Communicable Diseases in Schools
The following information were excerpts taken from Managing Communicable Diseases in Schools, prepared by the Michigan Department of Education and the Michigan Department of Community Heath, Division of Communicable Disease and immunization, Version 1 September 2014
Disease Basics
Schools can play a major role in helping to reduce or prevent the incidence of illness among children and adults in our communities. Encouraging good hand hygiene and following cleaning recommendations contribute to a safe and healthy learning environment for children. When schools report illness to their local health department (LHD), public health specialists can assist schools with disease prevention and control guidance. This document provides schools with general information on what steps they can take to prevent and control communicable disease.
How Diseases are Spread
Understanding how diseases are spread can help prevent illness. Here are the most common routes of transmission:
Fecal-oral: Contact with human stool; usually ingestion after contact with contaminated food or objects
Respiratory: Contact with respiratory particles or droplets from the nose, throat, and mouth
Direct skin-to-skin contact: Contact with infected skin
Indirect contact: Contact with contaminated objects or surfaces
Bloodborne: Contact with blood or body fluids
Coughing and Sneezing
Teach children (and adults) to cough or sneeze into tissues or their sleeve and not onto surfaces or other people. If children and adults sneeze into their hands, hands should be washed immediately.
Handwashing Procedures
Washing your hands is one of the easiest and best ways to prevent the spread of diseases. Hands should be washed frequently including after toileting, coming into contact with bodily fluids (such as nose wiping), before eating and handling food, and any time hands are soiled. It is also important that children’s hands be washed frequently. Water basins and pre-moistened cleansing wipes are not approved substitutes for soap and running water. Alcohol-based hand sanitizers containing at least 60% alcohol may be used when soap and water are not available and hands are not visibly soiled. However, sanitizers do not eliminate all types of germs so they should be used to supplement handwashing with soap and water. The general handwashing procedure includes the following steps:
· Wet hands under warm running water
· Apply soap
· Vigorously rub hands together for at least 20 seconds to lather all surfaces of the hands
· Pay special attention to cleaning under fingernails and thumbs
· Thoroughly rinse hands under warm running water
· Dry hands using a single-use disposable towel or an air dryer
· Turn off the faucet with the disposable towel, your wrists, or the backs of your hands
Bloodborne Exposures
Bloodborne pathogens, such as Hepatitis B virus (HBV), Hepatitis C virus (HCV) and human immunodeficiency virus (HIV), can be found in human blood and other body fluids. Bloodborne pathogens can be transmitted when there is direct contact with blood or other potentially infected material. This can include blood entering open cuts or blood splashing into mucous membranes (eyes, nose or mouth). All human blood should be treated as if it is infectious. If any bloodborne exposure occurs, contact your LHD to discuss the need for public health or medical follow-up. Carriers of bloodborne pathogens should not be excluded from school. For more information, see the Michigan Department of Education’s “Bloodborne Pathogens and School Employees” website at http://www.michigan.gov/mde/0,4615,7-140-28753_64839_38684_29233_29803-241996--,00.html
Responding to Disease in a School
Develop a plan for school staff on how to address illnesses and reduce spread. Prompt action by staff may prevent a serious outbreak of communicable disease. Consider contacting your LHD for guidance on creating a plan.
Maintain a Sanitary Setting
It is important to maintain a sanitary setting to prevent the spread of illnesses. Many items and surfaces in schools must be cleaned and sanitized frequently. To clean and sanitize means to wash vigorously with soap and water, rinse with clean water, and wipe or spray the surface with a sanitizing solution. The surface should air dry for at least two minutes. For items that cannot be submerged into solution, spray or wipe with a sanitizing solution. Allow surfaces to air dry (do not towel dry). Immediately wash, rinse, and sanitize items or surfaces that have been soiled with a discharge such as urine or nasal drainage. Examples of sanitizing solutions may include:
A solution of water and non-scented chlorine bleach with a concentration of bleach between 50–200 parts per million (one teaspoon to one tablespoon of bleach per gallon of water). Make this solution fresh daily.
Commercial sanitizers used only in accordance with the manufacturer’s instructions.
Remember that any cleaning, sanitizing or disinfecting product must always be safely stored out of reach of children. All sanitizers must be used in a manner consistent with their labeling. If there are still questions about the product, guidance is available from the National Antimicrobial Information Network at 1-800-621-8431 or npic@ace.orst.edu or from the National Pesticide Information Center at 1-800-858-7378.
Vaccination
Monitor the Michigan Care Improvement Registry (MCIR) to assure that children are up-to-date on their vaccinations. Assure that staff has also received all recommended vaccines. Visit http://www.michigan.gov/mdch/0,4612,7-132-2942_4911_4914_6385-150235--,00.html for the MDCH Immunization Division’s “School and Childcare/Pre-school Immunization Rules.”
When to Keep a Child Home*
1. Fever: A child has a temperature of 100F taken by mouth or 99F taken under the arm. The child
should not return until 24 hours of no fever, without the use of fever-reducing medications.
2. Diarrhea: A child has two loose or watery stools, even if there are no other signs of illness. The child should have no loose stools for 24 hours prior to returning to school. Exception: A healthcare provider has determined it is not infectious. Diarrhea may be caused by antibiotics or new foods a child has eaten. Discuss with a parent/guardian to find out if this is the likely cause. For students with diarrhea caused by Campylobacter, E. coli, Salmonella or Shigella, please refer to the chart below for exclusions and required clearance criteria.
3. Vomiting: A child that is vomiting. The child should have no vomiting episodes for 24 hours prior
to returning to school. Exception: A healthcare provider has determined it is not infectious.
4. Rash: The child develops a rash and has a fever or a change in behavior. Exclude until the rash
subsides or until a healthcare provider has determined it is not infectious. For students with a diagnosed rash, please refer to the chart below for exclusions and required clearance criteria.
5. Certain communicable diseases: Children and staff diagnosed with certain communicable diseases may have to be excluded for a certain period of time. See the chart below for disease-specific exclusion periods.
* These are general recommendations. Please consult your local health department for additional guidance.
Extracurricular activities also need to be curtailed when a student has a communicable disease. Anyone with a diarrheal illness (e.g., Norovirus, Salmonellosis, Shigellosis, Shiga-Toxin producing E. coli, Giardiasis, or Cryptosporidiosis) should not use swimming pools for 2 weeks after diarrhea has ceased.
Below is a list of diseases with important information on how they are spread, symptoms, incubation and contagious period, and suggestions on how to handle contact with others:
|
Disease |
Mode of Spread |
Symptoms |
Incubation Period |
Contagious Period |
Contacts |
Exclusions (subject to LHD approval) |
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|
Giardiasis** |
Person-to-person transmission of cysts from infected feces; contaminated water |
Diarrhea, abdominal cramps, bloating, fatigue, weight loss, pale, greasy stools; may be asymptomatic
|
Average 7-10 days (range 3-25+ days) |
During active infection |
Encourage good hand hygiene |
Exclude until diarrhea has ceased for at least 2 days; may be relapsing; additional restrictions may apply |
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|
Hand Foot and Mouth Disease** (Coxsackievirus) (Herpangina) |
Contact with respiratory secretions or by feces from infected person |
Sudden onset of fever, sore throat, cough, tiny blisters inside mouth, throat and on extremities
|
Average 3-5 days (range 2-14 days) |
From 2-3 days before onset and several days after onset; shed in feces for weeks |
Exclude with first signs of illness; encourage cough etiquette and good hand hygiene |
If secretions from blisters can be contained, no exclusion required |
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|
Head lice (Pediculosis) |
Head-to-head contact with an infected person and/or their personal items such as clothing or bedding |
Itching, especially nape of neck and behind ears; scalp can become pink and dry; patches may be rough and flake off |
1-2 weeks |
Until lice and viable eggs are destroyed, which generally requires 1-2 shampoo treatments and nit combing |
Avoid head-to-head contact during play; do not share personal items, such as hats, combs; inspect close contacts frequently
|
Students with live lice may stay in school until end of day; immediate treatment at home is advised; see Head Lice Manual |
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|
Hepatitis A** |
Fecal-oral; person-to-person or via contaminated food or water |
Loss of appetite, nausea, fever, jaundice, abdominal discomfort, diarrhea, dark urine, fatigue |
Average 25-30 days (range 15-50 days) |
2 weeks before onset of symptoms to 1 to 2 weeks after onset |
Immediately notify your LHD regarding evaluation and treatment of close contacts; encourage good hand hygiene
|
Exclude until at least 7 days after jaundice onset and medically cleared; exclude from food handling for 14 days after onset |
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|
Herpes simplex I, II (cold sores / fever blisters) (genital herpes) |
Infected secretions HSV I – salvia HSV II – sexual |
Tingling prior to fluid-filled blister(s) that recur in the same area (mouth, nose, genitals) |
2-14 days |
As long as lesions are present; may be intermittent shedding while asymptomatic |
Encourage good hand hygiene and age-appropriate STD prevention; avoid blister secretions; do not share personal items
|
No exclusion necessary |
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|
Impetigo (Impetigo contagiosa) |
Direct or indirect contact with lesions and their discharge |
Lesions/blisters are generally found on the mouth and nostrils; occasionally near eyes
|
Variable, usually 4-10 days, but can be as short as 1-3 days |
While sores are draining |
Exclude with first signs of illness; encourage good hand hygiene |
Exclude until under treatment for 24hrs and lesions are healing; cover lesions |
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|
*Influenza** (influenza-like illness) |
Droplet or contact with respiratory secretions (sneeze and cough, touching contaminated surfaces) |
High fever, fatigue, cough, muscle aches, sore throat, headache, runny / stuffy nose; vomiting and diarrhea infrequently reported |
1-4 days |
1 day prior to onset of symptoms to 1 week or more after onset |
Exclude with first signs of illness; encourage cough etiquette and good hand hygiene |
Exclude until 24hrs after fever has resolved (without fever-reducing medication) and cough has subsided |
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|
Measles** (Rubeola) (Hard/red measles) |
Contact with nasal or throat secretions; airborne via sneezing and coughing |
High fever, runny nose, cough, red, watery eyes, followed by rash first on face, then spreading over body
|
Average 10-12 days (range 7-21 days) from exposure to fever onset |
4 days before to 4 days after rash onset |
Exclude those without documentation of immunity |
Exclude until 4 days after rash onset |
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|
Meningitis** (Aseptic/viral) |
Varies with causative agent: droplet or fecal-oral route; may be complications of another illness |
Severe headache, stiff neck and back, vomiting, fever, intolerance to light, neurologic symptoms
|
Varies with causative agent |
Varies with causative agent, but generally 2-14 days |
Encourage cough etiquette and good hand hygiene |
Exclude until medically cleared |
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|
Meningitis** (Bacterial) (N. meningitis) (H. influenzae) (S. pneumoniae) |
Contact with saliva or nasal and throat secretions; spread by sneezing, coughing, and sharing beverages or utensils |
Severe headache, stiff neck and back, vomiting, fever, irritability, intolerance of light, neurologic symptoms; rash is possible
|
Average 2-4 days (range 1-10 days) |
Generally considered no longer contagious after 24hrs of antibiotic treatment |
Immediately notify your LHD; encourage good hand hygiene; do not share personal items and eating utensils |
Medical clearance required; exclude until 24 hrs after antimicrobial treatment |
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|
Mononucleosis |
Person-to-person via saliva |
Fever, sore throat, fatigue, swollen lymph nodes, enlarged spleen
|
30-50 days |
Prolonged, possibly longer than 1 year |
Do not share personal items |
Exclude until able to tolerate activity; exclude from contact sports until recovered |
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|
MRSA** (Methicillin-resistant Staphylococcus aureus) |
Transmitted by skin-to-skin contact and contact with surfaces that have contacted infection site drainage |
Fever may be present; commonly a lesion; may resemble a spider bite and be swollen, painful with drainage; a non-symptomatic carrier state is possible
|
Varies |
As long as lesions are draining; MRSA is frequently found in many environments; handwashing is the best way to avoid infection |
Encourage good hand hygiene; do not share personal items, including but not limited to towels, washcloths, clothing and uniforms |
No exclusion if wound is covered and drainage contained; exclusion from contact sports / swim until medical clearance |
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|
Mumps** |
Airborne or direct contact with saliva |
Swelling of 1 or more salivary glands (usually parotid); chills, fever, headache are possible
|
Average 16-18 days (range 12-25 days) |
Up to 7 days prior to and 8 days after parotitis onset |
Exclude those without documentation of immunity |
Exclude until 5 days after onset of salivary gland swelling |
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|
*Norovirus** (viral gastroenteritis) |
Food, water or surfaces contaminated with vomit or feces, person-to-person, aerosolized vomit |
Nausea, vomiting, diarrhea, abdominal pain for 12-72hrs; possibly low-grade fever, chills,headache |
Average 24-48hrs (range: 12-72hrs) |
Usually from onset until 2-3 days after recovery; typically, virus is no longer shed after 10 days
|
Encourage good hand hygiene; contact LHD for environmental cleaning recommendations |
Exclude until diarrhea has ceased for at least 2 days; exclude from food handling for 3 days after recovery |
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|
Pink Eye (conjunctivitis) |
Discharge from eyes, respiratory secretions; from contaminated fingers, shared eye make-up applicators |
Bacterial: Often yellow discharge in both eyes Viral: Often one eye with watery/clear discharge and significant redness Allergic: itchy eyes with watery discharge
|
Variable but often 1-3 days |
During active infection (range: a few days to 2-3 weeks) |
Exclude with first signs of illness; encourage good hand hygiene |
Bacterial: exclude until 24hrs after microbial therapy Viral or allergic: no exclusion necessary |
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|
Rash Illness (Unspecified) |
Variable depending on causative agent |
Skin rash with or without fever |
Variable depending on causative agent |
Variable depending on causative agent |
Variable depending on causative agent |
Exclude until rash has subsided or until medically cleared |
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|
Respiratory Illness (Unspecified) |
Contact with respiratory secretions |
Slight fever, sore throat, cough, runny or stuffy nose |
Variable but often 1-3 days |
Variable depending on causative agent |
Encourage cough etiquette and good hand hygiene |
Exclude if child has fever over 100F until fever free for 24hrs without fever-reducing medication
|
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|
Ringworm (Tinea) |
Direct contact with an infected animal, person, or contaminated surface |
Round patch of red, dry skin with red raised ring; temporary baldness |
Usually 4-14 days |
As long as lesions are present and fungal spores exist on materials |
Inspect skin for infection; do not share personal items; seek veterinary care for pets with signs of skin disease
|
Exclude until 24hrs of treatment; exclude from contact sports / swimming until treatment has been initiated |
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|
Rubella** (German Measles) |
Direct contact; contact with respiratory secretions; airborne via sneeze and cough |
Red, raised rash for ~3 days; possibly fever, headache, fatigue, red eyes |
Average 16-18 days (range: 14-21 days) |
7 days before to 7 days after rash onset |
If pregnant, consult OB; exclude those without documentation of immunity
|
Exclude until 7 days after onset of rash |
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|
Salmonellosis |
Fecal-oral: person-to-person, contact with infected animals or via contaminated food |
Abdominal pain, diarrhea (possibly bloody), fever, nausea, vomiting, dehydration |
Average 12-36hrs (range: 6hrs-7 days) |
During active illness and until organism is no longer detected in feces
|
Exclude with first signs of illness; encourage good hand hygiene |
Exclude until diarrhea has ceased for at least 2 days; additional restrictions may apply |
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|
Scabies |
Close, skin-to-skin contact with an infected person or via infested clothing or bedding |
Extreme itching (may be worse at night); mites burrowing in skin cause rash / bumps |
2-6 weeks for first exposure; 1-4 days for re-exposure |
Until mites are destroyed by chemical treatment; prescription skin and oral medications are generally effective after one treatment |
Treat close contacts and infected persons at the same time; exclude with first signs of illness; avoid skin-to-skin contact; do not share personal items |
Until treatment is completed; see MDCH Scabies Prevention and Control |
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|
Shigellosis** |
Fecal-oral: frequently person-to-person; also via contaminated food or water |
Abdominal pain, diarrhea (possibly bloody), fever, nausea, vomiting, dehydration |
Average 1-3 days (range 12-96hrs) |
During active illness and until no longer detected; treatment can shorten duration |
Exclude with first signs of illness; encourage good hand hygiene |
Medical clearance required; also, exclude until diarrhea has ceased for at least 2 days; additional restrictions may apply
|
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|
Strep throat / Scarlet Fever |
Respiratory droplet or direct contact; via contaminated food |
Sore throat, fever; Scarlet Fever: body rash and red tongue |
Average 2-5 days (range 1-7 days) |
Until 24hrs after treatment; (10-21 days without treatment) |
Exclude with signs of illness; encourage good hand hygiene
|
Exclude until 24hrs after antimicrobial therapy |
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|
Streptococcus pneumoniae |
Contact with respiratory secretions |
Variable: ear infection, sinusitis, pneumonia or meningitis
|
Varies; as short as 1-3 days |
Until 24hrs after antimicrobial therapy |
Consult your LHD to discuss the potential need for treatment |
Exclude until 24hrs after antimicrobial therapy |
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|
Tuberculosis (TB) ? |
Airborne; spread by coughing, sneezing, speaking or singing |
Fever, fatigue, weight loss, cough (lasting 3+ weeks), night sweats, loss of appetite |
2-10 weeks |
While actively infectious |
Consult your LHD to discuss for evaluation and potential testing of contacts |
Exclude until medically cleared |
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|
Typhoid fever (Salmonella typhi) |
Fecal-oral: person-to-person, ingestion of contaminated food or water (cases are usually travel-related) |
Gradual onset of fever, headache, malaise, anorexia, cough, abdominal pain, rose spots, diarrhea or constipation, change in mental status
|
Average range: 8-14 days (3-60 days reported) |
From first week of illness through convalescence |
Consult your LHD for evaluation of close contacts |
Medical clearance required; also, exclude until symptom free; additional restrictions will apply |
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|
Whopping Cough** (Pertussis) |
Contact with respiratory secretions |
Initially cold-like symptoms, later cough; may have inspiratory whoop, posttussive vomiting |
Average 7-10 days (range 5-21 days) |
With onset of cold-like symptoms until 21 days from onset (or until 5 days of treatment)
|
Consult your LHD to discuss the potential need for treatment |
Exclude until 21 days after onset or until 5 days of appropriate treatment |
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|
West Nile Virus |
Bite from an infected mosquito |
High fever, nausea, headache, stiff neck |
3-14 days |
Not spread person-to-person |
Protect against bites using EPA approved insect repellents
|
No exclusion necessary |
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The information presented above was taken from Managing Communicable Diseases in Schools, prepared by the Michigan Department of Education and the Michigan Department of Community Heath, Division of Communicable Disease and immunization, Version 1, September 2014.
