious Period Contacts Exclusions (subject to LHD approval) Pink Eye Discharge from eyes, Bacterial: Often yellow Variable but often 1-3 During active infection Encourage good hand Exclude only if herpes (conjunctivitis) respiratory secretions; discharge in both eyes days (range: a few days to hygiene simplex conjunctivitis from contaminated Viral: Often one eye 2-3 weeks) and eye is watering; fingers, shared eye with watery/clear exclusion also may be make-up applicators discharge and redness necessary if 2 or more Allergic: itchy eyes children have watery, with watery discharge red eyes; contact LHD Rash Illness Variable depending on Skin rash with or Variable depending on Variable depending on Variable depending on Exclude if also (Unspecified) causative agent without fever causative agent causative agent causative agent behavior changes or fever; may need to be medically cleared Respiratory Illness Contact with Slight fever, sore Variable but often 1-3 Variable depending on Encourage cough Exclude if also fever (Unspecified) respiratory secretions throat, cough, runny days causative agent etiquette and good until fever free for or stuffy nose hand hygiene 24hrs without fever- reducing medication Ringworm Direct contact with an Round patch of red, Usually 4-14 days As long as lesions are Inspect skin for Treatment may be (Tinea) infected animal, dry skin with red present and fungal infection; do not share delayed until end of person, or raised ring; temporary spores exist on personal items; seek the day; if treatment contaminated surface baldness materials veterinary care for started before next pets with signs of skin day’s return, no disease exclusion necessary; exclude from contact sports, swimming until start of treatment ** ⱡ Direct contact; contact Red, raised rash for ~3 Average 16-18 days 7 days before to 7 If pregnant, consult Exclude until 7 days (German Measles) with respiratory days; possibly fever, (range: 14-21 days) days after rash onset OB; Exclude contacts after onset of rash secretions; airborne headache, fatigue, red lacking documentation via and cough eyes of immunity until 21 days after last case onset; consult LHD ⱡ Fecal-oral: person-to- , Average 12-36hrs During active illness Exclude with first signs Exclude until diarrhea person, contact with diarrhea (possibly (range: 6hrs-7 days) and until organism is of illness; encourage has ceased for at least infected animals or via bloody), fever, nausea, no longer detected in good hand hygiene 2 days; additional contaminated food vomiting, feces restrictions may apply Scabies Close, skin-to-skin Extreme itching (may 2-6 weeks for first Until mites are Treat close contacts Treatment may be contact with an be worse at night); exposure; 1-4 days for destroyed by chemical and infected persons delayed until end of infected person or via mites burrowing in re-exposure treatment; at the same time; the day; if treatment infested clothing or skin cause rash / prescription skin and avoid skin-to-skin started before next bedding bumps oral are contact; do not share day’s return, no Scabies Prevention generally effective personal items; see exclusion necessary and Control Manual after one treatment exclusion criteria

Page 9 of 14 Disease Mode of Spread Symptoms Incubation Period Contagious Period Contacts Exclusions (subject to LHD approval) ** ⱡ Fecal-oral: frequently Abdominal pain, Average 1-3 days During active illness Exclude with first signs Medical clearance person-to-person; also diarrhea (possibly (range 12-96hrs) and until no longer of illness; encourage required; also, exclude via contaminated food bloody), fever, nausea, detected; treatment good hand hygiene until diarrhea has or water vomiting, dehydration can shorten duration ceased for at least 2 days Strep throat / or Sore throat, fever; Average 2-5 days Until 12hrs after Exclude with signs of Exclude until 12hrs direct contact; via Scarlet Fever: body (range 1-7 days) treatment; (10-21 illness; encourage after antimicrobial contaminated food rash and red tongue days without good hand hygiene therapy (at least 2 treatment) doses) Streptococcus Contact with Variable: infection, Varies; as short as 1-3 Until 24hrs after Consult LHD to discuss Exclude until 24hrs pneumoniae ⱡ respiratory secretions , days antimicrobial therapy the potential need for after antimicrobial or meningitis treatment therapy

Tuberculosis Airborne; spread by Fever, fatigue, weight 2-10 weeks While actively Consult LHD to discuss Exclude until medically (TB) ⱡ coughing, sneezing, loss, cough (lasting 3+ infectious for evaluation and cleared speaking or singing weeks), , potential testing of loss of appetite contacts Fecal-oral: person-to- Gradual onset fever, Average range: 8-14 From first week of Consult LHD for Medical clearance ( typhi) ⱡ person, ingestion of headache, malaise, days (3-60 days illness through evaluation of close required; also, exclude contaminated food or , cough, reported) convalescence contacts until symptom free; water (cases are abdominal pain, rose Contact LHD about usually travel-related) spots, diarrhea, additional restrictions constipation, change in mental status Vomiting Illness Varies; See Norovirus Vomiting; potential Varies; See Norovirus Varies; See Norovirus Encourage good hand Exclude until 24hrs (Unspecified) fever, nausea, cramps, hygiene; See after the last vomiting diarrhea Norovirus episode Whooping Cough** Contact with Initially cold-like Average 7-10 days With onset of cold-like Consult LHD to discuss Cases: Exclude until 21 (Pertussis) ⱡ respiratory secretions symptoms, later (range 5-21 days) symptoms until 21 the potential need for days after onset or cough; may have days from onset (or treatment until 5 days after start inspiratory whoop, until 5 days of of appropriate posttussive vomiting treatment) antibiotic treatment Bite from an infected High fever, nausea, 3-14 days Not spread person-to- Protect against bites No exclusion mosquito headache, stiff neck person using EPA approved necessary insect repellents All diseases in bold are to be reported to your local health department *Report only aggregate number of cases for these diseases ** Contact your local health department for a “letter to parents” ⱡ Consult with local health department on case-by-case basis Vaccination is highly encouraged to prevent or mitigate disease Page 10 of 14

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