Communicable Disease School Nurse Guidance

Teach effective, handwashing, good respiratory hygiene and cough etiquette
Colds are caused by viruses; antibiotics are not indicated.

For all diseases:

Good handwashing and hygiene practices; proper disposal of soiled tissues; avoid sharing linens; proper disinfection of surfaces and toys; cough into elbow or clothing when tissues unavailable.

Bronchiolitis, Bronchitis, Common Cold, Croup, Ear Infection, Pneumonia, Sinus Infection and Most Sore Throats (Respiratory diseases caused by many different viruses and occasionally bacteria)

Mode of Transmission

Breathing in respiratory droplets containing the pathogen after an infected person exhales, sneezes, or coughs -Direct contact with respiratory secretions from an infected person -Touching a contaminated object then touching mouth, nose or eyes

Symptoms

Variable, including runny nose, watery eyes, fatigue, coughing, and sneezing. May or may not have fever

Incubation Period

Period of Communicability

Variable, often from the day before symptoms begin up to 5 days after onset

Criteria for Exclusion from School

No exclusion unless febrile or other symptoms meeting exclusion criteria are present

Reporting Requirement

May depend of etiology/organism

Report unusual illness, clusters of cases above baseline for group and time of year, or increased/unusual severity of illness to the local health department

Conjunctivitis, Bacterial or Viral (Pink eye)

Mode of Transmission

Contact with an infected person’s skin, body fluid or though contact with a contaminated surface and then touching mucus membranes/eyes

Symptoms

Red eyes, usually with some discharge or crusting around eyes; may be itchy, sensitive to light, or watery

Bacterial: may have yellow/greenish discharge; may affect one or both eyes

Allergic and chemical conjunctivitis usually affects both eyes

Incubation Period

Viral: Varies with etiology

Period of Communicability

Bacterial: from onset of symptoms until after start of antibiotics, or as long as there is discharge form the eye

Viral: variable, before symptoms appear and while symptoms are present
(Allergic and chemical conjunctivitis is not contagious.)

Criteria for Exclusion from School

Bacterial, Viral, or unknown etiology: Exclude if conjunctivitis is accompanied by symptoms of systemic illness or if the child is unable to keep hands away from eye.

Childcare rules: exclude if purulent drainage until after 24 hours of treatment
http://www.ilga.gov/commission/jcar/admincode/089/089004070G03100R.html

Reporting Requirement

Not required to be reported

May notify local health department of large clusters of cases or cases with unusual severity of illness

Influenza

Mode of Transmission

Person to person by respiratory droplets created by coughing or sneezing, or though contact with a contaminated surface and then touching mucus membranes/eyes The virus can live on surfaces for several hours.

Symptoms

Sudden onset of fever, chills, headache, malaise, body aches, and nonproductive cough

Incubation Period

Period of Communicability

Variable, from 24 hours before onset of symptoms, peaks during first 3 days of illness through 7 days

Criteria for Exclusion from School

Until fever-free for 24 hours without using fever-reducing medications and symptoms are improving. Upon return, CDC recommends enhancing hygiene practices and wearing a well-fitted mask for 5 days.

Criteria may differ in pandemic or novel/variant strain influenza situation.

Reporting Requirement

Influenza A, variant virus cases are required to be reported immediately within 3 hours by healthcare providers.

Prevention & Control Measures

Annual influenza vaccine recommended for everyone 6 months and older, improve ventilation, wearing well-fitted masks, enhancing hygiene practices, and testing to inform actions.

Mumps

Mode of Transmission

Contact with droplets from eyes or mouth of infected person

Symptoms

Fever with swelling and tenderness of one or both parotid glands located below and in front of the ears Unrecognized mild cases without swelling may occur.

Incubation Period

12 to 25 days (usually 16 to 18 days)

Period of Communicability

Peak infectious time begins 1 to 2 days before swelling to 5 days after, but may range from 7 days before to 9 days after. For the purpose of contact tracing and exclusions, the infectious period is 2 days before to 5 days after parotitis.

Criteria for Exclusion from School

Exclude cases from school, childcare or workplace until 5 days after onset of parotitis. Note: daycare licensing rules require 9 days exclusion; refer to link below.

Susceptible contacts should be excluded from school or the workplace from days 12-25 after last exposure.

Reporting Requirement

Report case to local health department within 24 hours.

Outbreaks: three or more probable or confirmed cases linked by time and place.

Prevention & Control Measures

Timely immunization beginning at age 12 months; if outbreak occurs, unimmunized persons should be immunized or excluded for at least 26 days following onset of parotitis in last case.

Pertussis (Whooping Cough)

Mode of Transmission

Contact with droplets from nose, eyes or mouth of infected person

Symptoms

Initially cold-like symptoms, later cough; may have inspiratory whoop, post-tussive vomiting

Incubation Period

5 to 21 days (usually 7 to 10 days)

Period of Communicability

Before cough onset (with onset of runny nose), continuing until child has been on antibiotics for 5 days

If untreated, infectious for 3 weeks after cough begins

Criteria for Exclusion from School

School exclusion: Cases must be excluded from school until 5 days of appropriate antibiotic treatment is completed or 21 days after cough onset if no treatment is received.

Susceptible contacts do not need to be excluded unless they become symptomatic.

Reporting Requirement

Report as soon as possible, within 24 hours

Outbreaks: Five or more cases epidemiologically linked

Prevention & Control Measures

Timely immunization beginning at age 2 months; booster dose of Tdap is recommended at 11 years. All adults caring for children younger than 12 months should receive a booster dose of Tdap. Close contacts that are unimmunized should have pertussis immunization initiated. Chemoprophylaxis is recommended for targeted groups of close contacts regardless of age and immunization status. Contact the local health department for more information.

RSV

Mode of Transmission

Highly contagious; contact with droplets from nose, eyes or mouth of infected person; virus can live on surfaces (toys, tissues, doorknobs) for several hours

Symptoms

Fever, runny nose, cough. May have wheezing

Incubation Period

2 to 8 days (4 to 6 days most common)

Period of Communicability

Variable, from the day before until 3 to 8 days or longer; may last up to 3 to 4 weeks

Criteria for Exclusion from School

For 24 hours until both are true: fever-free without using fever-reducing medications and symptoms are improving overall. Upon return and for the next 5 days, CDC recommends enhancing hygiene practices, wearing a well-fitted mask and physical distance from others when indoors as much as possible.

Reporting Requirement

Prevention & Control Measures

Avoid sharing linens, toys, and other items

Staying up to date with vaccination for those eligible, improve ventilation, wearing well-fitted masks, enhancing hygiene practices, and testing to inform actions.

SARS-CoV-2 (COVID-19)

Mode of Transmission

Breathing in air when close to an infected person who is exhaling small droplets and particles that contain the virus.

Having these small droplets and particles that contain virus land on the eyes, nose, or mouth, especially through splashes and sprays like a cough or sneeze.

Touching eyes, nose, or mouth with hands that have the virus on them.

Symptoms

May have no symptoms or can have any of the following: Fever or chills, Cough, Shortness of breath or difficulty breathing, Fatigue, Muscle or body aches, Headache, New loss of taste or smell, Sore throat, Congestion or runny nose, Nausea or vomiting, Diarrhea, dermatologic manifestations

Incubation Period

Period of Communicability

From 2 days before symptom onset through Day 10 after symptom onset

Criteria for Exclusion from School

For 24 hours until both are true: fever-free without using fever-reducing medications and symptoms are improving overall. Upon return and for the next 5 days, CDC recommends enhancing hygiene practices, wearing a well-fitted mask and physical distance from others when indoors as much as possible.

Reporting Requirement

Outbreaks with hospitalization or deaths related to COVID-19 involving 3 or more in a core group of individuals within a 10-day period or if the school is no longer able to safely operate and provide essential services.

Prevention & Control Measures

Staying up to date with vaccination, improve ventilation, wearing well-fitted masks, enhancing hygiene practices, and testing to inform actions.

Strep throat/Scarlet Fever

Mode of Transmission

Contact with droplets from nose and mouth; close crowded contact, direct contact

Symptoms

Fever, sore throat with pus spots on tonsils, tender swollen glands

Scarlet fever has above symptoms plus a sandpaper-like rash Symptoms may vary.

Incubation Period

Period of Communicability

Highest during acute infection; no longer contagious within 24 hours after antibiotics

Criteria for Exclusion from School

Schools: Exclude until fever free without the use of fever-reducing medications or symptoms improving if fever not present AND on appropriate antibiotics for at least 12 hours. However, during outbreaks or in the setting of recurrent infection, IDPH recommends individuals stay home for at least 24 hours after on effective antibiotics AND fever free or symptoms improving if fever not present.

Child Care: rules: Exclude until 24 hours after treatment has been initiated and until the child has been without fever for 24 hours;
http://www.ilga.gov/commission/jcar/admincode/089/089004070G03100R.html

Reporting Requirement

Clusters of 10 epidemiologically linked cases of strep throat/scarlet fever within a 10 day period are reportable to the local health department.

Invasive disease from streptococcal bacteria is reportable.

Prevention & Control Measures

Avoid kissing, sharing drinks or utensils; exclude infected adults from food handling; symptomatic contacts of documented cases should be tested, and if results are positive, should be treated.

TB (tuberculosis)

Mode of Transmission

Airborne inhalation of droplets from nose and mouth of diseased person (children usually contract TB from close contact with a diseased adult)

Symptoms

Fever, fatigue, weight loss, cough (lasting 3+ weeks), night sweats, loss of appetite

Incubation Period

2 to 10 weeks to years; risk of developing disease is highest 6 months to 2 years after infection

Period of Communicability

Individuals with infection but without active disease (latent TB) are not infectious.

Individuals with active disease are infectious until treatment.

Criteria for Exclusion from School

For active disease: after therapy started, adherence documented, symptoms diminished, and determined to be non-infectious; consult with public health officials; no exclusion for latent infection

Reporting Requirement

Report suspect or confirmed TB cases to local health department within 7 days

Prevention & Control Measures

Routine TB skin testing is not recommended at this time for children; however, it is recommended that all adults who have contact with children in a child care setting are screened for TB; local health department personnel should be informed for contact investigation.

Gastrointestinal Illnesses

For all gastroenteritis diseases: Good handwashing and hygiene; proper disposal of dirty diapers; proper disinfection of changing tables, toys and food preparation areas. Avoid potentially contaminated beverages, food and water; divide food preparation and diapering responsibilities among staff

Enhanced environmental cleaning with EPA registered product labeled for efficacy against organism

Acute gastroenteritis cluster is defined as 4 or more persons with acute onset of vomiting and/or diarrhea (3 or more loose stools in a 24 hour period) in a classroom or otherwise defined group of students, or cases in more than 10% of the school/daycare’s census in a single day. Consult with Local Health Department for requirements for cases and contacts to return to work, school, and daycare settings

Gastroenteritis-(Vomiting and/or diarrhea): Bacterial

Proper cooking/handling of meats and raw eggs; Reptiles should not be permitted in child care centers.