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Transcript
SCHOOL/NURSERY INFORMATION PACK
(Updated: May 2006)
Published by:
Bedfordshire Health Protection Team
(Bedfordshire and Hertfordshire Health Protection Unit)
1 Doolittle Mill,
Ampthill
Beds MK45 2NX
Tel: 01525 636841
Fax: 01525 636842
Email: bedshpu@hpa.org.uk
For out of hours emergencies, please phone
one of the numbers below and ask to contact
the Emergency Public Health Doctor:
Bedford Hospital Switchboard: Tel: 01234 355 122
Luton & Dunstable Hospital Switchboard: Tel: 0845 127 0127
1
CONTENTS
Page
No.
3
List of notifiable diseases
4
List of Factsheets available
5
Chickenpox Factsheet
6
Head Lice
8
Impetigo
9
Measles
11
Mumps
12
Pertussis (Whooping Cough)
13
Ringworm
15
Rubella
17
Scabies
19
Threadworms
APPENDIX
Guidance on Infection control in Schools and Nurseries
2
DISEASES NOTIFIABLE UNDER THE PUBLIC HEALTH
(CONTROL OF DISEASE) ACT 1984
*Cholera (01 & 0139 have International implications and must be reported to CDSC)
*Plague
*Relapsing fever
*Smallpox
*Typhus
Food poisoning
DISEASES NOTIFIABLE UNDER THE PUBLIC HEALTH
(INFECTIOUS DISEASES) REGULATIONS 1988:
Acute encephalitis
*Acute poliomyelitis
Anthrax
*Diphtheria
Dysentery (amoebic or bacillary)
Leprosy
Leptospirosis
Malaria
Measles
Meningitis
Meningococcal septicaemia (without meningitis)
Mumps
Ophthalmic neonatorum
Paratyphoid fever
*Rabies
Rubella
Scarlet fever
Tetanus
Tuberculosis
Typhoid fever
*Viral haemorrhagic fever #
Viral hepatitis
Whooping cough
*Yellow fever
#
Viral haemorrhagic fever means Argentine haemorrhagic fever (Junin), Bolivian
haemorrhagic fever (Machupo), Chikungunya haemorrhagic fever, Congo/Crimean
haemorrhagic fever (Hantaan), Kyasanur Forest disease, Lassa fever, Marburg
disease, Omsk haemorrhagic fever and Rift Valley disease.
*
Discuss with the Consultant in Communicable Disease/Regional Epidemiologist
Notify Bedfordshire Health Protection Unit the next day (Tel: 01525 636841)
Notifications should be made to the Consultant in Communicable Disease Control,
BEDFORDSHIRE HEALTH PROTECTION UNIT
TEL: 01525 636841
3
FACTSHEETS
(available on request)
Bed Bugs
Campylobacter
Chicken Pox
Clostridium Difficile
Conjunctivitis
Cryptosporidium
Cytomegalovirus
Diphtheria
Dysentry
Ecoli 0157
Enteric Fever
Dysentry
Ecoli 0157
Enteric Fever
Food poisoning
Gastro Enteritis (viral - residential and
nursing homes)
Giardia
Hand Hygiene
Hand, Foot and Mouth Disease
Head Lice
Hepatitis A
Hepatitis B Factsheet
Hepatitis B – algorithm (follow up of patients
screened for Hep B)
Hepatitis B – Neonates (vaccination schedule)
Hepatitis B – Protocol (babies)
Hepatitis C
HIV pregnancy screening
Impetigo
Infection Control Advice Sheet
Leptosporosis
Listeriosis
Lyme Disease
Malaria
Measles
Meningococcal Meningitis & Septicaemia
Molluscum Contagiosum
MRSA
Mumps
Needlestick/Sharps Injury
Norovirus (D&V outbreaks – infection control
advice sheet for residential care settings)
Pertussis (whooping cough)
Ringworm
Rotavirus
Rubella
Salmonella
Scabies
Scabies in Primary Care
Scarlet Fever
Shigella - dysentry
Shingles
Skin Piercing
Slapped Cheek
Tetanus
Thiomersal – frequently asked questions
Threadworms
Tuberculosis – frequently asked questions
Typhoid and Paratyphoid
Whooping Cough
Bedfordshire Health Protection Unit
1 Doolittle Mill, Ampthill, Beds MK45 2NX
Tel: 01525 636841
Fax: 01525 636842
Email: bedshpu@hpa.org.uk
4
FACT SHEET: Chicken Pox
What is Chicken Pox? Chicken Pox is a mild disease in children caused by a virus. It may appear
suddenly resulting in vesicles (blisters) on the day of onset.
Who can get Chicken Pox? It is usually a childhood disease, but can occur in adults.
How is it spread? It is spread by airborne droplets from a cough, direct contact with skin, or indirectly
through articles freshly soiled by discharge by vesicles. The incubation period is two to three weeks after
exposure.
What are the symptoms? The illness presents with a moderate fever, generalised malaise and the
appearance of a rash which quickly develops into vesicles. Crops of vesicles appear over several days,
mainly on the trunk, but also the upper limbs and face.
Are there any complications? In otherwise healthy individuals complications are not common. Meningitis
may occur in children. Varicella Pnuemonia is a recognised complication in adults, particularly smokers and
pregnant women. In the first five months of pregnancy a small risk (less than 1%) of congenital varicella
syndrome exists. If infection occurs one week before or after delivery the baby is at special risk and
requires Zoster immunoglobulin.
How long is a person able to spread infection? Usually from two days before until five days after the
appearance of the first crop of vesicles.
Are there any long term side effects? Following an attack of Chicken Pox the virus can remain dormant
in the nervous system of the body. After a variable period, often several years, the virus may be reactivated
and this results in a vesicular rash. They usually appear on a well-defined area of the body along the
course of a nerve. The condition is known as Shingles or Herpes Zoster and affects one in four adults by
their eighth decade. It may also appear at an early age, especially if the child had Chicken Pox before the
age of two years. Herpes Zoster vesicles are infectious and can give rise to cases of Chicken Pox. The
infective period is similar to Chicken Pox.
Is there any treatment? In special circumstances Acyclovir has been used successfully for treating
Chicken Pox. (Calamine lotion may help to remove the itching caused by the vesicles). In a majority of
cases no specific treatment is necessary.
Hyper immune gamma globulin may be given to pregnant women who have never had Chicken Pox, to a
newborn baby whose mother developed Chicken Pox one week before or one-week after delivery, and
those who are immuno compromised. Vaccine is available on a named patient basis normally for immuno
compromised children.
Where any of the above specific issues are considered it must be discussed with Consultants in Paediatrics,
Infectious Disease and Medical Microbiology.
For further advice, contact: Your GP - Your health visitor
Bedfordshire Health Protection Unit
Unit 1, Doolittle Mill, Froghall Road, Ampthill, MK45 2NX
Tel: 01525 636841/636972 / Fax: 01525 636842
5
Updated: January 2005
FACT SHEET – Head Lice
What are Head Lice?
They are small insects about the size of a match head. They usually take the colour of the hair
they live in. A female louse lives up to one month and lays several eggs a day. Eggs stay close to
the scalp and hatch within seven to 10 days.
Nits
Empty eggshells are called nits and may be seen away from the scalp as the hair grows. Nits do
not fall off and need to be removed with a detection comb (a fine toothed ‘nit’ comb available from
pharmacies).
How are Head Lice Spread?
Very close head to head contact is needed for lice to be transferred from one person to the next.
Therefore, when lice are detected in a child or adult, it is important that all close contacts are
checked for head lice and, where necessary, treated.
Treatment of Head Lice
1.
Treatment of choice is wet combing.
conditioner applied.
Hair should be washed first, and then plenty of
Without washing off the conditioner, comb the hair from root to tip with a detection comb.
Continue combing until the comb comes through lice free. This may take 10 minutes (longer
and thicker hair may take more time). This treatment should be repeated every three to four
days for two weeks in order to remove newly hatched lice (hatchlings).
2.
Detection of adult lice at this time would mean re-infestation and presence of small lice would
indicate newly hatched lice from eggs. If lice are found, continue wet combing every 3 to 4
days for another two weeks.
Wet combing should be continued weekly to detect reinfestation.
3.
This method should be used for all family members and close contacts to detect head lice
and, where necessary, to treat.
4.
Detection combs are available from chemists. They also stock “bug busting kits” with clear
instructions on how to use the wet combing method effectively.
5.
If head lice are found after two cycles of wet combing (ie four weeks), we recommend using
insecticides (carbaryl, malathion or pyrethoid containing insecticides).
6
6.
A single treatment consists of one application as instructed on the pack, to kill adult lice and a
repeat 10 days later to kill any hatchlings. The treatment may be repeated once more in a
three-month period.
7.
For those with sensitive skin or asthma, Derbac-M and Quellada-M may also be used.
8.
All preparations recommended kill lice but do not kill eggs. As eggs hatch in seven to 10
days, a repeat application is recommended to kill newly hatched lice.
9.
When Suleo-M or Derbac-M treatment has not worked, the third line of treatment is Carbaryl.
One application should kill lice and eggs.
10. Please note that the Chief Medical Officer has warned about the rare possibility of cancer
with repeated use of Carbaryl. Therefore, this insecticide must only be used after discussion
with your doctor. Carbaryl is only available on prescription.
Failure to respond to the third line treatment at present will leave only one choice left
– back to wet combing.
Is Exclusion from School Necessary?
NO. Head lice do not cause disease in this country. Therefore, missing education because of
infestation is not recommended. The health agencies and Education Authorities in Bedfordshire do
not support exclusion.
Where can you get Further Help from:
Community Hygiene Concern is a charity which runs a helpline for those who wish to discuss the
matter further. Their number is 0207 6864 321.
Updated: February 2006
Bedfordshire Health Protection Unit
Unit 1, Doolittle Mill, Froghall Road, Ampthill, MK45 2NX
Tel: 01525 636841/636972 / Fax: 01525 636842
7
FACT SHEET – Impetigo
What is impetigo?
Impetigo is a common, highly infectious skin disease caused by staphylococcus bacteria or more rarely by
the streptococcus bacteria.
Impetigo spreads through scratching the itchy spots that indicate the condition. Long-standing infection can
leave scars behind.
Is impetigo dangerous?
It isn't dangerous but it is an extremely contagious illness.
What does impetigo look like?
It first appears as a small scratch or itchy patch of eczema - skin inflammation - on seemingly healthy skin.
A small red, itchy spot quickly develops into a blister containing a yellow substance.
Later, the top of the blister becomes crusty and weeps while new blisters develop in the same place or on
other parts of the body. Impetigo usually begins on the face, especially around the corners of the mouth, the
nose and back of the ears.
Who is in danger of infection?
Children and adolescents suffering from eczema (atopic dermatitis) are especially likely to develop impetigo.
Thorough skincare is important to prevent infection. Impetigo is easily spread through contact, so it is
commonly seen in nursery or play-group settings.
How is impetigo treated?
If you suspect impetigo, contact your GP as treatment should take place preferably before the child infects
other children. The treatment involves washing with soap and water and letting the impetigo dry in the air.
Many GPs choose to treat impetigo with bactericidal ointment, such as fusidic acid or mupirocin, but in more
severe cases oral antibiotics, such as flucloxacillin or erythromycin are necessary. It is important to soften
the scabs with ointment so that the ointment reaches the bacteria that cause the disease which live
underneath the scabs.
When can my child begin to mix again with other children?
A preschool child should not return to nursery school or play-group until the scabs have fallen off and he or
she is no longer contagious. Small children will touch and scratch their scabs and therefore run the risk of
infection. Schoolchildren can normally return to their classes 48 hours after the start of treatment, even with
scabs, as long as they remember not to scratch or touch them. Above all, they must remember to wash
their hands regularly and only use their own comb, brush, facecloth or towel.
Good advice
Cut your child’s nails short and encourage them not to scratch their scabs, pick their nose, bite their nails or
suck their fingers.
If your child already has eczema seek advice and effective treatment.
Always remember to wash your hands after having touched an infected child.
Teach your child to wash his or her hands regularly and always give them their own facecloth and towel.
Explain to your child why they need to pay special attention to hygiene and avoid touching their scabs.
Bedfordshire Health Protection Unit
Unit 1, Doolittle Mill, Froghall Road, Ampthill, MK45 2NX
Tel: 01525 636841/636972 / Fax: 01525 636842
Updated:
February 2006
8
FACT SHEET – Measles
What is Measles?
Measles is an infection caused by a virus (germ) and can cause:








Fever
Irritability
Cold/Catarrhal symptoms – running nose
Sore and runny eyes
Dry ‘croupy’ cough
White spots on the gums (2nd and 3rd day)
Rash (4th Day ) starting on the face and behind the ears, then spreading down the body
Diarrhoea – often in the early stages in children
Serious complications of measles infection can occur and secondary infections such as ear
infections (approx 1 in 20), bronchitis/pneumonia (approx 1 in 25), convulsions (approx 1 in
200) and in rare cases, encephalitis (infection of the brain) or meningitis (approx 1 in 1000)
may occur. The likelihood of problems varies with age and complications are generally more
common in young babies, older children and adults.
Who does it affect?
ANYONE – who has not developed natural immunity or has not been vaccinated against
measles. Children are most vulnerable though. Babies of up to approximately 6 months are
protected by their mother’s antibodies.
How do you get Measles?
Measles is very infectious and you catch it by being in close contact with someone who
already has the infection. The virus is passed in the secretions of the infected person’s nose
and throat and is spread by their sneezing and coughing. Also it is possible to catch measles
from direct contact with articles which have been contaminated by these infected secretions
e.g. hankies.
How do you prevent Measles?
 By immunisation – there is a safe and effective vaccine which protects against measles. It
is one of the M components in MMR vaccine and a child needs two doses of this vaccine at
15 – 18 months and a booster dose pre-school. Protection is life long. An unvaccinated
person has very little chance of going through life without becoming infected.
9
 By avoiding close personal contact with a person with measles if you are at risk. Because
measles vaccine is a live vaccine, it is not recommended that children who have a
weakened immune system e.g. because of medication or chemotherapy, should be
vaccinated so these children are particularly vulnerable and should avoid contact whenever
possible.
Do you need to stay off School/Work?
Yes – Measles is very infectious. Measles is infectious from just before the symptoms occur
and for approximately 5 days after the appearance of the rash, so general advice is to stay off
school or work for at least 7 days after the symptoms first develop.
Do you need treatment?
There is no specific treatment for measles but an appropriate medicine to help bring down a
high temperature should be used (do not use aspirin in children) and if necessary sponging
with tepid water. Also, if a secondary infection develops then the doctor may prescribe
antibiotics to treat this e.g. an ear or chest infection.
Updated: January 2005
Bedfordshire Health Protection Unit
Unit 1, Doolittle Mill, Froghall Road, Ampthill, MK45 2NX
Tel: 01525 636841/636972 / Fax: 01525 636842
10
FACT SHEET - Mumps
What is mumps?
Mumps is an acute viral illness characterised by fever, swelling and tenderness of one or more of the
salivary glands.
Who gets mumps?
Although older people may get the disease, mumps usually occurs in children between the ages of five and
fifteen. Mumps occurs less regularly than other common childhood communicable diseases. The greatest
risk of infection occurs among older children. Mumps is more common during winter and spring.
How is mumps spread?
Mumps is transmitted by direct contact with saliva and discharges from the nose and throat of infected
individuals.
What are the symptoms of mumps?
Symptoms of mumps include fever, swelling and tenderness of one or more of the salivary glands, usually
the parotid gland (located just below the front of the ear). Approximately one-third of infected people do not
exhibit symptoms.
How soon after infection do symptoms occur?
The incubation period is usually 16-18 days, although it may vary from 14 to 25 days.
What complications have been associated with mumps?
Swelling of the testicles occurs in 15 to 25% of infected males. Mumps can cause central nervous system
disorders such as encephalitis (inflammation of the brain) and meningitis (inflammation of the covering of
the brain and spinal column). Other complications include arthritis, kidney involvement, inflammation of the
thyroid gland and breasts and deafness.
When and how long is a person able to spread mumps?
Mumps is contagious seven days prior to and nine days after the onset of the symptoms. A person is most
contagious 48 hours prior to the appearance of symptoms.
Does past infection with mumps make a person immune?
Yes. Immunity acquired after contracting the disease is usually permanent.
Is there a vaccine for mumps?
Yes. Mumps vaccine is given on or after a child’s first birthday, and is given in combination with measles
and rubella vaccine. The vaccine is highly effective.
What can be done to prevent the spread of mumps?
The single most effective control measure is maintaining the highest possible level of immunisation in the
community. Children should not attend school during their infectious period.
Updated: January
2005
Bedfordshire Health Protection Unit
Unit 1, Doolittle Mill, Froghall Road, Ampthill, MK45 2NX
Tel: 01525 636841/636972 / Fax: 01525 636842
11
FACT SHEET
Pertussis (whooping cough)
What is pertussis?
Pertussis, or whooping cough, is a respiratory infection. It is caused by a bacterium – Bordetella pertussis.
Who gets pertussis?
Pertussis can occur at any age, although it is most common in children.
How is pertussis spread?
Pertussis is primarily spread by direct contact with discharges from the nose and throat of infected
individuals. Frequently, older brothers and sisters who may be harbouring the bacteria in their nose and
throat can bring the disease home and infect an infant in the household.
What are the symptoms of pertussis?
Pertussis begins as a mild upper respiratory infection. Initially symptoms resemble those of a common cold,
including sneezing, runny nose, low-grade fever and a mild cough. Within two weeks the cough becomes
more severe and is characterised by episodes of numerous rapid coughs followed by a crowing or high
pitched whoop. A thick clear mucous may be discharged. These episodes may recur for one to two
months, and are more frequent at night. Older people or partially immunised children generally have milder
symptoms.
How soon after infection do symptoms appear?
The incubation period is usually five to ten days but may be as long as 21 days.
When and for how long is a person able to spread pertussis?
A person can transmit pertussis from seven days following exposure up to three weeks after the onset of
coughing episodes. The period of communicability is reduced to between five and seven days when
antibiotic treatment is begun.
What is the vaccine for pertussis?
The vaccine for pertussis is usually given in combination with diphtheria and tetanus. It is recommended
that three doses of DTP (diphtheria, tetanus, pertussis) vaccine be given starting at two months of age.
What can be done to prevent the spread of pertussis?
The single most effective control measure is maintaining the highest possible level of immunisation in the
community. Treatment of cases with certain antibiotics such as erythromycin can shorten the infectious
period. People who have or may have pertussis should stay away from young children and infants until
properly treated.
Updated: February 2006
Bedfordshire Health Protection Unit
Unit 1, Doolittle Mill, Froghall Road, Ampthill, MK45 2NX
Tel: 01525 636841/636972 / Fax: 01525 636842
12
FACT SHEET – Ringworm
WHAT IS RINGWORM?
Ringworm is an infection caused by a fungus similar to the fungus that causes athlete’s foot. Ringworm
may occur on the scalp or anywhere on the skin. It is called ringworm due to the scaly, reddish ring-shaped
area that it causes. It is found world-wide and is common in children and young adults.
HOW DID I GET RINGWORM?
Ringworm affects people and animals. The fungus can survive on furniture, clothes, hairbrushes, etc so it is
not necessary to have close contact with an infected person.
WHAT TYPE OF RINGWORM HAVE I GOT?
Scalp Ringworm: Generally affects children, and is more common in males than females. Household pets
are a common source of infection. It may be caught from hairbrushes, barbers’ clippers, hats and the
back of chairs.
Ringworm of the body, legs and arms: Most common in tropical and sub-tropical regions, but can be
found world-wide. It may be due to infection spreading from feet or the head. Pets and farm animals
may be a source of infection. Person to person spread is uncommon, but may occur if direct contact
with the infected area occurs.
Ringworm of the groin and pubic region: Commonest between the ages of 18-25 and 40-50. It is more
common in men than in women. It is common for this to be spread from another part of the body. It is
very infectious and can be spread from person to person and on contaminated surfaces such as
bathroom floors, showers, hotel bedrooms and on towels.
Ringworm of the feet: This is most commonly found between the toes, but can affect the whole foot. It is
the commonest form of ringworm and may be passed from person to person, or on contaminated
floors (eg in showers) and towels.
Ringworm of the hands: This may be due to spread from another part of the body, or can be from
contaminated towels, gardening tools, etc.
Ringworm of the finger and toenails: Very common between the ages of 20 and 50, with toenails being
more commonly affected than fingernails. It may be passed by direct contact, or from contaminated
articles of clothing.
Your GP will be able to advise you on what type of ringworm you have.
HOW IS RINGWORM TREATED?
There are several creams which are very effective against ringworm of the skin and you should continue to
use them until the skin is completely clear.
A course of tablets/medicine and cream is usually needed for scalp ringworm. The treatment may need to
be taken for several months to be completely successful.
13
Good hygiene and housekeeping, particularly ensuring that clothes are washed effectively and frequently
will help.
WHAT IS THE RISK TO MY FAMILY?
If left untreated, some ringworm infections may be passed to other people. People with ringworm should not
share towels, flannels, combs or hairbrushes with others.
Everyone in the same household should be checked for infection. Pets or other animals should also be
checked, and if infected, be seen by a Vet, who will advise on their treatment.
WHEN CAN I RETURN TO WORK/SCHOOL?
Children with ringworm should be kept at home until adequate treatment has been commenced. So long as
the lesions are treated and covered, there is no need for longer exclusion. However, swimming and contact
sports should be avoided until completion of treatment.
Updated: October 2004
Bedfordshire Health Protection Unit
Unit 1, Doolittle Mill, Froghall Road, Ampthill, MK45 2NX
Tel: 01525 636841/636972 / Fax: 01525 636842
14
FACT SHEET – Rubella
What is Rubella?
Rubella is an infection caused by a virus (germ) and can cause:Sore throat
-
usually mild
Sore eyes
-
often just a gritty feeling
Fever
-
usually mild
Rash
-
A pink rash which usually appears 2-3 days after the first symptoms,
normally appearing on the face and neck first and then spreading to the
body and limbs.
Swollen lymph
glands
-
Usually in the neck
Joint pain
-
Usually in adults and can last for several weeks
Rubella is usually a very mild illness which often causes children no real problems but may be
worse in adults. Treatment is not usually required.
Who does it affect?
ANYONE- who has not developed a natural immunity, or has not been vaccinated against Rubella.
How do you get Rubella?
You get Rubella from being in close contact with someone who already has the infection. The
virus is passed in the secretions of the infected person’s nose and throat and is spread by their
coughing and sneezing, and by close personal contact with that person like the contact that takes
place within a household or family setting.
How do you prevent Rubella?

By immunisation – there is an effective and safe vaccination to protect against Rubella. It is
the ‘R’ component of the MMR vaccine and a child needs two doses, the first at 15-18 months
and a booster dose pre-school. Protection will usually be life-long and both girls and boys
need to be vaccinated. Also adults who have no history of immunisation and have not
developed natural immunity, can be vaccinated but this is usually only required in special
circumstances e.g. health care workers when a blood test will discover if you already have
immunity. If a woman is planning to have a baby and she is unsure if she has ever had
Rubella or has been vaccinated against Rubella, she should discuss this with her doctor or
practice nurse and they will advise her.

By avoiding close personal contact with a person with Rubella whenever possible if you think
you are at risk e.g. a pregnant woman.

As the Rubella vaccine is a ‘live’ vaccine it is not recommended that people with severely
weakened immune systems or pregnant women be given the vaccine.
15
Do you need to stay off Work/School?
YES – Rubella is infectious for about 5-7 days before the rash appears and for 4-7 days after, so
the general advice is to stay off school or work for 7 days after the rash first appears.
What is special about Rubella?
Rubella is one of the few infections which can affect the developing baby in a pregnant woman.
The risk to the baby depends upon when the mother gets the infection, the earlier in her pregnancy
the higher the risk of the infection affecting the baby – in very late pregnancy the risks are very low.
Rubella infection can cause death of the baby, premature birth, hearing and sight defects, heart
problems and mental defects, so if a pregnant woman comes into contact with Rubella and she is
unsure if she has previously had either the infection or the vaccination, she should seek
immediate advice from her doctor or midwife, who will discuss her past history of Rubella infection
or vaccination and take a blood specimen to test for past exposure and immunity to Rubella.
Updated: February 2006
Bedfordshire Health Protection Unit
Unit 1, Doolittle Mill, Froghall Road, Ampthill, MK45 2NX
Tel: 01525 636841/636972 / Fax: 01525 636842
16
FACT SHEET – Scabies
Scabies can cause severe itching leading to sleep disturbance, depression, and mental
disturbance. It may present itself in crowded or closely knit communities. In residential institutions
scabies can cause epidemics or may become endemic. With treatment it is easily cured. With
adequate medical attention however, it can be a mild illness.
Epidemiology of Scabies
Scabies usually appears in 30 year cycles. The disease is an infection caused by a mite. The
symptoms are due to an allergy to various chemicals produced by the scabies mite.
Spread
Direct skin contact is usually necessary for spread. Holding hands is the commonest mode of
transmission. It is also spread by sexual contact.
Symptoms
In people with normal immune system scabies produces classical symptoms of widespread itchy
rash, severe at night time or when the body is warm eg. after exercise, or a warm bath. Itching
normally develops 6-8 weeks after catching infection, therefore spread can occur before diagnosis
is made.
Incubation period
Usually 2 - 6 weeks
Crusted Scabies
In immune suppressed individuals the whole body may be affected including scalp and under the
nails. The rash is atypical and does not itch. It is often crusted, irregular, and may be lichenified.
The disease can also present itself in a combination of all these forms. It is highly infectious. The
elderly, after stroke and those with mental handicap are very susceptible.
Diagnosis
By microscopy: Mineral or paraffin oil is dropped on surface of skin and skin scrapings are taken.
Scabies mites will not be seen on microscopy. However, Scybala (excreta of mite) may be seen as
black dots about 15µ in size.
NB
Site of rash does not correspond to the site of the mite. If in doubt you must ask for a
dermatological opinion.
17
Common sites of infection
Treatment
All those who have had skin contact with scabies patient need to be treated.
NB.
The itching will persist for 2-3 weeks following effective treatment.
Recommended treatment
1)
Lyclear (Permethrin 5%)
Apply directly to cool, dry skin.
NB
Whole body ie, all areas of skin must be treated including head, ear, hair line, neck,
genitalia etc. Usually single treatment is curative.
2)
Derbac-M (Malathion 0.5%)
Aqueous based, therefore alternative choice where skin irritation is a problem.
3)
Quellada (Lindane 1%) - Now a second line of treatment because of its toxicity. Avoid in
pregnancy, breast feeding, epilepsy, low body weight infants etc. It may have a place in
treatment of crusted scabies.
Bedfordshire Health Protection Unit
Unit 1, Doolittle Mill, Froghall Road, Ampthill, MK45 2NX
Tel: 01525 636841/636972 / Fax: 01525 636842
18
Updated:
February 2006
FACT SHEET – Scarlet Fever
What is scarlet fever?
Scarlet fever is a bacterial illness that often presents with a distinctive rash made up of tiny pinkish-red spots
that cover the whole body. It usually affects people who have recently had a sore throat caused by certain
strains of the group A streptococcus bacteria. A toxin released by the streptococcal bacteria causes the rash
of scarlet fever. Scarlet fever has also been called scarlatina in the past.
How common is scarlet fever and who gets it?
Scarlet fever is not as common as it was a century ago when it was associated with deadly epidemics. The
development of antibiotics and their early use in the treatment of streptococcal infections has prevented
many cases of scarlet fever and the long-term complication of rheumatic fever.
Scarlet fever occurs mostly in children aged 4-8 years. By 10 years old, up to 80% of children have
developed lifelong protective antibodies against streptococcal toxins, whilst children younger than 2 years
still have acquired maternal antibodies. Males and females are affected equally.
How do you get scarlet fever?
Group A streptococcal infections that cause scarlet fever are contagious. Streptococcal bacteria can spread
from person to person by breathing in airborne droplets from an infected person's coughing or sneezing.
Bacteria can also be passed by touching the infected skin of someone with a streptococcal skin infection, or
by sharing contaminated clothes, towels or bed linen.
Scarlet fever can also be spread by infected individuals who are carriers of streptococcal bacteria but do not
show any symptoms. Up to 15-20% of school-age children are thought to be asymptomatic carriers.
To get scarlet fever you must still be susceptible to the toxin produced by the streptococcal bacteria.
Therefore, it can happen that 2 children of the same family may both have streptococcal infections, but only
one (who is still susceptible to the toxin) develops scarlet fever.
Scarlet fever generally has a 1- to 4-day incubation period.
Who is at risk of scarlet fever?
Those at greatest risk for scarlet fever include:

People living in overcrowded environment such as boarding schools, day care or military camps

Children older than 3 years

People in close contact with someone who has a strep throat or skin infection
What are the signs and symptoms of scarlet fever?
Scarlet fever usually starts with a sudden fever associated with sore throat, swollen neck glands, headache,
nausea, vomiting, loss of appetite, swollen and red strawberry tongue, abdominal pain, body aches, and
malaise.
The characteristic rash appears 12-48 hours after the start of the fever. The rash usually starts below the
ears, neck, chest, armpits and groin before spreading to the rest of the body over 24 hours.
Scarlet spots or blotches, giving a boiled lobster appearance, are often the first sign of rash.
As skin lesions progress and become more widespread, they start to look like sunburn with goose pimples.
The skin may have a rough sandpaper-like feel.
19
In body folds, especially the armpits and elbows, fragile blood vessels (capillaries) can rupture and cause
classic red streaks called Pastia lines. These may persist for 1-2 days after the generalised rash has gone.
In the untreated patient, the fever peaks by the second day and gradually returns to normal in 5-7 days.
When treated with appropriate antibiotics, the fever usually resolves within 12-24 hours. By about the sixth
day of the infection the rash starts to fade and peeling, similar to that of sunburned skin, occurs. Peeling of
the skin is most prominent in the armpits, groin, and tips of the fingers and/or toes and may continue up to 6
weeks.
How is scarlet fever diagnosed?
Diagnosis of scarlet fever is often suspected from the characteristic history and physical examination.
Taking a throat swab sample and testing it for bacterial growth is often done
What is the treatment of scarlet fever?
Once a streptococcal infection is confirmed, your doctor may prescribe a course of antibiotics, usually
penicillin or amoxycillin for up to 10 days. It is very important that the full antibiotic course is taken to ensure
all the infection is cleared, thus preventing complications from occurring.
Additional treatments include:

Paracetamol when necessary for fever, headache or throat pain.

Eating soft foods and drinking plenty of cool liquids, particularly if the throat is very painful.

Oral antihistamines or calamine lotion to relieve the itch of rash.

Keep fingernails short on young children to prevent them from damaging the skin.
The fever usually improves within 12-24 hours after starting antibiotics and most patients recover after 4-5
days with clearing of skin symptoms over several weeks.
What are the complications from scarlet fever?
Nowadays, scarlet fever infection usually follows a benign course when diagnosed and treated
appropriately. However before antibiotic use was widespread the following complications caused by the
streptococcus infection were more common.





Rheumatic fever
Otitis media
Pneumonia
Septicaemia
Glomerulonephritis
Rheumatic fever, which affects the heart, and glomerulonephritis, which affects the kidneys, may
permanently damage the body and require long-term treatment.
How to prevent scarlet fever
To prevent spread of streptococcus bacteria that cause scarlet fever, an infected individual should ideally be
isolated from other family members, especially infants and younger siblings. To help prevent spread, keep
drinking glasses and eating utensils used by the infected individual separate from those of other family
members. These items need to be washed thoroughly in very hot soapy water, preferably with antibacterial
soap.
Children should be kept away from school until they have received at least 24 hours of antibiotic therapy
and there are clear signs of improvement.
Bedfordshire Health Protection Unit
Unit 1, Doolittle Mill, Froghall Road, Ampthill, MK45 2NX
Tel: 01525 636841/636972 / Fax: 01525 636842
Updated: October 2004
20
FACT SHEET – Threadworms
What are threadworms?
They are tiny white worms about 2mm long which infect the bowel and lay their eggs on the skin around the
rectum/back passage.
Who can they affect?
ANYONE – they are the most common worm infection in the UK and are surprisingly common in young
children.
How do you know you have Threadworms?
 They can be seen in the stools/motions.
 They look like threads of white cotton or grains of white rice.
 They cause excessive itching around the rectum/back passage and the surrounding skin.
 Disturbed sleep due to itching.
How do you treat Threadworms?
 The doctor will prescribe a medicine to take to get rid of them.
 The whole family should be treated at the same time as they may have been passed on in the family this prevents re-infection.
How are Threadworms caught?
 When a person has threadworm they get eggs on their hands and under their finger nails, when they
scratch or when wiping themselves after going to the toilet.
 If hands and nails are not properly cleaned the eggs then get into food or in the mouth and get eaten.
Once eaten, they get into the bowel and hatch and start to lay eggs, causing a cycle of infection.
 From contaminated bed linen, night clothing, flannels and towels.
 From infected pets.
 Occasionally from contaminated carpets.
How do you prevent spread?
 By changing the sheets of an infected person daily.
 By thorough hand washing with soap and hot water and scrubbing finger nails:- After going to the toilet
- Before eating food
 By regular vacuuming of carpets.
 By using separate towels and flannels.
 By encouraging children to have good standards of hygiene.
 By not allowing dogs and cats to foul play areas, and sand pits, etc.
Threadworms are generally not harmful but are a nuisance and can be upsetting for the person infected.
Do you need to stay off work/school?
 Once an infection is found it should be treated immediately, but it is not necessary to stay off work or
school.
 The nursery or school should be informed of any infection as they may need to take action to prevent
spread within the premises.
Bedfordshire Health Protection Unit
Unit 1, Doolittle Mill, Froghall Road, Ampthill, MK45 2NX
Tel: 01525 636841/636972 / Fax: 01525 636842
Updated: February 2006
21
APPENDIX
Bedfordshire Health Protection Unit
1 Doolittle Mill
Froghall Road
Ampthill
Beds MK45 2NX
GUIDANCE ON INFECTION CONTROL
IN SCHOOLS AND NURSERIES
INDEX
1.
Diseases
a)
b)
c)
d)
e)
f)
Rashes & Skin
Diarrhoea & Vomiting Illness
Respiratory
Other
HIV/AIDS
Hepatitis B and C
2.
Outbreaks of Infection
3.
Immunisations
4.
Hands – washing and good hygiene procedure
5.
Cleaning Up Body Fluid Spills – universal precautions
6.
Vulnerable Children
7.
Female Staff in Schools – pregnancy
8.
Animals in School (permanently or visiting)
9.
Precautions for School Visits to Farms
10.
Immunisation
Please note that a poster version is available from the Department of Health. Requests
should be faxed to 01937 845 381.
A copy can also be found online at
Leaflet: http://www.wiredforhealth.gov.uk/PDF/pocketg.pdf
Poster: http://www.wiredforhealth.gov.uk/PDF/infect_poster.pdf
1
GUIDANCE ON INFECTION CONTROL
IN SCHOOLS AND NURSERIES
TO MINIMISE THE RISK OF TRANSMISSION OF INFECTION TO OTHER CHILDREN AND STAFF
(Adapted from the Department of Health Guidance guidelines)
1.
DISEASES
RASHES & SKIN
Athletes Foot
Chickenpox
Cold sores
(Herpes simplex
virus)
German measles
(Rubella)
Hand, foot and
mouth disease
Impetigo
Measles
Molluscum
contagiosum
Ringworm (Tinea)
Roseola
Scabies
Scarlet fever
Slapped cheek /
Fifth disease /
Parvovirus B19
Warts and
verrucae
Recommended period
to be kept away from
school (once child is
well)
None
For 5 days from onset of
rash
COMMENTS
Athlete’s foot is not a serious condition
It is not necessary to wait until spots have healed or
crusted. (IMPORTANT: See FEMALE STAFF IN
SCHOOLS, see VULNERABLE CHILDREN)
None
Avoid kissing and contact with the sores. Cold stores are
generally a mild self-limiting disease. Many healthy
children and adults excrete this virus at some time without
having a ‘sore’
Five days from onset of The child is most infectious before the diagnosis is made
rash
and most children should be immune due to immunisation
so that exclusion after the rash appears will prevent very
few cases.
(IMPORTANT: See FEMALE STAFF IN SCHOOLS)
None
Usually a mild disease not justifying time off school. (Not
related to foot and mouth disease.)
Until lesions are crusted Antibiotic treatment by mouth may speed healing. If
or healed
lesions can reliably be kept covered exclusion may be
shortened
Five days from onset of Highly infectious. Preventable by routine vaccination..
rash
(IMPORTANT: see VULNERABLE CHILDREN)
None
A mild condition not thought to be very infectious in
schools / nurseries.
Until on treatment.
Proper treatment by the GP is important. Scalp ringworm
needs treatment with an antifungal by mouth. Enhanced
cleaning and hand-washing is essential. Check and treat
symptomatic pets.
None
A mild illness, usually caught from well persons. Nearly all
children are affected in early childhood and will therefore
be immune by school age.
Until treated
Outbreaks have occasionally occurred in schools and
nurseries. Child can return as soon as properly treated.
This should include all the persons in the household. If
lesions can reliably be kept covered, or skin to skin
contact avoided, exclusion may be shortened.
Five days from
Treatment recommended for the affected child
commencing antibiotics
None
Exclusion is ineffective as nearly all transmission takes
place before the child becomes unwell. (IMPORTANT:
see FEMALE STAFF AND VULNERABLE CHILDREN IN
SCHOOLS)
None
Affected children may go swimming. Verrucae MUST be
covered in swimming pools, gymnasiums and changing
rooms.
2
DIARRHOEA AND
VOMITING
ILLNESS
Diarrhoea and/or
vomiting (with or
without a specified
diagnosis)
Recommended period
to be kept away from
school (once child is
well)
Until
diarrhoea
and
vomiting has settled
(neither for the previous
48 hours)
COMMENTS
Usually there will be no specific diagnosis and for most
conditions there is no specific treatment. A longer period
of exclusion may be appropriate for children under age 5
and older children unable to maintain good personal
hygiene. For diarrhoea, exclusion from swimming is
advisable.
E.coli and
Haemolytic
Uraemic Syndrome
Giardiasis
Depends on the type of
E.coli. Seek FURTHER
ADVICE from CCDC
Until
diarrhoea
and There is a specific antibiotic treatment
vomiting has settled
(neither for the previous
48 hours)
Salmonella
Until
diarrhoea
and If the child is under 5 years or has difficulty in personal
vomiting has settled
hygiene, seek advice from the Consultant in
(neither for the previous Communicable Disease Control
48 hours)
Shigella (Bacillary
Until
diarrhoea
and If the child is under 5 years or has difficulty in personal
dysentery)
vomiting
has settled hygiene, seek advice from the Consultant in
(neither for the previous Communicable Disease Control
48 hours)
(See also HANDS – WASHING AND GOOD HYGIENE PROCEDURES)
RESPIRATORY
Recommended period
COMMENTS
to be kept away from
school
‘Flu’ (influenza)
None
Flu is most infectious just before and at the onset of
symptoms
Tuberculosis
CCDC will advise on Generally requires quite prolonged, close contact for
action
spread. Not usually spread from children
Whooping cough
Five
days
from Treatment is recommended though non-infectious
(Pertussis)
commencing
antibiotic coughing may still continue for many weeks. If not on
treatment
treatment, can be infectious for 21 days. Preventable by
routine vaccination.
OTHERS
Recommended period COMMENTS
to be kept away from
school
Conjunctivitis
None
If an outbreak occurs consult Consultant in
Communicable Disease Control. Exclusion may be
considered.
Glandular fever
None
About 50 per cent of children get the disease before they
(Infectious
are five and many adults also acquire the disease without
mononucleosis)
being aware of it.
Head Lice
None
Treatment is recommended only in cases where live lice
have
definitely
been
seen
(see
FURTHER
INFORMATION). Close contacts should be checked and
treated if live lice are found.
Hepatitis A
See Comments
There is no justification for exclusion of well older children
with good hygiene. Exclusion should still be attempted in
nurseries where hygiene may be an issue, so causing a
risk to adults.
3
OTHERS
(continued)
Recommended period
to be kept away from
school (once child is
well)
The CCDC will give
specific advice on any
action needed
None
COMMENTS
Threadworms
None
Five days from the
onset of swollen glands
None
Tonsillitis
None
Milder illness
The child is most infectious before the diagnosis is made
and most children should be immune due to immunisation
Transmission is uncommon in schools but treatment is
recommended for the child and family
There are many causes, but most cases are due to
viruses and do not need an antibiotic. For one cause,
streptococcal
infection,
antibiotic
treatment
is
recommended.
Meningococcal
meningitis* /
Septicaemia
Meningitis* not due
to Meningococcal
infection
Viral Meningitis
Mumps*
HIV/AIDS
HEPATITIS B
AND C
There is no reason to exclude from schools siblings and
other close contacts of a case. Meningococcal C is
preventable by routine vaccination.
Once the child is well infection risk is minimal
HIV is not infectious through casual contact. There have been no recorded cases of
spread within a school or nursery. (See CLEANING UP BODY FLUID SPILLS)
Although more infectious than HIV, hepatitis B and C have only rarely spread within
a school setting. Universal precautions will minimise any possible danger of spread
of both hepatitis B and C. (See CLEANING UP BODY FLUID SPILLS)
* denotes a notifiable disease when Consultant in Communicable Disease Control at local Health
Protection Unit must be contacted by the diagnosing physician.
2. OUTBREAKS OF INFECTION
If a school or nursery suspects that some of its children are part of an outbreak of infection (an unusual
number of cases of an infectious disease) they should inform their Consultant in Communicable Disease
Control (see CONTACTS FOR FURTHER ADVICE). Advice can also be sought from the school doctor or
nurse.
3. IMMUNISATIONS
By the age of two all children should have received 3 doses of diphtheria/tetanus/whooping cough/Hib and
polio immunisations and at least one dose of measles, mumps, rubella (MMR) immunisation.
By age 5 all children should, in addition, have had a booster of diphtheria, tetanus and polio, and a second
dose of MMR.
4. HANDS – WASHING AND GOOD HYGIENE PROCEDURES







Effective hand washing is an important method of controlling the spread of infections, especially those
that cause diarrhoea and vomiting.
Always wash hands after using the toilet and before eating and handling food using warm, running
water and a mild, preferably liquid soap. Toilets must be kept clean.
Rub wet hands together vigorously until a soapy lather appears and continue for at least 15 seconds
ensuring all surfaces of the hands are covered.
Rinse hands under warm running water and dry hands with a hand dryer or clean towel (preferably
paper)
Discard disposable towels in a bin. Bins with foot-pedal operated lids are preferable.
Encourage the use of handkerchiefs when coughing and sneezing
If a food handler has diarrhoea or vomiting the CCDC’s advice should be sort urgently
4
5.
CLEANING UP BODY FLUID SPILLS – UNIVERSAL PRECAUTIONS


Spills of body fluids: Blood, Faeces, Nasal and Eye Discharges, Saliva and Vomit, must be cleaned up
immediately.
Wear disposable gloves. Be careful not to get any of the fluid you are cleaning up in your eyes, nose,
mouth or any open sores you may have.
Clean and disinfect any surfaces on which body fluids have been spilled. An effective disinfectant
solution is household bleach solution diluted 1 in 10 but is must be used carefully.
Discard fluid-contaminated material in a plastic bag along with the disposable gloves. The bag must
be securely sealed and disposed of according to local guidance.
Mops used to clean up body fluids should be cleaned in a cleaning equipment sink (not a kitchen
sink), rinsed with a disinfecting solution and dried.
Ensure contaminated clothing is hot laundered (minimum 60ºC)
6.
VULNERABLE CHILDREN






Some children have medical conditions that make them especially vulnerable to infections that would
rarely be serious in most children.
Such children include those being treated for leukaemia or other cancers, children on high doses of
steroids by mouth and children with conditions, which seriously reduce immunity. Usually schools or
nurseries are made aware of such children through their parents or the carers or the School Health
Service.
These children are especially vulnerable to chicken-pox or measles. If a vulnerable child is exposed
to either of these the parent/carers should be informed promptly so that they can seek further medical
advice as necessary
7. FEMALE STAFF IN SCHOOLS/NURSERIES – PREGNANCY




Some infections if caught by a pregnant woman can pose a danger to her unborn baby.
Chicken-pox: this can affect the pregnancy of a woman who has not previously had the disease. If a
pregnant woman is exposed early in pregnancy(the first 20 weeks) or very late in pregnancy (the last 3
weeks before birth) she should promptly inform her GP and whoever is giving her ante-natal care who
can do a blood test to check she is immune.
German measles (Rubella): if a woman who is not immune to rubella is exposed to this infection in
early pregnancy her baby can be affected. Female staff should be able to show evidence of immunity
to rubella or, if that is not available, have a blood test and, if appropriate, immunisation. If a woman
who may be pregnant comes into contact with rubella she should inform her GP promptly.
Slapped cheek disease (Parvovirus): occasionally, parvovirus can affect an unborn child. If a woman
is exposed early in pregnancy (before 20 weeks) she should promptly inform whoever is giving her
ante-natal care.
Measles during pregnancy is serious as it can result in early delivery or even loss of the baby. If
exposed, inform whoever is giving antenatal care as passive prophylaxis can be given.
8. ANIMALS IN SCHOOL (PERMANENTLY OR VISITING)
Animals may carry infections, especially gastroenteritis, and guidelines for protecting the health and safety
of the children should be followed.

Animal quarters should be kept clean. All waste should be disposed of regularly. Litter boxes should
not be accessible to children.

Young children should not play with animals unsupervised and children must wash their hands after
handling animals, cleaning cages, etc.

Particular care should be taken with reptiles as all species can carry salmonella.
5
9.









10.
PRECAUTIONS FOR SCHOOL VISITS TO FARMS
Check that the farm is well managed and that the grounds and public areas are as clean as possible.
Note that manure, slurry and sick animals present a particular risk of infection and animals must be
prohibited from any outdoor picnic areas.
Check that the farm has washing facilities adequate and accessible for the age of the children
visiting with running water, soap (preferably liquid) and disposable towels or hot air dryers. Any
drinking water taps should be appropriately designated in a suitable area.
Explain to pupils that they cannot be allowed to eat or drink anything, including crisps, sweets,
chewing gum, etc., while touring the farm, or put their fingers in the mouth, because of risk of
infection
If children are in contact with, or feeding, farm animals, warn them not to place their faces against
the animals or taste the animal feed.
Ensure all pupils wash and dry their hands thoroughly after contact with animals and particularly
before eating and drinking.
Meal breaks or snacks should be taken well away from areas where animals are kept, and pupils
warned not to eat anything, which may have fallen to the ground.
Any crops produced on the farm should be thoroughly washed in drinking water before consumption.
Ensure pupils do not consume unpasteurised produce, for example milk or cheese.
Ensure all children wash their hands thoroughly before departure and ensure that footwear is as free
as possible from faecal material.
IMMUNISATIONS
Immunisation status should always be checked at school entry and at the time of any vaccination. Any
vaccinations that have been missed should be given and further catch-up doses organised at school or
through the child’s GP.
All children should be vaccinated according to the national schedule, which in 2006 is:




2, 3 and 4 months: diphtheria, tetanus, whooping cough, polio, Hib and meningococcal C.
Around 13 months: 1 dose MMR
3 years and 4 months to ate 5: booster of diphtheria, tetanus, whooping cough and polio, and second
dose MMR
Between 13-18 years: booster of diphtheria, tetanus, polio.
USEFUL LINKS:
www.hpa.org.uk
www.dh.gov.uk
www.nhsdirect.nhs.uk
www.wiredforhealth.gov.uk
See also leaflet and poster at
Leaflet http://www.wiredforhealth.gov.uk/PDF/pocketg.pdf
Poster http://www.wiredforhealth.gov.uk/PDF/infect_poster.pdf
Hard copies, in poster format, are available from:
DH Publications Orderline
PO BOX 777
London SE1 6XH
Tel: 08701 555 455
Fax: 01623 724 524
Or Email: dh@prolog.uk.com
Item Code 50363
6