Prevention And Control Of Communicable Diseases
Prevention and Control of Communicable DiseasesA Guide for School Administrators, Nurses, Teachers,Child Care Providers, and Parents or GuardiansDepartment of Health and Senior ServicesBureau of Communicable Disease Control and PreventionJefferson City, MO 65102(573) 751-6113(866) 628-9891e-mail: info@health.mo.gov
Prevention and Control of Communicable DiseasesA Guide for School Administrators, Nurses, Teachers,Child Care Providers, and Parents or GuardiansEditors:Barbara WolkoffAutumn GrimHarvey L. Marx, Jr.Department of Health and Senior ServicesBureau of Communicable Disease Control and PreventionJefferson City, MO 65102(573) 751-6113(866) 628-9891e-mail: info@health.mo.govwww.health.mo.gov
FOREWORDHELP CONTROL COMMUNICABLE DISEASESVaccines are now available to control the majority of diseases that have caused illnessand death in children in the past. Medical treatments help to control many others, butschools and child care centers must continue to play an important role in controlling thespread of communicable disease. By enforcing the state communicable diseaseregulations, excluding children who are ill, and promptly reporting all suspected casesof communicable disease, personnel working with children can help ensure the goodhealth of the children in their care.Be alert for signs of illness such as elevated temperature, skin rashes, inflamed eyes,flushed, pale or sweaty appearance. If a child shows these or other signs of illness, painor physical distress, he/she should be evaluated by a health care provider. Children orstaff with communicable diseases should not be allowed to attend or work in a school orchild care setting until they are well. Recommendations for exclusion necessary toprevent exposure to others are contained in this document.Please report all suspected cases of communicable disease promptly to your city, countyor state health department. Prompt reporting is the first step to insuring appropriatecontrol measures.Additional information concerning individual communicable diseases is contained in theCommunicable Disease Investigation Reference Manual located on the Department of Healthand Senior Services website .ACKNOWLEDGEMENTSWe are grateful to the Hennepin County Human Services and Public Health Department, Hopkins,Minnesota, who allowed us to use their materials in the development of this manual.i
REVIEWER LISTWe would like to thank the following public health professionals for their valuable commentsand suggestions in reviewing this manual.Bureau of Environmental Health ServicesMark JenkersonBureau of HIV, STD, & HepatitisMelissa Van DyneOffice of Veterinary and Public HealthKaren YatesSection for Child Care RegulationSue PortingSection of Epidemiology for Public Health PracticesGeorge Turabelidze, MD, PhDCenter for Emergency Response and Terrorism (CERT)Robert H. Hamm, MD, MPHBureau of Communicable Disease Control and PreventionEddie HedrickBureau of Immunization Assessment and AssuranceSusan Kneeskern, RNBureau of Genetics and Healthy ChildhoodMarge Cole, RN, MSN, FASHABureau of WIC and Nutrition ServicesKathy MertzlufftSection for Disease Control and Environmental EpidemiologyKristi CampbellOffice of Public InformationJacqueline Lapineii
INTRODUCTIONThe number of families with young children in out-of-home childcare has been steadily increasing. Avariety of infections have been documented in children attending childcare, sometimes with spread tocaregivers and to others at home. Infants and preschool-aged children are very susceptible to contagiousdiseases because they 1) have not been exposed to many infections, 2) have little or no immunity to theseinfections, and 3) may not have received any or all of their vaccinations.Close physical contact for extended periods of time, inadequate hygiene habits, and underdevelopedimmune systems place children attending childcare and special needs settings at increased risk ofinfection. For instance, the spread of diarrheal disease may readily occur with children in diapers andothers with special needs due to inadequate handwashing, environmental sanitation practices, and diaperchanging.This manual contains 54 disease fact sheets for providers about specific infectious disease problems.These fact sheets have been designed to provide specific disease prevention and control guidelines thatare consistent with the national standards put forth by the American Public Health Association and theAmerican Academy of Pediatrics. Some indicate when immediate action is necessary. Please note thaton the PROVIDER fact sheets, for any diseases labeled "REPORTABLE", the provider MUSTconsult with the LOCAL or STATE HEALTH DEPARTMENT. After receiving approval from thelocal or state health department, the PARENT/GUARDIAN fact sheets would be posted or distributed tothe parents/guardians.In addition to the provider fact sheets, 47 of the fact sheets are available in a format specifically forparents/guardians of childcare and school-aged children. PARENT/GUARDIAN is written in the upperright hand corner.This manual contains information for both staff and parents/guardians on numerous topics. See Table ofContents for location of specific information.This document replaces all previous versions of the “Prevention and Control ofCommunicable Diseases, A Guide for School Administrators, Nurses, Teachers, and ChildCare Providers”.DISCLAIMER - In clinical practice, certain circumstances and individual cases requireprofessional judgment beyond the scope of this document. Practitioners and users of this manualshould not limit their judgment on the management and control of communicable disease to thispublication and are well advised to review the references that are listed, and remain informed of newdevelopments and resulting changes in recommendations on communicable disease prevention andcontrol.iii
TAKE TO BEGINNING OF DOCUMENTTABLE OF CONTENTSSECTION 1SECTION 2SECTION 3SECTION 4GUIDELINES: STAFF AND CHILDRENExclusion of Ill Children and Staff:GeneralChildcareSchoolsCommunicable Disease Concerns for Pregnant WomenCytomegalovirus (CMV) and PregnancyFifth Disease (Parvovirus B19) and PregnancyHand, Foot, and Mouth (Enteroviral Infections) and PregnancyHepatitis B Virus and PregnancyHuman Immunodeficiency Virus (HIV) and PregnancyRubella (German Measles) and PregnancyVaricella-Zoster Virus (Chickenpox and Shingles) and PregnancyHuman Biting INES: ENVIRONMENTCleaning, Sanitizing, and DisinfectionHow to Mix Bleach SolutionsRecommended Cleaning ScheduleDiaperingDiapering ProcedureChanging Pull-ups/Toilet Learning ProcedureFood Safety in Childcare Settings and SchoolsPets in Childcare Settings and SchoolsSwimming and Wading Pools35-39404142-44454647-4950-5253GUIDELINES: PREVENTION AND CONTROLCovering Your CoughCover Your Cough PosterGlovingHandwashingWhen toHow toInfection Control GuidelinesInfection Control Recommendations for School Athletic ProgramsMisuse of AntibioticsSafe Handling of Breast Milk54555657-5859606162-6364-6667-68COMMUNICABLE DISEASE REPORTINGMissouri Reporting RuleDiseases and Conditions Reportable in MissouriReports from Parents/Guardians6969-7171iv1-23-1011-171819-20
Reports from StaffSECTION 4(CONTINUED) Reports to Local/State Health DepartmentLocal and State Health Department Disease Prevention and Control Resources inMissouriLocal Health Department Telephone NumbersDepartment of Health and Senior Services District OfficesSECTION 5SECTION 6COMMUNICABLE DISEASE CONTROL AND MANAGEMENTControl and Management of Exposures and OutbreaksReports to Local/State Health DepartmentsNotification of Parents/Guardians and Childcare or School StaffSample Line List7172727272737373-7475COMMUNICABLE DISEASE FACT SHEETS*Diseases Reportable to a Local or State Health Department in MissouriHow and When to Use*Anaplasmosis (see Tick-Borne Disease)Bed BugsBronchitis, Acute (Chest Cold)/BronchiolitisParent Fact Sheet*California Group Encephalitis (see Mosquito-Borne Disease)*CampylobacteriosisParent Fact Sheet*Chickenpox (Varicella)Parent Fact SheetConjunctivitis (Pinkeye)Parent Fact SheetCroupParent Fact Sheet*CryptosporidiosisParent Fact SheetCytomegalovirus (CMV) InfectionParent Fact SheetDiarrhea (Infectious)Parent Fact Sheet*E. coli O157:H7 Infection and Hemolytic Uremic Syndrome (HUS) (seeSTEC)*Eastern Equine Encephalitis (EEE) (see Mosquito-Borne Disease)*Ehlichiosis (see Tick-Borne Disease)Enteroviral InfectionParent Fact SheetFifth DiseaseParent Fact 09192-9394959697-9899100101102-103104105-106
SECTION 6(CONTINUED)Parent Fact Sheet*Haemophilus Influenzae Type B (Hib) DiseaseParent Fact SheetHand, Foot, and Mouth DiseaseParent Fact SheetHead LiceParent Fact Sheet*Hepatitis AParent Fact Sheet*Hepatitis B*Hepatitis CHerpes GladiatorumParent Fact SheetHerpes, OralParent Fact Sheet*Human Immunodeficiency Virus (HIV) Infection/AIDSImpetigoParent Fact Sheet*InfluenzaParent Fact SheetLice (see Head Lice)*Lyme Disease (see Tick-Borne Disease)*MeaslesParent Fact Sheet*Meningococcal DiseaseParent Fact SheetMethicillin-Resistant Staphylococcus aureus (MRSA)Parent Fact SheetMolluscum ContagiosumParent Fact SheetMononucleosisParent Fact Sheet*Mosquito-Borne Disease (Viral)MRSA (see Methicillin-Resistant Staphylococcus aureus)*MumpsParent Fact SheetNorovirus (Norwalk-like Viruses)Parent Fact SheetParapertussisParent Fact Sheet*Pertussis (Whooping Cough)Parent Fact SheetPinwormsParent Fact SheetPneumococcal 67168-169
SECTION 6(CONTINUED)Parent Fact SheetPneumoniaParent Fact SheetRespiratory Infection (Viral)Parent Fact SheetRespiratory Syncytial Virus (RSV) InfectionParent Fact SheetRingwormParent Fact Sheet*Rocky Mountain Spotted Fever (RMSF) (see Tick-Borne Disease)RoseolaParent Fact SheetRotaviral InfectionParent Fact Sheet*Rubella (German Measles)Parent Fact Sheet*Saint Louis Encephalitis (see Mosquito-Borne Disease)*SalmonellosisParent Fact SheetScabiesParent Fact Sheet*Shiga toxin-producing Escherichia coli (STEC) and Hemolytic UremicSyndrome (HUS)Parent Fact Sheet*ShigellosisParent Fact SheetShingles (Zoster)Parent Fact SheetStaph Skin InfectionParent Fact SheetStreptococcal Infection (Strep Throat/Scarlet Fever)Parent Fact Sheet*Streptococcus Pneumoniae (see Pneumococcal Infection)*Tick-Borne Disease*Tularemia (see Tick-Borne Disease)*Tuberculosis (TB)Viral MeningitisParent Fact SheetWartsParent Fact Sheet*West Nile Encephalitis (see Mosquito-Borne Disease)*Western Equine Encephalitis (see Mosquito-Borne Disease)Yeast Infection (Candidiasis)Parent Fact 13-214215216217218-219220
SECTION 7SECTION 8SECTION 9SECTION 10SECTION 11IMMUNIZATION RESOURCESList of Web ResourcesMISSOURI LAWS RELATED TO CHILDCARE/SCHOOLSChildcare LicensingChapter 61 – Family Child Care HomesChapter 62 – Child Care FacilitiesMissouri RulesMissouri Immunization Requirements for School ChildrenDay Care Immunization RuleDiseases and Conditions Reportable in MissouriRecords and Reports (Data Privacy)Communicable Disease Rule221222222222223223223223223EMERGENCY PREPAREDNESSEmergency PreparednessPlanning ResourcesChildcareSchoolsIndividual and EFERENCESList of References and Website Resources235-237viii224
GENERAL EXCLUSION GUIDELINES FOR ILL CHILDREN/STAFFCertain symptoms in children may suggest the presence of a communicable disease. Excluding an illchild may decrease the spread of the disease to others in the childcare and school settings.Recommended exclusion varies by the disease or infectious agent. Children with the symptoms listedbelow should be excluded from the childcare or school setting until symptoms improve; or a healthcareprovider has determined that the child can return; or children can participate in routine activitieswithout more staff supervision than can be provided.NOTE: It is recommended that childcare/preschool providers and schools have policies that are clearlywritten for excluding sick children and staff. These policies should be placed in the student handbookor on the childcare or school website. Parents/guardians and staff should be given or directed to theseresources at the beginning of each school year or when the child is enrolled or the staff member ishired. This will help prevent problems later when the child or staff member is ill.Exclude children with any of the following:Unable to participate in routine activities or needs more care than can be provided byIllnessthe childcare/school staff.FeverA child's normal body temperature varies with age, general health, activity level, thetime of day and how much clothing the child is wearing. Everyone's temperaturetends to be lower early in the morning and higher between late afternoon and earlyevening. Body temperature also will be slightly higher with strenuous exercise. Mostmedical professionals define fever as a body core temperature elevation above100.4 F (38 C) and a fever which remains below 102 F (39 C) is considered a lowgrade fever. If a child is younger than three months of age and has a fever, it’simportant to always inform the caregiver immediately so they can call theirhealthcare provider right away.When determining whether the exclusion of a child with fever is needed, a numberof issues should be evaluated: recorded temperature; or is the fever accompanied bybehavior changes, headache, stiff neck, difficulty breathing, rash, sore throat, and/orother signs or symptoms of illness; or if child is unable to participate in routineactivities. Any child that has an elevated body temperature that is not excludedshould be closely monitored for possible change(s) in their condition. A temperatureshould be measured before giving medications to reduce the fever.Measurement methodNormal temperature range for ChildrenRectal36.6 C to 38 C (97.9 F to 100.4 F)Ear35.8 C to 38 C (96.4 F to 100.4 F)Oral35.5 C to 37.5 C (95.9 F to 99.5 F)Axillary (armpit)34.7 C to 37.3 C (94.5 F to 99.1 F)“Pediatric fever as defined by different measurement methods”, source: Pediatric Society of Canada, 2009 update*.When measuring ear temperatures follow the manufacturer’s instructions to ensure accurate results.Signs/Symptomsof Possible SevereIllnessUntil a healthcare provider has done an evaluation to rule out severe illness when thechild is unusually tired, has uncontrolled coughing, unexplained irritability,persistent crying, difficulty breathing, wheezing, or other unusual signs for the child.DiarrheaUntil the child has been free of diarrhea for at least 24 hours or until a medical examindicates that it is not due to a communicable disease. Diarrhea is defined as anincreased number of stools compared with a child's normal pattern, along withdecreased stool form and/or stools that are watery, bloody, or contain mucus.July 20111
GENERAL EXCLUSION GUIDELINES FOR ILL CHILDREN/STAFFVomitingVomiting two or more times in the previous 24 hours, unlessdetermined to be caused by a noncommunicable condition and the child is not indanger of dehydration.Mouth Sores withDroolingUntil a medical exam indicates the child may return or until sores have healed.Rash with Feveror BehaviorChangeUntil a medical exam indicates these symptoms are not those of a communicabledisease that requires exclusion.Eye DrainageWhen purulent (pus) drainage and/or fever or eye pain is present or a medical examindicates that a child may return.Unusual Color ofSkin, Eyes, Stool,or UrineUntil a medical exam indicates the child does not have hepatitis A. Symptoms ofhepatitis A include yellow eyes or skin (jaundice), gray or white stools, or dark (teaor cola-colored) urine.For specific guidelines for childcare settings, see pg 3-10.For specific guidelines for school settings, see pg 11-17.Specific guidelines can be found at: http://health.mo.gov/safety/childcare/index.phpFor more information, call Missouri Department of Health and Senior Services (MDHSS) at 573-7516113 or 866-628-9891 (8-5 Monday thru Friday) or call your local health department.July 20112
SPECIFIC DISEASE EXCLUSION FOR CHILDCARESee individual fact sheets for exclusion and other information on the diseases listed below.Acute Bronchitis (Chest Until fever is gone and the child is well enough to participate in iosisUntil the child has been free of diarrhea for at least 24 hours. Childrenwho have Campylobacter in their stools but who do not have symptomsdo not need to be excluded.No one with Campylobacter should use swimming beaches, pools, spas,water parks, or hot tubs until 2 weeks after diarrhea has stopped.Exclude symptomatic staff with Campylobacter from working in foodservice or providing childcare. Other restrictions may apply; call yourlocal health department for guidance.ChickenpoxUntil all the blisters have dried into scabs; usually by day 5 after therash began.It takes 14 to 21 days after receiving vaccine to develop immunity inchildren. Vaccine failure occasionally occurs. The incubation period is10 to 21 days. Therefore, exclude children who: appear to have chickenpox regardless of whether or not they havereceived varicella vaccine, or develop blisters within 10 to 21 days after vaccination.Chickenpox can occur even if someone has had the varicella vaccine.These are referred to as “breakthrough infections” and are usually lesssevere and have an atypical presentation. The rash may be atypical inappearance with fewer vesicles and predominance of maculopapularlesions. Persons with breakthrough varicella should be isolated as longas lesions persist.Although extremely rare, the vaccine virus has been transmitted tosusceptible contacts by vaccine recipients who develop a rash followingvaccination. Therefore, exclude vaccine recipients who develop a rashafter receiving varicella vaccine, using the above criteria.Conjunctivitis (Pinkeye)Purulent Conjunctivitis (redness of eyes and/or eyelids with thick whiteor yellow eye discharge and eye pain): Exclude until appropriatetreatment has been initiated or the discharge from the eyes has stoppedunless doctor has diagnosed a non-infectious conjunctivitis.Infected children without systemic illness (i.e. Adenoviral, Enteroviral,Coxsackie) should be allowed to remain in childcare once any indicatedtherapy is implemented, unless their behavior is such that close contactwith other children cannot be avoided.Nonpurulent conjunctivitis (redness of eyes with a clear, watery eyedischarge but without fever, eye pain, or eyelid redness): None.July 20113
SPECIFIC DISEASE EXCLUSION GUIDELINES FOR CHILDCAREUntil fever is gone and the child is well enough to participate in routineCroupactivities.CryptosporidiosisUntil the child has been free of diarrhea for at least 24 hours.No one with Cryptosporidium should use swimming beaches, pools,water parks, spas, or hot tubs for 2 weeks after diarrhea has stopped for24 hours.Exclude symptomatic staff with Cryptosporidium from working in foodservice or providing childcare until 24 hours after diarrhea has stopped.Other restrictions may apply; call your local health department forguidance.Cytomegalovirus(CMV) InfectionNone. Educational programs on CMV, its potential risks, andappropriate hygienic measures to minimize occupationally acquiredinfection should be provided for female workers in childcare centers.Diarrhea (Infectious)Until the child has been free of diarrhea for at least 24 hours. The lengthof time may vary depending on the organism. For some infectio
Prevention and Control of Communicable Diseases A Guide for School Administrators, Nurses, Teachers, Child Care Providers, and Parents or Guardians Department of Health and Senior Services Bureau of Communicable Disease Control and Prevention Jefferson City, MO 65102 (573) 751-6113 (866) 628-9891 e-mail: info@health.mo.gov
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