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)

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

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

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

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

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

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

*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

 

 

 

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

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

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

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

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

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

*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

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

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

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

 

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

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

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

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

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

 

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

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

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

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

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

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

                             

 

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.