Section 6 - Communicable Disease Fact Sheets

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Communicable Disease Fact Sheets How and When to Use

The fact sheets labeled PROVIDER are intended to provide child care directors, school health staff, health consultants, and other providers with background information about the conditions/diseases, exclusion, and methods for treatment, prevention, and control. Diseases that are reportable to the local or state health department in Missouri are indicated on the PROVIDER fact sheet. The phrase “Reportable to local or state health department” appears under the title of the disease. If children or staff have been diagnosed with or are suspected of having any of these diseases, contact the local or state health department for consultation before sharing any information about the disease.

Many of the fact sheets have accompanying PARENT/GUARDIAN fact sheets. You may copy and post or distribute those fact sheets unless the disease is REPORTABLE – do not post or distribute any fact sheet for reportable diseases without permission of the local or state health department.

For more information, call the Missouri Department of Health and Senior Services (MDHSS) Bureau of Communicable Disease Control and Prevention at 573-751-6113 or 800-392-0272 (24/7), or call your local health department.

Bed Bugs

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

The presence of bed bugs in hotels, motels, dormitories, apartments, and houses in the United States has increased in the past few years; however, bed bugs infest only a very small percentage of residences. The bite of a bed bug has not been shown to spread disease. Bed bugs may be difficult to control without help from a pest control professional.

Cause

Cimex lectularius, a parasitic insect.

Bed bugs are small (up to 1/4" long) flattened, wingless insects that feed on the blood of people and certain animals. After feeding, the color of a bed bug changes from brown to purplish-red. Bed bugs live close to areas where people sleep, rest, or sit for long periods. Bed bugs move quickly, feed at night, and hide in small spaces (under bed mattresses, in furniture, etc.) during the day.

Symptoms

Painless bites typically on the head, neck, arms, hands, or legs. Bites may become irritated and inflamed. Scratching may cause the bites to become infected. Bed bugs feed at night, so you may not be aware that you were bitten, or the bites can be mistaken for bites from another pest (fleas or mosquitoes).

Spread

Bed bugs do not jump or fly. They quickly crawl to find a human host, feed for less than 5 minutes, and then hide. Bed bugs like to hide in small places; therefore, it is possible that bed bugs will crawl into luggage, beds, or furniture that is being moved from one place to the next. It is also possible for bed bugs to crawl through small spaces between units in a hotel or apartment building. Because bed bugs can survive for many months without feeding, they may already be present and hidden in apartments or homes that appear to not have any bed bugs.

Signs of Bed Bugs

Remember: Bed bugs are not transmitted from person to person. They are not like lice and will not usually travel directly on a person’s body. Bed bugs are spread between residences when they hide and are transported in luggage, furniture, or other items.

If you or your family members notice bites after sleeping that were not there when you went to bed. Because several different kinds of insects look like bed bugs, carefully compare the bugs with good reference images to confirm their identity. If still unsure about the identity of bugs in the home, contact a pest control expert.
Look for blood stains from crushed bugs or dark red spots (bed bug fecal material) on bed sheets and mattresses. Cast skins, which are empty shells of bed bugs as they grow from one stage to the next, may be present.
Look for live, crawling bed bugs – usually found around the seams and in the folds of bed mattresses or in crevices of the bed frame. In heavier infestations, live bed bugs may be found further away from the bed (window and door frames, electrical boxes, cracks in floors and ceilings, within furniture, behind picture frames on the wall).

Exclusion

Child Care and School: Children and students living in households containing bed bugs do not need to be excluded.

Treatment

A healthcare provider may recommend an antihistamine or corticosteroid to reduce allergic reaction and inflammation due to bed bug bites. Bed bugs are not known to spread any diseases.

Prevention/Control

DO NOT bring infested items into the home. Carefully inspect clothing and baggage after traveling. Pay attention to cracks, crevices, seams, and folds of suitcases and luggage.
Use caution when buying used furniture. Inspect all furniture and avoid buying used bed mattresses and bed frames. Taking free furniture items left by the curb for disposal or behind places of business is not recommended.
After confirming a bed bug infestation in the home, consult a licensed pest control operator who has experience with bed bugs before beginning any control activities. (Tenants should contact their property manager or landlord to discuss their respective obligations and to agree on a plan to manage the infestation.)
Control plans will be made on a case by case basis; the control plan may include the following activities:
- Reduce clutter to limit the hiding places for bed bugs.
- Thoroughly clean infested rooms - vacuum carpets, upholstered furniture, bed mattresses, bed frames, etc. It may be necessary to move and disassemble furniture during cleaning.
- Wash all bedding and affected clothing in hot water and dry in a hot dryer for at least 20 minutes before using again.
- Caulk or seal all holes in ceilings, walls, and around baseboards.
- Various insecticide (chemicals that kill insects) treatments may be needed. The insecticides available are commercial products requiring special equipment and training and are not readily available in “over-the-counter” products. Insecticides should be applied by a licensed pest control operator.
DO NOT apply any insecticides to bed mattresses or on bedding or linens. Work with a certified pest control operator to determine how insecticides will be used and applied in your residence. Insecticide treatments may require you to leave your home for a few hours or even several days. Several treatments may be needed to fully control the problem.

For more information, call the Missouri Department of Health and Senior Services (MDHSS) Bureau of Environmental Health Services at 573-751-6095 or 800-392-0272 (24/7), or call your local health department.

For more information about bedbugs, refer to University of Missouri’s Extension Office website at: https://extension.missouri.edu/g7396

Bronchitis, Acute (Chest Cold)/Bronchiolitis

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Bronchitis, Acute (Chest Cold)/Bronchiolitis

Bronchiolitis is a respiratory condition that is usually seen in children under 2 years of age. Bronchitis and bronchiolitis tend to occur more often in the fall and winter months. When infants and young children experience common respiratory viruses and are exposed to secondhand tobacco smoke, they are at risk of developing bronchiolitis, bronchitis, pneumonia, and middle ear infections.

Cause

Many different viruses (most commonly respiratory syncytial virus [RSV], parainfluenza virus, influenza virus, and adenoviruses), Mycoplasma pneumoniae, and some bacteria. Most of these organisms can cause other illnesses and not all persons exposed to the same organism will develop bronchitis or bronchiolitis.

Symptoms

Usually starts with a runny nose, fever, and a dry, harsh cough that becomes looser as the illness progresses. Older children may cough up green or yellow sputum.
Sore throat can occur in some cases. It may take 1 to 2 weeks for the cough to stop.

Spread

Viruses and bacteria are spread by touching the secretions from the nose or mouth of an infected person and/or touching hands, tissues, or other items soiled with these secretions and then touching your eyes, nose, or mouth.

Incubation

Depends upon the organism that is causing the illness.

Contagious Period

Until shortly before symptoms begin and for the duration of acute symptoms.

Exclusion

Child Care and School: Until fever is gone and the child is well enough to participate in routine activities.

Diagnosis

Recommend parents/guardians call their healthcare provider if their child has a high fever, persistent sore throat, or persistent cough.

Treatment

Since viruses cause most cases of acute bronchitis or bronchiolitis, antibiotics will not be effective.

DO NOT GIVE ASPIRIN or SALICYLATE-CONTAINING MEDICATIONS TO ANY CHILD OR ADOLESCENT UNDER 18 YEARS OF AGE.

Prevention/Control

Cover nose and mouth with a tissue when coughing and sneezing or cough/sneeze into your sleeve. Dispose of used tissues.
Regular and thorough handwashing is the best way to prevent the spread of communicable diseases. Wash hands thoroughly with soap and warm running water after contact with secretions from the nose or mouth.
Clean and sanitize mouthed objects, and surfaces at least daily and when soiled.

Bronchitis, Acute (Chest Cold)/Bronchiolitis Parent Fact Sheet

Your child may have been exposed to:

Bronchitis
Bronchitis/bronchiolitis are respiratory illnesses caused by viruses or bacteria.

If you think your child has Bronchitis:

Tell your child care provider or call the school.
Need to stay home?
- Child Care and School:
  Yes, until fever is gone and the child is healthy enough for routine activities.

DO NOT give aspirin or salicylate-containing medicines to anyone under 18 years of age.

Symptoms

Your child may have a runny nose and fever. Cough starts out dry and harsh. It becomes looser after the child has been sick for a while. Your child may have a sore throat. The cough can last 1 to 2 weeks.

Spread

By touching secretions from the nose or mouth.
By touching contaminated hands, objects or surfaces.

Contagious Period

Shortly before and while your child has symptoms.

Call your Healthcare Provider

If your child has a fever. Also if your child has a sore throat or cough that won’t go away.

Antibiotics do not work for illnesses caused by a virus, including some types of bronchitis.

Prevention

Cover nose and mouth when coughing and sneezing. Use a tissue or your sleeve. Dispose of used tissues.
Wash hands after touching anything that could be contaminated with secretions from the nose or mouth. Your child may need help with handwashing.
Clean and disinfect any objects or surfaces that come in contact with secretions from the nose or mouth. Use a product that kills bacteria and viruses.
DO NOT expose your child to second-hand tobacco smoke. Smoke increases the risk for serious respiratory infections and middle ear infections.

Campylobacteriosis

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Reportable to local or state health department

Consult the health department before posting/distributing Parent/Guardian fact sheet.

Cause

Campylobacter bacteria.

Symptoms

Diarrhea (frequently bloody), abdominal pain, nausea, occasionally fever and vomiting. The diarrhea may contain mucus. Illness usually lasts 2 to 5 days. Persons with Campylobacter infections may have mild symptoms or may not have any symptoms at all.

Spread

Campylobacter bacteria leave the body through the feces of an infected person or animal and enter another person when hands, food, or objects (such as toys) contaminated with feces or raw meat or poultry are placed in the mouth. Spread can occur when people do not wash their hands after using the toilet or changing diapers. Spread can also occur through handling infected pets, usually puppies, kittens, or farm animals.

People most often get Campylobacter by eating contaminated food, drinking contaminated water or unpasteurized milk, or having contact with animals.

Incubation

It takes from 1 to 10 days, usually 2 to 5 days, from the time a person is exposed until symptoms begin.

Contagious Period

As long as Campylobacter are present in the feces, a person can pass these bacteria on to other people. Excretion typically lasts 2-3 weeks without antimicrobial treatment but can last as long as 7 weeks.

Exclusion

Child Care and School: Until the child has been free of diarrhea for at least 24 hours. Children who have Campylobacter in their feces but who do not have symptoms do not need to be excluded.

No one with Campylobacter should use recreational water venues (swimming beaches, pools, water parks, spas, or hot tubs) until 2 weeks after diarrhea has stopped.

Exclude symptomatic staff with Campylobacter from working in food service until asymptomatic for 24 hours.

Diagnosis

Recommend parents/guardians call their healthcare provider if their child has symptoms. There is a lab test to detect Campylobacter.

Treatment

Almost all persons infected with Campylobacter recover without any specific treatment. Patients should drink extra fluids as long as the diarrhea lasts. In more severe cases, antibiotics can be used, and may shorten the duration of symptoms if given early in the illness. A physician should decide whether antibiotics are necessary.

Prevention/Control

Regular and thorough handwashing is the best way to prevent the spread of communicable diseases. Wash hands thoroughly with soap and warm running water after using the toilet and changing diapers and before preparing or eating food. Staff should closely monitor or assist all children, as appropriate, with handwashing after children have used the bathroom or been diapered.
Wash hands thoroughly with soap and warm running water immediately after handling pets or other animals.
Clean and disinfect diapering area and potty chairs after each use and bathroom toilets, sinks, and toys at least daily and when soiled.
Clean and sanitize mouthed objects and surfaces whenever soiled and at least daily.
Food Safety
- Thoroughly cook all foods that come from animals, especially poultry.
- Store all uncooked meat and poultry on a shelf lower than any other foods in the refrigerator.
- DO NOT drink unpasteurized milk or juices.
- Wash and disinfect all cutting boards, knives, utensils, or dishes that have been used for raw meat or poultry before using with already cooked foods and with uncooked foods, such as fruits or vegetables.
- Always wash hands, cutting boards, utensils, and dishes between uncooked and cooked foods.
- Restrict students from sharing any communal food items that are brought from home. In the classroom, children should not serve themselves food items that are not individually wrapped.
  The teacher should hand out these items after washing his/her hands. (This is not intended to discourage family-style serving in the absence of an outbreak.)

Campylobacteriosis Parent Fact Sheet

Your child may have been exposed to:

Campylobacteriosis
Campylobacteriosis is a bacterial infection of the intestines.

If you think your child has Campylobacteriosis:

Tell your child care provider or call the school.
Need to stay home?
- Child Care and School:
  Yes, until the child has been diarrhea free for at least 24 hours

In addition, anyone with Campylobacteriosis should not use swimming beaches, pools, water parks, spas, or hot tubs until 2 weeks after diarrhea has stopped.

Symptoms

Your child may have diarrhea, vomiting, or a fever. Your child’s stomach may hurt. These symptoms may last up to 5 days.

If your child is infected, it may take 2 to 5 days for symptoms to start.

Spread

By eating or drinking contaminated beverages or food, including undercooked chicken.
By touching contaminated hands, surfaces, or objects.
By handling pets and farm animals.

Contagious Period

The illness can spread as long as Campylobacter bacteria are in the feces.

Call your Healthcare Provider

If anyone in your home has symptoms. Your doctor can test for Campylobacter and may decide you need to be treated with an antibiotic.
Ask how to prevent dehydration. Your child may become dehydrated due to vomiting or diarrhea.

Prevention

Wash hands after using the toilet and changing diapers and before preparing food or eating. Your child may need help with handwashing.
Clean and disinfect any objects that come in contact with feces. This includes toilets (potty chairs), sinks, toys, and diaper changing areas. Use a product that kills bacteria.
Puppies, kittens, or farm animals can cause Campylobacter infection. Wash your hands after touching pets and farm animals.
Cook foods thoroughly and do not drink unpasteurized milk or juice. Always disinfect food preparation surfaces, especially after handling or cutting raw chicken.

Chickenpox (Varicella)

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Reportable to local or state health department

Consult the health department before posting/distributing Parent/Guardian fact sheet.

Chickenpox (also known as varicella) is an acute viral illness. It is a common childhood infection that can be prevented by vaccination. It is highly contagious, but rarely serious for most children.

Cause

Varicella-zoster virus, a member of the herpesvirus family.

Symptoms

Mild fever and generalized skin rash that begins on the chest, back, underarms, neck, and face. It starts out as red bumps. Within several hours, the bumps turn into small blisters (fluid-filled bumps), and then scabs after a few days. The sores commonly occur in batches with different stages (bumps, blisters, and sores) present at the same time.

Chickenpox can be severe in newborns, adults, those with weakened immune systems, and susceptible pregnant women (those who have not had chickenpox in the past or varicella vaccine). Complications that commonly lead to hospitalization and can lead to death include severe skin and soft tissue infections, pneumonia, encephalitis, and dehydration.

Spread

From person to person by touching the blister fluid or secretions from the nose or mouth of a person with chickenpox, and by inhalation of aerosols from the blister fluid of skin lesions. Varicella-zoster virus can also spread through the air, when a person with chickenpox coughs or sneezes, tiny droplets with virus and another person breathes them in (airborne spread). Can be spread by contact with the lesions of someone with uncovered shingles (see shingles fact sheet).

Incubation

It takes from 10 to 21 days, usually 14 to 16 days, after being exposed until symptoms develop.

Contagious Period

From 1 to 2 days before the rash begins until all blisters have become scabs (generally within 5 days with a range of 4 to 7 days after the appearance of the first blisters in an otherwise healthy child). Persons who have progressive varicella (development of new lesions greater than 7 days) and persons with altered immunity might be contagious longer.

Diagnosis

Breakthrough disease is a varicella infection that develops more than 42 days after vaccination, which typically is mild with less than 50 skin lesions, low or no fever, and shorter (4 to 6 days) duration of illness. People with breakthrough varicella are just as contagious as unvaccinated people with the disease.

Treatment

Based on typical symptoms and the characteristic rash. Occasionally lab tests are done to confirm chickenpox.

Exclusion

Recommend parents/guardians call their healthcare provider.

Do not give aspirin or other salicylate-containing medications to any child or adolescent under 18 years of age.

Child Care and School: Until all the blisters have dried into scabs; usually by day 6 after the rash began.

It takes 10 to 14 days after receiving vaccine to develop immunity. Vaccine failures occasionally occur. The incubation period is 10 to 21 days. Therefore, exclude children who:

Appear to have chickenpox regardless of whether or not they have received 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 less severe and have an atypical presentation. Bumps rather than blisters may be present; therefore, scabs may not be present. These cases should be excluded until all bumps/blisters/scabs (sores) have faded and no new sores have occurred within a 24-hour period, whichever is later. Sores do not need to be completely resolved.

Although extremely rare, the vaccine virus has been transmitted to susceptible contacts by vaccine recipients who develop a rash following vaccination.

Therefore, exclude vaccine recipients who develop a rash after receiving varicella vaccine, using the above criteria.

Exposed children without symptoms do not need to stay home unless chickenpox develops.

Prevention/Control

All children should be routinely vaccinated with two doses of varicella vaccine; with the first dose at age 12 to15 months and the second dose typically at 4 to 6 years of age.
If you think a child has chickenpox, have the parent/guardian call their healthcare provider before taking the child into a healthcare facility.
Cover nose and mouth with a tissue when coughing or sneezing or cough/sneeze into your sleeve. Dispose of used tissues.
Regular and thorough handwashing is the best way to prevent the spread of communicable diseases. Wash hands thoroughly with soap and warm running water after contact with secretions from the nose or mouth or blister fluid.
Clean and sanitize mouthed objects and surfaces. Clean and disinfect objects and surfaces contaminated with secretions from the nose or mouth and/or blister fluid at least daily and when soiled.
Susceptible persons (those who have not had chickenpox or varicella vaccine in the past) who have been exposed to someone with chickenpox should call their healthcare provider immediately. This is especially important for pregnant women and persons with a weakened immune system. A health care provider may recommend post-exposure prophylaxis based on the timeframe for exposure and other factors. Getting varicella vaccine within 3 days, and possibly up to 5 days, of exposure may prevent disease in these people. Antiviral medicine may also be prescribed.

Chickenpox Parent Fact Sheet

Your child may have been exposed to:

Chickenpox
Chickenpox is a viral illness. It is common for children to get chickenpox. It may be prevented by vaccination.

If you think your child has Chickenpox:

Tell your child care provider or call the school.
Need to stay home?
- Child Care and School:
  Yes, until all the blisters have dried into scabs (this is usually by day 6 after the rash began) or, in vaccinated children who have a mild infection with no crusts, once no new lesions have appeared for at least 24 hours.

DO NOT give aspirin or salicylate-containing medicines to anyone under 18 years of age.

Symptoms

Your child will have a rash that begins as red bumps and may have a fever.

If your child is infected, it may take 10 to 21 days for symptoms to begin.

Spread

By touching the blister fluid or secretions from the nose or mouth of a person with chickenpox.
By coughing or sneezing.

Contagious Period

From 1 to 2 days before the rash begins until all blisters have become scabs. Scabs usually form within 6 days.

Call your Healthcare Provider

If someone in your home:

develops a rash with fever. Your doctor will decide if treatment is needed. DO NOT go to a healthcare facility without calling first. You will be separated from others to prevent spread of illness.
has been exposed to chickenpox and they have not had chickenpox disease or chickenpox (varicella) vaccine in the past or are pregnant.

Prevention

In Missouri, all children 12 months and older attending child care or school must be vaccinated with varicella vaccine, have a history of disease, or have an exemption.
Cover nose and mouth when sneezing or coughing. Use a tissue or your sleeve. Dispose of used tissues.
Wash hands after touching anything that could be contaminated with secretions from the nose and mouth. Your child may need help with handwashing.
Clean and disinfect any objects or surfaces that come in contact with secretions from the nose or mouth. Use a product that kills viruses.

Conjunctivitis (Pinkeye)

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Conjunctivitis is redness and inflammation of the membrane (conjunctiva) that covers the eye and lines the inner surface of the eyelid. Pinkeye is a common infection in young children.

Cause

Bacteria, viruses, allergies, eye injuries, or chemicals.

Symptoms

Includes redness, itching, pain, and discharge, depending on the cause. Bacterial conjunctivitis can sometimes be distinguished from other forms of conjunctivitis by a more purulent (pus) discharge.

Spread

Touching the secretions from the eyes, nose, or mouth of infected persons.

Incubation

It takes about 1 to 12 days after exposure for symptoms to begin, usually 1 to 3 days.

Contagious Period

Viral and bacterial conjunctivitis are infectious while there is discharge from the eye. Conjunctivitis caused by chemicals or allergies is not infectious.

Exclusion

Child Care and School: None, unless the child has fever or behavior changes, or the child is unable to participate and staff members determine they cannot care for the child without compromising their ability to care for other children in the group.

Diagnosis

Recommend parents/guardians call their healthcare provider if their child has redness of eyes and/or eyelids with pus and/or fever or eye pain.

Treatment

Antibiotic treatment (eye ointment or drops) is occasionally prescribed for bacterial conjunctivitis. If the infection appears to be viral, most cases require only symptomatic treatment however; severe cases may need treatment with antivirals and other medications.

Prevention/Control

Cover nose and mouth when sneezing or coughing. Use a tissue or your sleeve. Dispose of used tissues.
Encourage children not to rub eyes. Keep the child's eyes wiped free of discharge. Avoid contact with eye drainage.
Viral conjunctivitis spread may also occur through contact with infected upper respiratory droplets, fomites, and contaminated swimming pools. Isolation precautions may be needed for at least 2 weeks or as long as the eyes are red and weeping.
Regular and thorough handwashing is the best way to prevent the spread of communicable diseases. Wash hands thoroughly with soap and warm running water after contact with eye drainage.
DO NOT share any articles, such as towels and washcloths, eye makeup, contact lens solution, or eye drops.
Clean and sanitize mouthed objects, and surfaces at least daily and when soiled.

Pink Eye Parent Fact Sheet

Your child may have been exposed to:

Pink Eye
Conjunctivitis (pink eye) is redness and soreness of the eye.

If you think your child has Pink Eye:

Tell your child care provider or call the school.
Need to stay home?
- Child Care and School:
  No, unless the child has fever or behavior changes, or the child is unable to participate and staff members determine they cannot care for the child without compromising their ability to care for other children in the group.

Symptoms

Your child may have redness, itching, pain, and drainage from the eyes. Your child may have a fever.

If your child is infected, it usually takes 1 to 3 days for symptoms to start.

Spread

By touching secretions from the eyes, nose, or mouth.
By touching contaminated hands, objects, or surfaces.

Contagious Period

While symptoms are present.

Call your Healthcare Provider

If your child has thick drainage from the eye. Your doctor will decide if treatment is needed.
Antibiotic treatment may be prescribed. If the infection is caused by a virus, antiviral treatment may be needed.

Prevention

Cover nose and mouth when sneezing or coughing. Use a tissue or your sleeve. Dispose of used tissues.
Wash hands after touching anything that could be contaminated with secretions from the eyes, mouth, or nose. Your child may need help with handwashing.
Clean and disinfect objects that come in contact with the secretions from the eyes, mouth, or nose. Use a product that kills bacteria and viruses.
DO NOT share anything that touches the eyes, such as towels and washcloths, eye makeup, contact lens solution, or eye drops.
Discourage rubbing and touching the eyes. Keep the child's eyes wiped free of drainage.
Use a cotton-tipped swab to apply medication.

COVID-19

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Reportable to local or state health department

Consult the health department before posting/distributing Parent/Guardian fact sheet.

COVID-19 is an acute viral illness. It is highly contagious, but rarely serious for most children who are not at higher risk. It is a common infection that may be prevented by vaccination.

Note that SARS-CoV-2 mutates frequently. Please check the Centers for Disease Control and Prevention’s (CDC) COVID-19 website for the most up-to-date information.

Cause

SARS-CoV-2 Virus, a respiratory virus that is a member of the coronavirus family.

Symptoms

Children may experience a variety of symptoms, including: fever, chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headaches, new loss of taste or smell, sore throat, nasal congestion or runny nose, nausea or vomiting, or diarrhea. Asymptomatic infection is also possible (a child tests positive for COVID-19 but does not have any symptoms).

Children with underlying health conditions are at increased risk for severe illness from COVID-19. There is also some risk of children developing post-COVID conditions (“long COVID”), which includes a wide range of new, returning, or ongoing health problems for four or more weeks after first being infected.

A small number of children may develop a rare and serious condition called Multisystem Inflammatory Syndrome in Children (MIS-C).

Spread

When an infected person coughs, sneezes, or breathes out tiny droplets with COVID-19 virus into the air, and another susceptible person breathes them in.

Asymptomatic cases (those with no symptoms) can also spread COVID-19 to others.

Incubation

It takes from 2 to 14 days (median, 5 days) from the time a person is exposed until symptoms begin (or until a positive test if asymptomatic).

Contagious Period

For symptomatic cases: From 2 days before to 10 days after symptoms developed.

For asymptomatic cases: From 2 days before to 10 days after the positive test was taken.

Exclusion

Child Care and School:

Until symptoms are improving, and the child has been fever-free for 24 hours without the use of a fever-reducing medicine. After this time, the child may return, but it is encouraged to consider additional steps to prevent the spread of respiratory viruses for the next 5 days.
If child never had symptoms but tested positive for COVID-19, they may be contagious. It is encouraged to take added precautions for the 5 days after the positive test.

Diagnosis

Tests are performed on nasopharyngeal (NP), oropharyngeal (OP) (throat), nasal, or saliva specimens. For more about testing, see CDC’s Testing for COVID-19 | COVID-19 | CDC.

Treatment

Recommended parents/guardians contact their health care provider. There is no specific treatment for COVID-19 in children with mild symptoms.

Prevention/Control

Monitor/screen for symptoms; ill children/staff should stay home and seek testing.
Stay up to date with recommended immunizations.
Take precautions when you are sick to help stop the spread of respiratory viruses to others.
Cover nose and mouth with tissue when coughing and sneezing, or cough/sneeze into your sleeve. Dispose of used tissues in the trash. Wash hands thoroughly with soap and warm running water after contact with secretions from the nose or mouth or handling used tissues. If soap and water are not available, use an alcohol-based hand sanitizer.
Establish a regular schedule and checklist for cleaning and disinfecting commonly touched surfaces (workstations, keyboards, telephones, handrails, doorknobs, etc.), shared items, shared equipment, and high traffic areas.
Ventilation is an important factor in preventing COVID-19 transmission indoors. Facility owners and operations should evaluate the operational capacity of ventilation systems and increase and maintain ventilation provided throughout the building.
Consult your state and local health department if you have questions.

COVID-19 Parent Fact Sheet

Your child may have been exposed to:

COVID-19
COVID-19 is a highly contagious viral illness. It is a common infection that may be prevented by vaccination.

If you think your child has COVID-19:

Tell your child care provider or call the school.
Need to stay home?
Child Care and School:
Yes, until symptoms are improving, and your child has been fever-free for 24 hours without the use of a fever-reducing medicine.
After this time, your child may return, but consider added precautions for 5 days after return.

Symptoms

Your child may have a fever, chills, cough, shortness of breath, body aches, headache, vomiting/diarrhea, or a new loss of taste or smell. Your child may also be infected and have no symptoms (asymptomatic).

If your child has been infected, it may take 2 to 14 days for symptoms to start.

Spread

By close contact with someone who is infected.
By breathing, coughing, and sneezing.

Cases with no symptoms can still spread COVID-19 to others.

Contagious Period

If your child has symptoms: from 2 days before to 10 days after the symptoms started.

If your child never had any symptoms but tested positive: from 2 days before to 10 days after the positive test was taken.

Call your Healthcare Provider

If anyone in your home:

Has any COVID-19 symptoms, consider testing at home or through a provider.

Prevention

The primary ways to prevent a COVID-19 infection are:
- Cover nose and mouth when coughing or sneezing by using a tissue or your sleeve. Dispose of tissues in the trash.
- Wash hands after touching anything that could come in contact with secretions from the nose or mouth. Your child may need help with handwashing.
- Clean and disinfect any objects or surfaces that could come in contact with secretions from the nose or mouth.
- Stay up to date with recommended immunizations.
Monitor your child for COVID-19 symptoms. If your child is showing symptoms of COVID-19, stay home and consider testing.

Croup

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Croup refers to several fairly common respiratory illnesses that affect young children, usually between the ages of 3 months and 3 years, with most illness occurring during the second year of life. Croup occurs year-round depending upon the virus causing the illness.

Cause

Many different viruses, most commonly parainfluenza virus type 1. Not all persons exposed to the same virus will come down with croup. Since many different viruses can cause the illness, a child may develop croup more than once.

Symptoms

Runny nose, sore throat, mild cough, and fever often occur one to several days before the cough starts. Croup is characterized by hoarseness and a deepening, non-productive cough. Rapid breathing, sitting forward in bed to cough, or making a noise when taking a breath may also occur. The child may be better during the day, but gets worse at night. The illness lasts 3 to 4 days, but the cough may last longer. Hospitalization may be required if the illness is severe.

Spread

By touching the secretions from the nose or mouth of an infected person and/or touching hands, tissues, or other items soiled with these secretions and then touching your eyes, nose, or mouth.

Incubation

It may take up to 10 days after exposure for early symptoms to develop and several days later for the cough to occur.

Contagious Period

From shortly before symptoms begin and for as long as the acute symptoms last.

Exclusion

Child Care: Until fever is gone and the child is well enough to participate in routine activities.

Diagnosis

Recommend parents/guardians call their healthcare provider if their child has a high fever, difficulty swallowing or breathing, or persistent sore throat or cough.

Treatment

Croup is a viral illness; therefore, antibiotics will not be effective.

Do not give aspirin or salicylate-containing medications to any child or adolescent under 18 years of age.

Prevention/Control

Cover nose and mouth with tissue when coughing and sneezing or cough/sneeze into your sleeve. Dispose of used tissues.
Regular and thorough handwashing is the best way to prevent the spread of communicable diseases. Wash hands thoroughly with soap and warm running water after contact with secretions from the nose or mouth.
Clean and sanitize mouthed objects and surfaces at least daily and when soiled.

Croup Parent Fact Sheet

Your child may have been exposed to:

Croup
Croup is a respiratory illness caused by a virus. It usually affects young children.

If you think your child has Croup:

Tell your child care provider.
Need to stay home?
- Child Care and School:
  Yes, until fever is gone and the child is healthy enough for routine activities.

DO NOT give aspirin or salicylate-containing medicines to anyone under 18 years of age.

Symptoms

Your child may have a runny nose, sore throat, mild cough, and fever.

Several days later there may be a dry cough and hoarseness. Rapid breathing or making a noise when taking a breath may also occur. The cough may be worse at night. The illness lasts 3 to 4 days, but the cough may last longer.

If your child is infected, it may take up to 10 days for early symptoms to develop and a few more days for cough symptoms to start.

Spread

By touching secretions from the nose or mouth.
By touching contaminated hands, objects, or surfaces.

Contagious Period

From shortly before and while your child has symptoms.

Call your Healthcare Provider

If your child has a high fever or has a hard time swallowing or breathing. Also if your child has a sore throat or cough that won’t go away.

Antibiotics do not work for illnesses caused by a virus, including croup.

Prevention

Cover nose and mouth when coughing and sneezing. Use a tissue or your sleeve. Dispose of used tissues.
Wash hands after touching anything that could be contaminated with secretions from the nose or mouth and before preparing food or eating. Your child may need help with handwashing.
Clean and disinfect any objects or surfaces that come in contact with secretions from the nose or mouth. Use a product that kills bacteria and viruses.
DO NOT expose your child to second-hand tobacco smoke. Smoke increases the risk for serious respiratory infections and middle ear infections.

Cryptosporidiosis

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Reportable to local or state health department

Consult the health department before posting/distributing Parent/Guardian fact sheet.

Cause

Cryptosporidium, a parasite.

Symptoms

Frequent watery diarrhea, vomiting, and low-grade fever that lasts for several days are the most common symptoms. Other symptoms include stomach cramps, loss of appetite, and weight loss. Illness usually lasts from 7 to 10 days, but may last up to 3 weeks. Infected persons may have mild symptoms or may not have any symptoms at all. In persons with weakened immune systems, it can cause very serious illness and even result in death.

Spread

Cryptosporidium parasites leave the body through the feces of an infected person and enter another person when hands, food, or objects (such as toys) contaminated with feces are placed in the mouth. Spread can occur when people do not wash their hands after using the toilet or changing diapers. Spread can occur through contact with infected pets and farm animals, particularly cattle.

Outbreaks of cryptosporidiosis have occurred as a result of eating food and drinking water contaminated by the parasite. Waterborne outbreaks have occurred both as a result of drinking contaminated water and from swimming or playing in contaminated pools, lakes, or fountains.

Incubation

It takes 2 to 14 days, usually about 7 days, from the time a person is exposed until symptoms begin.

Contagious Period

As long as Cryptosporidium is present in the feces, a person can pass the bacteria on to other people. Cryptosporidium can be present in feces for at least 2 weeks after symptoms have stopped.

Exclusion

Child Care and School: Until 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.

Exclude symptomatic staff with Cryptosporidium from working in food service.

Diagnosis

Recommend parents/guardians call their healthcare provider if their child has symptoms. There is a lab test to detect Cryptosporidium in the feces.

Treatment

An antiparasitic drug has been approved for treatment of children and adults with healthy immune systems; however, the majority of healthy persons who are infected with Cryptosporidium get better without any specific treatment. Vomiting and diarrhea may lead to dehydration, which may be a medical emergency. Ask a healthcare provider how to prevent dehydration.

Prevention/Control

Regular and thorough handwashing is the best way to prevent the spread of communicable diseases. Wash hands thoroughly with soap and warm running water after using the toilet, changing diapers, and before preparing or eating food. Staff should closely monitor or assist all children, as appropriate, with handwashing after children have used the bathroom or been diapered.
Wash hands thoroughly with soap and warm running water immediately after handling pets and touching farm animals, particularly cattle.
Restrict students from sharing any communal food items that are brought from home. In the classroom, children should not serve themselves food items that are not individually wrapped. The teacher should hand out these items after washing his/her hands. (This is not intended to discourage family-style serving in the absence of an outbreak.)
DO NOT swallow water when swimming in lakes, swimming pools, hot tubs, or fountains. Cryptosporidium can survive for days in swimming pools with adequate chlorine levels.
Clean and disinfect diapering area and potty chairs after each use and bathroom toilets, sinks, and toys at least daily and when soiled.

Disinfecting Solutions

Bleach solutions are not effective for inactivating the Cryptosporidium parasite. Mechanically cleaning surfaces by scrubbing with soap or detergent and water will help reduce parasites. Contact your local health department for disinfection recommendations if an outbreak of cryptosporidiosis occurs.

Cryptosporidiosis Parent Fact Sheet

Your child may have been exposed to:

Cryptosporidiosis
Cryptosporidiosis is an infection of the intestines caused by a parasite.

If you think your child has Cryptosporidiosis:

Tell your child care provider or call the school.
Need to stay home?
- Child Care and School:
  Yes, until the child has been free of diarrhea for at least 24 hours.

In addition, anyone with Cryptosporidiosis should not use swimming beaches, pools, water parks, spas, or hot tubs for 2 weeks after diarrhea has stopped.

Symptoms

Your child may have watery diarrhea, vomiting, and fever. Your child may not be hungry or may complain about stomach pain. Illness can last 2 to 3 weeks (average of 7 to 10 days).

If your child is infected, it may take 2 to 14 days for symptoms to start.

Spread

By eating or drinking contaminated food or beverages.
By touching contaminated hands, surfaces, or objects.
By handling pets and farm animals.

Contagious Period

The illness can spread as long as Cryptosporidium parasites are in the feces. This may be 2 weeks or longer.

Call your Healthcare Provider

If anyone in your home has symptoms. There is a medical test to detect the parasite. There is a treatment; however, most people get better without any specific treatment.
Ask how to prevent dehydration. Your child may become dehydrated due to vomiting and diarrhea.

Prevention

Wash hands after using the toilet and changing diapers and before preparing food or eating. Your child may need help with handwashing.
Clean and disinfect any objects that come in contact with feces. This includes toilets (potty chairs), sinks, toys, and diaper changing areas. Use a product that kills parasites.
Pets and farm animals (particularly cattle) can cause cryptosporidiosis. Wash your hands after touching pets and farm animals.
DO NOT swallow water when swimming in lakes, swimming pools, hot tubs or fountains. Spread can occur through contaminated water.

Cytomegalovirus (CMV) Infection

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

CMV is a common virus that infects most people, but rarely causes illness. Most people have been exposed to CMV by adulthood.

Cause

Cytomegalovirus (CMV), a member of the herpesvirus family.

Symptoms

Most people have no symptoms. Occasionally, a person may develop mononucleosis-like symptoms that include fever, sore throat, tiredness, and swollen glands.

Some groups (e.g., those with a weakened immune system due to chemotherapy, organ transplants, or HIV infection) are at special risk for more serious infections. About 5% of children whose mothers were infected during pregnancy may have birth defects such as hearing loss, developmental delay, and delays in development. Babies can be infected in utero.

Spread

Most commonly through contact with saliva or urine of an infected person, but can also be spread through contact with blood, breast milk, and other secretions. Close, prolonged physical contact is necessary for spread to occur. CMV spreads easily in child care settings, most often among children who drool and/or are in diapers and have no symptoms.

Incubation

Unknown for person-to-person spread.

Contagious Period

Virus may be present in urine or saliva for long periods of time, even in people with no symptoms. The virus dies rapidly outside the body.

Exclusion

Child Care and School: None.

Treatment

None.

Prevention/Control

Regular and thorough handwashing is the best way to prevent the spread of communicable diseases. Wash hands thoroughly with soap and warm running water after changing diapers, assisting a child in the bathroom, having contact with a child's saliva or urine, or before preparing food or eating.
Minimize contact with children’s saliva by not kissing their lips or hands and by not having mouth contact with items that could be contaminated by saliva.
Clean and disinfect items contaminated with saliva or urine.
In addition to the above recommendations, female child care providers who are pregnant may consider working with only children older than 2 ½ years of age, especially if they have never been infected with CMV or are unsure if they have been exposed. However, contact with children that does not involve exposure to saliva or urine poses no risk.

CMV Parent Fact Sheet

Your child may have been exposed to:

CMV
CMV (cytomegalovirus) is a common virus that infects most people, but rarely causes illness.

If you think your child has CMV:

Tell your child care provider.
Need to stay home?
- Child Care and School:
  No.

Symptoms

Most people have no symptoms. Very rarely, a person may develop symptoms. These symptoms include fever, sore throat, tiredness, and swollen glands.

Spread

Through direct contact with saliva, urine, blood, breast milk, or other bodily fluids of an infected person.

Contagious Period

Virus may be in urine or saliva for long periods of time.

Call your Healthcare Provider

If anyone in your home has symptoms of CMV.

Prevention

Wash hands after using the toilet, changing diapers, touching secretions from the nose or mouth, and before preparing food or eating. Your child may need help with handwashing.
Clean and disinfect objects that come in contact with urine or saliva. Use a product that kills viruses.
Minimize contact with children’s saliva. Avoid kissing their lips or hands.
DO NOT have mouth contact with items contaminated with saliva.

Diarrhea (Infectious)

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Diarrhea is an increased number of bowel movements (compared with a person's normal pattern), along with watery, bloody, and/or mucus-containing feces. Diarrhea often is a symptom of infection caused by organisms such as bacteria, parasites, or viruses.

Cause

Many bacteria, parasites, and viruses can cause diarrhea. Some examples are:

Bacteria: Salmonella, Shigella, Campylobacter, STEC
Parasites: Giardia, Cryptosporidium, Cyclospora
Viruses: Norovirus (Norwalk-like), rotavirus, enterovirus

Symptoms

In addition to diarrhea, there may be blood and mucus in the feces.
Other symptoms may include nausea, stomach pain, vomiting, and fever.

Spread

Infectious bacteria leave the body through the feces of an infected person. Spread can occur when people do not properly wash their hands after using the toilet or changing diapers. If not removed by good handwashing, they may then contaminate food or objects (such as toys) and infect another person when the food or object is placed in that person’s mouth. Spread can occur whether or not a person feels sick.

Incubation

Varies by organism. It may take from 1 day to 4 weeks (sometimes longer) from the time a person is exposed until symptoms start.

Contagious Period

As long as infectious organisms are present in the feces, a person can pass the organism on to other people.

Exclusion

Child Care: Until the child has been free of diarrhea for at least 24 hours. The length of time may vary depending on the organism. For some infections, the person must also be treated with antibiotics or have negative laboratory tests before returning to child care. (See fact sheet for specific organism when known.)

School: Exclude children that have diarrhea that may be infectious until the child has been free of diarrhea for at least 24 hours. Further exclusion may be necessary during outbreaks.

No one with diarrhea should use swimming beaches, pools, spas, water parks, or hot tubs for at least 2 weeks after diarrhea has stopped.

Staff with diarrhea that could be infectious should be restricted from working in food service. Call your local health department to see if other restrictions apply.

Diagnosis

Recommend parents/guardians call their healthcare provider if their child has symptoms. A lab test (feces exam or culture) may be done to determine the cause.

Treatment

Treatment will depend on which organism is present. Vomiting and diarrhea may lead to dehydration, which may be a medical emergency. Ask a healthcare provider how to prevent dehydration.

Prevention/Control

Regular and thorough handwashing is the best way to prevent the spread of communicable diseases. Wash hands thoroughly with soap and warm running water after using the toilet or changing diapers and before preparing or eating food. Staff should closely monitor or assist all children, as appropriate, with handwashing after children have used the bathroom or been diapered.
Restrict students from sharing any communal food items that are brought from home. In the classroom, children should not serve themselves food items that are not individually wrapped. The teacher should hand out these items after washing his/her hands. (This is not intended to discourage family-style serving in the absence of an outbreak).
Clean and disinfect diapering area and potty chairs after each use and the bathroom toilets and sinks at least daily and when soiled.
Clean and sanitize mouthed objects and surfaces at least daily and when soiled

Infectious Diarrhea Parent Fact Sheet

Your child may have been exposed to:

Infectious Diarrhea
Diarrhea is more bowel movements that are looser and watery when compared to a person's normal pattern and form. Examples of causes include STEC, Salmonella, and rotavirus.

If you think your child has Infectious Diarrhea:

Tell your child care provider or call the school.
Need to stay home?
- Child Care:
  Yes, until the child has been free of diarrhea for at least 24 hours.
  Follow “stay home” guidelines for specific organism if the child was tested and the cause is known.
- School:
  Yes, until the child has been free of diarrhea for at least 24 hours.

Symptoms

A child with infectious diarrhea may have bowel movements that are loose and runny compared to normal. There may be blood and/or mucus in the feces. Other symptoms may include a stomach ache, vomiting, and fever.

If your child is infected, it may take 1 day to 4 weeks (sometimes longer) for symptoms to start.

Spread

By eating or drinking contaminated food or beverages.
By touching contaminated hands, surfaces, or objects.

Contagious Period

The illness can spread as long as bacteria are in the feces.

Call your Healthcare Provider

If anyone in your home has symptoms. There may be a medical test to detect the germ. Treatment may be available, depending on the germ that is causing diarrhea.
Ask how to prevent dehydration. Your child may become dehydrated due to vomiting and diarrhea.

Prevention

Wash hands after using the toilet or changing diapers and before preparing food or eating. Your child may need help with handwashing.
Clean and disinfect any objects that come in contact with feces. This includes toilets (potty chairs), sinks, toys, and diaper changing areas. Use a product that kills bacteria, viruses and parasites.
DO NOT use beaches, pools, water parks, spas, or hot tubs until 2 weeks after diarrhea has stopped.

Enteroviral Infection

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Cause

Coxsackieviruses, echoviruses, or other enteroviruses.

Symptoms

Cold-like symptoms, sore throat, mouth sores, fever, rash, vomiting, and diarrhea are the most common symptoms. Some people may not have any symptoms.

These viruses often cause mild infections such as colds, sore throats, and intestinal illnesses. Less often enteroviruses cause pneumonia, meningitis, or encephalitis.

Spread

Enteroviruses leave the body through the feces of an infected person and enter another person when hands, food, or objects (such as toys) contaminated with feces are placed in the mouth. Spread can occur when people do not wash their hands after using the toilet or changing diapers. Also, enteroviruses can be spread through droplets that are sent into the air from the nose and mouth of an infected person during sneezing, coughing, or vomiting and another person breathes them in.

Incubation

It usually takes from 3 to 6 days from the time a person is exposed until symptoms begin except for acute hemorrhagic conjunctivitis which takes 24 to 72 hours.

Contagious Period

During illness and possibly for several weeks after illness (through contact with feces). Infected persons who may not seem sick are able to spread infection.

Exclusion

Child Care and School: Until the child has been free of diarrhea and/or vomiting for at least 24 hours. For mild, cold-like symptoms: None, as long as the child is well enough to participate in routine activities.

Treatment

No specific treatment for these viruses. Vomiting and diarrhea may lead to dehydration, which may be a medical emergency. Ask a healthcare provider how to prevent dehydration.

Prevention/Control

Cover nose and mouth with a tissue when sneezing and coughing or cough/sneeze into your sleeve. Dispose of used tissues.
Regular and thorough handwashing is the best way to prevent the spread of communicable diseases. Wash hands thoroughly with soap and warm running water after using the toilet, changing diapers, touching nasal secretions, and before preparing or eating food. Staff should closely monitor or assist all children, as appropriate, with handwashing after children have used the bathroom or been diapered.
Clean and disinfect diapering area and potty chairs after each use and bathroom toilets, sinks, and toys at least daily and when soiled. Clean and sanitize mouthed objects and surfaces at least daily and when soiled.

Enteroviruses Parent Fact Sheet

Your child may have been exposed to:

Enteroviruses
Enteroviruses cause a variety of illnesses.

If you think your child has Enteroviral Infection:

Tell your child care provider or call the school.
Need to stay home?
- Child Care and School:
  Yes, until the child has been free of diarrhea and vomiting for at least 24 hours.
  For mild, cold-like symptoms: none, as long as the child is well enough to participate in routine activities.

Symptoms

Your child may have cold-like symptoms with fever. Sore throat, mouth sores, rash, vomiting, and diarrhea are the most common symptoms.

If your child is infected, it may take 3 to 6 days for symptoms to start.

Spread

By coughing or sneezing.
By touching contaminated hands, surfaces, or objects.
By eating or drinking contaminated food or beverages.

Contagious Period

During symptoms and as long as the virus is in the feces. This could be for several weeks.

Call your Healthcare Provider

No specific treatment is available. Ask how to prevent dehydration. Your child may become dehydrated due to vomiting or diarrhea.

Prevention

Cover nose and mouth when sneezing or coughing. Use a tissue or your sleeve. Dispose of used tissues.
Wash hands after touching anything that could be contaminated with the secretions from the mouth or nose or with feces and before preparing food or eating. Your child may need help with handwashing.
Clean and disinfect any objects that come in contact with feces or secretions from the nose or mouth. This includes toilets (potty chairs), sinks, toys, diaper changing areas, and surfaces. Use a product that kills viruses.

Fifth Disease

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Fifth disease (also called parvovirus B19 infection) is a mild, common illness caused by a virus. Rash is the most common symptom. Immunity increases with age; 50% to 80% of adults are immune. Outbreaks of fifth disease frequently occur in child care settings and schools.

Cause

Human parvovirus B19.

Symptoms

Rash; possibly a low-grade fever or sore throat. The characteristic rash causes an intense redness of the cheeks (a "slapped cheek" appearance) in children. The rash often begins on the cheeks and is later found on the arms, upper body, buttocks, and legs; it has a very fine, lacy, pink appearance. In general, the rash on the face will fade within 4 days. The rash on the rest of the body initially fades within 3 to 7 days. However, the rash may come and go for days or even weeks, when the person is exposed to sunlight or heat. Adults, especially women, may have pain, redness and swelling of the joints. Joint pain and swelling may last 1-3 months.

Most people who get fifth disease do not become very ill. However, children with sickle cell anemia, chronic anemia, or a weakened immune system may become seriously ill and require medical care when infected with parvovirus B19.

Spread

When an infected person coughs or sneezes. People can also become infected by touching these secretions and then touching their mouth, eyes, or nose.

Incubation

It takes from 4 to 21 days, usually 4 to 14 days, from the time of infection until symptoms begin.

Contagious Period

Most contagious before the beginning of the rash and unlikely to be contagious after the rash begins.

Exclusion

Child Care and School: None, if other rash-causing illnesses are ruled out by a healthcare provider. Persons with fifth disease are no longer infectious once the rash begins.

Diagnosis

Lab (blood) tests are available to determine whether you are immune or are currently infected with parvovirus B19.

Treatment

None.

Prevention/Control

Regular and thorough handwashing is the best way to prevent the spread of communicable diseases. Wash hands thoroughly with soap and warm running water after touching secretions from the nose or mouth.
Cover nose and mouth with a tissue when coughing and sneezing or cough/sneeze into your sleeve. Dispose of used tissues.
Notify your healthcare provider if you are pregnant or have a weakened immune system, sickle cell anemia, or other blood disorders and you have been exposed. If you do not know whether you are immune (have had fifth disease in the past), call your healthcare provider for advice and whether a blood test is needed.

Information for Pregnant Women/Teens

Usually there are no serious problems for a pregnant woman or her baby because of an exposure to fifth disease. About 50% of women have already had fifth disease (are immune), so they and their babies are not at risk. Even if a woman is susceptible and gets infected with parvovirus B19, she usually experiences only mild illness. Likewise, her unborn baby usually does not have any problems caused by parvovirus B19 infection.

Rarely, parvovirus B19 infection will cause the unborn baby to have severe anemia and the woman may have a miscarriage. This occurs in fewer than 5% of all pregnant women who are infected with parvovirus B19 and happens more commonly during the first half of pregnancy. There is no evidence that parvovirus B19 infection causes birth defects or developmental delay. (For additional information on parvovirus B19 virus and pregnancy, see Section 1)

Fifth Disease Parent Fact Sheet

Your child may have been exposed to:

Fifth Disease
Fifth Disease (Parvovirus) is a rash illness caused by a virus.

If you think your child has Fifth Disease:

Tell your child care provider or call the school.
Need to stay home?
- Child Care and School:
  No, if other rash-causing illnesses are ruled out by a healthcare provider.

Symptoms

Your child may have a sore throat or a low-grade fever. A rash that causes very red cheeks (a "slapped cheek" look) in children. The rash often begins on the cheeks and moves to the arms, upper body, buttocks, and legs. The rash looks very fine, lacy, and pink. It usually fades in 3 to 7 days. However, the rash may come and go for weeks, when your child is in the sunlight or heat.

If your child is infected, it may take 4 to 21 days for symptoms to start.

Spread

By coughing or sneezing.
By touching contaminated hands, surfaces, and objects.

Contagious Period

Until the rash appears.

Call your Healthcare Provider

If your child has a weakened immune system, sickle cell anemia, or other blood disorders and has been exposed to someone with fifth disease.
If you are a pregnant woman who is exposed to fifth disease. Your doctor will decide if a blood test is needed.

Prevention

Cover nose and mouth when sneezing or coughing. Use a tissue or your sleeve. Dispose of used tissues.
Wash hands after touching anything that could be contaminated with secretions from the nose or mouth. Your child may need help with handwashing.
Clean and disinfect any objects that come in contact with secretions from the nose or mouth. Use a product that kills viruses.
Any pregnant individuals in the home should consult their healthcare provider with regard to exposures.

Giardiasis

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Reportable to local or state health department

Consult the health department before posting/distributing Parent/Guardian fact sheet.

Cause

Giardia intestinalis (lamblia), a parasite.

Symptoms

Gas, stomach cramps and bloating, nausea, diarrhea (possibly ongoing or recurring), loss of appetite, and weight loss. Children who are infected often show no symptoms. Illness usually lasts between 2 to 6 weeks.

Spread

Giardia parasites leave the body through the feces of an infected person and enter another person when hands, food, or objects (such as toys) contaminated with feces are placed in the mouth. Spread can occur when people do not wash their hands after using the toilet or changing diapers. Spread can occur whether or not a person feels sick.

Incubation

It takes 1 to 3 weeks, usually 7 to 10 days, from the time a person is exposed until symptoms develop.

Contagious Period

As long as Giardia parasites are present in the feces a person can pass the parasite on to other people. Giardia can be present in feces for several weeks or months after symptoms have stopped.

Exclusion

Child Care: Persons with diarrhea should be excluded from child care and school until they are free of diarrhea for at least 24 hours. Children who have Giardia in their feces but who have no symptoms do not need to be excluded.

School: Until the child has been free of diarrhea for at least 24 hours. Further exclusion may be necessary during outbreaks.

No one with Giardia should use swimming beaches, pools, water parks, spas, or hot tubs for 2 weeks after diarrhea has stopped.

Symptomatic staff with Giardia should be restricted from working in food service.

Diagnosis

Recommend parents/guardians call their healthcare provider if their child has symptoms of giardiasis. There is a lab test to detect Giardia in the feces.

Treatment

Treatment is available. Vomiting and diarrhea may lead to dehydration, which may be a medical emergency. Ask a healthcare provider how to prevent dehydration.

Child Care: All symptomatic children, family members, and child care workers infected with Giardia intestinalis should be treated. Treatment of asymptomatic carriers is not recommended.

Prevention/Control

Regular and thorough handwashing is the best way to prevent the spread of communicable diseases. Wash hands thoroughly with soap and warm running water after using the toilet and changing diapers and before preparing or eating food. Staff should closely monitor or assist all children, as appropriate, with handwashing after children have used the bathroom or been diapered.
Restrict students from sharing any communal food items that are brought from home. In the classroom, children should not serve themselves food items that are not individually wrapped. The teacher should hand out these items after washing his/her hands. (This is not intended to discourage family-style serving in the absence of an outbreak.)
DO NOT allow children to swallow water when swimming in lakes or swimming pools, using hot tubs, or playing in fountains.
Clean and disinfect diapering area and potty chairs after each use and bathroom toilets, sinks, and toys at least daily and when soiled.
Clean and disinfect mouthed objects or surfaces at least daily and when soiled.

Giardiasis Parent Fact Sheet

Your child may have been exposed to:

Giardiasis
Giardiasis is an infection of the intestines caused by a parasite.

If you think your child has Giardiasis:

Tell your child care provider or call the school.
Need to stay home?
- Child Care:
  Yes, for 24 hours after treatment has been started and until the child has been free of diarrhea for at least 24 hours.
- School:
  Yes, until the child has been free of diarrhea for at least 24 hours.

Anyone with giardiasis should not use swimming beaches, pools, water parks, spas, or hot tubs for 2 weeks after diarrhea has stopped.

Symptoms

Your child may have gas, stomach cramps, bloating, and diarrhea. They may not be hungry and may lose weight. Illness usually lasts between 2 to 6 weeks.

If your child is infected, it may take 1 to 3 weeks (usually 7 to 10 days) for symptoms to start.

Spread

By eating or drinking contaminated food or beverages.
By touching contaminated hands, surfaces, or objects.

Contagious Period

The illness can spread as long as Giardia parasites are in the feces. This could be for several weeks or months.

Call your Healthcare Provider

If anyone in your home has symptoms. There is a medical test to detect the parasite. Treatment is available.
Ask how to prevent dehydration. Your child may become dehydrated due to vomiting or diarrhea.

Prevention

Wash hands after using the toilet and changing diapers and before preparing food or eating. Your child may need help with handwashing.
Clean and disinfect any objects that come in contact with feces. This includes toilets (potty chairs), sinks, toys, and diaper changing areas. Use a product that kills parasites.
DO NOT swallow water when swimming in lakes, swimming pools, water parks, hot tubs, or fountains. Spread can occur through contaminated water.

Haemophilus Influenzae Type B (Hib) Disease

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Reportable to local or state health department

Consult the health department before posting/distributing Parent/Guardian fact sheet.

Haemophilus influenzae type b (Hib) can cause a number of serious illnesses. It is not related to influenza or “stomach flu”. The number of infections in children has dropped due to use of the Hib vaccine.

Cause

Haemophilus influenzae type b bacteria.

Symptoms

Meningitis - Unusual sleepiness, fever, stiff neck, vomiting, headache, irritability, lack of appetite.
Cellulitis - A tender, rapid swelling of the skin, usually on the cheek or around the eye; may also have an ear infection on the same side; also a low-grade fever.
Epiglottitis - Fever, trouble swallowing, tiredness, difficult and rapid breathing (often confused with viral croup, which is a milder infection and lasts longer).
Pneumonia - Fever, cough, chest pains, difficulty breathing.
Bacteremia - Sudden onset of fever, chills, tiredness, irritability.
Arthritis - Swelling, redness, and loss of movement in the joints.

Children age 2 and under are most likely to develop these infections Invasive disease most commonly occurs in children who are too young to have completed their vaccination series.

Spread

When a person with Hib disease coughs or sneezes, tiny droplets containing Haemophilus influenzae type b bacteria spread through the air. Another person breathes them in. A person can also get infected from touching these secretions and then touching their mouth, eyes, or nose.

Incubation

Unknown; probably about 2 to 4 days from the time a person is exposed until symptoms begin.

Contagious Period

Until 24 to 48 hours after effective treatment begins.

Exclusion

Child Care: Until the child has been treated and is well enough to participate in routine activities.

Diagnosis

Recommend parents/guardians call their healthcare provider immediately if their child develops fever or any other symptoms. There are lab tests to detect Haemophilus.

Treatment

Hib disease can be treated with antibiotics. Immediate treatment is necessary to prevent long-term sequelae or death.

Prevention/Control

All infants should receive Hib vaccine as part of their routine vaccination schedule. All children between the ages of 2 months and 5 years who are in a licensed child care setting are required to have Hib vaccine or they must have a legal exemption.
Public health officials will make recommendations if exposed persons need to receive antibiotics and/or vaccine.
Cover nose and mouth with a tissue when coughing and sneezing or cough/sneeze into sleeve. Dispose of used tissues in the trash.
Wash hands thoroughly with soap and warm running water after contact with secretions from the nose or mouth or handling used tissues. Thorough handwashing is the best way to prevent the spread of communicable diseases. If soap and water are not available, use an alcohol-based hand sanitizer.
Clean and sanitize mouthed toys, objects, and surfaces at least daily and when soiled (see Section 2).

Haemophilus Influenzae Type B Parent Fact Sheet

Your child may have been exposed to:

Haemophilus Influenzae Type b
Haemophilus influenzae type b (Hib) bacteria can cause a number of serious illnesses. It is not related to influenza or “stomach flu”. Infection with Hib is extremely rare if your child has received the Hib vaccine.

If you think your child has Hib:

Tell your child care provider.
Need to stay home?
- Child Care and School:
  Yes, until the child has been treated and is healthy enough for routine activities.

Symptoms

Your child may have a fever with any of these conditions.

Meningitis - Your child may be tired, fussy and not want to eat. They may also have a fever, stiff neck, vomiting, and headache.
Cellulitis - Look for swollen skin, usually on the cheek or around the eye. Your child may also have an ear infection on the same side.
Epiglottitis - Your child may be tired. It may be hard for your child to swallow and to breathe.

If your child has been infected, it may take 2 to 4 days for symptoms to start

Spread

By sneezing or coughing.
By touching contaminated hands, surfaces, or objects contaminated with secretions from the nose or mouth.

Contagious Period

Until 24 to 48 hours after effective treatment begins.

Call your Healthcare Provider

If anyone in your home has symptoms of Hib. Your doctor may want to test for the bacteria and provide treatment.

Prevention

Cover nose and mouth when sneezing or coughing. Use a tissue or your sleeve. Dispose of used tissues.
Wash hands after touching anything that could be contaminated with secretions from the nose or mouth. Your child may need help with handwashing.
Clean and disinfect anything contaminated with secretions from the nose or mouth. Use a product that kills bacteria.
All children between the ages of 2 months and 5 years who are in a licensed child care setting must have Hib vaccine or a legal exemption.

Hand, Foot, and Mouth Disease

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Hand, foot, and mouth disease is a viral infection that causes a blister-like rash involving the hands, feet, and mouth. The infection occurs most commonly in children less than 10 years of age and most often in the summer and fall months. Outbreaks may occur in child care settings and preschools.

Cause

Coxsackievirus, most often A16 (an enterovirus).

Symptoms

Low-grade fever lasting 1 to 2 days, runny nose, and/or sore throat. Blister-like rash occurs in the mouth, on the sides of the tongue, inside the cheeks, and on the gums. These sores may last 7 to 10 days. Blister-like rash may occur on the palms and fingers of the hands and on the soles of the feet. The disease is usually self- limited, but in rare cases has been fatal in infants.

Spread

The viruses leave the body through the feces of an infected person and enter another person when hands, food, or objects (such as toys) contaminated with feces are placed in the mouth. It also is spread through droplets that are expelled from the nose and mouth of an infected person during sneezing and coughing and by direct contact with respiratory secretions.

Incubation

It usually takes 3 to 6 days after exposure for symptoms to begin.

Contagious Period

The virus may be shed for several weeks to months in the feces. Respiratory shedding of the virus lasts for 1 to 3 weeks. Infected persons who may not seem sick are able to spread the virus.

Exclusion

Child Care and School: Until fever is gone and the child is well enough to participate in routine activities (sores or rash may still be present).

Treatment

No specific treatment.

Prevention/Control

Cover nose and mouth with a tissue when coughing and sneezing or cough/sneeze into your sleeve. Dispose of used tissues.
Regular and thorough handwashing is the best way to prevent the spread of communicable diseases. Wash hands thoroughly with soap and warm running water after using the bathroom, after changing diapers, after handling anything soiled with feces or secretions from the nose or mouth, and before preparing food or eating. Staff should closely monitor or assist all children, as appropriate, with handwashing after children have used the bathroom or been diapered.
Clean and disinfect diapering area and potty chairs after each use and bathroom toilets, sinks, and toys at least daily and when soiled. Clean and sanitize mouthed objects and surfaces at least daily and when soiled. (See Section 2)

Hand, Foot, and Mouth Disease Parent Fact Sheet

Your child may have been exposed to:

Hand, Foot, and Mouth Disease
Hand, foot, and mouth disease is a viral infection that causes a blister-like rash.

If you think your child has Croup:

Tell your child care provider or call the school.
Need to stay home?
- Child Care and School:
  Yes, until fever is gone and the child is healthy enough for routine activities. Sores or a rash may still be present.

Symptoms

Your child may have a runny nose, low-grade fever, and sometimes a sore throat.

A blister-like rash occurs in the mouth. It may be on the sides of the tongue, inside the cheeks, and on the gums. These sores may last 7 to 10 days. This rash may occur on the palms and fingers of the hands and on the bottom of the feet.

If your child is infected, it may take 3 to 6 days for symptoms to start.

Spread

By coughing and sneezing.
By touching contaminated hands, surfaces, and objects.

Contagious Period

During the first week of illness. The virus may be in the feces for several weeks.

Call your Healthcare Provider

If anyone in your home has symptoms.

Prevention

Cover nose and mouth when sneezing or coughing. Use a tissue or your sleeve. Dispose of used tissues.
Wash hands after touching anything that could be contaminated with feces or secretions from the nose or mouth and before preparing food or eating. Your child may need help with handwashing.
Clean and disinfect any objects that come in contact with feces or secretions from the nose or mouth. This includes toilets (potty chairs), sinks, mouthed toys, and diaper changing areas. Use a product that kills viruses.

Head Lice

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Head lice infestations are a common problem for children in child care settings and schools. Anyone can get head lice. There are two other kinds of lice that infest people, but they do not live on the head. Parents should check their child(ren) for head lice regularly. If they find lice or eggs, use the information provided below.

Cause

Pediculus humanus capitis, a louse.

Head lice are very small (less than 1/8" long, about this size [--]), brownish-colored insects that live on human heads and lay their eggs (nits) close to the scalp. The eggs are tiny (about the size of the eye of a small needle) and gray or white in color. Adult lice move fast and do not like light.

Symptoms

Itching of the head and neck. Look for: 1) crawling lice in the hair, usually few in number; 2) eggs (nits) glued to the hair, often found behind the ears and at the back of the neck; and 3) scratch marks on the head or back of the neck at the hairline.

Spread

Lice are spread by head-to-head contact and by sharing personal items such as combs (especially on picture day), sports head gear, brushes, barrettes, hats, scarves, jackets, blankets, sheets, pillowcases, stuffed animals, play activity clothes, and hats. Head lice may be spread during sleepovers.

Lice do not jump or fly; they crawl and can fall off the head. Head lice do not live longer than 48 hours off the head. They only lay their eggs while on the head. Nits which are more than ½" from the scalp are dead or empty and will not hatch. The eggs do not hatch if they fall off the head. Lice do not spread to or from pets.

Incubation

It takes 7 to 10 days from when the eggs are laid until they hatch.

Contagious Period

Until treated with a lice treatment product.

Exclusion

Child Care and School: Until treatment has started and no live lice are seen. Nits are NOT considered live lice. Children do not need to be sent home immediately if lice are detected; however they should not return until effective treatment is given.

Treatment

Call a healthcare provider or pharmacist for advice. Recommended treatment includes using either an over-the-counter (OTC) or prescription medicated (lice killing) product. Use products that contain permethrin or a pyrethrin-based shampoo. Refer to the Centers for Disease Control and Prevention for the most current head lice treatment guidelines.
Follow the product directions carefully (especially the amount of product to use, length of time on the hair, and whether to use on dry or damp hair). Directions will vary, depending on the product used.
With certain products a second treatment is recommended 7 to 10 days later to kill any lice that may have hatched after the first treatment. Until the treatment course is completed, avoid any activity that involves the child in head-to-head contact with other children. Do not resume these activities until no new lice are seen and there are no nits within ¼" of the scalp for anyone in the group.
It may take 24 hours for products to kill lice.
Lice treatment products are not 100% effective in killing lice, especially nits. Removing the nits (nitpicking) is an essential part of the treatment for controlling the spread of head lice. The nits are glued onto the hair shaft as they are laid and require effort to remove. To remove the nits, use a metal nit comb, cat flea comb, or your fingernails to slide eggs off the hair shafts, or use scissors to cut the hair shafts that have nits glued to them. Continue checking the head and combing hair daily for 2 weeks. If all nits within ½" of the scalp are not removed, some may hatch and the child will be infested again. Remember: it takes at least 2 weeks to get rid of lice.
Check all household members for head lice. Treat only household members with head lice, and treat all at the same time.
Many alternatives to OTC or prescription head lice control products have been suggested. CDC does not have clear scientific evidence to determine if suffocation of head lice with mayonnaise, olive oil, margarine, butter, or similar substances is an effective form of treatment.

Prevention/Control

DO NOT share combs, brushes, other hair grooming items and other hair accessories (barrettes, etc.), towels, bedding, clothing, hats, and headgear, such as personal headphones and sports helmets.
Hang coats, jackets, and caps in individual lockers or on assigned coat hooks. If this is not possible, put the clothing in separate plastic bags. Bedding, when not in use for naptime, can be stored in individual plastic bags or storage boxes.
Parents should check their child's head frequently throughout the year. If one person in a household, child care, school, etc., has head lice, others should be checked too. Sleepovers are a common setting in which head lice are spread. When a child returns from a sleepover, check the child’s head and launder any bedding that they brought home.
Clean all combs, brushes, other hair grooming items and accessories (barrettes, etc.) by doing one of the following:
- soaking in the lice treatment product for 10 minutes.
- cleaning with hot soapy water.
- boiling for 5 minutes.
Vacuum carpets, upholstered furniture, mattresses, and seats in the car(s) thoroughly. Insecticide sprays are NOT recommended because this will expose household members to unnecessary pesticides and most viable lice are found on the head, not in the environment.
Wash clothing worn in the last 3 days (e.g., jackets, hats, scarves, pajamas), bedding, and towels in hot (1300 F or higher) water and dry in a hot dryer for at least 20 minutes before using again. Clothing or backpacks that cannot be washed or dried, linens, and stuffed toys can be dry cleaned or sealed in plastic bags for 2 weeks.

More information about head lice can be found on the Centers for Disease Control and Prevention website.

A flowchart has been developed for your use in determining appropriate actions to take in a school setting.

Infographic on How to Manage Head Lice in a School Setting

Head Lice Parent Fact Sheet

Your child may have been exposed to:

Head Lice
Anyone can get head lice. Head lice are very small brownish-colored insects that live on the head. They are less than 1/8" long, about this size [--]. They lay eggs (nits) close to the scalp. The eggs are tiny (size of the eye of a small needle) and gray or white in color.

If you think your child has Head Lice:

Tell your child care provider or call the school.
Treat your child for head lice and check child’s head and remove nits daily. It takes at least 2 weeks to get rid of lice.
If all nits within ½" of the scalp are not removed, some may hatch and your child will be infested again.
Check everyone in the house for head lice. Treat only household members with head lice, and treat them all at once.
Need to stay home?
- Child Care and School:
  Yes, until treatment has started and no live lice are seen. Nits are NOT considered live lice.

Symptoms

Itching of the head and neck. Look for: 1) crawling lice in the hair, usually there aren’t very many; 2) eggs (nits) glued to the hair, often found behind the ears and at the back of the neck; and 3) scratch marks on the head or back of the neck at the hairline.

If your child is infested with lice it will take 7 to 10 days from when the eggs are laid until they hatch.

Spread

By head-to-head contact. Check your child for lice often.

Lice do not jump or fly; they crawl and can fall off the head. Head lice do not live longer than 48 hours off the head.
They only lay their eggs while on the head. The eggs do not hatch if they fall off the head. Lice do not spread to or from pets.

Contagious Period

Until treated with a lice killing product.

Call your Healthcare Provider

Call your healthcare provider or pharmacy for advice. Recommended treatment includes using either a prescription or store-bought lice killing product.
Follow the product directions carefully. With certain products a second treatment is recommended 7 to 10 days later. Lice treatment products are not 100% effective in killing lice, especially nits.
Removing the nits (nitpicking) is a very important part of the treatment for controlling head lice. The nits are glued onto the hair shaft as they are laid, and require effort to remove. To remove the nits, use a metal nit comb, cat flea comb, or your fingernails to slide eggs off the hair shafts, or use scissors to cut the hair shafts that have nits glued to them. Continue checking the head and combing hair daily for 2 weeks. If all nits within ½” of the scalp are not removed, some may hatch and your child will get head lice again.

Prevention

Never share hair grooming items and hair accessories (barrettes, combs, brushes, etc.). Clean all hair items by soaking in the lice treatment product for 10 minutes or cleaning with hot, soapy or boiling water for 5 minutes.
Never share towels, bedding, clothing, hats, and headgear.
Check your child's head every month. If one person in the home has head lice, others should be checked too. Sleepovers are a common place for head lice to spread. Check your child’s head after a sleepover and wash all bedding brought home from the sleepover.
Vacuum carpets, upholstered furniture, mattresses, and seats in the car(s) thoroughly. Insecticide sprays are NOT recommended because this will expose household members to unnecessary pesticides.
Wash clothing worn in the last 3 days (e.g., jackets, hats, scarves, pajamas) bedding, and towels in hot water and dry in a hot dryer for at least 20 minutes before using again. Clothing, stuffed toys, linens or backpacks that cannot be washed or dried can be dry cleaned or sealed in plastic for 2 weeks.

How to Remove Nits
Work in a well lit room or under a bright lamp (using a magnifying glass may help you see the nits)
Divide the hair into 4 parts and divide each part into 1-inch sections.
Stating at the scalp, use a metal nit comb, cat flea comb, or your fingernails to comb each hair section individually.
Use the comb or your fingernail to slide eggs off the hair shaft or use scissors to cut hair shafts that have nits glued to them.
Remove all nits each time you comb the hair.
Remember: it can take at least 2 weeks to get rid of lice.

More information about head lice can be found at the CDC website.

Hepatitis A

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Reportable to local or state health department

Consult the health department before posting/distributing Parent/Guardian fact sheet.

Hepatitis A is an infection of the liver. It is the most common form of hepatitis infection in the United States. Among reported cases, the most frequent source of infection is household or sexual contact with a person who has hepatitis A, followed by attending or working in child care settings, recent international travel, or connection with suspected food or waterborne outbreaks.

Cause

Hepatitis A virus.

Symptoms

Usually starts suddenly with fever, tiredness, loss of appetite, and nausea. Dark (tea or cola-colored) urine, light-colored feces, and jaundice (yellowing of eyes or skin) may appear a few days later. Most children younger than 6 years of age, (70%) do not show symptoms. Older children and adults with hepatitis A usually have symptoms, often including jaundice.

Spread

Hepatitis A viruses leave the body through the feces of an infected person and enter another person when hands, food, or objects (such as toys) contaminated with feces are placed in the mouth. Spread can occur either by person-to-person contact or when people do not wash their hands after using the toilet or changing diapers and later prepare/handle food.

Children may pass the virus to household members or child care staff without ever having symptoms.

Incubation

It takes from 15 to 50 days, usually about 28 days, from the time a person is exposed to the virus until symptoms begin.

Contagious Period

From 2 weeks before to 2 weeks after symptoms begin. Minimal risk one week after the onset of jaundice.

Exclusion

Child Care and School: Consult with your local or state health department. Each situation must be looked at individually to decide if the person with hepatitis A can spread the virus to others.

Diagnosis

A blood test (Hepatitis A IgM antibody test) is done to determine whether there is recent or current infection.

Treatment

No specific medication is given to the person with hepatitis A.

Prevention/Control

Hepatitis A vaccine is recommended for all children 12 to 23 months of age and should be considered for groups at increased risk for hepatitis. Those persons include international travelers, men who have sex with men, illicit drug users, and persons with occupational risk. Vaccine should also be considered for those with chronic liver disease because they are at increased risk for severe problems.
Regular and thorough handwashing is the best way to prevent the spread of communicable diseases. Wash hands thoroughly with soap and warm running water after using the toilet and changing diapers and before preparing or eating food. Staff should closely monitor or assist all children, as appropriate, with handwashing after children have used the bathroom or been diapered.
Restrict students from sharing any communal food items that are brought from home. In the classroom, children should not serve themselves food items that are not individually wrapped. The teacher should hand out these items after washing his/her hands. (This is not intended to discourage family- style serving in the absence of an outbreak).
Clean and disinfect diapering area and potty chairs after each use and bathroom toilets, sinks, and toys when soiled and at least daily.
Clean and sanitize mouthed objects and surfaces at least daily and when soiled.
If there is a case of hepatitis A in a child care or school, consult with the local or state health department. They will determine who has been exposed and make recommendations.

Hepatitis A Parent Fact Sheet

Your child may have been exposed to:

Hepatitis A
Hepatitis A is a viral infection of the liver.

If you think your child has Croup:

Tell your child care provider or call the school.
Need to stay home?
- Child Care and School:
  Consult with your local or state health department. Each situation must be looked at individually to decide if the person with hepatitis A can spread the virus to others.

Symptoms

Your child may suddenly have a fever and may be tired and not want to eat.

A few days later, your child may have urine that is as dark as tea or cola. Feces may be white or gray-colored. Your child may appear jaundiced (yellowing of eyes or skin).

If your child is infected, it may take 15 to 50 days for symptoms to start. It usually takes 28 days.

Spread

By eating or drinking contaminated food or water.
By touching contaminated hands, surfaces, or objects.

Contagious Period

From 2 weeks before to 2 weeks after symptoms start.

Call your Healthcare Provider

If someone in your home:

has symptoms of hepatitis A. Blood tests can be done. No specific treatment is given.
has been exposed to hepatitis A.

Prevention

Wash hands after using the toilet and changing diapers and before preparing food or eating. Your child may need help with handwashing.
Clean and disinfect anything contaminated with feces. This includes toilets (potty chairs), sinks, toys, and diaper changing areas. Use a product that kills viruses.
Ask your healthcare provider about hepatitis A vaccine. Hepatitis A vaccine is recommended for all children 12 to 23 months of age and should be considered for groups at increased risk of hepatitis A.

Hepatitis B

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Reportable to local or state health department

This fact sheet is for provider information only.
If you have questions, please call the health department.

It is rare for children to be infected with hepatitis B with the exception of those children infected by their mothers during pregnancy or childbirth. These children may have a lifelong infection (chronic infection). Children who have chronic hepatitis B infection may be attending child care or school; however, spread of hepatitis B in these settings is very rare.

Cause

Hepatitis B virus.

Symptoms

Loss of appetite, tiredness, stomach pain, nausea, vomiting, dark (tea or cola-colored) urine, light-colored feces, and sometime rash or joint pain. Jaundice (yellowing of eyes or skin) may be present in adults but it is uncommon in young children. Symptoms vary greatly from none at all to severe illness. Adults have symptoms more often than children.

Spread

Virus is present in the blood and other body fluids that may contain blood. It can be spread person-to-person when blood from an infected person enters an open cut or splashes into the eye or mouth of another person, by sharing any equipment to inject drugs or puncture the skin, such as tattooing or body piercing, or through sexual contact. Although virus can be found in saliva, the amount of virus in the saliva is so low that spread is very unlikely. It can also be spread from a mother to her baby during pregnancy or childbirth.

Incubation

It takes from 45 to 160 days, with an average of 90 days, from the time a person is exposed to hepatitis B virus until disease occurs.

Contagious Period

May be infectious for many weeks before onset of symptoms and remain infectious for 4 to 6 months. Some people may have chronic hepatitis B infection and may be infectious for life.

Exclusion

None, unless the child has unusually aggressive behavior (e.g., biting) that cannot be controlled, oozing sores that cannot be covered, or bleeding problems. The child’s health professional and the child care program director or school principal should assess on a case-by-case basis to determine whether exclusion from some activities is necessary. Children with hepatitis B infection should not be excluded from school, child care, or other group care settings solely based on their hepatitis B infection.

Diagnosis

Hepatitis B can be diagnosed through blood tests.

Treatment

Recommend parents/guardians call their healthcare provider.

Prevention/Control

All children should receive the three dose hepatitis B vaccine series as part of their routine immunizations.
- Child care providers/school staff should discuss the need for hepatitis B vaccine with their healthcare provider.
- Hepatitis B vaccine is recommended for unvaccinated adolescents and adults who are at risk for exposure to blood borne pathogens in their work or personal life.
Persons exposed to blood or bloody body fluids from an infected person should contact their healthcare provider or the local or state health department immediately regarding the possible need for hepatitis B immune globulin (HBIG) and hepatitis B vaccine.
Cleaning and disinfecting of blood and body fluid spills: (See Cleaning, Sanitizing, and Disinfection)
- Surfaces and objects contaminated with blood or bloody body fluids must be cleaned with soap or detergent and water and then disinfected immediately. Hepatitis B virus, as well as other infectious bacteria, may be found in the blood and other bloody body fluids of any person, even when there are no symptoms to suggest infection is present.
- Wear disposable medical gloves when handling blood (nosebleeds, cuts) or items, surfaces, or clothing soiled by blood or bloody body fluids, or when there are open sores, cuts, or abrasions on the hands.
- Regular and thorough handwashing is the best way to prevent the spread of communicable diseases. Wash hands immediately after contact with any body fluids, even if gloves have been worn. Wash hands thoroughly with soap and warm running water.
DO NOT allow sharing of toothbrushes, nail clippers, or razors.
Encourage students and staff to do self-care when age appropriate.

For more information, call the Missouri Department of Health and Senior Services (MDHSS) at Bureau of HIV, STD, and Hepatitis at 573-751-6439.

Hepatitis C

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Reportable to local or state health department

This fact sheet is for provider information only.
If you have questions, please call the health department.

It is rare for children to be infected with hepatitis C, the exception may be those children infected by their mothers during childbirth and children who received blood products before July 1992. Most persons infected with hepatitis C develop lifelong infection (chronic infection). While children infected with hepatitis C may be attending child care or schools, spread of hepatitis C in these settings has not been documented.

Cause

Hepatitis C virus.

Symptoms

Young children infected with hepatitis C would most likely not have symptoms. Only 20% of adults have symptoms when first infected. These symptoms may include fatigue, abdominal pain, and jaundice (yellowing of eyes or skin). Adults may not have symptoms until after 10 to 30 years of chronic (lifelong) infection.

Spread

Virus is present in the blood and other body fluids that may contain blood. It can be spread person to person when blood from an infected person enters an open cut of another person or by sharing equipment to inject drugs or puncture the skin, such as tattooing or body piercing. Sexual transmission can occur but is less likely.

Hepatitis C is not spread by kissing or casual contact. Spread among household contacts is uncommon. The risk of spread from an infected mother to a newborn is low.

Incubation

It takes from 2 weeks to 6 months, usually about 6 to 7 weeks, from the time a person is exposed to hepatitis C virus until disease occurs.

Contagious Period

As long as the person has hepatitis C virus present in the blood. About 80% of persons who get hepatitis C will have lifelong (chronic) infection.

Exclusion

None, unless the child has unusually aggressive behavior (e.g., biting) that cannot be controlled, oozing sores that cannot be covered, or bleeding problems. The child’s health professional and the child care program director or school principal should assess on a case-by-case basis to determine whether exclusion from some activities is necessary. Children with hepatitis C infection should not be excluded from school, child care, or other group care settings solely based on their hepatitis C infection.

Diagnosis

Hepatitis C can be diagnosed through blood tests.

Persons exposed to blood or bloody body fluids from an infected person should call their healthcare provider immediately regarding blood testing.

Treatment

There is no vaccine to protect against hepatitis C. People infected with hepatitis C should be vaccinated against hepatitis A, and all children should be vaccinated against hepatitis B.

Prevention/Control

Cleaning and disinfecting of blood and body fluid spills: (See Cleaning, Sanitizing, and Disinfection)
- Surfaces and objects contaminated with blood or bloody body fluids must be cleaned with soap or detergent and water and then disinfected immediately. Hepatitis C virus, as well as other infectious bacteria, may be found in blood and other bloody body fluids of any person, even when there are no symptoms to suggest infection is present.
- Wear disposable medical gloves when handling blood (nosebleeds, cuts) or items, surfaces, or clothing soiled by blood or bloody body fluids, or when there are open sores, cuts, or abrasions on the hands.
- Regular and thorough handwashing is the best way to prevent the spread of communicable diseases. Wash hands immediately after contact with any body fluids, even if gloves have been worn. Wash hands thoroughly with soap and warm running water.
DO NOT allow sharing of toothbrushes, nail clippers, or razors.
Encourage students and staff to do self-care when appropriate.

For more information, call the Missouri Department of Health and Senior Services (MDHSS) Bureau of HIV, STD, and Hepatitis at 573-751-6439.

Herpes Gladiatorum

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

(Herpes on Skin)

Cause

Herpes simplex virus type 1 (HSV-1).

Symptoms

The most obvious symptom is a cluster of blisters (fluid-filled bumps) on exposed areas of the body (typically the head, neck and shoulders). Fever, sore throat, swollen lymph nodes, or burning or tingling of the skin may be present in the 24 hours before the blisters appear. Blisters will eventually scab and crust. Herpes gladiatorum infections can recur throughout life.

Spread

Extremely contagious by skin-to-skin contact during athletic competition involving close physical contact and frequent skin abrasions (e.g., wrestling, rugby).
Abrasions and other skin conditions increase the chance of getting the infection. Saliva of persons may also contain the virus and even people without symptoms can spread it to others. Surfaces and/or objects like mats, floors, locker room surfaces, equipment, and clothing are not likely causes of infection.

Incubation

It takes from 2 to 14 days, usually 8 days, from the time a person is exposed for the first time until symptoms develop.

Contagious Period

Most often while blisters and sores are present and unhealed. However, people without symptoms may also be contagious.

Exclusion

Contact Sports: Exclude from practice and competition until all sores are dry and scabbed. Treatment with oral medication may shorten exclusion time. Follow the athlete’s healthcare provider’s recommendations and specific sports league rules for when the athlete can return to practice and competition.

Treatment

Recommend parents call their healthcare provider. Antiviral medications can shorten the duration of infection. They are not effective after blisters have opened.

Prevention/Control

Coaches and trainers

Examine athletes for undiagnosed rashes, blisters, or sores on exposed areas of the body and around the eyes or mouth before practice or competition.
Check the specific sports league rules for when athlete can return to practice and competition.
Instruct athletes to report blisters and/or sores.
Instruct athletes to report any burning or tingling if it occurs at the prior site of infection.

Coaches and Trainers ensure athletes follow these hygiene measures

Showering
- Shower at school after practice or competition, using liquid soap and water.
- Have their own plastic bottle of liquid soap.
- Have their own towel. DO NOT allow anyone to share towels.
- Wash their towels after each use, using hot water with detergent (and bleach if possible); and dry on high heat setting.
General hygiene
- Clean their hands often! Scrub up for at least 15 seconds using soap and warm water. Use an alcohol-based hand rub if their hands are not visibly soiled.
- Encourage them to avoid touching their eyes, nose, or mouth.
- Have them clean their hands before and after practice and competitions.
- DO NOT let them pick or squeeze skin sores as the drainage is very infectious.
Equipment and clothing
- Change their practice and competition clothing every day.
- Clean their equipment daily according to manufacturer’s directions.
School - Have written procedures for cleaning and disinfecting* the environment.
- Wash mats after every practice or competition.
- Clean and disinfect locker rooms and shower areas daily.
- Launder mop heads and cleaning cloths daily using laundry detergent in hot water and dry on high heat setting.

* Always use an EPA-approved disinfectant* (viricidal, fungicidal, bactericidal) according to manufacturer recommendations OR bleach solution (800 ppm = ¼ cup bleach into 1 gallon of water). Mix daily.

Herpes Gladiatorum Parent Fact Sheet

Your child may have been exposed to:

Herpes Gladiatorum
Herpes gladiatorum is a viral skin infection that occurs frequently among wrestlers. It is not a sexually transmitted disease.

If you think your child has Herpes Gladiatorum:

Tell the coaches and school health staff.

No Contact Sports:
Until all sores are dry and scabbed. Follow your healthcare provider recommendations and the specific sports league rules about when to return to practice and competition.

Symptoms

A single blister or a cluster of blisters (fluid-filled bumps) may be the only symptom. The bumps are usually on exposed areas of the head, neck, and shoulders.
Sometimes, fever, sore throat, swollen lymph nodes or burning or tingling of the skin may be present before the blisters appear. Blisters will eventually scab and crust.

If your child is infected, it may take 2 to 14 days for symptoms to start.

Spread

By skin to skin contact or touching saliva. Usually spreads during sports with close physical contact or during sports that tend to cause skin abrasions.

Contagious Period

Until all sores are dry and scabbed. Herpes gladiatorum infections can recur throughout life.

Call your Healthcare Provider

If anyone in your home has symptoms. Your doctor will decide what treatment is needed.

Prevention

Inform parents/guardians and coaching staff:

If you have blisters and/or sores.
If you have had this infection before and develop burning or tingling at the site where the infection was before.

General Hygiene

DO NOT pick or squeeze skin sores; drainage is very infectious.
Avoid touching your eyes, nose, or mouth with your hands.
Clean your hands with warm water and liquid soap before and after practice and competitions.
Shower at school after practice or competition. Use your own plastic bottle of liquid soap. Wash your towel after each use, using hot water with detergent (and bleach if possible); and dry on high heat setting.
Change clothes and clean equipment daily. Clean equipment with the same soap you use for showering.

Herpes, Oral

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Commonly, these infections are acquired for the first time in early childhood and may reappear throughout a person's lifetime (recurrent infection).

Cause

Herpes simplex virus type 1 (HSV-1).

Symptoms

Primary infection causes blister-like sores inside the mouth (gingivostomatitis) and on the gums. Fever and irritability may also occur. Recurrent infections (cold sores, fever blisters) appear on lips and face. Some children may have the virus in their bodies, but do not develop symptoms. Herpes simplex virus can also cause infections of the eyes, fingers, and central nervous system.

Spread

By close person-to-person contact, such as through direct contact through kissing and contact with open sores, contact with saliva (e.g., from mouthed toys) or touching the fluid from the blisters or sores.

Incubation

It takes 2 to 14 days from the time a person is exposed for the first time until symptoms occur.

Contagious Period

First occurrence (primary infection): up to 2 weeks, occasionally up to 7 weeks. Recurrent infection: usually 3 to 5 days.

Exclusion

Child Care: Primary infection - until those children who do not have control of their oral secretions no longer have active sores inside the mouth.
Recurrent infections (fever blisters and cold sores) - None.

School: None.

Treatment

A topical medication may be prescribed.

Prevention/Control

Encourage children not to touch the sores.
Regular and thorough handwashing is the best way to prevent the spread of communicable diseases. Wash hands thoroughly with soap and warm running water after having contact with the sores or saliva.
Wear disposable medical gloves when touching the sores is necessary (e.g., when applying medication).
DO NOT kiss an infected person on or near the mouth when sores are present.
Clean and sanitize mouthed objects, and surfaces at least daily and when soiled.

Herpes (Cold Sores) Parent Fact Sheet

Your child may have been exposed to:

Herpes (Cold Sores)
Herpes simplex is a viral infection that may cause sores in the mouth or on the lips and face. The sores are commonly called cold sores.

If you think your child has Cold Sores:

Tell your child care provider or call the school.
Need to stay home?
- Child Care:
  
  First infection: Yes, if children that drool have active sores.
  They can return when the sores in the mouth have healed.
  
  Recurring infections: No.
- School: No.

Symptoms

The first time a child is infected, there may be blister-like sores inside the mouth and on the gums. A child may have a fever and be fussy. The cold sores and fever blisters may occur many times in a person’s life.

If your child is infected for the first time, it may take 2 to 14 days for symptoms to start.

Spread

By having direct contact with saliva, commonly by kissing.
By touching the fluid from the blisters or sores.

Contagious Period

First infection: up to 2 weeks, sometimes longer. Recurring infection: usually 3 to 5 days.

Call your Healthcare Provider

If anyone in your home has symptoms of oral herpes infection.

Prevention

Remind children not to touch the sores.
Wash hands after touching anything that could be contaminated with secretions from the mouth or the sores. Your child may need help with handwashing.
Clean and disinfect objects that come in contact with the sores or secretions from the mouth. Use a product that kills viruses.
DO NOT kiss a person with sores on or near the mouth.
Use a cotton-tipped swab to apply medication.

Human Immunodeficiency Virus (HIV) Infection/AIDS

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Reportable to local or state health department

This fact sheet is for provider information only.
If you have questions, please call the health department.

The spread of HIV, the virus that causes Acquired Immunodeficiency Syndrome (AIDS), has not been documented in the child care setting or schools. Since children infected with this virus may be in child care or school, this information is provided to further reduce the extremely unlikely possibility of spread.

Cause

Human immunodeficiency virus (HIV).

Symptoms

HIV commonly attacks the immune system, leaving people susceptible to a variety of infections. Symptoms will depend on the type of infection. Children may experience no symptoms, or they may have symptoms such as diarrhea, fever, weight loss, or failure to thrive.

Spread

It may be possible, but unlikely, in the child care or school setting, for spread to occur by getting blood from an infected person into open cuts, scrapes, or the mouth or eyes of another person. Most children who are infected get the virus from their infected mothers during pregnancy or at the time of birth. Some children have been infected through transfusions of blood products that contained HIV. In adults, the virus is most often spread through sexual contact or by sharing needles.

HIV has been found in blood, semen, vaginal fluids, saliva, urine, tears, breast milk, and other body fluids, but spread has not been shown to occur from contact with fluids other than blood, semen, vaginal fluids, and breast milk.

HIV is not spread by coughing, sneezing, hugging, mosquito bites, or contact with eating utensils, faucets, doorknobs, or toilet seats.

Diagnosis

Recommend parents/guardians call their healthcare provider. HIV infection is diagnosed by a blood test.

Most HIV tests are antibody tests that measure the antibodies the body makes against HIV. It can take some time for the immune system to produce enough antibodies for the antibody test to detect, and this time period can vary from person to person. Most people will develop detectable antibodies within 2 to 8 weeks (the average is 25 days). Ninety-seven percent of persons will develop antibodies in the first 3 months following the time of their infection. In very rare cases, it can take up to 6 months to develop antibodies to HIV.

Contagious Period

Probably from the time of infection throughout the remainder of the person's life.

Exclusion

None, unless the child has unusually aggressive behavior (e.g., biting) that cannot be controlled, oozing sores that cannot be covered, or bleeding problems. The child’s health professional and the child care program director or school principal should assess on a case-by-case basis to determine whether exclusion from some activities is necessary. Children with HIV infection should not be excluded from school, child care or other group care settings solely based on their HIV infection.

Children who are infected with HIV may have weakened immune systems. This would make them more likely to have serious problems from infections such as chickenpox, measles, CMV, or TB. Parents/guardians of infected children should call their healthcare provider if these illnesses occur in the child care or school.
Adults infected with HIV may work in the child care setting if they do not have any medical conditions which would allow their body fluids to come into contact with others. HIV-infected child care workers should call their healthcare provider if diseases like chickenpox, measles, CMV, or TB occur.

Prevention/Control

There is no indication for routine screening of children for HIV antibody status before they enter child care. CDC recommends that everyone ages 13 thru 64 should be screened annually for HIV.
Children and staff should not share toothbrushes or nail clippers.
Clean and disinfect blood and body fluid spills:
- Clean all surfaces and objects contaminated with blood or body fluids with soap or a detergent and water, and then disinfect immediately with an effective disinfectant. HIV, as well as other infectious bacteria, may be found in blood and other body fluids of any person even when there are no symptoms to suggest infection is present.
- Wear disposable medical gloves when handling blood (nosebleeds, cuts) or items, surfaces, or clothing contaminated with blood or bloody body fluids or when there are open sores, cuts, or abrasions on the hands.
- Regular and thorough handwashing is the best way to prevent the spread of communicable diseases. Wash hands immediately after contact with any body fluids, even if gloves have been worn. Wash hands thoroughly with soap and warm running water.

For more information, call the Missouri Department of Health and Senior Services (MDHSS) Bureau of HIV, STD, and Hepatitis at 573-751-6439.

Impetigo

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Impetigo is a contagious skin infection often occurring on the nose, arms, or legs or around the mouth. This infection is common in young children.

Cause

Streptococcus and/or Staphylococcus bacteria, including Methicillin-resistant Staphylococcus aureus (MRSA).

Symptoms

Typically begins at a break in the skin (e.g., insect bite, cut). Sores form on the skin and produce a thick golden-yellow discharge that dries, crusts, and sticks to the skin.

Rarely, problems such as kidney disease or cellulitis (skin infection) may develop if children do not receive proper treatment.

Spread

From person-to-person through touching the fluid from the sores. Rarely, through touching contaminated objects.

Incubation

It usually takes 1 to 10 days from the time a person is exposed until symptoms begin. Symptoms usually begin 1 to 3 days after exposure to Streptococcus, and usually 4 to 10 days after exposure to Staphylococcus.

Contagious Period

Until sores are healed or the person has been treated with antibiotics for 24 hours.

Exclusion

Child Care and School: If impetigo is confirmed by a healthcare provider, until 24 hours after treatment has been initiated. Lesions on exposed skin should be covered with watertight dressing.

Diagnosis

Recommend parents/guardians call their healthcare provider if their child has impetigo.

Treatment

Impetigo can be treated with topical antibiotics (applied directly to the skin) when only a few sores are present. Oral or injectable antibiotics may also be prescribed.

Prevention/Control

Regular and thorough handwashing is the best way to prevent the spread of communicable diseases. Wash hands thoroughly with soap and warm running water after contact with sores.
Wear disposable medical gloves if applying ointment to sores or use cotton- tipped swabs.
Cover sores whenever possible to prevent spread. Discourage children from scratching infected areas.
DO NOT share towels, washcloths, or clothing.
Clean and sanitize mouthed objects, and surfaces at least daily and when soiled.

Impetigo Parent Fact Sheet

Your child may have been exposed to:

Impetigo
Impetigo is a bacterial skin infection. It usually occurs on the nose, arms, or legs or around the mouth.

If you think your child has Impetigo:

Tell your child care provider or call the school.
Need to stay home?
- Child Care and School:
  Yes, if impetigo is confirmed by your healthcare provider, until 24 hours of treatment has been completed.
  Lesions on exposed skin should be covered with watertight dressing and the sores are drying.

Symptoms

Your child may have sores on the skin. The sores can produce a thick golden-yellow discharge that dries, crusts, and sticks to the skin. It usually begins at a break in the skin. It could start near a cut or insect bite.

If your child is infected, it may take 1 to 10 days for symptoms to start.

Spread

By touching the fluid from the sores.

Contagious Period

Until sores are healed or the person has been treated for at least 24 hours.

Call your Healthcare Provider

If anyone in your home has symptoms of impetigo. Your doctor may prescribe a medication.

Prevention

Wash hands after touching anything that could be contaminated with fluid from the sores. Your child may need help with handwashing.
Clean and disinfect objects that come in contact with fluid from the sores. Use a product that kills bacteria.
DO NOT share towels, washcloths, or clothing.
Keep sores covered with a bandage. Remind children not to scratch the sores.

Influenza

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Reportable to local or state health department

Influenza (also known as flu) is a very common respiratory disease. Influenza is not what is commonly referred to as “the stomach flu,” which is a term used by some to describe illnesses causing vomiting or diarrhea. Every year, millions of people in the United States get influenza. Influenza often results in more severe illness than other respiratory viruses.

Cause

Influenza virus. The two main types of influenza viruses are type A and type B. Within each type there are many related strains or subtypes, which can change every year. This is the reason a person can get influenza more than once and why a person should get vaccinated every year. Influenza usually occurs in the United States between October and May.

Symptoms

Influenza starts quickly with fever, chills, body aches, headache, cough, runny or stuffy nose, and sore throat. Illness usually lasts 3 to 7 days. Children may develop ear infections, pneumonia, or croup as a result of influenza infection.

Serious complications of influenza occur most often in the elderly, young infants, or people with chronic health problems or weakened immune systems.

Spread

Influenza is spread mainly person to person through droplets created with coughing and sneezing by persons infected with the virus. Infection occurs when a person has contact with droplets in the air or touches contaminated surfaces then touches their eyes, mouth or nose.

Incubation

It takes from 1 to 4 days, usually 2 days, from the time of infection until symptoms begin.

Contagious Period

Most contagious during the 24 hours before the symptoms begin (very young children may be contagious even earlier). After the symptoms start, children can be contagious up to 7 days and adults are generally contagious for 5 days.

Exclusion

Child Care and School: Those with flu-like illness should stay home for at least 24 hours after they no longer have a fever, or signs of a fever, without the use of fever- reducing medicines. They should stay home even if they are using antiviral drugs.

Decisions about extending the exclusion period could be made at the community level, in conjunction with local and state health officials. More stringent guidelines and longer periods of exclusion – for example, until complete resolution of all symptoms – may be considered for people returning to a setting where high numbers of high-risk people may be exposed, such as a camp for children with asthma or a child care facility for children younger than 5 years old.

Diagnosis

Recommend parents/guardians call their healthcare provider if their child has a high fever and/or persistent cough. Viral cultures may be taken.

Treatment

Antiviral medications (antivirals) can shorten the course of illness if given within 36 to 48 hours after the symptoms begin. Influenza is a viral illness; therefore, antibiotics will not be effective.

Do not give aspirin or salicylate-containing medications to any child or adolescent under 18 years of age.

Acetaminophen (Tylenol) may be used to reduce fever and body aches.

Prevention/Control

Annual influenza vaccinations are recommended for everyone 6 months of age and older.
Those at highest risk for influenza include:
- People with certain medical conditions like asthma, diabetes, and chronic lung disease.
- Pregnant women.
- People 65 years and older.
In addition, flu vaccine can be given to anyone else who wishes to reduce the likelihood of becoming ill with influenza. The vaccine is usually given in the late fall. People who were not vaccinated in the fall may be vaccinated any time during the influenza season. For current recommendations check the MDHSS website. [NEEDS LINK]
Cover nose and mouth with a tissue when coughing or sneezing, or cough/sneeze into your sleeve. Dispose of used tissues.
Regular and thorough handwashing is the best way to prevent the spread of communicable diseases. Wash hands thoroughly with soap and warm running water after contact with secretions from the nose or mouth or handling used tissues.
Try to avoid close contact with sick people.
While sick, limit contact with others as much as possible to keep from infecting them.
Take flu antiviral drugs if your doctor recommends them.
Clean and disinfect commonly touched surfaces (door knobs, refrigerator handle, water faucets, cupboard handles, and computer keyboards) at least daily. (See Cleaning, Sanitizing, and Disinfection)
Clean and sanitize mouthed objects and surfaces at least daily and when soiled. (See Cleaning, Sanitizing, and Disinfection)
DO NOT allow sharing of anything that goes into the mouth such as drinking cups, straws, water bottles, and eating utensils.
Stay home if you are ill. Encourage parents/guardians to keep ill children at home.

During Pandemic Influenza Additional Recommendations

A flu (influenza) pandemic is an outbreak caused by a new human flu virus that spreads around the world. Because the pandemic flu virus will be new to people, many people could get very sick or could die. Seasonal flu shots do not protect people from pandemic flu.
Antiviral medication may be used for the prevention or treatment of influenza. During a pandemic the Department of Health and Senior Services has a limited supply of medication that will be used according to Missouri’s Influenza Plan.
Child care programs should work closely and directly with their local and state public health officials to make appropriate decisions and implement strategies in a coordinated manner.
Child care providers should conduct daily health checks on all children.
Ill children should stay home and not be taken out of one child care program and put into another child care program even temporarily.
Child care programs can help serve as a focus for educational activities aimed at promoting ways to reduce the spread of influenza, including hand hygiene and cough etiquette. See Influenza | Health & Senior Services (mo.gov) [NEEDS LINK]
The Missouri State Public Health Laboratory performs testing for public health surveillance and for epidemiological purposes. For questions related to testing of clinical specimens or other questions related to pandemic influenza, contact the Department of Health and Senior Services at (800) 392-0272 (24/7) or 573-751-6113 (8-5 Monday thru Friday).

For more information on influenza and pandemic flu planning see the following:

http://www.pandemicflu.gov/

Order materials from the following:

http://health.mo.gov/emergencies/readyin3/mainreadyform.php [NEEDS LINK]

Influenza (Flu) Parent Fact Sheet

Your child may have been exposed to:

Influenza (Flu)
Influenza (also known as flu) is a common viral respiratory infection.
Influenza is not “stomach flu”, a term used by some to describe illnesses causing vomiting or diarrhea.

If you think your child has the Flu:

Tell your child care provider or call the school.
Need to stay home?
- Child Care and School:
  Yes, until fever is gone for at least 24 hours (without the use of a fever reducing medicine) and the child is healthy enough for routine activities.

DO NOT give aspirin or salicylate-containing medicines to anyone under 18 years of age.

Symptoms

Your child may have chills, body aches, fever, and headache. Your child may also have a cough, runny or stuffy nose, and sore throat.

Illness may last up to 7 days.

If your child has been infected, it may take 1 to 4 days (usually 2 days) for symptoms to start.

Spread

By coughing and sneezing.
By touching contaminated hands, objects or surfaces.

Contagious Period

During the 24 hours before and up to 7 days after the illness begins.

Call your Healthcare Provider

If anyone in your home has a high fever and/or coughs a lot. Your doctor may give medications.

Antibiotics do not work for illnesses caused by a virus, including influenza.

Prevention

Cover nose and mouth when sneezing or coughing. Use a tissue or your sleeve. Dispose of used tissues.
Wash hands after touching anything that could be contaminated with secretions from the nose or mouth. Your child may need help with handwashing.
DO NOT share anything that goes into the mouth, such as drinking cups, straws, and water bottles.
Clean and disinfect anything that comes in contact with secretions from the nose or mouth. This includes door knobs, refrigerator handle, water faucets, and cupboard handles. Use a product that kills viruses.
Annual influenza vaccination is recommended for everyone older than 6 months of age. Ask your health care provider about the flu vaccine.

Measles

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Reportable to local or state health department

Consult the health department before posting/distributing Parent/Guardian fact sheet.

Measles (also called rubeola, red measles, or hard measles) is a highly contagious virus and is a serious illness that can be prevented by vaccination. Currently, measles most often occurs in susceptible persons (those who have never had measles or measles vaccine) who are traveling into and out of the United States. Once measles cases occur, there may be spread to persons or groups of people who have not been vaccinated.

Cause

Measles virus.

Symptoms

The first symptoms seem like the beginning of a cold with a high fever, watery eyes, runny nose, and cough. A red blotchy rash appears 3 to 5 days after the start of symptoms, usually beginning on the face (hairline), spreading down the trunk and down the arms and legs. The fever may still be present after the rash starts.

The rash usually lasts 4 to 7 days. Complications of measles are more common among children younger than 5 years of age and adults 20 years of age and older. These complications can include diarrhea, ear infection, pneumonia, and rarely encephalitis (inflammation of the brain). About 1 child out of every 1,000 who get measles will develop encephalitis (swelling of the brain) that can lead to convulsions and can leave the child deaf or with developmental delay.

Spread

Measles virus is spread when an infected person coughs, sneezes, or breathes out tiny droplets with measles virus into the air and another susceptible person breathes them in. The virus can sometimes float in the air and infect others for approximately two hours after a person with measles leaves a room. Measles is also spread to susceptible persons by touching contaminated objects and then touching one’s eyes, nose, or mouth.

Incubation

It takes from 10 to 12 days from the time a person is exposed until cold-like symptoms begin. The time from exposure to when the rash starts is usually 14 days, but may be up to 21 days.

Contagious Period

From 4 days before to 4 days after the rash appears.

Exclusion

Child Care and School: Until 4 days after the rash appears. A child with measles should not attend any activities during this time period.

Exclude unvaccinated children and staff, who are not vaccinated within 72 hours of exposure or given immune globulin (IG) within 6 days of exposure. Susceptible children and staff who do not receive the above prophylaxis may be excluded for 21 days after the onset of rash in the last person who developed measles. Recommendations for exclusion should be done in collaboration with your local/state public health department.

Diagnosis

A rash may occur with many viral illnesses. If measles is suspected, a blood test for measles antibody should be done 3 to 5 days after rash begins.

Persons who have been exposed to measles should contact their healthcare provider if they develop cold-like symptoms with a fever and/or rash. They should NOT go to any healthcare facility without calling first. The child will be kept separate from others to prevent further spread.

Treatment

Recommend parents/guardians call their healthcare provider. There is no specific treatment for measles

Prevention/Control

Measles vaccine is usually combined with mumps and rubella vaccine (MMR) and given at 12 to 15 months of age. A second MMR vaccine is recommended at 4 to 6 years of age, but may be given as soon as four weeks after the first dose. Two doses or a legal exemption are required for kindergarten and seventh grade enrollment.
Unvaccinated people who have been exposed to measles should call their healthcare provider or local public health clinic as soon as possible to be vaccinated. Vaccination is contraindicated during pregnancy.
- If measles vaccine is given within 72 hours of exposure, it may provide some protection. Encourage parents/guardians to notify the child care provider or school when their child is vaccinated so their records can be updated.
- Immune globulin (IG) if given within 6 days of exposure can prevent or make the symptoms of measles milder. This should be strongly considered for contacts younger than one year of age, pregnant women who have never had measles or measles vaccine, or persons with a weakened immune system.
Recommend staff stay home if they develop symptoms of measles. Encourage parents/guardians keep their child home if they develop symptoms of measles.
Teach children and staff not to touch their eyes, nose, or mouth.
Cover your nose and mouth with a tissue when coughing or sneezing, or cough/sneeze into your sleeve. Dispose of used tissues.
Clean and sanitize mouthed objects and surfaces at least daily and when soiled.
Wash hands thoroughly with soap and warm running water after touching secretions from the nose or mouth. If soap and water are not available, use an alcohol-based hand sanitizer.

For more information, call the Missouri Department of Health and Senior Services (MDHSS) Bureau of Communicable Disease Control and Prevention at 573- 751-6113 or 800-392-0272 (24/7), or call your local health department.

Measles Parent Fact Sheet

Your child may have been exposed to:

Measles
Measles is a serious viral illness that may be prevented by vaccination.

If you think your child has Measles:

Tell your child care provider.
Need to stay home?
- Child Care and School:
  Yes, until 4 days after the rash begins.
  A child with measles should not attend any activities during this time period.

If a case of measles occurs in your child care or school, consult with public health to determine how long unvaccinated children and staff need to stay home.

Symptoms

Your child may have a high fever, watery eyes, a runny nose, and a cough.

A rash appears on the third to seventh day of illness. The rash may appear red and blotchy. It usually begins on the face (in the hairline) and then spreads down the body, arms and legs. The rash may eventually cover the entire body. Rash may last for 7 days. If your child has been infected, it may take 7 to 21 days for symptoms to start.

Spread

By coughing and sneezing.
By touching contaminated objects or surfaces.

Contagious Period

From 4 days before to 4 days after the rash starts.

Call your Healthcare Provider

If anyone in your home:

was exposed to measles and has not had measles or measles vaccine in the past.
develops cold-like symptoms with a fever and/or a rash. Keep them at home. DO NOT go to a healthcare facility without calling first. Your child will be kept separate from others to prevent further spread. A blood test may be done.

Prevention

All children by the age of 15 months must be vaccinated against measles or have an exemption for child care enrollment. An additional dose or an exemption is required for kindergarten or two doses by seventh-grade enrollment. Potentially exposed, susceptible contacts should be excluded from the school or child care facility. Consult with public health on the duration of exclusion.
People receiving their second dose, as well as unimmunized people receiving their first dose before or within 72 hours of exposure, generally may return to the school or child care facility.
Parents should keep infants away from individuals with a cough illness.
People who have close contact with infants should be up-to-date on their immunizations.
Cover nose and mouth when coughing and sneezing. Use a tissue or your sleeve. Dispose of used tissues.
Wash hands after touching anything that could be contaminated with secretions from the nose or mouth. Your child may need help with handwashing.
Clean and disinfect anything that comes in contact with secretions from the nose or mouth. Use a product that kills viruses.

Meningococcal Disease

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Reportable to local or state health department

Consult the health department before posting/distributing Parent/Guardian fact sheet.

This disease most often affects children and young adults. Meningococcal disease is a medical emergency that requires prompt treatment. Vaccination may help prevent some cases of this illness.

Cause

Neisseria meningitidis bacteria.

Symptoms

Bacteremia - sudden onset of fever, chills, and tiredness; sometimes a rash.
Meningitis - fever, vomiting, headache, stiff neck, extreme sleepiness, confusion, irritability, and lack of appetite; sometimes a rash or seizures.

Spread

Through direct contact with secretions from the nose and throat of an infected or colonized person (e.g., through kissing; sharing food, beverages, toothbrushes, or cigarettes). Spread is more common among people with close personal contact or in households, child care settings, or schools where there is close prolonged physical contact.

Incubation

It takes 1 to 10 days, but usually 3 to 4 days, from the time a person is exposed to the bacteria until symptoms begin.

Contagious Period

Until 24 hours after antibiotic treatment begins.

Exclusion

Child Care and School: Consult with your local or state health department. Each situation must be looked at individually to determine appropriate control measures to implement. Most children may return after the child has been on appropriate antibiotics for at least 24 hours and is well enough to participate in routine activities.

The child care provider or school may choose to exclude exposed staff and attendees until preventive treatment has been started, or if there is concern that they will not follow through with recommended preventive treatment.

Diagnosis

Laboratory tests can be done to detect N. meningitides when disease is suspected.

Treatment

Meningococcal disease is caused by bacteria and can be treated with antibiotics.
Exposed persons should contact a healthcare provider at the first signs of meningococcal disease.

Prevention/Control

Public health will make recommendations to the child care, school, and other contacts. Antibiotics and/or vaccine may be recommended.
Antibiotics to prevent meningitis are recommended for:
- Household contacts.
- Overnight visitors to the household.
- Persons who had contact with the secretions from the mouth or throat through:
  - kissing.
  - sharing food (eating from the same utensils, plate, etc.).
  - sharing beverages (drinking from the same cup, can, glass, or straw).
  - sharing cigarettes, cigars, snuff, pipes, etc.
  - sharing lip balm, lipstick, lip gloss, etc.
  - sharing a toothbrush.
The following activities are not considered direct contact with the person with meningitis: sharing a book or pencil, walking down the hall, riding the bus, or sitting or standing next to them.
Persons who have been exposed should remain under medical observation because preventive antibiotics are not always completely effective. If an exposed person develops a fever, call a healthcare provider immediately.
Do not share drink containers and cups or silverware. Wash and sanitize all dishes and silverware after each use. Encourage children to have their own water bottles.
Clean and sanitize mouthed objects and surfaces. Clean and disinfect other items or surfaces that come in contact with secretions from the nose or mouth.
There are two vaccines to prevent Neisseria meningitidis: Meningococcal polysaccharide vaccine (MPSV4) and meningococcal conjugate vaccine (MCV4). The vaccines are highly effective at preventing four of the strains of bacteria that cause meningococcal meningitis. However, the vaccine takes some time to take effect and is not considered a substitute for antibiotics following a high risk exposure.
MPSV4 vaccine is recommended for certain high-risk adults over the age of 55 years.
MCV4 vaccine is routinely recommended for all 11 to 12 year olds and certain high-risk children from the ages of 2 to 12 years. The vaccine is also recommended for 13 to 18 year olds who did not receive it previously and also for unvaccinated college freshman living in dormitories.

Meningococcal Disease Parent Fact Sheet

Your child may have been exposed to:

Meningococcal Disease
Meningococcal disease is a bacterial infection of the covering of the brain or spinal cord (meningitis) or of the blood (bacteremia) that requires prompt treatment.

If you think your child has Meningococcal Disease:

Tell your child care provider.
Need to stay home?
- Child Care and School:
  Yes, until the child has been on antibiotics at least 24 hours. The child should also be healthy enough for routine activities.

Symptoms

Your child may have chills, a headache, fever, and stiff neck. The child may vomit, be extremely sleepy, and be confused and fussy. The child may not be hungry.
Sometimes symptoms include a rash or seizures.

If your child is infected, it may take 1 to 10 days for symptoms to start. It usually takes 3 or 4 days.

Spread

By direct contact with saliva and secretions of the nose and throat. This may happen by kissing, sharing food, beverages, toothbrushes, or silverware.

Contagious Period

Until 24 hours after starting antibiotic treatment.

Call your Healthcare Provider

If anyone in your home:

has symptoms of the illness. Your doctor will decide if a test or treatment is needed.
has been exposed (by direct contact with saliva or is a household contact) to someone with meningococcal disease.

Prevention

The local or state health department will help to determine who has been exposed and will need to take preventive antibiotics.
DO NOT share drink containers, water bottles, straws, silverware, cigarettes, lip balm, toothbrushes, or other things that come in contact with the mouth. Wash all dishes with hot soapy water between uses.
Clean and disinfect objects that come in contact with secretions from the nose or mouth. Use a product that kills bacteria.
Check with your healthcare provider about vaccinations that can protect against some strains of meningococcal disease.

Methicillin-Resistant Staphylococcus aureus (MRSA)

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Staphylococcus aureus (staph) bacteria are commonly found in the nose and on the skin of healthy people. When staph is present on or in the body without causing illness, this is called colonization. Staph with resistance to some antibiotics (e.g., methicillin) is known as methicillin-resistant Staphylococcus aureus (MRSA). When bacteria are resistant to an antibiotic it means that particular antibiotic will not kill the bacteria. MRSA was first identified in healthcare facilities. MRSA is now being seen among young healthy people in the community; this is referred to as community-acquired MRSA.

Cause

Staphylococcus aureus bacteria resistant to some antibiotics.

Symptoms

Most MRSA infections are skin infections that typically cause local redness and warmth of the infected area with or without pus/drainage. These infections commonly occur at sites of visible skin trauma, such as cuts and abrasions, and areas of the body covered by hair (e.g., back of neck, groin, buttock, and armpit).

Localized infections include boils, impetigo, cellulitis, and wound infections. More serious infections, such as pneumonia, bloodstream infections, or bone infections, are very rare in healthy people who get MRSA skin infections.

Spread

By contact with hands, skin drainage, pus, or secretions from the nose of a person who is infected or colonized with MRSA.

Incubation

Variable. A long delay may occur between colonization with staph and the onset of infection.

Contagious Period

As long as infection or colonization lasts. Persons who have draining infections are shedding more bacteria and are more infectious than persons who are colonized only.

Exclusion

Child Care and School: If draining sores are present which cannot be completely covered and contained with a clean, dry bandage or if the person cannot maintain good personal hygiene.

Children who are only colonized do not need to be excluded.

Activities: Children with draining sores should not participate in any activities where skin-to-skin contact is likely to occur until their sores are healed. This means no contact sports.

Treatment

Children with skin infections need to be referred to a licensed health care provider for diagnosis and treatment. Child care/school personnel should notify parents/guardians when possible skin infections are detected.

Prevention/Control

Regular and thorough handwashing is the best way to prevent the spread of communicable diseases. Wash hands thoroughly with soap and warm running water after touching secretions from the nose, tracheostomies, gastrostomies, or skin drainage of an infected or colonized person.
Wear disposable medical gloves when touching any draining sores or changing bandages.
Dispose of bandages in a plastic bag immediately to prevent contamination of surfaces. Close the plastic bag and dispose in the trash.
Keep wounds clean and dry and covered with a bandage.
DO NOT share personal items such as towels, washcloths, bar soap, combs, razors, or clothing.
Wash bedding separately from other laundry in hot water with detergent. Dry in a hot dryer.
Clean and disinfect contaminated surfaces or objects daily or when soiled.
Food handlers with open sores should wear waterproof disposable gloves.

More information about MRSA can be found at the Missouri DHSS website. [NEEDS LINK]

MRSA Parent Fact Sheet

Your child may have been exposed to:

MRSA
Methicillin-resistant Staphylococcus aureus (MRSA) are Staphylococcus aureus (staph) bacteria with resistance to some antibiotics. When bacteria are antibiotic resistant it means that an antibiotic will not kill the bacteria.

If you think your child has MRSA:

Tell your child care provider or call the school.
Need to stay home?
- Child Care and School:
  Yes, if draining sores are present and cannot be completely covered and contained with a clean, dry bandage.
  No, if child is only colonized.
  
  Activities:
  Avoid participating in activities where skin-to- skin contact is likely to occur until sores are healed. This means no contact sports.

Symptoms

An area of skin infection that may be red and warm. There may be pus or drainage. These infections commonly occur where children have cuts and scrapes. Examples include boils, impetigo, cellulitis, and wound infections.

People may be “colonized” with staph bacteria in their nose or on their skin. This means that the bacteria are there without causing any infection or any harm.

If your child is infected, the time it will take for symptoms to start will vary by type of infection.

Spread

By contact with hands, skin drainage, pus, or secretions from the nose.

Contagious Period

As long as the bacteria are present. A child who has draining infections has more bacteria and is more contagious than a child who is only colonized.

Call your Healthcare Provider

If anyone in your home has symptoms. Your doctor will decide what treatment is needed.

Prevention

Wear disposable gloves when changing bandages. Wash hands after touching any draining sores or changing bandages. Your child may need help with handwashing.
Keep wounds clean, dry, and covered with a bandage. Put used bandages in a plastic bag right away. Close the plastic bag and put it in the trash.
If possible, people with staph infections should do their own first aid on cuts/scrapes.
Never share personal items such as washcloths, bar soap, combs, razors, or clothing.
Keep contaminated laundry separate from other laundry. Wash clothes, bed sheets, and blankets in hot water with detergent and dry in a hot dryer.
Clean and disinfect contaminated surfaces and objects with a disinfectant that kills Staphylococcus aureus bacteria.

Molluscum Contagiosum

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Molluscum contagiosum is a common skin infection that is caused by a virus. Most commonly, it affects children 1 to 10 years and young adults.

Cause

A Poxvirus.

Symptoms

Small, pale, shiny, domed-shaped bumps on the skin, often with a characteristic dimple on the top. The bumps may be flesh-colored, white, translucent, or pink. The bumps are usually painless, but, on rare occasions, can be itchy, red, swollen, and/or sore. In children, the bumps occur on the face, body, arms, or legs. It may last longer and cover more of the body in people with eczema (skin disease) or those who have a weakened immune system.

Spread

From direct skin-to-skin contact with an infected person. It can also be spread by contact with contaminated objects such as shared clothes, towels, washcloths, gym or pool equipment, and wrestling mats.

Persons with this skin disease can accidentally spread the virus to other parts of their body. Spread can occur by touching or scratching the bumps and then touching another part of the body (autoinoculation).

Although the virus might be spread by sharing swimming pools, baths, saunas, etc., this has not been proven. Researchers who have investigated this idea think it is more likely that the virus is spread by sharing towels and other items around a pool or sauna than through water.

Incubation

Typically, it takes 2 to 7 weeks from when a person is exposed until symptoms develop. However, it could be up to 6 months.

Contagious Period

People can spread the infection until the soft white core comes out of the center of their bump(s). After that, the bumps will begin to heal and the risk of spreading the infections will be very low. In general, contagiousness is low.

Reinfection is possible but not common.

Exclusion

Child Care and School: None. Encourage parents/guardians to cover bumps with clothing when there is a possibility that others will come in contact with the skin. If not covered by clothing, cover with a bandage.

Activities: Exclude any child with bumps that cannot be covered with a watertight bandage from participating in swimming or other contact sports.

Diagnosis

Recommend parents/guardians call their healthcare provider.

Treatment

Treatment options should be discussed with a healthcare provider.

Prevention/Control

Discourage children from touching, picking, or scratching any skin with bumps or blisters.
Have parents/guardians change bandage daily or when obviously soiled.
Use disposable medical gloves if bandage is changed at the child care or school.
Discard used bandages and gloves in the trash.
Regular and thorough handwashing is the best way to prevent the spread of communicable diseases. Wash hands thoroughly with soap and warm running water after touching the bumps or discarding bandages.
School sports with body contact or shared equipment:
- Require bumps be covered with clothing or a watertight bandage.
- DO NOT allow children to share towels, washcloths, uniforms, clothing, or other personal items.
- DO NOT allow sharing of sports equipment or pool equipment.
Provide individual kick boards and other pool equipment.
Clean and disinfect any surfaces and equipment thoroughly that may have been contaminated.

Information was taken from the CDC information sheet on Molluscum contagiousum.

Molluscum Contagiosum Parent Fact Sheet

Your child may have been exposed to:

Molluscum Contagiosum
Molluscum contagiosum is a common viral skin infection.

If you think your child has Molluscum Contagiosum:

Tell your child care provider.
Need to stay home?
- Child Care and School:
  No. Cover bumps with clothing if skin-to-skin contact will occur.
  Activities:
  Avoid participating in swimming or contact sports if the bumps cannot be covered with clothing or a watertight bandage.

Symptoms

Your child may have bumps on the face, body, arms, or legs. The bumps are small, pale, shiny, and dome- shaped. The bump color may be flesh, white or pink.

There may be a dimple on the top. The bumps are usually painless. Rarely, the bumps are itchy, red, swollen, and/or sore.

If your child is infected, it may take 2 to 7 weeks for symptoms to develop. However, it could be up to 6 months.

Spread

By skin-to-skin contact with an infected person.
By using contaminated towels, washcloths, or equipment.
By touching or scratching your bumps and then touching another part of your body.

Contagious Period

Until the soft, white core comes out of the center of the bumps. After the bumps begin to heal, the risk of spreading the infection will be very low.

Call your Healthcare Provider

If anyone in your home has symptoms. Your doctor will decide if treatment is needed.

Prevention

Avoid touching, picking, or scratching skin with bumps or blisters.
Cover bumps with clothing or a bandage when others will come in contact with the skin. This will help prevent touching or scratching the bumps and help prevent spread.
Change bandages daily or when soiled. Discard used bandages in trash.
Wash hands after touching the bumps or handling bandages.

Contact sports or using shared equipment:

Avoid sharing towels, wash cloths, uniforms, clothing, or other personal items.
Avoid using sports or pool equipment that has not been disinfected.

Mononucleosis

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Mononucleosis (mono) is often seen in high school and college students. About 50% of those infected will develop symptoms of infectious mononucleosis.

Cause

Most of the cases are caused by Epstein-Barr virus (EBV). However, about 5% to 7% of cases are caused by cytomegalovirus (CMV).

Symptoms

Fever, sore throat, swollen glands (especially behind the neck), headache, tiredness, and sometimes a rash. Mono can last up to several weeks. It may take weeks to months to regain energy; however, this will vary from person to person.

Less common problems include jaundice (yellowing of the skin or eyes) and/or enlarged spleen or liver. Although rare, the spleen may rupture in extreme cases.

Spread

From person-to-person through saliva. Spread can occur by kissing or sharing items contaminated with saliva (e.g., drinking cups, straws, bottles, mouthed pens and pencils, lip balm, or toothbrushes). Since this virus does not live long on surfaces and objects, you need to be exposed to fresh saliva to become infected.

Incubation

It takes about 4 to 6 weeks from the time a person is exposed until symptoms begin.

Contagious Period

From many weeks to a year or more. Some adults are carriers of the virus.

Exclusion

Child Care and School: None, as long as the child is able to participate in routine activities. Because students/adults can have the virus without any symptoms and can be contagious for such a long time, exclusion will not prevent spread.

Sports: Contact sports should be avoided until the student is recovered fully and the spleen is no longer palpable.

Diagnosis

A healthcare provider may do blood tests.

Treatment

May include bed rest, drinking plenty of water, restriction on lifting heavy objects or vigorous exercise, including contact sports.

Prevention/Control

Regular and thorough handwashing is the best way to prevent the spread of communicable diseases. Wash hands thoroughly with soap and warm running water after any contact with saliva or items contaminated with saliva.
DO NOT allow sharing of drinking cups, bottles, straws, cigarettes, mouthed pens and pencils, toothbrushes, or lip balm. DO NOT allow sharing of water bottles during sports events.
Avoid kissing an infected child on the lips or having contact with their saliva.
Clean and sanitize mouthed objects and surfaces at least daily and when soiled.

Mononucleosis Parent Fact Sheet

Your child may have been exposed to:

Mononucleosis
Mononucleosis (mono) is a viral illness.

If you think your child has Mono:

Tell your child care provider or call the school.
Need to stay home?
- Child Care and School:
  No, as long as the child is healthy enough for routine activities.
  Sports:
  Children with an enlarged spleen should avoid contact sports until cleared by their healthcare provider.

Symptoms

Your child may have a sore throat, swollen glands, headache, fever, and sometimes a rash. Your child may be very tired.

Mono usually lasts from one week to several weeks. The time it takes to recover and regain energy varies from person to person.

Less common problems include jaundice (yellowing of the skin or eyes) and/or enlarged spleen or liver.

If your child is infected, it may take about 4 to 6 weeks for symptoms to start.

Spread

By kissing or sharing items contaminated with saliva.

Contagious Period

For several weeks or longer.

Call your Healthcare Provider

If anyone in your home has symptoms of mononucleosis. Your child may need bed rest, to drink plenty of water, and to avoid some physical activities.

Prevention

Wash hands after touching anything that could be contaminated with secretions from the nose or mouth. Your child may need help with handwashing.
Avoid sharing drink containers and cups or silverware. Wash all dishes with hot soapy water between uses.
Clean and disinfect any objects that come in contact with the nose or mouth (for example, mouthed toys). Use a product that kills viruses.
Avoid kissing or having contact with the saliva of an infected child.

Mosquito-Borne Disease (Viral)

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Reportable to local or state health departments

This fact sheet is for provider information only.
If you have questions, please call the health department.

Mosquito-borne diseases are viral diseases that are spread by infected mosquitoes. Each disease is caused by a different virus. The many viruses have the potential of causing serious disease affecting the brain and central nervous system. Removal of potential breeding sites is important in preventing the spread of mosquitoes.

Cause

West Nile virus (WNV) - flavivirus
Eastern Equine encephalitis (EEE) - alphavirus
Western Equine encephalitis (WEE) - alphavirus
Saint Louis encephalitis (SLE) - flavivirus
California Group (i.e. La Crosse ) - bunyavirus

Symptoms

May not be apparent or may range from mild headaches and influenza-like symptoms (such as fever, malaise, tiredness, headache, stiff neck, nausea, vomiting, rash, or muscle aches) to mental confusion and convulsions. Severe cases may develop inflammation of the brain (encephalitis). Most infections do not progress to encephalitis.

Spread

Each virus is spread through the bite of a specific species of mosquito. West Nile disease may be spread by blood transfusion and transplanted organs. Some mosquitoes are weak flyers and tend to live close to their hatching sites.

Birdbaths, wading pools, dog bowls, and other artificial containers of water should be emptied weekly to eliminate mosquito-breeding areas. Road ditches should be properly graded to allow water to drain. Rain gutters should be cleaned annually (every spring). Tires are notorious breeding places for mosquitoes.

Incubation

The incubation period is usually 2 to 6 days, but ranges from 2 to 14 days, and may be up to 21 days in immunocompromised people.

Contagious Period

None. It is not spread person-to-person.

Exclusion

Child Care and School: None.

Diagnosis

Recommend parents/guardians call their healthcare provider if symptoms of arboviral disease are present. A healthcare provider must make the diagnosis.

Treatment

Recommend parents/guardians call their healthcare provider.

Prevention/Control

Eliminate potential breeding sites. Mosquitoes breed in water and artificial containers, especially flower pots, birdbaths, cans, children’s toys, wading pools, tire swings, old tires, or anything that will hold a small pool of water should be emptied or discarded. Old tires should be sent to a recycling center for proper disposal. Gas stations or tire stores may be a potential drop-off site.
Wear protective clothing, such as long-sleeved shirts and pants, when outdoors.
Use an insect repellent with DEET (the active ingredient in most insect repellents) before going outside. Repellents containing DEET (up to 30% concentration for both adults and children; do not use DEET on infants younger than 2 months of age) may be used on clothing or skin. Always follow the label directions. If used properly, most repellents are very safe.

Mumps

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Reportable to local or state health department

Consult the health department before posting/distributing Parent/Guardian fact sheet.

Cause

Mumps virus.

Symptoms

Most commonly, swollen glands in front of and below the ear, headache, low-grade fever, muscle aches, loss of appetite, and earache. Up to 30% of all people infected with the mumps virus have no symptoms. Orchitis (swelling of the testicles) is a common symptom in males after puberty. Rarely, swelling of the spinal cord and brain (encephalitis), inflammation of the ovaries (oophoritis) or breasts (mastitis), and deafness may occur. Serious problems from mumps are more common among adults than among children.

Spread

When a person with mumps sneezes or coughs tiny droplets with mumps virus into the air and another person breathes them in or by touching secretions from the nose and throat of an infected person and then touching your eyes, nose, or mouth.

Other examples of how the virus can be spread is through sharing toys, beverage containers, eating utensils, and smoking materials (e.g. cigarettes), and kissing.

Incubation

From 3 days before until 5 days after swelling begins. Most contagious 48 hours before the illness begins.

Contagious Period

From 2 days before until 5 days after swelling begins.

Exclusion

Child Care and School: Until 5 days after swelling begins.

Exclude unvaccinated children and staff if two or more cases of mumps occur. Exclusion will last through at least 26 days after the onset of parotid gland swelling in the last person who developed mumps. Once vaccinated, students and staff can be readmitted. Recommendations for exclusion should be made in collaboration with your local/state public health department.

Diagnosis

Swollen glands can be found with other illnesses. Swabs from the cheek, throat, or urine may be collected for testing. A blood test specific for mumps antibody may also be done.

Treatment

None, only symptom care.

Prevention/Control

Mumps vaccine is usually combined with measles and rubella (MMR) or measles, rubella, and varicella (MMRV) and given at 12-15 months and 4-6 years of age. Two doses or a legal exemption are required for kindergarten.
Unvaccinated people who have been exposed to mumps should call their healthcare provider or local public health clinic as soon as possible to be vaccinated.
Encourage parents/guardians to notify their child care provider or school when their child is vaccinated so their records can be updated.
Recommend staff stay home if they develop symptoms of mumps. Encourage parents/guardians to keep their child home if they develop symptoms of mumps.
Cover your nose and mouth with a tissue when coughing or sneezing, or cough/sneeze into your sleeve. Dispose of used tissues.
DO NOT allow sharing of beverage containers, eating utensils, smoking materials (cigarettes, cigars, snuff, pipes, etc.), toothbrushes, lip gloss, lip balm, and lipstick.
Regular and thorough handwashing is the best way to prevent the spread of communicable diseases. Wash hands thoroughly with soap and warm running water after contact with secretions from the nose or mouth.
Clean and sanitize mouthed objects and surfaces at least daily and when soiled.

Mumps Parent Fact Sheet

Your child may have been exposed to:

Mumps
Mumps is a viral illness that can be prevented through vaccination.

If you think your child has Mumps:

Tell your child care provider or call the school.
Need to stay home?
- Child Care and School:
  Yes, until 5 days after swelling begins.

If two or more cases of mumps occur in your child care or school, public health will inform unvaccinated children and staff how long they will need to stay home.

Symptoms

Your child may have swollen glands in front of and below the ear. Your child may have a headache or a fever.

If your child is infected, it may take 12 to 25 days for symptoms to start.

Spread

By coughing or sneezing.
By touching contaminated hands, objects, or surfaces.

Contagious Period

For 3 days before until 5 days after swelling begins. Most contagious 48 hours before illness begins.

Call your Healthcare Provider

If anyone in your home:

was exposed to mumps and has not had mumps or mumps vaccine in the past.
develops symptoms of mumps. A blood test may be done.

Prevention

All children by the age of 15 months must be vaccinated against mumps or have an exemption for child care enrollment. Mumps vaccine is usually combined with measles and rubella (MMR) or measles, rubella, and varicella (MMRV) and given at 12-15 months and 4-6 years of age. Two doses or a legal exemption are required for kindergarten. . When a mumps outbreak is identified, exemptions in child care centers or schools will not be allowed.
An unimmunized person can be readmitted immediately after immunization. Students who refuse immunization should be excluded until at least 26 days after the onset of parotitis in the last person with mumps in the affected school or child care center.
Parents should keep infants away from individuals suspected of having mumps.
People who have close contact with infants should be up-to-date on their immunizations.
Cover nose and mouth when coughing and sneezing. Use a tissue or your sleeve. Dispose of used tissues.
Wash hands after touching anything that could be contaminated with secretions from the nose or mouth. Your child may need help with handwashing.
Clean and disinfect anything that comes in contact with secretions from the nose or mouth. Use a product that kills viruses.
DO NOT share anything that you put in your mouth, for example, beverage containers, eating utensils, cigarettes, toothbrushes, and lip balm.

Norovirus (Norwalk-like Viruses)

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

(Norwalk-like Viruses)

Noroviruses cause gastroenteritis, an inflammation of the stomach and small and large intestines. Norovirus is often incorrectly called the “stomach flu”, although it is not caused by the influenza virus.

Cause

Norovirus (previously known as calicivirus, Norwalk virus, or Norwalk-like virus).

Symptoms

Watery diarrhea and vomiting. In addition, fever, headache, muscle aches, fatigue, and stomach cramps can occur. The illness can be mild to moderately severe with symptoms usually lasting 24 to 72 hours.

Spread

The viruses leave the body through the feces of an infected person and enter another person when hands, food, or objects (such as toys) contaminated with feces are placed in the mouth. Spread can occur when people do not wash their hands after using the toilet or changing diapers. People can also get sick by eating food items contaminated during preparation or serving. Aerosolized spread from vomiting is possible. Person-to-person spread often occurs within families, schools, nursing homes, cruise ships, in child care settings, and communities.

Incubation

It takes 10 to 50 hours, usually from 12 to 48 hours, from the time a person is exposed until symptoms develop.

Contagious Period

Individuals are most contagious while the symptoms are present; generally the first 72 hours after onset. Prolonged shedding can occur up to 3 weeks.

Exclusion

Child Care and School: Until the child has been free of diarrhea and vomiting for at least 24 hours.

No one with vomiting and/or diarrhea should use pools, swimming beaches, recreational water parks, spas, or hot tubs for 2 weeks after diarrhea and/or vomiting symptoms have stopped.

Staff must avoid food preparation when diarrhea and vomiting are present and for at least 3 days after diarrhea and/or vomiting have stopped. Please call your local health department to see if these restrictions apply.

Diagnosis

Recommend parents/guardians call their healthcare provider if their child has symptoms to discuss whether laboratory tests need to be done to determine the cause.

Treatment

Vomiting and diarrhea may lead to dehydration, which may be a medical emergency. Ask a healthcare provider how to prevent dehydration.

Prevention/Control

Regular and thorough handwashing is the best way to prevent the spread of communicable diseases. Wash hands thoroughly with soap and warm running water after using the toilet and changing diapers and before preparing or eating food. Staff should closely monitor or assist all children, as appropriate, with handwashing after children have used the bathroom or been diapered.
Restrict students from sharing any communal food items that are brought from home. In the classroom, children should not serve themselves food items that are not individually wrapped. The teacher should hand out these items after washing his/her hands. (This is not intended to discourage family-style serving in the absence of an outbreak.)
Clean and disinfect diapering area and potty chairs after each use and bathroom toilets, sinks, and toys at least daily and when soiled.
Clean and sanitize mouthed objects and surfaces at least daily and when soiled.

Norovirus Parent Fact Sheet

Your child may have been exposed to:

Norovirus
Norovirus is a viral infection of the stomach and intestines.

If you think your child has Norovirus:

Tell your child care provider.
Need to stay home?
- Child Care and School:
  Yes, until the child has been free of diarrhea and vomiting for at least 24 hours.

In addition, anyone with vomiting and/or diarrhea should NOT use pools, swimming beaches, recreational water parks, spas, or hot tubs for at least 2 weeks after diarrhea and/or vomiting have stopped.

Symptoms

Your child may have watery diarrhea, vomiting, and fever. Other symptoms may include headache, stomach cramps, and tiredness. Illness usually lasts for 24 to 72 hours.

If your child is infected, it may take 1 to 2 days for symptoms to start.

Spread

By eating or drinking contaminated food or beverages.
By touching contaminated hands, surfaces, or objects.
Also when someone vomits and bacteria get in the air. Norovirus is easily spread in the household.

Contagious Period

The illness can spread as long as the virus is in the feces.

Call your Healthcare Provider

No specific treatment is available.
Ask how to prevent dehydration. Your child may become dehydrated due to vomiting or diarrhea.

Prevention

Wash hands after using the toilet and changing diapers and before preparing food or eating. Your child may need help with handwashing.
Clean and disinfect any objects that come in contact with feces. This includes toilets (potty chairs), sinks, toys, and diaper changing areas. Use a product that kills viruses.

Parapertussis

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Parapertussis is similar to pertussis but tends to be a milder disease than pertussis.

Cause

Bordetella parapertussis bacteria.

Symptoms

Parapertussis begins with a runny nose, sneezing, mild cough, and possibly a low- grade fever. The cough may occur in sudden, uncontrollable bursts, sometimes ending with high-pitched whooping sounds and/or vomiting.

Spread

When a person with parapertussis coughs tiny droplets with parapertussis bacteria into the air and another person breathes them in.

Incubation

It takes from 6 to 21 days, usually 7 to 10 days from the time a person is exposed until symptoms start.

Contagious Period

Unknown, but probably most infectious at the time of early cold-like symptoms.

Exclusion

Child Care and School: None, if the child is well enough to participate in routine activities.

Diagnosis

To confirm a diagnosis of parapertussis, laboratory tests are performed on material collected by placing a flexible swab through the nostril to the back of the nose and throat.

Treatment

Persons with parapertussis can be treated with antibiotics, but antibiotics may do little to lessen the symptoms. Treatment is most effective if started soon after cough begins.

Prevention/Control

Cover your nose and mouth with a tissue when coughing or sneezing, or cough/sneeze into your sleeve. Dispose of used tissues.
Regular and thorough handwashing is the best way to prevent spread of communicable diseases. Wash hands thoroughly with soap and warm running water after contact with secretions from the nose or mouth.
Preventive treatment is not generally recommended for contacts of people with parapertussis. Preventive treatment may be considered for close contacts who are at a higher risk for more severe disease, including infants and immuno- compromised persons. Vaccines for pertussis (DTaP and Tdap) are not effective against parapertussis.
Clean and sanitize mouthed objects, and surfaces at least daily and when soiled.

Parapertussis Parent Fact Sheet

Your child may have been exposed to:

Parapertussis
Parapertussis is a bacterial illness similar to pertussis (whooping cough) but it tends to be more mild.

If you think your child has Parapertussis:

Tell your child care provider or call the school.
Need to stay home?
- Child Care and School:
  No, if the child is healthy enough for routine activities.

Symptoms

Your child may have a runny nose, sneezing, or mild coughing. Your child may cough in sudden, uncontrollable bursts. The cough may end with whooping sounds and/or vomiting.

If your child has been infected, it takes 6 to 21 days (usually 7 to 10 days) for symptoms to start.

Spread

By sneezing or coughing.

Contagious Period

Unknown, but likely to be most contagious at the time of early cold-like symptoms.

Call your Healthcare Provider

If anyone in your home is coughing for more than 7 days. Your doctor may want to test for the bacteria. Antibiotics may be given.

Prevention

Cover nose and mouth when coughing or sneezing. Use a tissue or your sleeve. Dispose of used tissues.
Wash hands after touching anything that could be contaminated with secretions from the nose or mouth. Your child may need help with handwashing.
Clean and disinfect anything that comes in contact with secretions from the nose or mouth. Use a product that kills bacteria..

Pertussis (Whooping Cough)

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Reportable to local or state health department

Consult the health department before posting/distributing Parent/Guardian fact sheet.

Pertussis (also known as whooping cough) can be a serious illness, especially in young, unvaccinated children. Adults and older children with pertussis may be the source of infection for infants and young children. This is a concern because in recent years, more adults, adolescents, and school-aged children have been contracting pertussis.

Cause

Bordetella pertussis bacteria.

Symptoms

Pertussis begins with a runny nose, sneezing, mild cough, and possibly a low-grade fever. After a week or two, a persistent cough develops, which may occur in explosive bursts (paroxysmal coughing), sometimes ending in a high-pitched whoop and vomiting. A whoop may be absent in older children, adults, and infants younger than 6 months. Coughing attacks occur more frequently at night. The coughing attacks usually increase during the first two weeks of illness and then remain the same for two or three more weeks before gradually decreasing. Some people, particularly infants, may develop pneumonia and ear infections. Pertussis can occur in vaccinated children, but the illness is usually milder.

Older children and adults may have a less typical cough; however, it is usually persistent and may lead to vomiting or a whoop. Although the disease may be less severe in adults and older children, they can unknowingly infect infants and preschoolers who are at risk for serious illness.

Spread

When an infected person coughs or sneezes tiny droplets into the air, and another person breathes them in. Also can be spread by touching the secretions from the nose and mouth of an infected person or by touching hands, tissues, or other items soiled with these secretions and then touching one’s eyes, nose, or mouth. A person is at greater risk of infection if they are in close contact with someone with pertussis (within three feet of an individual for at least 10 hours a week).

Incubation

It takes 4 to 21 days, usually 7 to 10 days, from the time a person is exposed until symptoms start.

Contagious Period

Begins at the time of early cold-like symptoms, before a persistent cough and explosive bursts of coughing start. Persons remain contagious until three weeks after cough onset. Those treated with antibiotics are contagious until 5 days of treatment are completed.

Exclusion

Until 5 days after appropriate antibiotic treatment begins. During this time, the person with pertussis should NOT participate in any child care, school, or community activities. If not treated with 5 days of antibiotics, exclusion should be for 21 days after cough onset.

If there is a high index of suspicion that the person has pertussis, exclude until the individual has been evaluated by a medical provider and deemed no longer infectious by the local health department, 5 days of antibiotics are completed or until the laboratory test comes back negative.

Diagnosis

Laboratory tests are performed on material collected by placing a flexible swab through the nostril to the back of the nose and throat or on a blood sample. Some lab tests (pertussis cultures) are less accurate after antibiotics are given or if significant time has passed since the cough onset. Only symptomatic persons should be tested.

Treatment

Antibiotics shorten the time a person with pertussis can give it to others, but may do little to lessen their symptoms. Treatment is most effective if started soon after cough begins. Antibiotics are not recommended for individuals who have had a cough for more than 21 days.

Prevention/Control

Studies have shown that protection from the pertussis vaccine (DTP/DTaP) decreases from 3 to 5 years after the last vaccination.
Adolescents ages 11 through 18: Adolescents aged 11 or 12 should receive a single dose of tetanus, diphtheria, and pertussis (Tdap) in place of tetanus and diphtheria (Td). Adolescents aged 13 through 18 should receive a single dose of Tdap if they have not already received one regardless of when Td (tetanus/diphtheria) was last administered.
Adults Ages 19 through 64: One dose of Tdap vaccine should be administered in place of the next booster of Td, especially if the adult is in close contact with infants less than 12 months of age. Tdap can be given no matter when Td was last received.
Adults ages 65 and older: Should receive a single dose of Tdap if adult anticipates being in close contact with an infant younger than 12 months of age.
Pregnant women: One dose of Tdap vaccine is recommended during each pregnancy, preferably at 27 through 36 weeks (third trimester). If Tdap was not administered during pregnancy, Tdap should be administered immediately after delivery.
People who develop the symptoms of pertussis within 21 days of exposure should stay home and call their healthcare provider.
Cover your nose and mouth with a tissue when coughing or sneezing, or cough/sneeze into your sleeve. Dispose of used tissues.
Regular and thorough handwashing is the best way to prevent spread of communicable diseases. Wash hands thoroughly with soap and warm running water after contact with secretions from the nose or mouth. If soap and water are not available, use an alcohol-based hand sanitizer.
Clean and sanitize mouthed objects and surfaces at least daily and when soiled.
People who are exposed to pertussis and who are not up to date on pertussis vaccinations should contact their healthcare provider or public health clinic to be vaccinated.
Public health will determine if preventive antibiotics are needed if someone in your child care or school develops pertussis.

Pertussis Parent Fact Sheet

Your child may have been exposed to:

Pertussis
Pertussis (whooping cough) can be a serious bacterial illness especially in young, unvaccinated children.

If you think your child has Pertussis:

Tell your child care provider or call the school.
Need to stay home?
- Child Care and School:
  Yes, until 5 days after your child starts taking antibiotics.

If staff or children are not treated, they need to stay home until 21 days after cough starts.

Symptoms

Your child may first have a runny nose, sneezing, mild cough, and possibly fever.

After 1 or 2 weeks, your child may cough in explosive bursts. These coughing attacks can end in vomiting and/or in a high-pitched whoop. Coughing attacks occur most often at night. This may last up to three months.

If your child has been infected, it may take 5 to 21 days (usually 7 to 10 days) for symptoms to start.

Spread

By coughing or sneezing.
By touching contaminated hands, objects, or surfaces.

Contagious Period

From the time of the first cold-like symptoms until 21 days after coughing begins or after taking 5 days of antibiotics. Antibiotics shorten the time a child with pertussis can give it to others.

Call your Healthcare Provider

If someone in your home has:

had a cough 7 or more days. Laboratory tests may be done. Antibiotics will reduce the contagious period, but may do little to relieve your child’s cough.
been exposed to pertussis. Also, if public health has recommended that antibiotics are needed because of an exposure.

Prevention

Cover nose and mouth when coughing and sneezing. Use a tissue or your sleeve. Dispose of used tissues.
Wash hands after touching anything that could be contaminated with secretions from the nose or mouth. Your child may need help with handwashing.
All children 2 months of age or older enrolled in child care or school must be vaccinated against pertussis or have an exemption. Consider a pertussis booster vaccine for adolescents and adults (Tdap), especially for those who have close contact with young children. Pregnant women should get a Tdap during each pregnancy, preferably during their third trimester.
There is also a pertussis vaccine for adolescents and adults, and it is recommended for persons having close contact with children under one year of age.
Parents should keep infants away from individuals with cough illness.

Pinworms

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Pinworm infection is the most common intestinal worm infection in the United States. Pinworms are most often found in preschool and school-aged children and their parents. These small worms are found in the human intestine and crawl out of the rectum at night to lay eggs on the anal area.

Cause

Enterobius vermicularis, a parasite.

Symptoms

Itching of the anal area (especially at night), irritability, and disturbed sleep.

Spread

Pinworms are spread when uninfected people touch the anal area of an infected person (e.g., during diaper changing) or handle contaminated pajamas, underwear, or bedding and then touch their mouth. Spread can also occur when infected people do not wash their hands well after scratching the anal area and then touch food or other objects, which are then eaten or touched by an uninfected person. Pinworms do not come from pets – only from other people.

Incubation

It takes 2 to 8 weeks from the time a person is exposed until symptoms start.

Contagious Period

As long as eggs are present. Eggs can cause infection even when they have been outside the body for as long as 2 to 3 weeks.

Exclusion

Child Care and School: None.

Diagnosis

Recommend parents/guardians call their healthcare provider if they suspect pinworms. The whole family may need to be examined.

Treatment

Usually medication is given in a single dose at the time of diagnosis and then another dose is given in two weeks.

Prevention/Control

Regular and thorough handwashing is the best way to prevent the spread of communicable diseases. Wash hands thoroughly with soap and warm running water after using the toilet, after contact with the anal area, handling bedding or underclothing, and before eating or preparing food. Use a fingernail brush when washing hands.
Discourage children from scratching or touching bare anal area and from biting their nails. Encourage children to keep their nails short.
For several days after treatment, all bedding and underclothing should be handled carefully, should not be shaken, and should be laundered promptly.

Pinworms Parent Fact Sheet

Your child may have been exposed to:

Pinworms
Pinworms are small worms that live in the human intestine (gut) and crawl out at night to lay eggs in the anal area.

If you think your child has Pinworms:

Tell your child care provider or call the school.
Need to stay home?
- Child Care and School:
  No.

Symptoms

Your child may have itching of the anal area, especially at night. Your child may be fussy and wake often at night.

If your child is infected, it may take 2 to 8 weeks for symptoms to start.

Spread

By touching the anal area of an infected person. This can happen while changing a diaper.
By handling contaminated pajamas, underwear, or bedding.
By having contact with contaminated food, objects, or surfaces.

Contagious Period

As long as eggs are present. Eggs can cause infection even after being off of the body for 2 to 3 weeks.

Call your Healthcare Provider

If you suspect pinworms. The whole family may need to be examined. Your doctor may prescribe a medication.

Prevention

Wash hands after using the toilet or changing diapers and before preparing food or eating. Your child may need help with handwashing.
Avoid scratching or touching bare anal area or biting nails. Keep nails short.
Clean and disinfect any objects that come in contact with feces. This includes toilets (potty chairs), sinks, toys, and diaper changing areas.
Wash every morning (a shower is best) using a fresh washcloth and towel. Wear clean underwear each day. Handle sheets, blankets, and underwear of infected children carefully. Avoid shaking the items and wash dirty laundry promptly.

Pneumococcal Infection

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Consult the health department before posting/distributing Parent/Guardian fact sheet.

Streptococcus pneumoniae is a bacterium commonly found in the nose and throat (but is not the cause of strep throat) and is the most common cause of middle ear infections and sepsis (blood infection) in children. Rates of serious pneumococcal infections in children have decreased markedly since use of the conjugate pneumococcal vaccine.

Cause

Streptococcus pneumoniae bacteria.

Symptoms

Symptoms of ear infection can include fever, ear pain, pulling at the ear, behavior or appetite change, and sometimes ear redness or drainage.

More serious pneumococcal infections include lung infection (pneumonia), bloodstream infection (septicemia), and infection of the brain (meningitis).

Spread

Spread by touching secretions from the nose or mouth of an infected or colonized person and then touching one’s eyes, nose, or mouth. Persons may “carry” pneumococcus in their nose or throat (also referred to as being colonized) meaning that the bacteria are present without causing illness. Spread may occur when a “carrier” of the pneumococcus bacteria coughs or sneezes the bacteria into the air and another person breathes them in.

Incubation

Varies by type of infection.

Contagious Period

Unknown.

Exclusion

None, if the child is well enough to participate in routine activities.

Diagnosis

Recommend parents/guardians call their healthcare provider if their child has a high fever or persistent ear pain.

Treatment

Pneumococcal infections are often treated with antibiotics.

Prevention/Control

Pneumococcal conjugate vaccine (PCV) should be given to all children at 2, 4, and 6 months, plus a booster at 12 to 15 months of age.
Pneumococcal polysaccharide vaccine (PPSV23) should be given to children over the age of 2 who have certain high-risk conditions (e.g., a weakened immune system), adults 65 years of age and older, and those 19 years of age or older who are smokers or have asthma. A health care provider can determine the need for this vaccine.
Unnecessary antibiotic use or not taking antibiotics as prescribed (not finishing the entire prescription or sharing the antibiotics with others) contribute to the development of antibiotic-resistant bacteria.
Pregnant women who have been exposed to someone with a pneumococcal infection should contact their health care provider and follow treatment guidelines.
Do not expose children to second-hand tobacco smoke. Smoke increases the risk for serious respiratory infections and middle ear infections.
Cover nose and mouth with a tissue when coughing and sneezing or cough/sneeze into your sleeve. Dispose of used tissues.
Regular and thorough handwashing is the best way to prevent the spread of communicable diseases. Wash hands thoroughly with soap and warm running water after contact with secretions from the nose or mouth. If soap and water are not available, use an alcohol-based hand sanitizer.
Clean and sanitize mouthed objects and surfaces at least daily and when soiled.

Invasive Pneumococcal Disease Parent Fact Sheet

Your child may have been exposed to:

Invasive Pneumococcal Disease
Pneumococcus (Streptococcus pneumoniae) is a bacteria that can cause ear and lung infections.

If you think your child has a Pneumococcal Infection:

Tell your child care provider or call the school.
Need to stay home?
- Child Care and School:
  No, if the child is healthy enough for routine activities

Symptoms

Your child may have fever, ear pain, or pull on their ear. Sometimes there is ear drainage and redness. Your child may change behavior or eating habits.

Spread

By coughing or sneezing.
By touching secretions from the nose or mouth.

Contagious Period

Unknown.

Call your Healthcare Provider

If your child has a high fever or ear pain that does not stop. Antibiotics may be prescribed.

Prevention

Ensure your child has received pneumococcal vaccine.
Cover nose and mouth when coughing and sneezing. Use a tissue or your sleeve. Dispose of used tissues.
Wash hands after touching anything that could be contaminated with secretions from the nose or mouth. Your child may need help with handwashing.
Clean and disinfect anything that comes in contact with secretions from the nose or mouth. Use a product that kills bacteria.
DO NOT expose your child to second-hand tobacco smoke. Smoke increases the risk for serious respiratory infections and middle ear infections.

Pneumonia

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Pneumonia (inflammation of the lung) is a serious respiratory condition. Pneumonia can be a complication of other illnesses and can occur throughout the year. Infants and young children who experience common respiratory viruses and are exposed to second-hand tobacco smoke are at increased risk of developing bronchiolitis, bronchitis, pneumonia, and middle ear infections.

Cause

Many different viruses, most commonly respiratory syncytial virus (RSV) and influenza virus, and some bacteria. Most of these viruses or bacteria can cause other illnesses, and not all persons exposed to them will develop pneumonia. Physical and chemical irritants may also cause pneumonia.

Symptoms

May have runny nose, mild cough, and fever several days before developing pneumonia. Rapid breathing, chest pain, cough, and usually fever will occur.

Spread

Viruses and bacteria are spread from person-to-person by touching the secretions from the nose and mouth of an infected person. Spread may also occur by touching the hands, tissues, or other items soiled with nose and mouth secretions from an infected person and then touching your eyes, nose, or mouth.

Incubation

Depends upon the germ that is causing the illness.

Contagious Period

From shortly before symptoms begin and while the child feels sick.

Exclusion

Child Care and School: Until fever is gone and the child is well enough to participate in routine activities.

Diagnosis

Recommend parents/guardians call their healthcare provider if their child has a high fever or persistent sore throat or cough.

Treatment

The healthcare provider will decide if treatment is needed.

Do not give aspirin or salicylate-containing medications to any child or adolescent under 18 years of age.

Prevention/Control

Cover nose and mouth with a tissue when coughing and sneezing or cough/sneeze into your sleeve. Dispose of used tissues.
Regular and thorough handwashing is the best way to prevent the spread of communicable diseases. Wash hands thoroughly with soap and warm running water after touching the secretions from the nose or mouth.
DO NOT share cups, glasses, or eating utensils.
Clean and sanitize mouthed objects and surfaces at least daily and when soiled. Clean and sanitize dishes and silverware after each use.

Pneumonia Parent Fact Sheet

Your child may have been exposed to:

Pneumonia
Many different viruses and some bacteria can cause pneumonia (inflammation of the lungs).

If you think your child has Pneumonia:

Tell your child care provider.
Need to stay home?
- Child Care and School:
  Yes, until fever is gone and the child is healthy enough for routine activities.

DO NOT give aspirin or salicylate-containing medicines to anyone under 18 years of age.

Symptoms

Your child may have a runny nose, cough, fever, rapid breathing, and chest pain.

Spread

By sneezing or coughing.
By touching contaminated hands, surfaces, or objects.

Contagious Period

Shortly before and while your child has symptoms.

Call your Healthcare Provider

If your child has a high fever or a sore throat or a cough that does not go away.

Antibiotics do not work for illnesses caused by a virus, including colds and certain respiratory infections.

Prevention

Cover nose and mouth when sneezing or coughing. Use a tissue or your sleeve. Dispose of used tissues.
Wash hands after touching anything that could be contaminated with the secretions from the mouth or nose. Your child may need help with handwashing.
Clean and disinfect anything that comes in contact with secretions from the nose or mouth. Use a product that kills bacteria and viruses.
DO NOT expose your child to second-hand tobacco smoke. Smoke increases the risk for serious respiratory infections and middle ear infections.

Respiratory Infection (Viral)

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Many different viruses may cause colds and viral respiratory illnesses with fever. These illnesses are very common during fall and winter months. Infants and young children who experience common respiratory infections and are also exposed to second-hand tobacco smoke are at increased risk of developing bronchiolitis, bronchitis, pneumonia, and middle ear infections.

Cause

Many different viruses.

Symptoms

Include runny nose, sneezing, chills, tiredness, fever, muscle aches, sore throat, and cough which may last two to seven days.

Spread

Viruses are spread from person-to-person by touching the secretions from the nose and mouth of an infected person and by touching the hands, tissues, or other items soiled with nose and mouth secretions from an infected person and then touching your eyes, nose, or mouth.

Incubation

It may take up to10 days after exposure for symptoms to start.

Contagious Period

Shortly before symptoms begin through the duration of acute symptoms. This may last from 5 to 8 days.

Exclusion

Child Care and School: Until fever is gone and the child is well enough to participate in routine activities

Diagnosis

Recommend parents/guardians call their healthcare provider if their child has a high fever or persistent sore throat or cough.

Treatment

These are viral illnesses; therefore, antibiotics will not be effective.

Do not give aspirin or salicylate-containing medications to any child or adolescent under 18 years of age.

Prevention/Control

Cover nose and mouth with a tissue when coughing and sneezing or cough/sneeze into your sleeve. Dispose of used tissues.
Regular and thorough handwashing is the best way to prevent the spread of communicable diseases. Wash hands thoroughly with soap and warm running water after contact with secretions from the nose or mouth.
DO NOT share cups, glasses, or eating utensils.
Clean and disinfect commonly touched surfaces (doorknobs, refrigerator handle, water faucets, cupboard handles) at least daily. Clean and sanitize mouthed objects and surfaces at least daily and when soiled. Clean and sanitize all dishes and silverware after each use.

Respiratory Infection Parent Fact Sheet

Your child may have been exposed to:

Respiratory Infection
Many different viruses can cause respiratory infections (or colds) with fevers.

If you think your child has a Respiratory Infection:

Tell your child care provider.
Need to stay home?
- Child Care and School:
  Yes, until fever is gone and the child is healthy enough for routine activities.

DO NOT give aspirin or salicylate-containing medicines to anyone under 18 years of age.

Symptoms

Symptoms may include a runny nose, chills, muscle aches, and a sore throat. Your child may sneeze and cough and be more tired than usual. Check your child for a fever. Symptoms last about 7 days.

If your child is infected, it may take up to 10 days for symptoms to start.

Spread

By sneezing or coughing.
By touching contaminated hands, surfaces, or objects.

Contagious Period

Shortly before and while your child has symptoms.

Call your Healthcare Provider

If your child has a high fever or a sore throat or a cough that does not go away.

Antibiotics do not work for illnesses caused by a virus, including colds and respiratory infections.

Prevention

Cover nose and mouth when sneezing or coughing. Use a tissue or your sleeve. Dispose of used tissues.
Wash hands after touching anything that could be contaminated with the secretions from the mouth or nose. Your child may need help with handwashing.
DO NOT share drink containers and cups or silverware. Wash all dishes with hot soapy water between uses.
Clean and disinfect anything that comes in contact with secretions from the nose or mouth. Use a product that kills bacteria and viruses.
DO NOT expose your child to second-hand tobacco smoke. Smoke increases the risk for serious respiratory infections and middle ear infections.

Respiratory Syncytial Virus (RSV) Infection

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

RSV infection is a common respiratory illness that can affect persons of any age. It is the most common cause of bronchiolitis and pneumonia in infants and children under 2 years of age. RSV infection spreads quickly to adults and children alike. Outbreaks of RSV occur almost every year during the winter and early spring.

Cause

Respiratory syncytial virus.

Symptoms

Symptoms can be similar to a mild cold with low-grade or no fever, cough, watery eyes, runny nose, nasal stuffiness, and sneezing. However, the more severe form includes wheezing, as seen in bronchiolitis. Lung congestion can be seen in pneumonia. Infants infected during the first few weeks of life may only show tiredness, irritability, and loss of appetite and may have episodes where they stop breathing for short time periods (apnea) with few other respiratory signs.

RSV infection can be especially serious in infants who were born prematurely or those with heart, lung, or immune system problems. However, severe lower respiratory tract disease may occur at any age, especially in the elderly or those with heart, lung, or immune system problems. People usually have moderate to severe cold-like symptoms. You can have more than one RSV infection during your lifetime.

Spread

By close contact with droplets containing RSV that are expelled from the nose and mouth of an infected person during sneezing or coughing. By touching the secretions from the nose and mouth of an infected person and also by touching hands, tissues, or other items soiled with these secretions and then touching your eyes, nose, or mouth. The virus can live on hands for one-half hour or more and on environmental surfaces for several hours.

Incubation

It takes 2 to 8 days, usually 4 to 6 days, from the time a person is exposed until symptoms start.

Contagious Period

The virus is usually found in respiratory secretions for 3 to 8 days, although some infants can spread RSV for as long as 3 to 4 weeks.

Exclusion

Child Care: Until fever is gone and the child is well enough to participate in routine activities.

Diagnosis

Recommend parents/guardians call their healthcare provider if their child has symptoms of RSV. There is a lab test to detect RSV.

Treatment

Antiviral treatment is not recommended for routine use but may be considered for use in select patients with documented potentially life threatening RSV infection.

Do not give aspirin or salicylate-containing medications to any child or adolescent under 18 years of age.

Prevention/Control

Cover nose and mouth with tissue when coughing or sneezing or cough/sneeze into your sleeve. Dispose of used tissues.
Regular and thorough handwashing is the best way to prevent the spread of communicable diseases. Wash hands thoroughly with soap and warm running water after contact with secretions from the nose or mouth.
DO NOT share cups, glasses, or eating utensils.
Clean and disinfect commonly touched surfaces (doorknobs, refrigerator handle, water faucets, cupboard handles) at least daily.
Clean and sanitize mouthed objects and surfaces at least daily and when soiled. Clean and sanitize all dishes and silverware after each use.
Certain high-risk infants (e.g., premature babies) can be given a medication to prevent infection. Have the parents/guardians talk to their healthcare provider.
CDC recommends adults 60 years and older may receive a single dose of RSV vaccine, based on discussions between the patient and health care provider.

Respiratory Syncytial Virus Parent Fact Sheet

Your child may have been exposed to:

Respiratory Syncytial Virus
Respiratory Syncytial Virus (RSV) is a common viral infection.

If you think your child has Croup:

Tell your child care provider.
Need to stay home?
- Child Care:
  Yes, until fever is gone and the child is healthy enough for routine activities

DO NOT give aspirin or salicylate-containing medicines to anyone under 18 years of age.

Symptoms

Your child may have a cough, watery eyes, runny nose or stuffiness, or sneezing. Symptoms may last for 7 days.

People with severe RSV may wheeze and/or have lung congestion. RSV can be serious for premature babies and people with heart, lung, or immune system problems.

If your child is infected, it may take 2 to 8 days for symptoms to start.

Spread

By sneezing or coughing.
By touching contaminated hands, surfaces, or objects.

Contagious Period

For 3 to 8 days. Some infants can spread RSV for up to 4 weeks.

Call your Healthcare Provider

If anyone in your home has symptoms. Your doctor may want to test for the virus. Infants who are hospitalized may be treated with a special medication called an antiviral drug.

Prevention

Cover nose and mouth when sneezing or coughing. Use a tissue or your sleeve. Dispose of used tissues.
Wash hands after touching anything that could be contaminated with the secretions from the mouth or nose. Your child may need help with handwashing.
DO NOT share drink containers and cups or silverware. Wash all dishes with hot soapy water between uses.
Clean and disinfect anything that comes in contact with secretions from the nose or mouth. Use a product that kills viruses.
Some babies, including infants who were born prematurely, can be given a medication to prevent infection. Talk to your healthcare provider.

Ringworm

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Ringworm is a fungal infection of the body, scalp, or feet. The scalp infection is most common in children, whereas infection of the feet is more common in adolescents and adults.

Cause

Several different types of fungus. (It is not a worm.)

Symptoms

Body - Appears as flat, spreading, ring-shaped areas on the skin (lesions). The edge of the lesion may be dry and scaly or moist and crusted. As the lesion spreads outward, the center often becomes clear.
Scalp - May be hard to detect in the early stages. It often begins as a small scaly patch on the scalp and may progress to larger areas of scaling. Mild redness, swelling, itching, and pustules (pus-filled bumps) may occur. Infected hairs become brittle and break off easily.
Feet - (Also called athlete’s foot.) Scaling or cracking of the skin, especially between the toes, or blisters containing thin, watery fluid may be seen. Itching is common. Serious problems can include bacterial skin infection (cellulitis) and fungal infections of the toenails.

Spread

May occur by touching the lesions of infected persons or pets (usually dogs and cats); by sharing objects that touched the lesions of an infected person, (e.g., hats, caps, combs, brushes, towels, pillows, bedding, sofas, clothing, hair ribbons, barrettes); or having contact with skin scales containing fungi on shower stalls or floors, swimming pool decks, and locker room benches or floors.

Incubation

Body - 7 to 21 days after exposure for symptoms to appear.
Scalp - 10 to 14 days.
Feet - Unknown

Contagious Period

Contagious as long as lesions are present. Contagiousness is reduced once treatment has begun.

Exclusion

Child Care or School: Until treatment has been started. If on the scalp, until 24 hours after treatment has been started.

Any child with ringworm should not participate in gym, swimming, and other close contact activities that are likely to expose others until after treatment has begun or the lesions can be completely covered.

Sports: Athletes with ringworm of the body in sports with person to-person contact cannot participate in matches for 72 hours after starting treatment unless area can be covered. Follow athlete’s healthcare provider’s recommendations and the specific sports league rules for return to practice and competition.

Diagnosis

Recommend parents/guardians call their healthcare provider if they suspect ringworm in household members. Contact a veterinarian if you suspect a pet has ringworm.

Treatment

Body – Antifungal ointments are used on skin lesions for 4 weeks.
Scalp – May require oral medication if lesions are extensive. Oral medications should be taken for 4 to 8 weeks. Antifungal shampoos may also be prescribed.
Foot – Antifungal ointments for 1 to 4 weeks. Oral medications may need to be taken for 6 to 8 weeks for severe or recurring problems.

Prevention/Control

Wash hands after touching lesions on humans and pets.
Ensure lesions are completely covered.
Wash combs and brushes in hot, soapy water, if used by the infected person.
Check for signs of infection in all pets in the child care and school setting. Have a veterinarian evaluate any pet with a skin infection or problem. If infection is present, treatment should be started as soon as possible.
If the pet has ringworm, children should not be allowed to have contact with the pet until the rash has been treated and heals.
DO NOT allow sharing of personal items such as brushes, combs, towels, bedding or pillows, clothing, hats, caps, hair ribbons, barrettes, and headgear (helmets).
Have separate bedding and pillows for each child at the child care.
Wash bedding in hot, soapy water daily while a person is infected.
Provide separate storage space for personal items for each child or staff member.
Vacuum carpeted areas and upholstered furniture regularly.
Schools/Public facilities:
- Require shower shoes (e.g., flip-flops or water sandals) be worn in locker rooms or showers or on pool decks.
- Exclude from using locker rooms, showers, or pools when active lesions are present if not covered by a waterproof bandage.
- Disinfect showers and dressing rooms daily with an EPA-approved disinfectant.

Ringworm Parent Fact Sheet

Your child may have been exposed to:

Ringworm
Ringworm is a fungal infection. It is not a worm. The scalp infection is most common in children. Infection of the feet is more common in adolescents and adults.

If you think your child has Ringworm:

Tell your child care provider or call the school.
Need to stay home?
- Child Care and School:
  Yes, until treatment has been started. If on the scalp, until 24 hours after treatment has been started.
- Activities: Limit gym, swimming, and other close contact activities if the lesion cannot be covered or until after treatment has begun.
- Sports: Athletes follow your healthcare provider’s recommendations and the specific sports league rules.

Symptoms

Body - Flat, spreading, round shapes on the skin. If your child is infected, it may take 7 to 21 days for symptoms to start.

Scalp - Begins as a small scaly patch on the scalp and may cover more of the head. Mild redness, swelling, itching, and pustules (pus-filled bumps) may occur.
Infected hairs become brittle and break off easily. If your child is infected, it may take 10 to 14 days for symptoms to start.

Feet (athlete’s foot) - Scaling or cracking of the skin or blisters. Itching is common.

Spread

By touching the infected skin of a person or pet (usually, dogs and cats).
By sharing or touching contaminated objects.

Contagious Period

As long as you can see the ringworm on your child’s skin. Once treatment has begun your child is less contagious.

Call your Healthcare Provider

If anyone in your home has symptoms. Your doctor will decide if treatment is needed. It is important to follow your doctor’s treatment directions exactly.
If you think a pet has ringworm, call a veterinarian.

Prevention

Wash hands after touching infected skin on humans and pets. Your child may need help with handwashing.
Cover skin lesions.
Wash bedding, clothing, combs and brushes in hot, soapy water.
Check all household members and all pets for signs of infection.
DO NOT let children touch an infected pet’s skin until it has been treated and heals.

Roseola

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Roseola is a common rash illness that usually occurs in children under 4 years of age. It is the most common cause of rash in children 6 months to 2 years of age.

Cause

Human herpesvirus 6.

Symptoms

Usually a high fever that appears suddenly and generally lasts 3 to 7 days. As the fever breaks, a rash appears on the trunk and neck and may later spread to the rest of the body. The rash may last from several hours to several days. At this time, the child usually does not feel very sick. Infection also occurs without symptoms in many children. Seizures may occur in children with high fevers.

Persons with weakened immune systems may have more severe disease and symptoms may last longer.

Spread

Most likely person-to-person through respiratory secretions.

Incubation

Estimated to be 9 to 10 days.

Contagious Period

Most likely during the fever and before the rash appears.

Exclusion

Child Care: Until fever is gone and other rash illnesses, especially measles, have been ruled out.

Diagnosis

Recommend parents/guardians call their healthcare provider if their child has fever and rash.

Treatment

None.

Prevention/Control

Regular and thorough handwashing is the best way to prevent the spread of communicable diseases. Wash hands thoroughly with soap and warm running water after touching anything contaminated with secretions from the nose and mouth and before preparing or eating food.
Clean and sanitize mouthed objects and surfaces at least daily and when soiled.

Roseola Parent Fact Sheet

Your child may have been exposed to:

Roseola
Roseola is a viral rash. It is the most common cause of rashes in children 6 months to 2 years of age.

If you think your child has Roseola:

Tell your child care provider.
Need to stay home?
- Child Care:
  Yes, until fever is gone and other rash illnesses, especially measles, have been ruled out.

Symptoms

Your child may have a high fever that starts suddenly and generally lasts for a few days. As the fever breaks, a rash appears on the child’s belly, chest, back, and neck. It may later spread to the rest of the body. Even with a rash, your child may still feel okay. Illness may last up to 7 days.

If your child is infected, it may take 9 to 10 days for symptoms to start.

Spread

By touching the secretions from the nose or mouth.

Contagious Period

Most likely during the fever and before the rash appears.

Call your Healthcare Provider

If your child has a fever and a rash.

Prevention

Wash hands after touching anything that could be contaminated with secretions from the nose or mouth. Your child may need help with handwashing.
Clean and disinfect any objects or surfaces that come in contact with secretions from the nose or mouth. Use a product that kills viruses.

Rotaviral Infection

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Diarrhea caused by rotavirus is common in infants and young children during the winter months. It can spread quickly to others, including adult caregivers, in child care settings.

Cause

Rotaviruses.

Symptoms

Vomiting, fever, and watery diarrhea. Sometimes a cough, runny nose, or ear infection is present. Symptoms may last 3 to 7 days. Children with rotavirus diarrhea are sometimes hospitalized because of dehydration.

Spread

Rotaviruses leave the body through the feces of an infected person and enter another person when hands, food, or objects (such as toys) contaminated with feces are placed in the mouth. Spread can occur when people do not wash their hands after using the toilet or changing diapers. Also, rotavirus can be spread through droplets that are expelled from the nose and mouth during sneezing and coughing.

Incubation

It usually takes less than 48 hours from the time a person is exposed until symptoms begin

Contagious Period

From 1 to 2 days before until 10 days after symptoms begin.

Exclusion

Child Care and School: Until the child has been free of diarrhea for at least 24 hours.

Diagnosis

Recommend parents/guardians call their healthcare provider if their child has the symptoms of rotavirus infection. There is a lab test to detect the virus in the feces.

Treatment

No specific treatment is available. Vomiting and diarrhea may lead to dehydration, which may be a medical emergency. Ask a healthcare provider how to prevent dehydration.

Prevention/Control

The FDA has approved RotaTeq™ and Rotarix™ vaccines to prevent rotavirus. RotaTeq™ is licensed for infants 6 to 32 weeks of age and is given by mouth as a three-dose series. Maximum age for last dose is 8 months. Rotarix™ is licensed for infants 6 to 24 weeks of age and is given orally as a two-dose series. A different vaccine for rotavirus (Rotashield™) was withdrawn from the market in 1999 due to an increased risk of intussusception, a blockage or twisting of the intestines. Studies of RotaTeq™ and Rotarix™ show that they do not cause an increased risk of intussusception.
Cover nose and mouth with a tissue when coughing or sneezing, or cough/sneeze into your sleeve. Dispose of used tissues.

Regular and thorough handwashing is the best way to prevent the spread of communicable diseases. Wash hands thoroughly with soap and warm running water after using the toilet, after changing diapers and before preparing or eating food. Staff should closely monitor or assist all children, as appropriate, with handwashing after children have used the bathroom or been diapered.
Clean and disinfect diapering area and potty chairs after each use and bathroom toilets, sinks, and toys at least daily and when soiled.
Clean and sanitize mouthed objects and surfaces at least daily and when soiled.

Rotavirus Parent Fact Sheet

Your child may have been exposed to:

Rotavirus
Rotavirus is a viral infection of the intestines.

If you think your child has Rotavirus:

Tell your child care provider or call the school.
Need to stay home?
- Child Care and School:
  Yes, until the child has been free of diarrhea for at least 24 hours.

Symptoms

Your child may have watery diarrhea, vomiting, or fever. Also may have a cough, runny nose, or ear infection.
Illness generally lasts 3 to 7 days.

If your child is infected, it may take up to 48 hours for symptoms to start.

Spread

By eating or drinking contaminated food or beverages.
By coughing or sneezing.
By touching contaminated hands, surfaces, or objects.

Contagious Period

The illness can spread as long as the virus is in the feces. A person is contagious for 1 to 2 days before to 10 days after symptoms start.

Call your Healthcare Provider

If anyone in your home has symptoms. There is a medical test to detect the virus. No specific treatment is available.
Ask how to prevent dehydration. Your child may become dehydrated due to vomiting or diarrhea.

Prevention

Cover nose and mouth when sneezing or coughing. Use a tissue or your sleeve. Dispose of used tissues.
Wash hands after touching anything that could be contaminated with the secretions from the mouth or nose or with feces and before preparing food or eating. Your child may need help with handwashing.
Clean and disinfect any objects that come in contact with feces or secretions from the nose or mouth. This includes toilets (potty chairs), sinks, toys, and diaper changing areas. Use a product that kills viruses.

Rubella (German Measles)

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Reportable to local or state health department

Consult the health department before posting/distributing Parent/Guardian fact sheet.

Rubella (German measles) is a mild rash illness that can be prevented through vaccination. If a pregnant woman develops rubella, the baby can become infected and develop serious problems known as congenital rubella syndrome (CRS). If a pregnant woman is exposed to rubella, she should call her healthcare provider immediately, particularly if she does not know whether she is immune (has had rubella disease or vaccine in the past). (See Rubella and Pregnancy fact sheet).

Cause

Rubella virus.

Symptoms

Low-grade fever, swollen glands in the area behind the ears and in the neck, and rash. Rash usually appears first on the face and moves from head to foot. The rash usually lasts 3 days. Adults, especially women, may have sore or swollen joints.

This joint pain usually lasts for less than one month. Up to half of all infected persons have no symptoms. Rarely, encephalitis (inflammation of the brain) may occur.

Spread

Rubella is spread when an infected person coughs or sneezes tiny droplets with rubella virus into the air and another person breathes them in. People can also get infected from touching the secretions from the nose or mouth of an infected person and then touching their mouth, eyes, or nose.

Incubation

It takes 14 to 21 days, usually 16 to 18 days, from the time a person is exposed until the symptoms begin.

Contagious Period

From 7 days before to 7 days after the rash begins; children are most contagious from 3 to 4 days before rash starts until 7 days after the rash starts. Infants with CRS may shed virus for 12 months.

Exclusion

Child Care and School: Until 7 days after the rash appears.

Exclude unvaccinated children and staff for at least 3 weeks after the onset of rash in the last person who developed rubella. Recommendations for exclusion should be done in collaboration with public health staff.

Diagnosis

Swabs from the throat or nose should be collected as soon as possible after rash onset and a blood test should be done 3 to 5 days after the symptoms begin. Other laboratory specimens may be collected.

Treatment

Recommend parents/guardians call their healthcare provider.

Prevention/Control

All children 15 months of age or older must be vaccinated against rubella or have an exemption for child care/preschool enrollment. Two doses or a legal exemption are required for K-12 school enrollment.
Unvaccinated people who have been exposed to rubella should call their healthcare provider or local public health clinic as soon as possible to be vaccinated.
Encourage parents/guardians to notify the child care provider or school when their child is vaccinated so their records can be updated.
Recommend staff stay home if they develop symptoms of rubella. Encourage parents/guardians to keep their child home if they develop a rash, fever, and swollen glands behind the ears or neck.
Cover your nose and mouth with a tissue when coughing or sneezing, or cough/sneeze into your sleeve. Dispose of used tissues in the trash.
Clean and sanitize mouthed objects and surfaces at least daily and when soiled. (See Cleaning, Sanitizing, and Disinfection)
Regular and thorough handwashing is the best way to prevent the spread of communicable diseases. Wash hands thoroughly with soap and warm running water after contact with secretions from the nose or mouth or handling used tissues. If soap and water are not available, use an alcohol-based hand sanitizer.

Rubella Parent Fact Sheet

Your child may have been exposed to:

Rubella
Rubella is a viral illness that can be prevented through vaccination.

If you think your child has Rubella:

Tell your child care provider or call the school.
Need to stay home?
- Child Care and School:
  Yes, until 7 days after the rash appears.

If a case of rubella occurs in your child care or school, public health will inform unvaccinated children and staff how long they will need to stay home.

Symptoms

Your child may have fever, rash, and swollen glands. The rash usually appears first on the face and moves toward the feet, and typically lasts 3 days. Other symptoms may include cough, runny nose, headache, malaise, and conjunctivitis.

If your child has been infected, it may take 14 to 21 days for symptoms to start.

Spread

By coughing and sneezing.
By touching contaminated objects or surfaces.

Contagious Period

From 7 days before until 7 days after the rash begins.

Call your Healthcare Provider

If anyone in your home:

was exposed to rubella and has not had rubella disease or rubella vaccine in the past.
develops a rash, fever, and swollen glands. A lab test may be done.
is pregnant and/or develops a rash. This is important because the baby can become infected.

Prevention

All children 15 months of age or older must be vaccinated against rubella or have an exemption for child care/preschool enrollment. Two doses or a legal exemption are required for K-12 school enrollment.
When a rubella outbreak is identified, susceptible individuals should be excluded or vaccinated. Exclusion should continue until at least 3 weeks after the onset of rash in the last reported case-patient in the outbreak setting.
Parents should keep infants away from individuals suspected of having rubella.
People who have close contact with infants should be up-to-date on their immunizations.
Cover nose and mouth when coughing and sneezing; use a tissue or your sleeve. Dispose of used tissues in the trash.
Wash hands after touching anything that could be contaminated with secretions from the nose or mouth. Your child may need help with handwashing.
Clean and disinfect anything that comes in contact with secretions from the nose or mouth. Use a product that kills viruses.
DO NOT share anything that you put in your mouth, for example, beverage containers, eating utensils, cigarettes, toothbrushes, and lip balm.

Reportable to local or state health department

Consult the health department before posting/distributing Parent/Guardian fact sheet.

Cause

Rubella virus.

Symptoms

This joint pain usually lasts for less than one month. Up to half of all infected persons have no symptoms. Rarely, encephalitis (inflammation of the brain) may occur.

Spread

Incubation

It takes 14 to 21 days, usually 16 to 18 days, from the time a person is exposed until the symptoms begin.

Contagious Period

From 7 days before to 7 days after the rash begins; children are most contagious from 3 to 4 days before rash starts until 7 days after the rash starts. Infants with CRS may shed virus for 12 months.

Exclusion

Child Care and School: Until 7 days after the rash appears.

Diagnosis

Treatment

Recommend parents/guardians call their healthcare provider.

Prevention/Control

All children 15 months of age or older must be vaccinated against rubella or have an exemption for child care/preschool enrollment. Two doses or a legal exemption are required for K-12 school enrollment.
Unvaccinated people who have been exposed to rubella should call their healthcare provider or local public health clinic as soon as possible to be vaccinated.
Encourage parents/guardians to notify the child care provider or school when their child is vaccinated so their records can be updated.
Recommend staff stay home if they develop symptoms of rubella. Encourage parents/guardians to keep their child home if they develop a rash, fever, and swollen glands behind the ears or neck.
Cover your nose and mouth with a tissue when coughing or sneezing, or cough/sneeze into your sleeve. Dispose of used tissues in the trash.
Clean and sanitize mouthed objects and surfaces at least daily and when soiled. (See Cleaning, Sanitizing, and Disinfection)
Regular and thorough handwashing is the best way to prevent the spread of communicable diseases. Wash hands thoroughly with soap and warm running water after contact with secretions from the nose or mouth or handling used tissues. If soap and water are not available, use an alcohol-based hand sanitizer.

Rubella Parent Fact Sheet

Your child may have been exposed to:

Rubella
Rubella is a viral illness that can be prevented through vaccination.

If you think your child has Croup:

Tell your child care provider or call the school.
Need to stay home?
- Child Care and School:
  Yes, until 7 days after the rash appears.

If a case of rubella occurs in your child care or school, public health will inform unvaccinated children and staff how long they will need to stay home.

Symptoms

If your child has been infected, it may take 14 to 21 days for symptoms to start.

Spread

By coughing and sneezing.
By touching contaminated objects or surfaces.

Contagious Period

From 7 days before until 7 days after the rash begins.

Call your Healthcare Provider

If anyone in your home:

was exposed to rubella and has not had rubella disease or rubella vaccine in the past.
develops a rash, fever, and swollen glands. A lab test may be done.
is pregnant and/or develops a rash. This is important because the baby can become infected.

Prevention

All children 15 months of age or older must be vaccinated against rubella or have an exemption for child care/preschool enrollment. Two doses or a legal exemption are required for K-12 school enrollment.
When a rubella outbreak is identified, susceptible individuals should be excluded or vaccinated. Exclusion should continue until at least 3 weeks after the onset of rash in the last reported case-patient in the outbreak setting.
Parents should keep infants away from individuals suspected of having rubella.
People who have close contact with infants should be up-to-date on their immunizations.
Cover nose and mouth when coughing and sneezing; use a tissue or your sleeve. Dispose of used tissues in the trash.
Wash hands after touching anything that could be contaminated with secretions from the nose or mouth. Your child may need help with handwashing.
Clean and disinfect anything that comes in contact with secretions from the nose or mouth. Use a product that kills viruses.
DO NOT share anything that you put in your mouth, for example, beverage containers, eating utensils, cigarettes, toothbrushes, and lip balm.

Salmonellosis

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Reportable to local or state health department

Consult the health department before posting/distributing Parent/Guardian fact sheet.

Outbreaks of Salmonella infections are unusual in child care and school settings, but can occur, especially in settings where children are in diapers or have contact with reptiles.

Cause

Salmonella bacteria.

Symptoms

Diarrhea, cramps, nausea, headache, fever, and sometimes vomiting. Infected persons may show mild symptoms or may not have any symptoms at all. Illness usually lasts 4 to 7 days.

Spread

Salmonella bacteria leave the body through the feces of an infected person and enter another person when hands, food, or objects (such as toys) contaminated with feces are placed in the mouth. Spread can occur when people do not wash their hands after using the toilet or changing diapers. Spread can also occur through contact with reptiles, farm animals, and infected pets (usually puppies, kittens, or chicks).

Most outbreaks of salmonellosis are associated with eating undercooked or raw food items that are contaminated with feces, such as eggs, poultry, meat, fruits, and vegetables.

Incubation

It takes 6 to 72 hours, usually 12 to 36 hours, from the time a person is exposed until symptoms start. It can be as long as 8 days before symptoms develop.

Contagious Period

As long as Salmonella is present in the feces, a person may pass the bacteria on to other people. Salmonella can be present in feces for several weeks after symptoms have stopped.

Exclusion

Child Care and School: Until the child has been free of diarrhea for at least 24 hours.

Symptomatic staff with Salmonella should be restricted from working in food service until free of diarrhea for at least 24 hours.

*If a case of Salmonella typhi or paratyphi is identified in a child care center or school, please consult with your local or state health department. Each situation must be looked at individually to determine appropriate control measures to implement.

Diagnosis

Recommend parents/guardians call their healthcare provider if their child has symptoms of salmonellosis. There is a lab test to detect Salmonella in the feces.

Treatment

Antibiotic treatment is not usually given. Vomiting and diarrhea may lead to dehydration, which may be a medical emergency. Ask a healthcare provider how to prevent dehydration.

Prevention/Control

Regular and thorough handwashing is the best way to prevent the spread of communicable diseases. Wash hands thoroughly with soap and warm running water after using the toilet or changing diapers and before preparing or eating food. Staff should closely monitor or assist all children, as appropriate, with handwashing after children have used the bathroom or been diapered.
Animals can carry Salmonella. Chicks, ducklings, reptiles (e.g., pet turtles, iguanas, snakes), and amphibians commonly carry Salmonella and are not recommended for child care/school settings. Wash your hands after touching animals.
Clean and sanitize diapering area and potty chairs after each use and bathroom toilets, sinks, and toys at least daily and when soiled.
Clean and sanitize mouthed objects and surfaces at least daily and when soiled.
Food Safety
- Thoroughly cook all foods that come from animals, especially poultry.
- Store all uncooked meat and poultry in the refrigerator on a shelf lower than any other foods and keep separate from produce, cooked foods, and ready-to-eat foods.
- DO NOT serve unpasteurized milk or juices.
- Use pasteurized eggs and milk in food that will not be cooked.
- Wash and sanitize all cutting boards, knives, utensils, or dishes that have been used for raw meat or poultry before using with uncooked foods, such as fruits or vegetables, or cooked foods.
- Use a thermometer to make sure correct temperatures are reached when cooking foods. Check with the local environmental health agency for appropriate temperatures.
- Restrict students from sharing any communal food items that are brought from home. In the classroom, children should not serve themselves food items that are not individually wrapped. The teacher should hand out these items after washing his/her hands. (This is not intended to discourage family-style serving in the absence of an outbreak.)

Salmonellosis Parent Fact Sheet

Your child may have been exposed to:

Salmonellosis
Salmonellosis is a bacterial infection of the intestines.

If you think your child has Salmonellosis:

Tell your child care provider or call the school.
Need to stay home?
- Child Care and School:
  Yes, until free of diarrhea for at least 24 hours.

Symptoms

Your child may have diarrhea, cramps, headache, vomiting, or fever. Illness may last up to 7 days.

If your child is infected, it generally takes 6 to 72 hours for symptoms to start.

Spread

By eating or drinking contaminated food or beverages.
By touching contaminated hands, surfaces, or objects.
By handling chicks, ducklings, reptiles, and amphibians.

Contagious Period

The illness can spread as long as Salmonella bacteria are in the feces. This could be for several weeks.

Call your Healthcare Provider

If anyone in your home has symptoms. There is a medical test to detect the bacteria.
Ask how to prevent dehydration. Your child may become dehydrated due to vomiting or diarrhea.

Prevention

Wash hands after using the toilet or changing diapers, especially before preparing food or eating. Your child may need help with handwashing.
Clean and sanitize any objects that come in contact with feces. This includes toilets (potty chairs), sinks, toys, and diaper changing areas. Use a product that kills bacteria.
Animals can carry Salmonella. Chicks, ducklings, reptiles (e.g., pet turtles, iguanas, snakes), and amphibians commonly carry Salmonella. Wash your hands after touching animals.
Cook foods thoroughly and do not drink unpasteurized milk or juice.
Always sanitize food preparation surfaces.

Scabies

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Scabies is an infestation caused by tiny mites that burrow and lay eggs under the skin. If scabies has been reported in the child care or school setting, parents/guardians should check their child for a rash.

Cause

Sarcoptes scabiei, a mite.

Symptoms

Rash consisting of pink bumps or tiny blisters and intense itching, which may be more severe at night. Frequently only scratch marks can be seen. Common locations to see the rash are folds of skin between fingers, around wrists and elbows, and armpits. Other areas where rash may appear are knees, waist, thighs, genital area, abdomen, chest, breasts, and lower portion of buttocks. Infants and young children may be infested on head, neck, palms, and soles of feet.

Spread

By frequent or prolonged direct contact with the skin of a person with scabies (also during sexual contact) or by sharing bedding, towels, or underclothing of a person with scabies. Mites cannot survive off the human body for more than 3 days and cannot reproduce off the body.

Incubation

It takes 2 to 6 weeks from the time a person is exposed until symptoms appear.
Symptoms may appear in 1 to 4 days if the person has had scabies before.

Contagious Period

From the time a person acquires the mites (before rash appears) until 24 hours after treatment begins.

Exclusion

Child Care and School: Until 24 hours after treatment begins.

Diagnosis

Recommend parents/guardians call their healthcare provider if they suspect scabies in their household members. Skin scrapings should be examined to identify the mites.

Treatment

The healthcare provider will prescribe a medication, usually a cream or lotion.
There are several prescription scabicides. Directions must be followed carefully.

Itching and rash may not go away immediately after treatment. It often takes 2 to 3 weeks for rash and itching to go away.
It is recommended that household members are treated, particularly those with prolonged direct skin-to-skin contact. Other people to consider for treatment are the babysitter, boyfriend/girlfriend, and non-custodial parent.

Prevention/Control

Wash bedding and towels used in the past 48 hours in hot water and dry in a hot dryer at the time of treatment. Items that cannot be laundered should be sealed in a bag for one week.
Vacuum upholstered furniture and carpeting (if dealing with case(s) of Norwegian (encrusted) scabies). DO NOT use insecticide sprays.

Scabies Parent Fact Sheet

Your child may have been exposed to:

Scabies
Scabies is caused by tiny mites that live under the skin. Check your child for a rash.

If you think your child has Scabies:

Tell your child care provider.
Need to stay home?
- Child Care and School:
  Yes, until 24 hours after treatment begins.

Symptoms

Your child may itch the most at night. Look for a rash of pink bumps or tiny blisters. Sometimes, you can only see scratch marks. Common locations for the rash and itching are between fingers, around wrists and elbows, and armpits. Infants and young children may be infested on head, neck, palms, and bottoms of feet.

People without previous exposure may develop symptoms in 2 to 6 weeks. People who were previously infested are sensitized and may develop symptoms in 1 to 4 days.

Spread

By having repeated direct contact with the skin of a person with scabies.
By sharing bedding, towels, or clothing that was used by a person with scabies.

The mites cannot live off the human body for more than 3 days. They cannot reproduce off the body or on pets.

Contagious Period

From when a child gets the mites until 24 hours after treatment begins. A child is contagious before the rash.

Call your Healthcare Provider

If anyone in your home has symptoms. Your doctor may do a test and/or give a medication, usually a cream or lotion.
Even with treatment, it often takes 2 to 3 weeks for rash and itching to go away. Ask your doctor who in the household needs to be treated.

Prevention

At time of treatment, wash items used in the past 48 hours in hot water and put them in a hot dryer. Examples of things to wash are underwear, pajamas, bedding, and towels. Items that cannot be washed should be sealed in a plastic bag for one week.
Vacuum upholstered furniture and carpeting. DO NOT use insecticide sprays.

Shiga toxin-producing Escherichia coli (STEC) and Hemolytic Uremic Syndrome (HUS)

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Reportable to local or state health department

Consult the health department before posting/distributing Parent/Guardian fact sheet.

Cause

Shiga toxin-producing Escherichia coli bacteria

Symptoms

Watery or bloody diarrhea, stomach cramps, and low-grade fever. Some infected persons may have mild symptoms or no symptoms at all.

In some cases, people infected with STEC can develop HUS, which is a serious disease that affects the kidneys and the blood’s ability to clot. HUS is more common in children than in adults.

Spread

STEC bacteria leave the body through the feces of an infected person and enter another person when hands, food, objects (such as toys) contaminated with feces are placed in the mouth, or through contact with cattle or the farm environment. Cattle are a source of these bacteria. These bacteria can easily spread from person to person, especially from children in diapers.

Outbreaks have been linked to ground beef, exposure to animals in public settings including petting zoos, unpasteurized dairy products or fruit juices, raw fruits and vegetables, salami, yogurt, drinking water, and recreational water.

Incubation

For most E. coli strains is 10 hours to 6 days; for STEC, the incubation period usually is 3 to 4 days (range from 1 to 10 days) from exposure until symptoms develop.

Contagious Period

STEC bacteria can be transmitted as long as it is in the feces. STEC typically disappear from the feces by the time the illness is resolved, but may be shed for several weeks, even after symptoms go away. Young children tend to carry STEC longer than adults. A few people keep shedding these bacteria for several months.

Exclusion

Child Care: Until diarrhea has ceased for 24 hours, and two follow-up tests at the state public health laboratory obtained at least 24 hours apart have tested negative. Specimens should not be obtained earlier than 48 hours after discontinuation of antibiotics. Further requirements may be necessary during outbreaks.

The child care should be closed to new admissions during the outbreaks, and no transfer of exposed children to other centers should be allowed.

School: Until free of diarrhea for at least 24 hours. Further exclusion may be necessary during outbreaks.

No one with STEC should use swimming beaches, pools, water parks, spas, or hot tubs until 2 weeks after diarrhea has stopped.

Food service employees with STEC infection should be excluded from working in food service. An employee may return to work once they are free of the STEC infection based on test results showing 2 consecutive negative stool specimens that are taken at least 24 hours after diarrhea ceases, not earlier than 48 hours after discontinuation of antibiotics, and at least 24 hours apart; or the food employee may be reinstated once they have been asymptomatic for more than 7 calendar days.

Outbreaks: Screenings should be conducted by the Missouri State Public Health Lab.

Other restrictions may apply; call your local/state health department for guidance.

Diagnosis

Recommend parents/guardians call their healthcare provider if their child has symptoms of STEC or HUS.

Treatment

Diarrhea caused by STEC usually goes away after a few days without any treatment. Antibiotics and drugs to stop diarrhea are usually not recommended because they may actually increase the likelihood of HUS. Treatment of HUS usually requires hospitalization and often dialysis (artificial kidney) and blood or platelet transfusions. Vomiting and diarrhea may lead to dehydration, which may be a medical emergency.

Prevention/Control

Regular and thorough handwashing is the best way to prevent the spread of communicable diseases. Wash hands thoroughly with soap and warm running water after using the toilet and changing diapers and before preparing or eating food. Staff should closely monitor/assist handwashing of all children, as appropriate, after they have used the bathroom or have been diapered.
Restrict students from sharing any communal food items that are brought from home. In the classroom, children should not serve themselves food items that are not individually wrapped. The teacher should hand out these items after washing his/her hands. (This is not intended to discourage family- style serving in the absence of an outbreak.)
Avoid having contact with cattle, particularly calves, at a petting zoo or farm. Wash hands thoroughly with soap and warm running water after touching any animals.
Clean and disinfect diapering area and potty chairs after each use and bathroom toilets, sinks, and toys at least daily and when soiled.
Clean and sanitize mouthed objects and surfaces at least daily and when soiled.
Food Safety
- Thoroughly cook all hamburger or ground beef until it is brown, not pink, inside and the juices are clear. Heat kills the bacteria. Use a thermometer to ensure that the internal temperature of the meat is at least 155 o F.
- DO NOT drink unpasteurized milk or fruit juices.
- Wash and disinfect all cutting boards, knives, utensils, or dishes that have been used for raw meat before using with uncooked foods, such as fruits or vegetables, and cooked foods.

STEC Parent Fact Sheet

Your child may have been exposed to:

STEC
Shiga Toxin-Producing Escherichia Coli (STEC) Infection can cause a bacterial infection of the intestines.

If you think your child has STEC:

Tell your child care provider and call the school.
Need to stay home?
- Child Care:
  Yes, until diarrhea has ceased for 24 hours, and two follow-up tests at the state public health laboratory obtained at least 24 hours apart have tested negative.
  
  School:
  Yes, until free of diarrhea for at least 24 hours.

Symptoms

Your child may have watery or bloody diarrhea, stomach cramps, and fever. Most people get better within 5-7 days. Some infections are very mild, but others may result in life- threatening complications such as Hemolytic Uremic Syndrome (HUS).

If your child is infected with STEC, it may take 1 to 10 days for symptoms to start.

Spread

By eating or drinking contaminated food or beverages.
By touching contaminated hands, surfaces, or objects.
By handling pets and farm animals.

Contagious Period

Call your Healthcare Provider

If anyone in your home is suspected of having STEC.
Ask how to prevent dehydration. Your child may become dehydrated due to vomiting and diarrhea.

Prevention

Wash hands after using the toilet and changing diapers and before preparing food or eating. Your child may need help with handwashing.
Clean and disinfect any objects that come in contact with feces. This includes toilets (potty chairs), sinks, toys, and diaper changing areas. Use a product that kills bacteria.
Farm animals (especially cattle and calves) can carry STEC. Wash your hands after touching pets and farm animals.
Cook food thoroughly and do not drink unpasteurized milk or juice. Always sanitize food preparation surfaces.
Anyone with STEC should not use swimming beaches, pools, water parks, spas, or hot tubs until 2 weeks after the diarrhea has stopped.

Shigellosis

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Reportable to local or state health department

Consult the health department before posting/distributing Parent/Guardian fact sheet.

Cause

Shigella bacteria.

Symptoms

Diarrhea (may be watery), fever, stomach cramps, nausea, or vomiting. Feces may contain blood or mucus. Infected persons may have mild symptoms or may not have any symptoms at all. Illness usually lasts 4 to 7 days.

Spread

Shigella bacteria leave the body through the feces of an infected person. Spread can occur when people do not properly wash their hands after using the toilet or changing diapers. If not removed by good handwashing, the Shigella bacteria may contaminate food or objects (such as toys) and infect another person when the food or object is placed in that person’s mouth. Spread can occur whether or not an infected person feels sick.

Incubation

It takes from 1 to 7 days, usually 2 to 4 days, from the time a person is exposed until symptoms start.

Contagious Period

As long as Shigella bacteria are present in the feces, a person can pass the bacteria on to other people. For some children, the bacteria can be found in the feces up to 4 weeks after illness.

Exclusion

Child Care: Children and staff with diarrhea should be excluded from child care until they are well. The child care should be closed to new admissions during the outbreaks, and no transfer of exposed children to other centers should be allowed. Shigellosis is transmitted easily and can be severe, so all symptomatic persons (employees and children) should be excluded from child care setting in which Shigella infection has been identified, until diarrhea has ceased for 24 hours, and one (1) stool culture is free of Shigella spp. Specimens should not be obtained earlier than 48 hours after discontinuation of antibiotics. Antimicrobial therapy is effective in shortening the duration of diarrhea and eradicating organisms from feces.

School: Until free of diarrhea for at least 24 hours. Further exclusion may be necessary during outbreaks.

No one with Shigella should use swimming beaches, pools, spas, water parks, or hot tubs until 1 week after diarrhea has stopped.

Food service employees infected with Shigella bacteria should be excluded from working in food service. An employee may return to work once they are free of the Shigella infection based on test results showing two (2) consecutive negative stool cultures that are taken at least 24 hours after diarrhea ceases, not earlier than 48 hours after discontinuation of antibiotics, and at least 24 hours apart; or the food employee may be reinstated once they have been asymptomatic for more than 7 calendar days.

Outbreaks:

Screenings should be conducted by the Missouri State Public Health Lab.

Other restrictions may apply; call your local/state health department for guidance.

Diagnosis

Recommend parents/guardians call their healthcare provider if their child has symptoms of shigellosis. There is a lab test to detect Shigella in the feces.

Treatment

If Shigella bacteria are found, antibiotic treatment is available. Children and staff in child care settings should be treated. Shigella bacteria can be resistant to one or more antibiotics, so physicians should test to see which antibiotics are effective. Vomiting and diarrhea may lead to dehydration, which may be a medical emergency. Ask a healthcare provider how to prevent dehydration.

Prevention/Control

Regular and thorough handwashing is the best way to prevent the spread of communicable diseases. Wash hands thoroughly with soap and warm running water after using the toilet or changing diapers and before preparing or eating food. Staff should closely monitor or assist all children, as appropriate, with handwashing after children have used the bathroom or been diapered.
Restrict students from sharing any communal food items that are brought from home. In the classroom, children should not serve themselves food items that are not individually wrapped. The teacher should hand out these items after washing his/her hands. (This is not intended to discourage family-style serving in the absence of an outbreak.)
DO NOT allow children to swallow water when swimming in lakes, swimming pools, hot tubs, water parks, or fountains.
Clean and sanitize diapering area and potty chairs after each use and bathroom toilets and sinks at least daily and when soiled.
Clean and sanitize mouthed objects and surfaces at least daily and when soiled.

Shigellosis Parent Fact Sheet

Your child may have been exposed to:

Shigellosis
Shigellosis is a bacterial infection of the intestines.

If you think your child has Shigellosis:

Tell your child care provider or call the school.
Need to stay home?
- Child Care:
  Yes, until the child has been free of diarrhea for at least 24 hours and one stool culture is negative.
  
  School:
  Yes, until free of diarrhea for at least 24 hours.

Symptoms

Your child may have diarrhea (may be watery and/or contain blood or mucus), stomach cramps, nausea, vomiting, or fever. Illness may last 4 to 7 days.

If your child is infected, it may take 1 to 7 days for symptoms to start.

Spread

By eating or drinking contaminated food or beverages.
By touching contaminated hands, surfaces, or objects.

Contagious Period

The illness can spread as long as Shigella bacteria are in the feces. This could be for up to 4 weeks.

Call your Healthcare Provider

If anyone in your home has symptoms. There is a medical test to detect the bacteria. Antibiotic treatment is available.
Ask how to prevent dehydration. Your child may become dehydrated due to vomiting and diarrhea.

Prevention

Wash hands after using the toilet or changing diapers and before preparing food or eating. Your child may need help with handwashing.
Clean and sanitize any objects that come in contact with feces. This includes toilets (potty chairs), sinks, toys, and diaper changing areas. Use a product that kills bacteria.
No one with shigellosis should use swimming beaches, pools, water parks, spas, or hot tubs until 1 week after the diarrhea has stopped.

Shingles (Zoster)

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Shingles (zoster) is caused by the varicella-zoster virus that remains inactive (dormant) in the body of people who have had chickenpox (varicella). You get shingles from your own chickenpox virus, not from someone else. This usually occurs when the immune system is weakened for various reasons, including certain illnesses or conditions, or treatments, or aging. Although shingles usually occurs in adulthood, children who were infected with varicella in utero or during infancy may develop shingles during childhood.

Cause

Varicella-zoster virus, a member of the herpesvirus family.

Symptoms

Severe pain, itching, and numbness along certain nerve pathways, commonly involving one side of the body. About 1 to 3 days later, a red rash appears at the site. Clusters of blisters appear soon after, usually on one side of the body and closer together than in chickenpox. The blisters dry out and crust over within a few days. The rash and pain usually disappear within 3 to 5 weeks.

Shingles is a milder illness in children than in adults, but it can be a serious illness in those who have weakened immune systems.

Spread

A person must have already had chickenpox disease in the past to develop shingles. Shingles does not spread from one person to another as shingles. When people who have not had chickenpox have contact with the fluid from the shingles blisters, they can develop chickenpox.

Incubation

None.

Contagious Period

In an otherwise healthy person, from the start of the rash until all the blisters have crusted.

Exclusion

Child Care and School: None, if blisters can be completely covered by clothing or a bandage. If blisters cannot be covered, exclude until the blisters have crusted.
Persons with severe, disseminated shingles should be excluded regardless of whether the sores can be covered.

Treatment

Antiviral medications may be prescribed.

Do not give aspirin or salicylate-containing medications to any child or adolescent under 18 years of age.

Prevention/Control

Pregnant women or persons with weakened immune systems who have not had chickenpox and are exposed to shingles virus should call their healthcare provider immediately for possible treatment. Vaccine is contraindicated during pregnancy. (See Section 1 for information on varicella-zoster and pregnancy.)
Thorough handwashing is the best way to prevent the spread of communicable diseases. Wash hands thoroughly with soap and warm running water after contact with fluid from blisters or sores.
Susceptible persons (those who have not had chickenpox or varicella vaccine in the past) who have been exposed to someone with shingles should call their healthcare provider immediately to prevent chickenpox. Getting varicella vaccine within 3 days, and possibly up to 5 days, of exposure may prevent chickenpox in these people.
Clean and disinfect all objects and surfaces contaminated with blister fluid at least daily and when soiled.

Shingles Parent Fact Sheet

Your child may have been exposed to:

Shingles
Shingles (zoster) is caused by the varicella-zoster virus that remains in the body after a child has chickenpox (varicella).

If you think your child has Shingles:

Tell your child care provider or call the school.
Need to stay home?
- Child Care and School:
  No, if blisters can be covered with clothing or bandage.
  Yes, if blisters cannot be covered by clothing or bandages, until the blisters have crusted.
  Persons with severe, disseminated shingles should be excluded regardless of whether the sores can be covered.

Symptoms

At first, your child may have a lot of pain and itching. Numbness is common around the trunk or on the face. A red rash appears about 1 to 3 days later. Next, clusters of blisters appear. They are usually on one side of the body. The blisters crust over within a few days.

The rash and pain usually disappear in 3 to 5 weeks.

Spread

Shingles does not spread from person-to-person as shingles. If someone who has not had chickenpox in the past touches the fluid from the shingles blisters they may get chickenpox.

Contagious Period

From 1 to 2 days before the rash to crusting of all lesions.

Call your Healthcare Provider

If anyone in your home:

has symptoms. Treatment may be available.
was exposed to shingles and has not had chickenpox or the chickenpox (varicella) vaccine in the past or is pregnant.

Prevention

Wash hands after contact with fluid from blisters or sores. Your child may need help with handwashing.
Cover blisters with clothing or bandages.

Staph Skin Infection

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Staphylococcus aureus (S. aureus or staph) bacteria can commonly be found in the nose and on the skin of healthy people. When staph is present on or in the body without causing illness, it is called colonization. Because staph is so often present on skin, it is the leading cause of skin and soft tissue infections. Over time, 20% of the population will almost always be colonized with S. aureus, 60% of the population will be colonized with S. aureus off and on, and another 20% are almost never colonized.

Cause

Staphylococcus aureus bacteria.

Symptoms

Local redness and warmth of the infected area with or without pus. Examples of localized infections are boils, impetigo, wound infections, and infections of hair follicles (folliculitis). Such infections can result in a pustule (bump on the skin filled with pus) that can become reddened, hard, and painful. Most infections are uncomplicated, but the bacteria can get into the bloodstream and other body sites and cause severe illness.

Spread

By contact with hands, skin drainage, or secretions from the nose of a person who is infected or colonized.

Incubation

Variable. A long delay may occur between colonization with staph and when the symptoms of infection begin.

Contagious Period

As long as infection or colonization lasts. Persons who have draining infections are shedding more bacteria and are more infectious than persons who are only colonized.

Exclusion

Child Care and School: If draining sores are present and cannot be completely covered and contained with a clean, dry bandage or if the person cannot maintain good personal hygiene.

Children who are only colonized do not need to be excluded.

Activities: Children with draining sores should not participate in activities where skin-to-skin contact is likely to occur until their sores are healed. This means no contact sports.

Treatment

Children with skin infections need to be referred to a licensed healthcare provider for diagnosis and treatment. Child care/school personnel should notify parents/guardians when possible skin infections are detected.

Some strains of staph have developed resistance to some antibiotics. Such strains are known as methicillin-resistant Staphylococcus aureus or “MRSA.” (See MRSA fact sheet)

Prevention/Control

Regular and thorough handwashing is the best way to prevent the spread of communicable diseases. Wash hands thoroughly with soap and warm running water after touching body secretions or skin drainage of an infected or colonized person.
Wear disposable medical gloves when touching any draining sores or changing bandages.
Have persons who are prone to staph skin infections do self-care, if age appropriate. They should take care to keep their skin clean and dry and do first aid care when an injury (cut, scrape, etc.) occurs.
Keep wounds clean and covered with a bandage.
Dispose of bandages in a plastic bag immediately to prevent contamination of surfaces. Close the plastic bag and dispose in the trash.
DO NOT allow sharing of personal items such as towels, washcloths, bar soap, combs, razors, or clothing.
Wash bedding (linens) separately from other laundry in hot water with detergent. Dry bedding in a hot dryer.
Clean and disinfect contaminated surfaces or objects daily or when soiled.
Food handlers with open sores should wear waterproof disposable gloves and wash their hands routinely.

Staph Infection Parent Fact Sheet

Your child may have been exposed to:

Staph Infection
Staphylococcus aureus (S. aureus or staph) bacteria are the leading cause of skin and soft tissue infections.

If you think your child has a Staph Infection:

Tell your child care provider or call the school.
Need to stay home?
- Child Care and School:
  Yes, if draining sores cannot be completely covered and contained with a clean, dry bandage.
  No, if child is only colonized.
  Activities:
  Avoid activities where skin-to-skin contact is likely to occur until sores are healed. This means no contact sports.

Symptoms

Your child may have infected areas that are red and warm with or without pus. Examples are boils, impetigo, wound infections, and infections of hair follicles. Sometimes the staph bacteria can get into the bloodstream and other body sites and cause severe illness.

Your child may have staph bacteria “colonized” in the nose or on skin. This means that the bacteria may be there but it does not cause infection or harm.

If your child is infected, the time it will take for symptoms to start will vary by type of infection.

Spread

By touching contaminated hands, skin drainage, pus, or secretions from the nose.

Contagious Period

As long as the infection or colonization is present. A child who has draining infections has more bacteria and is more contagious than a child who is only colonized.

Call your Healthcare Provider

If anyone in your home has symptoms. Your doctor will decide what treatment is needed.

Prevention

Wear disposable gloves when changing bandages. Wash hands after you touch any draining sores or change bandages. Your child may need help with handwashing.
Keep wounds clean, dry, and covered with a bandage. Put used bandages in a plastic bag, close the plastic bag, and put it in the trash.
Avoid sharing personal items such as washcloths, bar soap, combs, razors, or clothing.
If possible, people with staph infections should do their own first aid on cuts/scrapes. This prevents spread to others.
Keep contaminated laundry separate from other laundry. Wash clothes, bed sheets, and blankets in hot water with detergent and dry in a hot dryer.
Clean and disinfect contaminated surfaces or objects. Use a disinfectant that kills Staphylococcus aureus bacteria.

Streptococcal Infection (Strep Throat/Scarlet Fever)

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

(Strep Throat/Scarlet Fever)

Streptococcal sore throat (strep throat) and a strep throat with a rash (scarlet fever) are common infections in children.

Cause

Streptococcus bacteria (Group A beta-hemolytic strep).

Symptoms

Strep throat - Starts suddenly with fever, red sore throat, and swollen glands. Headache may occur. Nausea, abdominal pain, and vomiting may be more common in children.
Scarlet fever - A very fine raised rash (feels like sandpaper) is present. The rash blanches with pressure. The rash appears most often on the neck, chest, elbow, and groin, and in the inner thigh and folds of the armpit. Later on, there may be peeling of the skin on the fingertips and toes.

These illnesses are usually not serious; however, rare problems such as rheumatic fever (which can damage heart valves) or kidney disease may develop if children do not receive proper antibiotic treatment.

Spread

Coughing or sneezing tiny droplets into the air and another person breathes them in.

Incubation

It usually takes 2 to 5 days from the time a person is exposed until symptoms start.

Contagious Period

Until 12 hours after antibiotic treatment begins.

Exclusion

Child Care and School: Until 24 hours after antibiotic treatment begins and the child is without fever.

Children without symptoms, regardless of a positive throat culture, do not need to be excluded from child care or school. Persons who have strep bacteria in their throats and do not have any symptoms (carriers) appear to be at little risk of spreading infection to those who live, go to child care or school, or work around them.

Check with your local environmental health department to see if people with skin lesions need to be excluded from food handling.

Diagnosis

Recommend parents/guardians call their healthcare provider. Strep may be identified in the throat either by using a rapid strep test, which can provide results the same day, or by throat culture.

Treatment

Oral or injectable antibiotics may be prescribed. Treatment may be dependent on how severe the infection is and will help prevent more serious illness such as rheumatic fever.

Prevention/Control

Cover nose and mouth when coughing or sneezing or cough/sneeze into your sleeve. Dispose of used tissues.
Regular and thorough handwashing is the best way to prevent the spread of communicable diseases. Wash hands thoroughly with soap and warm running water after contact with secretions from the nose or mouth.
Clean and sanitize mouthed objects and surfaces at least daily and when soiled.
Recommend a new toothbrush for the person with strep after they are no longer contagious.

Strep Throat Parent Fact Sheet

Your child may have been exposed to:

Strep Throat
Strep throat and a strep throat with a rash (scarlet fever) are common bacterial infections in children.

If you think your child has Strep Throat:

Tell your child care provider or call the school.
Need to stay home?
- Child Care and School:
  Yes, until 24 hours after antibiotic treatment begins and fever is gone.
  Children who test positive for strep but do not show symptoms do not need to be excluded. They are unlikely to spread the infection to other people.

Symptoms

Strep throat - Your child may have a fever that starts suddenly, red sore throat, and swollen glands.
Headache may occur. Children may have stomach pain and vomiting.

Scarlet fever - Rarely, a very fine raised rash appears at the same time as the throat soreness. The rash feels like sandpaper. The rash is most often on the neck, chest, elbow, and groin and in the inner thigh and folds of the armpit. Later on, the skin on the fingertips and toes may peel.

If your child is infected, it may take 2 to 5 days for symptoms to start.

Spread

By coughing or sneezing.

Contagious Period

Until 24 hours after antibiotic treatment begins.

Call your Healthcare Provider

If anyone in your home has symptoms. A doctor may do a lab test and give antibiotics.

Prevention

Cover nose and mouth when coughing or sneezing. Use a tissue or your sleeve. Dispose of used tissues.
Wash hands after touching anything that could be contaminated with secretions from the nose or mouth. Your child may need help with handwashing.
Never share drink containers and cups or silverware. Wash all dishes with hot soapy water between uses.
Clean and disinfect any objects that come in contact with the nose or mouth (especially mouthed toys). Use a product that kills bacteria.

Tick-Borne Disease

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Reportable to local or state health departments

This fact sheet is for provider information only.
If you have questions, please call the health department.

Disease	Tulameria	Spotted Fever Rickettsioses	Lyme/Lyme-Like	Ehlichiosis	Anaplasmosis
Symptoms	high fever, chills, myalgia, headache, non-healing tick bite, swollen glands	fever, chills, myalgia, severe headache, anorexia, spotted rash	fever, malaise, headache, myalgia, arthralgia, mild neck stiffness, bull’s eye rash	fever, headache, chills, rigors, fatigue, muscle aches, arthralgia	fever, headache, chills, rigors, fatigue, muscle aches, arthralgia
Cause	Francisella tularensis	Rickettsia rickettsii	Lyme: Borrelia burgdorferi Lyme-Like: Unknown	Ehrlichia chaffeensis & E. ewingii	Anaplasma phagocytophilum
Incubation	3-5 days with a range of 1- 21 days	7 days with a range of 3-12 days	3-32 days with a median of 11 days	5-14 days with a median of 9 days	5-14 days with a median of 9 days

Tick Involved	Tulameria	Spotted Fever Rickettsioses	Lyme/Lyme-Like	Ehlichiosis	Anaplasmosis
American Dog tick: Dermacentor variabilis	yes	yes	-	-	-
Lone star tick: Amblyomma americanum	yes	-	-	yes	no
Black legged tick or deer tick: Ixodes scapularis	-	-	yes	no	yes

Spread

Each disease is spread by the bite of a tick or contact with tick blood or feces.

Tularemia is also spread by infected meat and blood of animals such as rabbits and cat bites. For more information about each of the above diseases see the CDC website. Click on the appropriate letter and follow the links.

Follow tick precautions: Wear light colored clothing, wear insect repellants, and do tick check of the full body every night after being in tick infested areas.

Contagious Period

None. They are not spread person-to-person.

Exclusion

Child Care and School: None.

Diagnosis

Recommend parents/guardians call their healthcare provider if symptoms of any of the tick-borne diseases are present. Tick attachments may not be apparent. Rashes may not be present or may be delayed. Blood tests are available but may not be specific. The Centers for Disease Control and Prevention recommends that confirmation testing be done in addition to the screening test to ensure more accurate results.

Treatment

Each disease can be treated with antibiotics. Treatment works best if it is started early. Discuss treatment options with the healthcare provider.

Prevention/Control

Children should not handle sick or dead animals, both domestic pets and wild animals.
Game meats should be cooked thoroughly.
Avoid tick-infested areas, especially from April through September.
Wear proper clothing when in endemic areas. Wear long pants, tuck pants into socks, wear a long sleeved shirt tucked into pants, and wear light-colored clothing so ticks are easier to see.
Check for ticks on clothing and entire body while outdoors and when returning indoors. Check pets for ticks before letting them indoors.
Remove ticks promptly. See the CDC website. Always grasp the tick by the head or mouth parts and gently but steadily pull straight back. Squeezing the body may cause the tick to inject infected saliva or blood. Do not use petroleum jelly, nail polish, or burning matches to remove ticks.
Apply insect repellants with 20% - 50% DEET on skin and clothing.
Children 2 months and older, use a repellant with 30% DEET or less.

Tuberculosis (TB)

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Reportable to local or state health department

This fact sheet is for provider information only.
If you have questions, please call the health department.

Tuberculosis (TB) is an infection that usually affects the lungs, but can affect any part of the body. TB can be life-threatening, but it is curable with antibiotic medications.

Cause

Mycobacterium tuberculosis bacteria.

Symptoms

General symptoms of active TB disease may include feeling tired or sick, weight loss, fever, or night sweats. When active TB disease is in the lungs, there may be cough, chest pain, and possibly coughing up blood. Symptoms often develop gradually and worsen until treatment is started. If TB is elsewhere in the body, there may be other symptoms.

Spread

When someone with TB disease in their lungs coughs, sneezes, yells, or sings, tiny droplets with Mycobacterium tuberculosis are released into the air and another person breathes in these droplets. Most healthy people who become infected with TB bacteria develop latent TB infection and have no symptoms.

Incubation

The incubation period from infection to development of a positive Tuberculin Skin Test (TST) or Interferon Gamma Release Assay (IGRA) (blood test) result is 2 to 10 weeks. The risk of developing tuberculosis disease is highest during the 6 months after infection and remains high for 2 years; however, many years can elapse between initial tuberculosis infection and tuberculosis disease.

Contagious Period

Only active TB disease of the lungs or voice box (larynx) is contagious. The contagious period varies from person to person, but usually from when the symptoms begin until the person has completed several weeks of adequate treatment and had significant clinical response to therapy and had 3 consecutive negative sputum smear results. For MDR and XDR tuberculosis consult your state or local health department. TB disease in other parts of the body is usually not contagious. Young children, who lack capacity to cough forcefully, typically are not as contagious as adults.

Exclusion

A person with a newly positive tuberculin skin test (TST) or interferon gamma release assay (IGRA) should see a healthcare provider as soon as possible after the positive test is detected for further evaluation and possible treatment. Consult with your local or state health department immediately. Each situation must be evaluated individually to determine whether the person is contagious and poses a risk to others. Latent tuberculosis infection and tuberculosis disease are reportable conditions in Missouri.

Diagnosis

Tuberculosis is diagnosed based on signs and symptoms, physical exam, TST/IGRA results, chest x-ray (if indicated), and laboratory exam of material obtained from cough specimens, other body fluids, or tissues.

Treatment

Active tuberculosis disease is treated with multiple antibiotic medications for a minimum of 6 months or as long as 2 years. Latent TB infection is usually treated with a single antibiotic medication for 9 months to prevent the development of active TB disease.

Prevention/Control

Tuberculosis testing is not universally recommended for Missouri children, including those attending child care.
Persons exposed to active, infectious TB disease should have a TST or IGRA performed. If the first TST is negative, another TST may be needed to determine if infection has developed.

Viral Meningitis

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Consult the health department before posting/distributing Parent/Guardian fact sheet.

Viral meningitis is an infection of the meninges (a thin lining covering the brain and spinal cord) and is caused by any one of a number of different viruses. It occurs most often in children; however, anyone can get viral meningitis. Almost all of the cases occur as single, isolated events.

Cause

Enteroviruses cause most (about 90%) of the cases in the United States.
Occasionally, viral meningitis is also associated with mumps or herpes virus infections. Illnesses caused by enteroviruses (e.g., coxsackie viruses, echoviruses) usually occur in the summer and early fall. Arboviruses, which are carried by mosquitoes, typically cause encephalitis, but can also cause viral meningitis.

Symptoms

Start suddenly with fever, headache, stiff neck, fatigue, and rash. Sore throat, nausea, vomiting, and diarrhea may also occur. In babies symptoms are harder to identify. They may include fever, fussiness or irritability, difficulty walking, or refusing to eat.

Spread

Enteroviruses are spread by touching feces or touching secretions from the nose or mouth of an infected person. Spread may also be possible when touching objects or surfaces contaminated with feces or secretions from the nose or mouth. Most people who are exposed to enteroviruses will not get viral meningitis.

Incubation

Usually within one week from the time a person is exposed until symptoms appear, but could range from 2 to 21 days, depending on the virus.

Contagious Period

Varies depending on the organism causing the infection. For enteroviruses: Beginning 3 days after being infected until 10 days after symptoms start and possibly for several weeks after illness (through contact with feces).

Exclusion

Child Care: Until fever is gone or diarrhea has stopped and the child is well enough to participate in routine activities.

School: None, if the child is well enough to participate in routine activities.

Diagnosis

Often the symptoms of viral meningitis and bacterial meningitis (meningococcal disease) are similar. While viral meningitis is rarely fatal, bacterial meningitis can be very serious and result in disability or death if not treated promptly. A healthcare provider will make the diagnosis based on clinical symptoms or may perform lab tests.

Treatment

Recommend parents/guardians call their healthcare provider.

Prevention/Control

Cover nose and mouth when coughing or sneezing or cough/sneeze into your sleeve. Dispose of used tissues.
Regular and thorough handwashing is the best way to prevent the spread of communicable diseases. Wash hands thoroughly with soap and warm running water after using the toilet, changing diapers, handling anything soiled with feces, and contact with secretions from the nose or mouth and before preparing food or eating.
DO NOT allow sharing of eating utensils (forks, spoons) and drinking containers (cups, glasses).
Clean and sanitize mouthed objects and surfaces at least daily and when soiled. Clean and sanitize dishes and silverware after every use.
Clean and disinfect diapering area and potty chairs after each use and bathroom toilets, sinks, and toys at least daily and when soiled.

Viral Meningitis Parent Fact Sheet

Your child may have been exposed to:

Viral Meningitis
Viral meningitis affects the thin lining covering the brain and spinal cord. It is usually caused by enteroviruses.

If you think your child has Viral Meningitis:

Tell your child care provider or call the school.
Need to stay home?
- Child Care:
  Yes, until fever and/or diarrhea is gone and your child is healthy enough for routine activities.
  School:
  No, if the child is healthy enough to participate in routine activities.

Symptoms

Your child may be unusually tired and suddenly have a fever, headache, stiff neck and/or rash. Other symptoms may be sore throat, diarrhea, and vomiting.

It is hard to tell if babies have viral meningitis. Babies with the virus may have a fever. They may also be fussy, refuse to eat, or be difficult to wake.

If your child is infected, it may take from 2 to 21 days for symptoms to start. It usually takes 7 days.

Spread

By sneezing or coughing.
By touching contaminated hands, surfaces or objects. Feces from infected people can also carry the bacteria.

Contagious Period

For 3 days before until 10 days after symptoms start. Virus may be in the feces for several weeks.

Call your Healthcare Provider

If anyone in your home has symptoms. Your doctor may want to test for the virus.

Prevention

Cover nose and mouth when sneezing or coughing. Use a tissue or your sleeve. Dispose of used tissues.
Wash hands after touching anything that could be contaminated with the secretions from the mouth or nose or with feces. Your child may need help with handwashing.
DO NOT share drink containers and cups or silverware. Wash all dishes with hot soapy water between uses.
Clean and sanitize anything that comes in contact with secretions from the nose or mouth or with feces. This includes toilets (potty chairs), sinks, toys, and diaper changing areas. Use a product that kills viruses.

Warts

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Warts are skin growths caused by a virus. Common and flat warts occur most often in younger children and plantar warts in school-aged children.

Cause

Human papillomavirus.

Symptoms

Common - Dome-shaped and have a rough appearance. They usually grow on the fingers, on the backs of the hands, and around the nails but may be more common where skin is broken (e.g., bitten fingernails or picked hangnails). Black dots in a wart are produced by broken blood vessels.

Plantar (foot) - Usually seen on the bottoms of the feet. Most of these warts flatten because the pressure of walking pushes them back into the skin. They can be very painful. They may also have black dots.

Flat - Smaller and smoother than other warts. They tend to grow in large numbers (20 to 100) at a time and can grow anywhere. However, in children they are most common on the face. They are found in the beard area of men and on the legs of women.

Spread

Passed from person-to-person, sometimes indirectly from contaminated objects, such as locker room floors, showers, or pool decks. The virus more easily enters the body through an area of skin that is moist, peeling, or cracked.

Incubation

It can take from several months to years for symptoms to begin.

Contagious Period

Unknown; probably as long as the wart is present.

Exclusion

Child Care and School: None.

Diagnosis

Recommend parents/guardians call their healthcare provider.

Treatment

Based on the type of wart.

Prevention/Control

Discourage children from biting their nails or picking their hangnails.
Encourage students to do basic first aid when they have an injury (e.g., cut or scrape), if appropriate for age group.
Encourage children to wear shower shoes (e.g., flip-flops or water sandals) in locker rooms and showers or on pool decks.
DO NOT allow sharing personal items such as razors or nail clippers.

Warts Parent Fact Sheet

Your child may have been exposed to:

Warts
Warts are skin growths caused by a virus. Common and flat warts are seen most often in younger children and plantar warts in school-aged children.

If you think your child has Warts:

Tell your child care provider or call the school.
Need to stay home?
- Child Care and School:
  No.

Symptoms

Common - Dome-shaped and have a rough appearance. Check the fingers, on the backs of the hands, and around the nails. They may be more common where a child has bitten fingernails or picked hangnails.

Plantar (foot) - Usually seen on the bottoms of the feet. Most of these warts flatten because the pressure of walking pushes them back into the skin. They can be very painful.

Flat - Smaller and smoother than other warts. They tend to grow in large numbers (20 to 100) at a time. They can grow anywhere on the body.

If your child is infected, it may take several months to years before symptoms start.

Spread

From person to person.
By touching contaminated objects, such as locker room floors, showers, or pool decks.

Contagious Period

Probably as long as the wart is present.

Call your Healthcare Provider

Your doctor will decide if treatment is needed.

Prevention

Avoid biting your nails or picking your hangnails. Keep nails trimmed.
Take care to keep feet and hands clean and dry. Do basic first aid when an injury (cut, scrape, etc.) occurs.
Wear shoes like flip-flops or water sandals in locker rooms and showers or on pool decks.
Avoid sharing personal items such as razors.
Clean and disinfect contaminated areas. Use a product that kills viruses.

Yeast Infection (Candidiasis)

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Candida can normally be found on the skin and in the mouth, throat, intestinal tract, and vagina of healthy people. In children, yeast infections are commonly found in the mouth or throat (thrush) or the diaper area.

Cause

Candida albicans, a fungus

Symptoms

Thrush - White, slightly raised patches on the tongue or inside the cheek. Smooth, shiny "fire engine" red rash with a raised border.
Diaper Rash - Children who suck their thumbs or fingers may occasionally develop Candida infections around their fingernails

Under certain conditions, such as during antibiotic use or when skin is damaged and exposed to excessive moisture, the balance of the normal, healthy skin bacteria is upset. Therefore, yeast that normally lives on the skin can overgrow and cause yeast infections. Most of the time these infections heal quickly, but sometimes illness can occur in infants, persons with weakened immune systems, or those taking certain antibiotics.

Spread

Rarely, by contact with skin lesions and mouth secretions of infected persons or asymptomatic carriers. Most infants who have Candida got it from their mother during childbirth.

Incubation

Variable. For thrush in infants, it usually takes 2 to 5 days. For others, yeast infections may occur while taking antibiotics or shortly after stopping the antibiotics.

Contagious Period

Contagious while lesions are present. Most infections occur from yeast in the person’s own body.

Diagnosis

Recommend parents/guardians call their healthcare provider to identify the fungus.

Exclusion

Child Care and School: None.

Treatment

Anti-fungal medication may be prescribed.

Prevention/Control

Regular and thorough handwashing is the best way to prevent the spread of communicable diseases. Wash hands thoroughly with soap and warm running water after contact with secretions from the mouth or nose or the skin in the diaper area.
Minimize contact with secretions from the nose or mouth of infected persons.
Dispose of used tissues.
Clean and sanitize mouthed objects and surfaces at least daily and when soiled.
Clean and sanitize bottle nipples and pacifiers daily.
Recommend parents/guardians replace bottle nipples and pacifiers after treatment.

Yeast Parent Fact Sheet

Your child may have been exposed to:

Yeast
Yeast is a fungus that can cause infection. It is common to have yeast infections of the mouth or throat (thrush) or the diaper area (diaper rash).

If you think your child has a Yeast Infection:

Tell your child care provider or call the school.
Need to stay home?
- Child Care and School:
  No.

Symptoms

Thrush - White, slightly raised patches on the tongue or inside the cheek. Sucking on fingers or thumbs may cause children to develop the infection around the fingernails.

Diaper Rash - Smooth, shiny, red rash with a raised border.

Spread

Rarely, by touching skin lesions or secretions from the mouth.

Contagious Period

The illness can spread as long as sores are present.

Call your Healthcare Provider

If anyone in your home has symptoms of thrush or diaper rash.

Prevention

Wash hands after touching anything that could be contaminated with secretions from the nose or mouth and after changing diapers. Your child may need help with handwashing.
Clean and disinfect objects that come in contact with secretions from the mouth or nose and diaper area. Use a product that kills fungus.
Replace bottle nipples and pacifiers after treatment.

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Communicable Disease Fact Sheets How and When to Use

Table of Contents

On this page

Bed Bugs

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Cause

Symptoms

Spread

Signs of Bed Bugs

Exclusion

Treatment

Prevention/Control

Table of Contents

On this page

Bronchitis, Acute (Chest Cold)/Bronchiolitis

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Bronchitis, Acute (Chest Cold)/Bronchiolitis

Cause

Symptoms

Spread

Incubation

Contagious Period

Exclusion

Diagnosis

Treatment

Prevention/Control

Bronchitis, Acute (Chest Cold)/Bronchiolitis Parent Fact Sheet

Bronchitis

If you think your child has Bronchitis:

Symptoms

Spread

Contagious Period

Call your Healthcare Provider

Prevention

Table of Contents

On this page

Campylobacteriosis

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Cause

Symptoms

Spread

Incubation

Contagious Period

Exclusion

Diagnosis

Treatment

Prevention/Control

Campylobacteriosis Parent Fact Sheet

Campylobacteriosis

If you think your child has Campylobacteriosis:

Symptoms

Spread

Contagious Period

Call your Healthcare Provider

Prevention

Table of Contents

On this page

Chickenpox (Varicella)

Prevention and Control of Communicable Diseases

Section 6 - Communicable Disease Fact Sheets

Cause

Symptoms

Spread

Incubation

Contagious Period

Diagnosis

Treatment

Exclusion

Prevention/Control

Chickenpox Parent Fact Sheet

Chickenpox

If you think your child has Chickenpox:

Symptoms