Download Disease Control Day Care Manual - Jefferson County Department of

C AROLYN DOBBS, M.D., PH.D., M.P.H.
MEDICAL DIRECTOR
DISEASE CONTROL SERVICES
Dear Child Care Director,
The Prevention and Epidemiology division of Disease Control Services has developed a Day
Care Manual for distribution to all childcare facilities. The manual is provided as a courtesy to
you and your facility and should be used as a reference for making disease control management
decisions. As disease control management protocols change, we will provide you with updated
information. Please keep this manual in the facility office for use by you and your staff.
We hope that you will find this manual helpful. Please call me at 930-1458 if you have
questions or need additional information. Because of funding limitations we can only provide
one manual per facility. The manual should remain with the facility.
Sincerely,
Stephanie Ayers-Millsap, M.P.H.
Disease Intervention Program Manager
Prevention and Epidemiology
SAM/ad
Infection Control in the
Child Care Center and Pre-School
Information for Directors, Caregivers,
and Parents or Guardians
Third Edition
2009
Disease Control Services
Jefferson County Department of Health
1400 Sixth Avenue South
PO Box 2648
Birmingham, AL 35202
(205) 933-9110
TABLE OF CONTENTS
Page
SECTION I.
General Guidelines........................................................................................................................... 1
A.
B.
C.
D.
E.
Cleaning and Disinfection .................................................................................. 2-5
1.
General Information
2.
Definitions
3.
Guidelines and Procedures
4.
Instructions for Mix and Use of Disinfection Agents
Diapering ............................................................................................................ 6-8
1.
Equipment
2.
Proper Procedure
3.
Clean-up
Handwashing ......................................................................................................... 9
Exclusion of Ill Persons .................................................................................. 10-13
1.
General Guidelines
2.
Disease Specific Guidelines
3.
Inadequately Immunized
4.
Staff Exclusion
Standard Precautions............................................................................................ 14
SECTION II.
Disease Reporting .......................................................................................................................... 15
A.
B.
C.
D.
E.
Reportable Disease Law ................................................................................. 16-17
Alabama Notifiable Diseases ............................................................................... 18
Reporting to Local/ State Health Department ...................................................... 19
Reporting to Parents............................................................................................. 19
Reporting from Parents ........................................................................................ 19
SECTION III.
Exposure Control and Outbreak Management ............................................................................... 20
A.
B.
Protocol for Control of Contagious Diseases.................. .....................................21
Individual Listing/Description of Selected Reportable or Contagious
Diseases with Prevention or Control Recommendations .............. .......................22
Campylobacteriosis.......................................................................................... …23
Conjunctivitis (Pinkeye) .............................. ........................................................24
Cytomegalovirus (CMV). ............................... .....................................................25
i
Diarrhea
a. Norovirus ............................... ..........................................................................26
b. Rotavirus .................................. ........................................................................27
c. Diarrhea (not caused by any specific pathogen).. .............................. ..............28
Ear Infection... ............................................. .....................................................................29
Enteroviruses... ............................................. ....................................................................30
Escherichia coli (E. coli) O157:H7.... ............................................ ..................................31
Fifth Disease. .............................................. ......................................................................32
Giardiasis... ............................................. ..........................................................................33
Haemophilus influenzae type b (Hib)....... ........................................... .............................34
Hand, Foot, and Mouth Disease..... ............................................ .......................................35
Hepatitis A....... ............................................. ....................................................................36
Hepatitis B.... .............................................. ......................................................................37
Human Immunodeficiency Virus (HIV) / AIDS.................................... ...........................38
Impetigo. ............................................... ............................................................................39
Lice...... ............................................. ................................................................................40
Lyme Disease....... ............................................ ............................................................41-42
Measles (Rubeola)...................... ...................................................................................... 43
Meningococcal Disease.......... ......................................... .................................................44
Mononucleosis... ........................................... ....................................................................45
Mumps... ............................................. ..............................................................................46
Oral Herpes. ............................................. .........................................................................47
Pertussis (Whooping cough)...... ............. ..........................................................................48
Pinworms..... ............................................ .........................................................................49
Respiratory Infections (viral)......... .......................................... .........................................50
Respiratory Syncytial Virus (RSV)........ .............................. ............................................51
Reye Syndrome.... ........................................... ..................................................................52
Ringworm....... ........................................... .......................................................................53
Roseola............................................... ...............................................................................54
Rubella (German measles).... ............. ...............................................................................55
Salmonellosis.. ........................................... .......................................................................56
Scabies...... ........................................... .............................................................................57
Shigellosis........ ............................................ .....................................................................58
Shingles (Herpes zoster)......... ................. .........................................................................59
Strep Throat / Scarlet Fever....... .......................................... .............................................60
Tuberculosis (TB)...... ................................. ......................................................................61
Varicella (Chickenpox)………. ...................................................................................... ..62
Yeast Infections (Thrush)....... ......................................... .................................................63
Yersiniosis....... ................................................................ .................................................64
SECTION IV.
Quick Reference Summary Chart of Infectious Diseases.... ........................................ .............65-70
ii
SECTION V.
Sample Letters to Parents.................................... ...........................................................................71
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
Updated Blue Form Request ................................................................................72
Giardiasis.. ............................................................................................................73
Hepatitis A..... ................. ................................................................................74-75
Head Lice...................... ................. .................................................................76-77
Hib 1 (One Case) ................................................................................................. 78
Hib 2 (Two Cases) ............................................................................................... 79
Meningococcal Disease ....................................................................................... 80
Pertussis (Whooping Cough) ............................................................................... 81
Shigellosis......... .................. .................................................................................82
Varicella (Chickenpox) ........................................................................................ 83
SECTION VI.
Immunizations... .............................................................................................................................84
A.
B.
C.
D.
E.
F.
Alabama Immunization Law... ............... .............................................................85
Copy of Current Immunization Schedule... .............. ...........................................85
Example of Blue Form.......................... ................... ............................................85
Exemptions.............................................. ................ ............................................85
1.
Medical Exemption from Immunization
2.
Religious Exemption from Immunization
Explanation of Blue Form Compliance Requirements.. .................. ....................86
1.
Certificate of Excellence
2.
Tickler System for Monitoring Blue Forms
3.
Letter to Parents Requesting Updated Form
Instructions on When, Where, and How Children Can Get Free Shots. ............ ..87
SECTION VII.
Glossary……... ……. .............................................................. .................................................88-89
SECTION VIII.
List of references...................................................................... ......................................................90
SECTION IX.
Daycare Preparedness Planning Guide.......................... ............. ..............................................91-92
iii
INTRODUCTION
The purpose of this manual is to serve as a resource for the child care center director,
caregiver, and parent and/or guardian with the responsibility of practicing disease control.
Disease control is the implementation of strategies to reduce disease occurrence. In many
instances disease control can be expressed in terms of a protocol, but it must be remembered
that a general protocol may not suit a given situation exactly. Commonly we resort to
national consensus guidelines such as those developed by the Immunization Practices
Advisory Committee, the American Academy of Pediatrics, and the Centers for Disease
Control and Prevention for disease control strategies. The policies of other states and local
health departments are helpful. The focus of this manual will be the diseases that mostly
affect children at day care centers and others associated with day care centers. The goal of
this manual is to educate those working with children in order to reduce the spread of
infectious diseases.
SECTION I.
Explains the specific guidelines pertaining to cleaning and disinfection, diapering,
handwashing, exclusion of ill persons, and universal precautions.
SECTION II.
Explains the process of disease reporting both by the day care to parents and by parents
to the day care.
SECTION III.
Explains the protocol for control of contagious diseases and includes individual fact
sheets on diseases that most affect day care centers and the people associated with
them. Reportable diseases are marked.
SECTION IV.
Lists each disease in a quick reference chart.
SECTION V.
Provides sample letters addressed to parents concerning infectious diseases at day care
centers.
SECTION VI.
Explains the law and processes of immunization in the State of Alabama.
SECTION VII.
Provides a glossary for words pertaining to this manual as well as to infection control in
day care centers.
SECTION VIII.
Provides a list of references used in preparing this manual.
SECTION IX.
Provides resources for child care centers to prepare for and respond to potential
emergencies, including natural disasters and terrorists attacks.
iv
QUICK REFERENCE RESOURCE LIST
The Child Care Resource Center
252-1991
The Poison Control Center at
The Childrens' Hospital of Alabama
933-4050
(Statewide) 1-800-292-6678
The Child Development Council
933-1095
Department of Human Resources
State Licensure and Certification
945-4630
Jefferson County Department of Health
Disease Control Services
930-1440
Jefferson County Department of Health
Nutrition Services
930-1481
Jefferson County Department of Health
Dental Health Services
930-1409
Jefferson County Department of Health
Immunization Program
930-1450
Jefferson County Department of Health
Environmental Health Services
Food and Lodging Division
930-1215
Jefferson County Department of Health
Nursing Services
930-1343
v
SECTION I.
GENERAL GUIDELINES
A.
Cleaning and Disinfection
1.
General Information
2.
Definitions
3.
Guidelines and Procedures
4.
Instructions for Mix and Use of Disinfection Agents
B.
Diapering
1.
Equipment
2.
Proper Procedure
3.
Clean-up
C.
Handwashing
D.
Exclusion of Ill Persons
1.
General Guidelines
2.
Disease Specific Guidelines
3.
Inadequately Immunized
4.
Staff Exclusion
E.
Universal Precautions
1
CLEANING AND DISINFECTION
1.
General Information
The close, long-term contact that occurs in day care centers makes it essential that certain
cleaning and disinfection techniques be followed by those working in the day care setting.
Following these techniques will decrease the chance of spreading the harmful germs that may
cause illness in children or staff. The necessary techniques include proper handwashing, proper
cleaning and disinfection of surfaces or objects that children or staff may come in contact with,
and proper disposal of contaminated objects. It is recommended that age groups be separated if
possible in order to reduce the spread of certain diseases such as diarrhea and hepatitis A. This
recommendation is made since certain age groups, especially those under the age of three years,
are more likely to spread infectious diseases. Children in this age group are mobile, are in
diapers, and usually do not practice good hygiene.
Cleaning and disinfection of objects and surfaces that children and staff commonly come in
contact with should be done regularly even though infectious agents may not be seen. These
techniques should also be used regardless of whether or not children are showing any signs of
illness since many diseases can be asymptomatic in children.
When contact with blood or other body fluids occur, they should be treated as contaminated.
This universal precaution is to ensure the safety of the children and staff in the day care even if
there is no one presenting with symptoms.
2.
Definitions
Cleaning:
Involves the act of making a surface or object free from contaminates, germs or disease.
Disinfecting:
Involves the act of making a surface or object free from infectious agents particularly by
destroying harmful germs.
3.
Guidelines and Procedures
SPECIFIC GUIDELINES
a.
Surfaces and objects that have been contaminated with urine, stool, vomit or
blood: Clean immediately with detergent and water and disinfect with bleach
solution. Use the proper procedures outlined later in this section.
b.
Objects handled by children: Clean and disinfect daily or as necessary when
dirty (toys, eating utensils, high chair trays, etc.).
2
c.
Diaper changing areas: Clean and disinfect after each changing using bleach
solution.
d.
Bathrooms: Clean and disinfect daily or as necessary when dirty.
e.
Toilet-training chairs: Empty contents into toilet; clean and disinfect with
bleach solution after each use.
f.
Handwashing sinks/faucet handles: Clean and disinfect daily or as necessary
when dirty.
g.
Indoor surfaces on which activities occur: Clean and disinfect weekly or as
necessary when dirty.
h.
Bottles, nipples, caps: Clean the insides with soapy water and a brush. Disinfect
by washing only in a commercial dishwasher, immersing in a 50-100 ppm
chlorine bleach solution (see recipe on p. 5), or boiling for 5 minutes just before
filling.
I.
Pacifiers and thermometers: Clean and disinfect with bleach solution after each
use.
j.
Flooring that is uncarpeted: Vacuum or sweep and mop with bleach solution
daily or as necessary when dirty.
k.
Flooring that is carpeted: Vacuum daily and shampoo every 3 to 6 months or as
necessary when dirty.
l.
Mops: Clean with water and detergent. Soak for 10 to 30 minutes after use in
bleach solution.
m.
Cleaning gloves: Clean in soapy water and bleach solution after each use.
n.
Water play tables: Clean and disinfect daily and as necessary when dirty with
bleach solution.
SPECIFIC PROCEDURES
A.
Cleaning
Objects and surfaces that come in contact with blood and/or body fluids
(stool, urine, vomit) need to be cleaned immediately.
1.
Use disposable gloves when handling blood or objects containing
blood. Use disposable gloves when open sores and cuts are present. Use
disposable gloves when cleaning areas, such as bathroom or diaperchanging areas, that are contaminated with blood and/or body fluids.
2.
Areas with blood or body fluids should be wiped with a disposable
towel after which it should be discarded in a plastic-lined hazardous
waste container.
3
B.
3.
Fresh water and detergent should be used for cleaning contaminated
and/or dirty objects and surfaces. DO NOT REUSE WATER.
4.
If possible, rinse objects under water after cleaning.
5.
Disinfect all areas, surfaces and objects after cleaning.
Disinfection
Objects and surfaces that come in contact with blood and/or body fluids
(stool, urine, vomit) need to be disinfected immediately after cleaning.
C.
1.
Use the recommended disinfectant, a bleach and water solution
(preparation procedures follow on page 5).
2.
Only use commercial disinfectants that are approved by the US
Environmental Protection Agency that are also effective against hardto-kill bacteria.
3.
Use a recommended disinfectant or a bleach and water solution
(preparation procedures follow on page 5) on toys, eating utensils, and
food-contact surfaces. Clean toys and utensils first, then soak in
solution for no less than 2 minutes. Let objects air dry. DO NOT
RINSE.
4.
MAKE SOLUTION DAILY or at least every 4 hours. The bleach
and water solution will lose its ability to kill germs over time, so it is
imperative that it be made daily. Test bottled bleach with chlorine strips
for its strength, and do not keep for more than six months.
5.
KEEP BLEACH OR BLEACH AND WATER SOLUTION OUT
OF THE REACH OF CHILDREN.
6.
Remove gloves and discard after use. If hands have come in contact
with blood or body fluids, WASH IMMEDIATELY, even if gloves
have been used.
Alternate Cleaning and Disinfection Procedures
1.
Washing machines and commercial dishwashers are acceptable
alternatives for cleaning and disinfecting contaminated objects if hot
water is used.
2.
Objects (such as bottle nipples, pacifiers, and combs) may be boiled for
no less than 5 minutes in order to disinfect.
4
INSTRUCTIONS FOR MIX AND USE OF DISINFECTION AGENTS
FORMULAS FOR MIXING CHLORINE BLEACH SOLUTIONS
Some of the proportions will be approximate for both formulations. Standard abbreviation for
cups (C.), tablespoons (T.), and teaspoons (t.) are used. Measurement equivalents are 2 T. = 1
oz.; 1 T. = 1.2 oz.; 2 t. = 1/4 oz. (approximate).
1:32 Chlorine Bleach Solution
Amount of Bleach
2 t.
1 T.
2 T.
1/4 C.
1/2 C.
Amount of Water
1 C.
1 pt.
1 qt.
2 qt.
4 qt.
Final Amount of Solution
1 C.
1 pt.
1 qt.
1/2 gal.
1 gal.
This solution is used for general cleaning of non-porous environmental surfaces on a routine
basis. The solution must be MADE FRESH DAILY or at least every four hours, as the active
ingredient is lost more rapidly in very dilute solutions than in the more concentrated solutions.
5
DIAPERING
It is important to have proper diapering techniques in order to decrease the spread of infectious agents.
Agents that are spread in stool or urine include Campylobacter, Giardia, Hepatitis A, Salmonella, and
Shigella. Germs are easily spread by contaminated hands, food, water, and/or surfaces. The germs that
cause infectious diseases are included and need to be contained so illness does not occur or spread.
Following proper diapering techniques is one way to reduce the risk of contracting an infectious disease.
BASIC STANDARDS
•
•
•
•
•
•
1.
Only designated areas should be used to change diapers.
Diaper area should be separate from any food storage, preparation area and /or eating area.
Objects, such as pacifiers, toys, baby bottles, and food should be kept separate from diaper area.
Soiled diapers should be disposed of properly.
Staff should always wash their hands after diapering.
Children being toilet trained and children who are already toilet trained should be taught to always
wash their hands after using the bathroom or toilet training chair.
Equipment
a.
Changing surface
•
•
•
b.
Changing surface should be at least 3 feet above the ground in order to keep children
away from the surface.
Surface should be made from a material that is easily cleaned and moisture-resistant.
Non-absorbent, disposable paper should be used to cover the changing surface for extra
protection.
Handwashing sink and supplies
•
•
•
•
•
•
Sink faucet should have both hot and cold water running through it. The hot water
temperature should be no less than 100oF and no greater than 120oF.
To avoid hand contamination, faucets should be operated by the foot, knee, or wrist.
Handwashing and food sinks should be separated from each other. Handwashing sink
should be located next to the changing area.
Liquid soap, towels, and fingernail brushes should be kept within a close proximity of
the handwashing sink.
Paper towels should be used instead of cloth towels.
If a foot- or knee-operated faucet is not available, the faucet should be turned off with a
paper towel to avoid contaminating hands.
6
c.
Diapers
•
•
•
•
d.
Disposable gloves
•
•
•
•
e.
•
•
•
Skin care items should be kept out of the reach of children but well within the reach of
the staff.
Individual containers of skin care products should be labeled for each child with the
child’s name.
A written and signed letter must accompany any skin care products to be used on a
child.
Directions on the package should be followed for proper use.
Plastic bags
•
•
h.
Wipes must be dispensed without contaminating the container or other wipes.
If this dispensing method cannot be practiced, each child should have his/her own set
of wipes.
Skin care items
•
g.
Gloves should be worn during diaper changing if the child has diarrhea or an infection
that is transmitted through stool.
Gloves should be worn by pregnant women or women considering pregnancy when
changing diapers.
Gloves should be worn by those with cuts, sores or cracked skin or if the child has
cuts, sores or cracked skin.
Gloves should be disposed of after each diaper change and hands should be washed
immediately.
Disposable wipes
•
•
f.
High-absorbency disposable diapers should be used since cloth diapers tend to leak
more and require more handling.
Diapers with an absorbent inner lining that is completely contained with an outside
waterproof material should be used.
The outer and inner lining of cloth diapers should be changed at the same time. Outside
linings may be used only if laundered.
Approved procedures for the use of cloth diapers are available from your health
representative.
Disposable plastic bags should be used in lining waste containers for transporting
soiled clothing from the day care to the child’s home.
Plastic bags should be stored out of the reach of children.
Waste container
•
•
•
•
•
Waste containers should be foot-operated and tightly covered.
Waste containers should be kept out of the reach of children.
Waste containers should be lined with a plastic bag.
Waste containers should be emptied before getting full and/or at least once a day.
Waste containers should be properly cleaned and disinfected once a day.
7
i.
Toilet training seats
•
•
•
2.
Proper Procedure
•
•
•
•
•
•
•
•
•
•
•
•
•
3.
Flush toilets are preferred over toilet training seats.
Should toilet training seats be used, seats should be smooth and easy to clean.
Toilet training seats should be emptied, cleaned and disinfected after each use.
Wash hands before changing diapers.
Gather necessary supplies needed for diaper changing:
Clean diaper.
Wipes or paper towels.
Nonabsorbent paper sheets.
Gloves, as necessary.
Other: ointment, cotton swabs, clean clothes, etc.
Cover changing table with nonabsorbent paper. The paper should be at least the length of the
child.
Put on gloves.
Put child on the changing table.
Always leave one hand on the child.
Keep other children away from the changing area.
Remove the child’s clothing.
Remove dirty diaper. Place diaper in waste container immediately.
Clean child’s diaper area.
Front to back and including skin creases.
Use child’s personal wipes.
Dispose of wipes in waste container immediately.
Dry diaper area completely.
Remove gloves and place in waste container immediately.
Place clean nonabsorbent paper under child.
Use ointment if needed and apply with clean gloves or cotton swabs.
Diaper child and dress.
Wash child’s hands and your hands after dressing. This should be done at the sink.
Return child to proper area in the day care.
Clean-up
•
•
•
•
•
Be sure that all soiled items are placed in the proper plastic lined waste container (diapers,
wipes, changing paper, gloves, etc.).
Place any dirty clothing in plastic bag to be sent home.
Clean and disinfect diaper changing area.
Wash hands using proper procedure.
Record diaper change and any unusual characteristics to discuss with parents (color, odor,
frequency, consistency, rash, etc.).
8
HANDWASHING
Handwashing is the most effective way of preventing the spread of infectious agents. Hands harbor germs
because they are moist and warm; additionally they are the part of the body that most frequently comes in
contact with germs. With children not practicing good personal hygiene (e.g., thumb sucking, eye rubbing,
placing any object in their mouths), it is important to recognize that day care centers are play grounds for
the spread of infectious agents. With this in mind, it is important for staff to learn the proper techniques of
handwashing not only for themselves, but for the sake of the children and their health.
Soap
Use liquid soap (not bar soap) in the day care setting because it is easier for the children to handle.
Fingernails
Use fingernail brushes to remove any blood or other body fluids from under the nails. Keeping fingernails
short makes them easier to keep clean.
Gloves
Gloves are NOT an alternative to handwashing. Hands must be washed before putting on clean gloves and
after removal of disposable gloves.
PROCEDURE
WHEN
• Whenever hands do not seem clean (look, smell, or feel unclean).
• When arriving at work.
• Before and after eating.
• Before and after preparing food.
• Before serving food.
• Before giving medications.
• Before and after changing diapers.
• Before and after using items or toys that are moist.
• After using the bathroom.
• After handling any blood or body fluids.
• After coughing, sneezing, or blowing your nose.
• After playing with animals.
• After playing outdoors.
HOW
• Remove any jewelry and roll up sleeves.
• Wet hands with water (temperature should be between 100oF and 120oF).
• Lather with liquid soap.
• Wash hands for a minimum of 20 seconds; during this time wash palms, backs of hands, between the
fingers, under fingernails and wrists.
• Rinse with warm water holding the fingers downward.
• Dry hands with clean paper towel or under a hot air dryer.
• Turn off the faucet using a paper towel to avoid recontamination.
• Throw paper towels and any other dirty items in the appropriate waste containers.
9
EXCLUSION OF ILL PERSONS
There are certain infectious diseases which require the exclusion of persons from work or day care in order
to avoid further spread. Children and staff members should be excluded from day care centers when they
present certain symptoms associated with these infectious diseases. Exclusion should continue until
symptoms have disappeared or until a physician has declared that the symptoms are not associated with an
infectious agent.
Children who are mildly ill may attend day care should the center have the capability of caring for that
child without disrupting normal activities.
1.
General Guidelines
Exclusion should occur if a child presents with any of the following:
Signs/Symptoms of Illness
Exclusion should occur until physician determines the child may return.
These signs/symptoms may include increased tiredness, increased
irritability, increased persisitent crying, and uncontrolled coughing.
Fever
Exclusion should occur until physician determines the child may return.
Temperatures of 100oF or higher (armpit), 100oF or higher (oral), and
102oF or higher (rectal) should be excluded.
Uncontrollable Diarrhea
Exclusion should occur until diarrhea stops or until physician determines
that it is not related to an infectious disease.
Vomiting
Exclusion should occur until vomiting stops.
Rash with Fever
or Behavior Change
Exclusion should occur until physician determines that it is not related to
an infectious disease.
Eye Drainage
Exclusion should occur until 24 hours after proper treatment has begun.
Unusual Color
Exclusion should occur until physician determines that it is not related to
an infectious disease.
Mouth Sores with Drooling
Exclusion should occur until physician determines the child may return.
10
2.
Disease-Specific Guidelines
The following infectious diseases are of concern to day care centers and those associated. Please follow the
proper procedures when dealing with a possible case of one of these diseases. More information is provided
on the individual fact sheets.
Campylobacteriosis
Until diarrhea is no longer present.
Conjunctivitis (Pinkeye)
Bacterial - Until treatment has been in effect for at least 24
hours and child can participate in daily activities.
Viral - None.
Cytomegalovirus (CMV)
None.
Diarrhea
a. Norovirus
b. Rotavirus
c. Diarrhea (no specific pathogen)
Until diarrhea is no longer present.
Until diarrhea is no longer present.
Until diarrhea is no longer present.
Ear Infection
Until fever is no longer present and child can participate in
daily activities.
Enteroviruses
Until diarrhea is no longer present.
E. coli O157:H7
Until pathogen is not present in the stool.
Fifth Disease
Until child can participate in daily activities.
Giardiasis
Until treatment has been in effect for at least 24 hours
and diarrhea is no longer present.
Haemophilus influenzae type b (Hib)
Until treatment has begun and child can participate in
daily activities.
Hand, Foot, and Mouth Disease
Until fever is no longer present.
Hepatitis A
Until 10 days after jaundice.
Hepatitis B
None unless there is the possibility of blood exposure
(child bites, hemophiliac, child has open sores, etc.)
Human Immunodeficiency Virus (HIV)
See individual fact sheet.
Impetigo
Until treatment has been in effect for at least 24 hours.
Lice
After treatment and no more live lice or eggs are found.
Lyme Disease
None.
Measles
Until at least 4 days after rash appears.
Meningococcal Disease
Until treatment has begun and child can participate in
daily activities.
11
Mononucleosis
Until treatment has begun and child can participate in
daily activities.
Mumps
During contagious period; the 12th through 25th day after
exposure.
Oral Herpes
Only necessary for children with active lesions who have
no control over oral secretions.
Pertussis
Until 5 days of a 14 day treatment has been administered.
Pinworms
Until treatment has been in effect for at least 24 hours.
Respiratory Infections (viral)
Until fever is no longer present and child can participate
in daily activities.
Respiratory Syncytial Virus
Until fever is no longer present.
Reye Syndrome
Until child can participate in daily activities.
Ringworm
Until treatment has been in effect for at least 24 hours.
Roseola
Until fever is no longer present.
Rubella
Until 7 days after rash onset.
Salmonellosis
Until diarrhea is no longer present.
Scabies
Until treatment has been in effect for at least 24 hours.
Shigellosis
Until treatment is complete and 2 stool cultures taken 24
hours apart are negative.
Shingles
Until sores are dried or if they can be covered there is no
exclusion.
Strep Throat / Scarlet Fever
Until fever is no longer present and treatment has been
in effect for at least 24 hours.
Tuberculosis
Until physician determines that the child is no longer
contagious.
Varicella (Chickenpox)
Until at least 5 days after onset and blisters are dry.
Yeast Infections (Thrush)
None.
Yersiniosis
Until diarrhea is no longer present.
12
3.
Inadequately Immunized
In order to avoid further spread of infectious diseases such as mumps, measles, rubella, pertussis, polio, and
diphtheria, children who are not adequately immunized shall be excluded from the day care. This exclusion
should continue through the incubation period of the disease to keep those not immunized from contracting
the disease and further spreading the disease to others. Children who have not been immunized for medical
or religious reasons should also be excluded during disease outbreaks.
4.
Staff Exclusion
Even though not all staff members come in direct contact with children, those staff members with an
infectious disease should follow the same exclusion recommendations listed above. This is to ensure that
staff members do not spread the disease to the children or to other staff members working with the children.
Staff who are involved in food preparation, service, or feeding or assist in these duties (including preparing
or serving snacks or beverages) cannot come to work if they are experiencing vomiting, diarrhea, sore
throat with fever, or jaundice. They may return to work 24 hours after the symptoms of diarrhea and
vomiting have ceased; jaundice or sore throat with fever require a medical release and approval from the
health department.
Employees who have been diagnosed with an illness cause by Norovirus may return 48 hours after
symptoms have passed; if diagnosed with illness caused by Samonella typhii (Typhoid Fever), Hepatitis A
virus, E. coli O157:H7 or other STEC/EHEC (Shiga toxin-producing E. coli/Enterohemorrhagic E. coli), or
Shigella (Shigellosis), medical clearance is required to return to work.
13
STANDARD PRECAUTIONS
Since certain diseases such as HIV and hepatitis B are not always readily identifiable, universal precautions
should take place when handling blood, certain body fluids (amniotic fluid, cerebrospinal fluid, semen and
vaginal secretions, etc.) and any body fluid contaminated with blood. Treat the fluids as if they are infected.
Gloves need to be worn when coming in contact with these fluids. Protective eyewear should be worn if
there is the potential for these fluids to splatter. Needles and sharp objects need to be handled, disposed and
decontaminated properly in order to avoid spread of infectious diseases.
1.
Handwashing
•
•
•
2.
Gloves
•
•
•
•
•
3.
Handwashing is the single most effective way to prevent the spread of infectious diseases.
Do not use sinks to wash hands contaminated with blood or other body fluids that are used for
food preparation.
Wash hands:
• Whenever hands do not seem clean (look, smell, or feel unclean).
• When arriving at work.
• Before and after eating.
• Before and after preparing food.
• Before serving food.
• Before giving medications.
• Before and after changing diapers.
• Before and after using items or toys that are moist.
• After using the bathroom.
• After handling any blood or body fluids.
• After coughing, sneezing, or blowing your nose.
• After playing with animals.
• After playing outdoors.
• After touching hair or body of yourself or child.
Wear gloves:
• When in contact with blood or other body fluids is certain.
• When items such as blood, urine and vomit will be handled.
• When changing diapers when a known infectious agent is present in the stool or urine.
• If pregnant or considering pregnancy and changing diapers when a known infectious agent
is present in the stool or urine.
If tearing occurs, gloves should be changed immediately.
New gloves should be used each time a different child is handled.
Dispose of gloves in the proper waste containers.
When handling any ready-to-eat food.
Cleaning and Disinfection
•
•
•
•
•
Immediately clean any surface or items that are contaminated with blood or other body fluids.
Disposable paper towels should be used in the cleaning process.
Disinfect all surfaces after cleaning using the correct bleach solution.
Disinfect all toys, eating utensils and food-contact areas using the correct bleach solution.
Make the bleach solution FRESH DAILY or at least every four hours since it loses its
ability to kill germs over time.
14
SECTION II.
DISEASE REPORTING
A.
Reportable Disease Law
B.
Alabama Notifiable Diseases
C.
Reporting to Local/ State Health Department
D.
Reporting to Parents
E.
Reporting from Parents
15
REPORTABLE DISEASE LAW
The Notifiable Disease Act (87 - 574) and subsequently promulgated rules and regulations are the legal
basis by which the Alabama Department of Public Health designates certain diseases and health conditions
as notifiable and mandates their reporting. Copies of the law and regulations are attached.
Notifiable diseases are listed on page 18. Diseases are designated as either group A or group B. Group A
diseases are those that should be reported by healthcare workers within 24 hours of diagnosis, usually by
telephonic report, to the county health department. Group A diseases are those for which prompt reporting
is indicated so that contacts can be prophylaxed (e.g., hepatitis A), potential health hazards can be
identified (e.g., botulism), and appropriate investigations initiated (e.g., outbreak of any kind). Group B
diseases are those for which promptness of reporting is not so urgent but which are of public health
importance (e.g., salmonellosis). They are to be reported by notifiable disease card within 7 days of
diagnosis.
RULES OF STATE BOARD OF HEALTH
DIVISION OF DISEASE CONTROL
CHAPTER 420-4-1
NOTIFIABLE DISEASES
420-4-1-.01
Purpose. The purpose of these rules is to provide administrative details and
procedures for the control of notifiable diseases or health conditions.
420-4-1-.03
Enumeration.
(1) The State Committee of Public Health, acting for the State Board of Health, shall designate in
accordance with the Administrative Procedure Act, by majority vote, the diseases and health conditions
which are notifiable and may change or amend such lists as deemed necessary. The diseases and health
conditions so designated are declared to be diseases and health conditions of epidemic potential, a threat to
the health and welfare of the public or otherwise of public health importance.
(2) Disease Categories. The State Committee of Public Health designates that the notifiable
diseases shall be divided into two categories: (a) Group A – immediate reporting, (b) Group B – disease
notifiable within seven days.
(3) Sexually Transmitted Diseases. The State Committee of Public Health, acting for the State
Board of Health, shall designate in accordance with the Administrative Procedure Act, by majority vote,
those notifiable diseases which shall be designated as sexually transmitted. Such sexually transmitted
notifiable diseases shall be included within those designated in Rule 420-4-1.03 (1). Such sexually
transmitted notifiable diseases shall be reported as provided in Rule 420-4-1.03 (2). Said sexually
transmitted notifiable diseases are enumerated in Appendix 1 of the Notifiable Disease Act.
(4) Duration of Reportability. Diseases declared to be notifiable by the State Committee of Public
Health shall remain on the list of notifiable diseases until removed by majority vote of the State Committee
of Public Health in accordance with the Administrative Procedure Act unless said Committee designates a
specific period of time for a given disease to be notifiable as herein provided.
16
(5) Temporary Designation. The State Committee of Public Health, acting for the State Board of
Health, may designate in accordance with the Administrative Procedure Act, by majority vote, a disease to
be notifiable for a specified period of time. Said diseases and health conditions must be of epidemic
potential, a threat to the health and welfare of the public or otherwise of public health significance. When a
disease or condition is so designated for a specified period of time, said diseases shall be added to the list of
notifiable diseases effective immediately upon said designation and shall be removed from the list of
notifiable diseases after the period of time designated has expired.
(6) Emergency Designation. The State Health Officer acting for the State Committee
of Public
Health and for the State Board of Health may, when in his discretion he deems emergency actions
necessary, designate a disease or health condition to be notifiable. Diseases so designated by the State
Health Officer shall remain notifiable until the next meeting of the Committee of Public Health unless such
designation is confirmed by the action of the State Committee of Public Health; in which case, the disease
shall be made either permanently notifiable or temporarily notifiable by said Committee as herein provided.
420-4-1-.06
HIV Testing Procedures.
(1) Individuals shall be notified of the results of positive human immunodeficiency virus antibody
tests only after preliminary screening tests have been found to be repeatedly reactive and a confirmatory
test such as the western blot or the immunofluorescence test has been found to be positive.
(2) Except in emergency circumstances when, in the best medical judgment of the attending
physician, there is reasonable cause to believe that there is a real, present and immediate danger of
communication of the HIV virus to attending medical personnel, testing for infection with the human
immunodeficiency virus either by antibody tests or other methods shall be performed only with the
knowledge and consent of the individual being tested if said test results can be linked to a specific
individual or as ordered by the Health Officer as provided by Act 87-574. Nothing in this section shall
preclude the use of anonymous blind serologic testing to establish seroprevalence of HIV infection in
targeted groups, so long as test results cannot be linked to a specific individual nor preclude the routine
testing of blood donors, organ donors, semen donors nor individuals sentenced to confinement or
imprisonment in city, county or state correction facilities.
(3) Testing for the human immunodeficiency virus by antibody determination or by other means
shall be performed only with the provision of counseling to the individual tested. Such counseling shall, at
a minimum, provide information on the meaning of the test, on ways to avoid becoming infected and on
ways to avoid transmission of the virus to others. However, nothing in this paragraph shall apply to any
business organization providing life, health, or disability insurance.
17
ALABAMA NOTIFIABLE DISEASES
Group A Disease/Conditions: Report to the Jefferson County Department of Health by telephone,
fax, or in person within 24 hours of diagnosis.
RABIES, HUMAN AND ANIMAL
SEVERE ACUTE RESPIRATORY SYNDROME (SARS)
TRICHINOSIS
TUBERCULOSIS
TYPHOID FEVER
YELLOW FEVER
OUTBREAKS ANY KIND
CASES RELATED TO NUCLEAR, BIOLOGICAL, OR
CHEMICAL TERRORISTIC AGENTS
CASES OF POTENTIAL PUBLIC HEALTH
IMPORTANCE ***
ANTHRAX, human
BOTULISM
CHOLERA
DIPHTHERIA
H. INFLUENZAE, INVASIVE DISEASES*
HEPATITIS A
LISTERIOSIS
MEASLES (RUBEOLA)
N. MENINGITIDIS, INVASIVE DISEASES**
PERTUSSIS
POLIOMYELITIS, PARALYTIC
*
I.e., meningitis, epiglotitis, sepsis, cellulitis, septic arthritis, osteomyelitis, pericarditis, and type b
pneumonia
** Detection of organism from normally sterile site (e.g., blood and cerebrospinal fluid)
*** As determined by the reporting healthcare provider
Group B Diseases/Conditions: Report in writing to the Jefferson County Department of Health
within 7 days of diagnosis.
LYME DISEASE
LYMPHOGRANULOMA VENEREUM
MALARIA
MUMPS
PSITTACOSIS
Q FEVER
ROCKY MOUNTAIN SPOTTED FEVER
RUBELLA
SALMONELLOSIS
SHIGELLOSIS
SYPHILIS
TETANUS
TOXIC SHOCK SYNDROME
TULAREMIA
VACCINIA VIRUS INFECTION OR DISEASE OTHER
THAN EXPECTED RESPONSE TO SMALLPOX
VACCINATION
VARICELLA
VIBRIOSIS
YERSINIOSIS
BRUCELLOSIS
CAMPYLOBACTERIOSIS
CHANCROID
CHLAMYDIA TRACHOMATIS
CRYPTOSPORIDIOSIS
DENGUE FEVER
E. COLI O157:H7 (INCLUDING HUS AND TTP)
EHRLICHIOSIS
ENCEPHALITIS, VIRAL
GIARDIASIS
GONORRHEA
GRANULOMA INGUINALE
HEPATITIS B, C, AND OTHER VIRAL
HISTOPLASMOSIS
HUMAN IMMUNODEFICIENCY VIRUS INFECTION
(INCLUDING ASYMPTOMATIC INFECTION,
ARC, AND AIDS)
LEAD, ELEVATED BLOOD LEVELS (≥ 10 MCG/DL)
LEGIONELLOSIS
LEPROSY
LEPTOSPIROSIS
Jefferson County Department of Health
Disease Control Services
930-1440
18
REPORTING TO LOCAL/ STATE HEALTH DEPARTMENT
420-4-1-.04
Reporting.
(1) Responsibility for Reporting. Each physician, dentist, nurse, medical examiner, hospital
administrator, nursing home administrator, laboratory director, school principal, and day care center
director shall be responsible to report cases or suspected cases of notifiable diseases and health conditions.
Said reports shall contain such data as may be required by the rules of the State Board of Health. Said
report shall be in the manner designated in Rule 420-4-1-.04 (2) and (3).
(2) Report of Group A Disease. Diseases designated as Group A shall be reported to the state
Health Officer or the County Health Officer within twenty-four (24) hours of diagnosis, by telephone,
telegraph, or in person. Said report shall contain, as a minimum, the name of the disease or health
condition, the name and address of the person having the disease or health condition, the date of onset
and/or date of diagnosis of said disease or health condition.
(3) Report of Group B Diseases. Group B diseases are notifiable within seven (7) days. Diseases
and health conditions designated as Group B diseases shall require notification, in writing, to either the
County Health Officer or the State Health Officer within seven (7) days. Said report shall include, at a
minimum, the name of the disease or health condition, the name and address of the person having the
disease or health condition, the date of onset and/or date of diagnosis of said disease or health condition.
(4) Supplemental Information. The State Health Officer may require additional information
concerning any of the notifiable diseases or health conditions in order to properly investigate and control
said disease or health condition. For this purpose, the State Health Officer may designate supplemental
forms for various notifiable diseases for collecting the required information. Physicians, hospitals, nurses,
and others as required by law shall, in addition to the basic information required on the initial report,
provide such information as required on the supplemental report for those diseases so designated.
REPORTING TO PARENTS
Department of Human Resource regulations indicate that when a communicable disease has been
introduced into a child care center parents of exposed children shall be notified. The day care center is
responsible for reporting any known or suspected cases of communicable disease to the local health
department. Notifying the parents allows them to monitor their child for the signs and symptoms of the
disease and to get the child the proper care should he/she be affected by the disease. The appropriate fact
sheet should either be posted where every parent can see or it should be sent home as soon as the disease is
identified. Reassurance to the parents can be enhanced by obtaining more information from your local
health department concerning the containment of the disease. Immediate and appropriate actions must be
taken in order to avoid further spread through the day care or to the family members of those attending the
day care.
REPORTING FROM PARENTS
It is imperative that parents notify the day care center immediately if their child has been diagnosed with an
infectious disease. This allows the director and staff members to monitor the other children in the center for
19
the signs and symptoms of the disease. The staff is also able to notify other parents for monitoring at home.
Notification by both the day care center and the parents is essential for the control of infectious diseases.
SECTION III.
EXPOSURE CONTROL AND OUTBREAK MANAGEMENT
A.
Protocol for Control of Contagious Diseases
B.
Individual Listing/Description of Each Reportable or
Contagious Disease with Prevention or Control
Recommendations
20
PROTOCOL FOR CONTROL OF CONTAGIOUS DISEASE
The following law explains the requirements for controlling infectious diseases. Early identification,
treatment and notification are integral to control the spread of infectious diseases.
420-4-1-.05
Control Procedures.
(1) The State Health Officer may act to prevent the spread of any notifiable disease or health
condition in a manner consistent with the current medical and epidemiological knowledge about the mode
of transmission of said disease or health condition. Said actions for control of disease include any of the
following actions or any combinations thereof or any other lawful action necessary to prevent the spread of
disease.
(a) The Health Officer or his designee may cause a person or persons to be placed in
isolation and order said person or persons to remain in such status until released by said
Health Officer or his designee as provided for Act 87-574.
(b) The Health Officer or his designee may cause a person or persons to restrict their
activities and not engage in certain specified activities or enter certain places while they are
potentially capable of transmitting a notifiable disease or health condition.
(c) The Health Officer or his designee may cause a person or persons to be quarantined in
their own dwelling or such other facility as may be deemed appropriate and may order
removal of said person if not in their own home, in accordance with Section 8 of Act 87574.
21
INDIVIDUAL LISTING/DESCRIPTION OF EACH REPORTABLE OR CONTAGIOUS
DISEASE WITH PREVENTION OR CONTROL RECOMMENDATION
Campylobacteriosis
Conjunctivitis (Pinkeye)
Cytomegalovirus (CMV)
Diarrhea
a. Norovirus
b. Rotavirus
c. Diarrhea (not caused by any specific pathogen)
Ear infection
Enteroviruses
Escherichia coli (E. coli) O157:H7
Fifth Disease (Erythema Infectiosum, Parvovirus B19 infection)
Giardiasis
Haemophilus influenzae type b (Hib)
Hand, Foot, and Mouth Disease
He patitis A
Hepatitis B
Human Immunodeficiency Virus (HIV) / AIDS
Impetigo
Lice
Lyme Disease
Measles (Rubeola)
Meningococcal Disease
Mononucleosis
Mumps
Oral Herpes
Pertussis (Whooping cough)
Pinworms
Respiratory Infections (viral)
Respiratory Syncytial Virus (RSV)
Reye Syndrome
Ringworm
Roseola
Rubella (German measles)
Salmonellosis
Scabies
Shigellosis
Shingles (Herpes zoster)
Strep Throat / Scarlet Fever
Tuberculosis (TB)
Varicella (Chickenpox)
Yeast Infections (Thrush)
Yersiniosis
Outbreaks of Any Kind
***Items in bold type are conditions reportable the Jefferson County Department of Health***
Please follow proper instructions for reporting cases.
22
CAMPYLOBACTERIOSIS
BACKGROUND
Campylobacteriosis is a bacterial infection that affects the intestinal tract
and, rarely, the bloodstream. Most cases are seen in the summer months
and occur as single cases or outbreaks.
REPORTABLE (GROUP A OR B)
Group B: report within 7 days to county or state health department.
INFECTIOUS AGENT(S)
Campylobacter jejuni.
MODE OF TRANSMISSION
Campylobacter are generally spread by eating or drinking contaminated
food or water and, occasionally, by contact with infected people or
animals. Many animals, including swine, cattle, dogs and birds,
(particularly poultry) carry the germ in their intestines. These sources in
turn may contaminate meat products (particularly poultry), water
supplies, milk and other items in the food chain.
OCCURRENCE
Worldwide; any age group. In developed countries, mostly seen in
children under 2 years of age.
SYMPTOMS
Mild or severe diarrhea, vomiting, nausea, abdominal cramps, fever, and
traces of blood in the stool.
INCUBATION PERIOD
2 to 5 days; with a range of 1 to 10 days.
CONTAGIOUS PERIOD
A few days to a few weeks; as long as Campylobacter is found in the
stool.
EXCLUSION
Until diarrhea is no longer present.
PREVENTION/CONTROL MEASURES
•
•
•
•
•
•
•
•
•
•
Always treat raw poultry, beef and pork as if they are contaminated and handle accordingly.
Wrap fresh meats in plastic bags at the market to prevent blood from dripping on other foods.
Refrigerate foods promptly; minimize holding at room temperature.
Cutting boards and counters used for preparation should be washed immediately after use to prevent crosscontamination with other foods.
Avoid eating raw or undercooked meats.
Ensure that the correct internal cooking temperature is reached, particularly when using a microwave.
Avoid eating raw eggs or undercooked foods containing raw eggs.
Avoid using raw milk.
Encourage careful handwashing before and after food preparation.
Make sure children, particularly those who handle pets, attend to handwashing.
POSSIBLE COMPLICATIONS
None.
SPECIAL WARNINGS
None.
VACCINE AVAILABILITY
None.
Contact Jefferson County Department of Health, 930-1440, or your physician with any related questions concerning
Campylobacteriosis.
23
CONJUNCTIVITIS (Pinkeye)
BACKGROUND
Conjunctivitis is a non-fatal disease affecting one or both eyes with
irritation and discharge. In the US, conjunctivitis is most common to
southern areas, especially in summer and fall, due to their warm
climates. Two types of conjunctivitis exist: bacterial and viral. Bacterial
conjunctivitis is the most common type found in day care centers. Viral
conjunctivitis is mostly associated with the common cold.
REPORTABLE (TYPE A OR B)
Not reportable.
INFECTIOUS AGENT(S)
Various agents.
MODE OF TRANSMISSION
Conjunctivitis can be contracted from direct contact with discharge from
an infected person's eye or from the upper respiratory tract of those
infected. It may also be contracted from fingers, clothing, or shared eye
makeup that is contaminated.
OCCURRENCE
Worldwide; any age group.
SYMPTOMS
Bacterial – Discharge from one or both eyes, red or pink conjunctiva (the
white area of the eyeball), and red eyelids and pain in one or both eyes.
Viral – Watery discharge from one or both eyes, pink conjunctiva, and
red eyelids and pain in one or both eyes.
INCUBATION PERIOD
Typically 24 to 72 hours.
CONTAGIOUS PERIOD
While the infection is active; anywhere from 2 days to 2-3 weeks.
EXCLUSION
Until treatment has been in effect for at least 24 hours and child can
participate in daily activities (bacterial conjunctivitis only). None for
viral conjunctivitis.
PREVENTION / CONTROL MEASURES
•
•
•
Proper personal hygiene and proper medical treatment of eyes.
Keeping eyes clean and free of discharge.
Proper handwashing procedures before and after cleaning the eyes.
POSSIBLE COMPLICATIONS
None.
SPECIAL WARNINGS
None.
VACCINE AVAILABILITY
None.
Contact Jefferson County Department of Health, 930-1440, or your physician with any related questions concerning
conjunctivitis (pinkeye).
24
CYTOMEGALOVIRUS (CMV)
BACKGROUND
Cytomegalovirus is a common disease that is present in most children
and adults even though there are usually no signs/symptoms present.
Individuals with lowered immune systems (HIV patients, chemotherapy
patients, organ transplant patients, etc.) are at higher risk for developing
more serious complications associated with CMV. Pregnant women can
infect their newborns with CMV during childbirth. Children are at
greatest risk when born to a mother not immune to cytomegalovirus.
REPORTABLE (GROUP A OR B)
Not reportable.
INFECTIOUS AGENT(S)
Human herpesvirus 5.
MODE OF TRANSMISSION
Direct contact of mucosa with infected secretions, excretion, and tissues
from an infected person. CMV is also secreted in saliva and urine.
OCCURRENCE
Worldwide; any age group.
SYMPTOMS
Fever, tiredness, sore throat, possible convulsions and jaundice (the
yellowing of the skin and the whites of the eyes). Most people do not
have symptoms.
INCUBATION PERIOD
Usually 3 to 12 weeks depending on the age of the person at time of
infection.
CONTAGIOUS PERIOD
Varies depending on age of person. For children, the contagious period
can be months to years; for adults, it can be a shorter amount of time.
EXCLUSION
None.
PREVENTION / CONTROL MEASURES
•
•
•
Handle diapers with care.
Carefully wash hands after handling diapers or toilet care of children.
Clean and disinfect items that come in contact with salvia and/or urine frequently.
POSSIBLE COMPLICATIONS
Can cause retardation, motor disabilities, loss of hearing and chronic
liver disease for those acquiring CMV during the perinatal period. Death
can result inutero.
SPECIAL WARNINGS
Pregnant women or those of childbearing age who work in schools
should take universal precautions to avoid contracting or infecting their
fetuses.
VACCINE AVAILABILITY
None.
Contact Jefferson County Department of Health, 930-1440, or your physician with any related questions concerning
cytomegalovirus (CMV).
25
DIARRHEA – NOROVIRUS
BACKGROUND
Noroviruses typically occur in outbreaks and cause mild to moderate
disease that is self-limiting. Noroviruses cause more disease in those in
developed countries over 10 years of age than any other of the agents
responsible for causing gastroenteritis.
REPORTABLE (GROUP A OR B)
Not reportable.
INFECTIOUS AGENT(S)
Norovirus.
MODE OF TRANSMISSION
Most likely fecal-oral transmission occurs with some airborne
transmission possible; however the true mode is unknown.
OCCURRENCE
Worldwide; any age group.
SYMPTOMS
Watery diarrhea, nausea, vomiting, abdominal cramps, headache, and
low grade fever.
INCUBATION PERIOD
24 to 48 hours; with a range of 10 to 50 hours.
CONTAGIOUS PERIOD
From acute stage to 48 hours after diarrhea stops.
EXCLUSION
Until diarrhea is no longer present.
PREVENTION / CONTROL MEASURES
•
•
•
Practicing proper hygiene, such as proper handwashing techniques, may reduce transmission.
Sanitary handling of foods is recommended.
Clean and disinfect areas that have been contaminated.
POSSIBLE COMPLICATIONS
None.
SPECIAL WARNINGS
Norovirus has the potential for severe outbreaks. Infants and young
children should not be exposed to those with the disease.
VACCINE AVAILABILITY
None.
Contact Jefferson County Department of Health, 930-1440, or your physician with any related questions concerning
diarrhea associated with Norovirus.
26
DIARRHEA – ROTAVIRUS
BACKGROUND
Rotavirus is the cause of a seasonal and sporadic gastroenteritis. It occurs
in temperate climates in the cooler months; in tropical climates, it is
present year round. It is the most common cause of nosocomial diarrhea
in children attending day care. Essentially all children are infected by age
3, but they are most likely to be infected between 4 and 24 months of
age.
REPORTABLE (GROUP A OR B)
Not reportable.
INFECTIOUS AGENT(S)
Rotavirus; group A is common in children, group B is common in adults
but not infants, and group C is rare in humans.
MODE OF TRANSMISSION
Fecal-oral and respiratory transmission are most probable.
OCCURRENCE
Worldwide; any age group.
SYMPTOMS
Fever, vomiting, followed by diarrhea; sometimes dehydration and death
can occur in young children.
INCUBATION PERIOD
24 to 72 hours.
CONTAGIOUS PERIOD
During the acute stage of disease and while the virus is being shed;
symptoms typically last 3 to 8 days.
EXCLUSION
Until diarrhea is no longer present.
PREVENTION / CONTROL MEASURES
•
•
•
•
Practicing proper hygiene, such as proper handwashing techniques, may reduce transmission.
Sanitary handling of foods is recommended.
Clean and disinfect areas that have been contaminated.
Rotavirus vaccine is given at 2, 4, and 6 months of age. Vaccination is recommended for day care center
attendance in Alabama.
POSSIBLE COMPLICATIONS
None.
SPECIAL WARNING
Rotavirus has outbreak implications.
VACCINE AVAILABILITY
Available. See Prevention/Control Measures.
Contact Jefferson County Department of Health, 930-1440, or your physician with any related questions concerning
diarrhea associated with Rotavirus.
27
DIARRHEA – NO SPECIFIC PATHOGEN
BACKGROUND
Diarrhea is characterized by increased stools that are usually watery. It
can be caused by various agents.
REPORTABLE (GROUP A OR B)
Not reportable.
INFECTIOUS AGENT(S)
Various agents including Salmonella,
Noroviruses and Rotaviruses.
MODE OF TRANSMISSION
Fecal-oral is the most common mode.
OCCURRENCE
Worldwide; any age group.
SYMPTOMS
Frequent, loose or watery stools, vomiting, and fever.
INCUBATION PERIOD
24 to 72 hours.
CONTAGIOUS PERIOD
While pathogen is being shed; acute period.
EXCLUSION
Until diarrhea is no longer present.
Shigella,
Campylobacter,
PREVENTION / CONTROL MEASURES
•
•
•
Practicing proper hygiene, such as proper handwashing techniques, may reduce transmission.
Sanitary handling of foods is recommended.
Clean and disinfect areas that have been contaminated.
POSSIBLE COMPLICATIONS
None.
SPECIAL WARNINGS
Diarrhea has possible outbreak implications.
VACCINE AVAILABILITY
None.
Contact Jefferson County Department of Health, 930-1440, or your physician with any related questions concerning
diarrhea.
28
EAR INFECTION
BACKGROUND
Ear infections are commonly seen in children. Though they are not
considered contagious, they usually follow colds.
REPORTABLE (GROUP A OR B)
Not reportable.
INFECTIOUS AGENT(S)
Bacteria or virus.
MODE OF TRANSMISSION
Not contagious; usually follows a cold.
OCCURRENCE
Worldwide; any age group.
SYMPTOMS
Earache, fever, irritability; pulling on the ear, and sometimes drainage
from the ear. The pain associated with ear infections may last from 1 to 2
hours. Some people are asymptomatic.
INCUBATION PERIOD
Unknown.
CONTAGIOUS PERIOD
None.
EXCLUSION
Until fever is no longer present and child can participate in daily
activities.
PREVENTION / CONTROL MEASURES
•
•
•
Baby bottles should not be propped.
Infants and young children should not be placed in bed with a bottle.
Use standard precautions.
POSSIBLE COMPLICATIONS
None.
SPECIAL WARNINGS
None.
VACCINE AVAILABILITY
None.
Contact Jefferson County Department of Health, 930-1440, or your physician with any related questions concerning
ear infections.
29
ENTEROVIRUSES
BACKGROUND
Enteroviruses, which are associated with various illnesses, usually occur
in children. These illnesses are more common during the summer and
fall. Illnesses associated with enteroviruses include colds, throat
infections, pneumonia and meningitis or encephalitis.
REPORTABLE (GROUP A OR B)
Not reportable.
INFECTIOUS AGENT(S)
Coxsackieviruses; echoviruses; enteroviruses.
MODE OF TRANSMISSION
Fecal-oral transmission is most common, with some respiratory/airborne
spread possible.
OCCURRENCE
Worldwide; any age group.
SYMPTOMS
Sore throat, fever, rash, vomiting, nausea, and diarrhea. Some people are
asymptomatic.
INCUBATION PERIOD
3 to 6 days.
CONTAGIOUS PERIOD
From acute period to several weeks after.
EXCLUSION
Until diarrhea is no longer present.
PREVENTION / CONTROL MEASURES
•
•
Proper handwashing techniques should be followed, especially after changing diapers.
Clean and disinfect areas that are contaminated.
POSSIBLE COMPLICATIONS
None.
SPECIAL WARNINGS
None.
VACCINE AVAILABILITY
None.
Contact Jefferson County Department of Health, 930-1440, or your physician with any related questions concerning
enteroviruses.
30
ESCHERICHIA COLI (E. COLI) O157:H7
BACKGROUND
Escherichia coli (E. coli) O157:H7 is a bacteria that causes diarrhea in
those infected and is the main serotype to cause diarrhea by the
enterohemorrhagic strains. This strain is one of five categories, each of
which present their own pathogenicity, virulence properties, and
serotypes, as well as clinical symptoms.
REPORTABLE (GROUP A OR B)
Group B: report within 7 days to county or state health department.
INFECTIOUS AGENT(S)
O157:H7 is the main serotype, O26:H11 and O111:H8 have also been
identified.
MODE OF TRANSMISSION
Consumption of contaminated foods, such as undercooked beef and raw
milk.
OCCURRENCE
Established in North America, Europe and South America; any age
group.
SYMPTOMS
Watery stool that is nonbloody at first and may become extremely
bloody, fever, and abdominal pain. Some people may not have any
symptoms.
INCUBATION PERIOD
48 hours; with a range of 12 to 60 hours.
CONTAGIOUS PERIOD
While the pathogen is present in feces.
EXCLUSION
Until pathogen is not present in the stool.
PREVENTION / CONTROL MEASURES
•
•
•
•
Proper handwashing techniques should be followed to help avoid spread.
Clean and disinfect areas that are contaminated.
Properly cook meats to kill the bacteria.
Do not drink unpasteurized milk or milk products.
POSSIBLE COMPLICATIONS
None.
SPECIAL WARNINGS
None.
VACCINE AVAILABILITY
None.
Contact Jefferson County Department of Health, 930-1440, or your physician with any related questions concerning
Escherichia coli O157:H7.
31
FIFTH DISEASE (Erythema Infectiosum, Parvovirus B19 infection)
BACKGROUND
Fifth disease is a viral infection which often affects red blood cells. For
many years, fifth disease was viewed as an unimportant rash illness of
children. Recently, studies have shown that the virus may be responsible
for serious complications in certain individuals.
REPORTABLE (TYPE A OR B)
Not reportable.
INFECTIOUS AGENT(S)
Parvovirus B19.
MODE OF TRANSMISSION
The virus is spread by exposure to airborne droplets from the nose and
throat of infected an person.
OCCURRENCE
Worldwide; any age group. Most common in elementary school-aged
children.
SYMPTOMS
Low grade fever, fatigue, a red rash generally appears on the cheeks
giving a “slapped” face appearance. The rash may then extend to the
body and with tendencies to fade and reappear. Sometimes, the rash is
lacy in appearance and may be itchy. Some children may have vague
signs of illness or no symptoms at all.
INCUBATION PERIOD
Varies; typically 4 to 20 days for rash development.
CONTAGIOUS PERIOD
During the week prior to the appearance of the rash to one week after
onset for those with aplastic crisis syndrome.
EXCLUSION
Until child can participate in daily activities.
PREVENTION / CONTROL MEASURES
•
Measures to effectively control fifth disease have not been developed yet; however proper handwashing
techniques after wiping nose or mouth are helpful in controlling the spread of infectious agents.
POSSIBLE COMPLICATIONS
While most women infected during pregnancy will not be affected, some
studies have shown that parvovirus B19 may infect the fetus and increase
the risk of miscarriage. In people with chronic red blood cell disorders,
such as sickle cell disease, infection may result in severe anemia.
Infection has also been associated with arthritis in adults.
SPECIAL WARNINGS
During outbreaks in schools, pregnant employees and people with
chronic red blood cell disorders should consult their physician for advice.
VACCINE AVAILABILITY
None.
Contact Jefferson County Department of Health, 930-1440, or your physician with any related questions concerning
fifth disease.
32
GIARDIASIS
BACKGROUND
Giardiasis is an intestinal illness and is a fairly common cause of
diarrheal illness. Cases may occur sporadically or in clusters or
outbreaks. Giardia has been found in infected people (with or without
out symptoms) and wild and domestic animals.
REPORTABLE (GROUP A OR B)
Group B: report within 7 days to county or state health department.
INFECTIOUS AGENT(S)
Giardia lamblia (G. intestinalis), a flagellate protozoan.
MODE OF TRANSMISSION
Giardia is passed in the feces of an infected person or animal and may
contaminate cookware or food. Person-to-person (fecal-oral)
transmission may also occur in day care centers or other settings where
handwashing practices are poor.
OCCURRENCE
Worldwide; any age group. Tends to occur more often in people in
institutional settings, people in day care centers, foreign travelers and
individuals who consume improperly treated surface water. Homosexual
males may also be at increased risk of contracting giardiasis.
SYMPTOMS
Mild or severe diarrhea, abdominal cramps, and nausea. Some people
show no symptoms at all. Fever is rarely present. Occasionally, some will
have chronic diarrhea over several weeks or months with significant
weight loss.
INCUBATION PERIOD
5 to 25 days; usually within 10 days.
CONTAGIOUS PERIOD
A few weeks to a few months; as long as pathogen is present in stool.
EXCLUSION
Until treatment has been in effect for at least 24 hours. Some local health
departments may require follow-up stool testing to confirm that the
person is no longer contagious.
PREVENTION / CONTROL MEASURES
•
•
•
Carefully and thoroughly wash hands after toilet visits.
Carefully dispose of sewage wastes so as not to contaminate surface or groundwater.
Avoid consuming improperly treated drinking water.
POSSIBLE COMPLICATIONS
None.
SPECIAL WARNINGS
None.
VACCINE AVAILABILITY
None.
Contact Jefferson County Department of Health, 930-1440, or your physician department with any related questions
concerning giardiasis.
33
HAEMOPHILUS INFLUENZAE TYPE B (Hib)
BACKGROUND
Hib can cause serious bacterial infections in young children. Hib may
contribute to a variety of diseases such as meningitis (inflammation of
the coverings of the spinal cord and brain), blood stream infections,
pneumonia, arthritis, and infections of other parts of the body. It is most
common in children three months to three years of age. Past infection in
children younger than 24 months of age does not make a person immune.
REPORTABLE (GROUP A OR B)
Group A: report within 24 hours of diagnosis.
INFECTIOUS AGENT(S)
Haemophilus influenzae type b bacteria.
MODE OF TRANSMISSION
Hib disease may be transmitted through contact with mucus or droplets
from the nose and throat of an infected person.
OCCURRENCE
Worldwide; any age group.
SYMPTOMS
Fever, nausea, and vomiting. Other symptoms depend upon the part of
the body affected.
INCUBATION PERIOD
Less than 10 days; commonly 2 to 4 days.
CONTAGIOUS PERIOD
Varies; unless treated, may persist for as long as the organism is present
in the nose and throat, even after symptoms have disappeared.
EXCLUSION
Until fever is no longer present and child can participate in daily
activities.
PREVENTION / CONTROL MEASURES
•
•
•
Maintain the highest levels of immunization in day care centers.
Treatment with appropriate antibiotics.
Hib vaccine is given at 2, 4, 6 and 12 months of age. Vaccination is a requirement for day care center attendance
in Alabama.
POSSIBLE COMPLICATIONS
Hib manifests itself in a variety of ways, most commonly meningitis.
When Hib meningitis occurs, a certain proportion of those who recover
may suffer long-lasting neurologic problems. In some instances, cases
may be fatal.
SPECIAL WARNINGS
None.
VACCINE AVAILABILITY
Available. See Prevention/Control Measures.
Contact Jefferson County Department of Health, 930-1440, or your physician with any related questions concerning
Haemophilus influenzae type b (Hib).
34
HAND, FOOT, AND MOUTH DISEASE
BACKGROUND
The greatest occurrence of hand, foot and mouth disease is in summer
and fall. It is most common in children under the age of ten.
REPORTABLE (GROUP A OR B)
Not reportable.
INFECTIOUS AGENT(S)
Coxsackievirus group A: types 4, 5, 9, 10, and enterovirus 71.
MODE OF TRANSMISSION
Direct contact with discharge from the nose or throat of an infected
person or from the feces of an infected person.
OCCURRENCE
Worldwide; any age group.
SYMPTOMS
Sudden fever, sore throat, and small grayish oral lesions on the cheeks
and gums as well as on the sides of the tongue. Lesions also may appear
on the palms of the hands, soles of the feet, and on the fingers.
INCUBATION PERIOD
Typically 3 to 5 days.
CONTAGIOUS PERIOD
During the acute stage and several weeks after.
EXCLUSION
Until fever is no longer present.
PREVENTION / CONTROL MEASURES
•
•
•
•
Reduce direct person-to-person contact.
Practice personal hygiene such as handwashing.
Wash or discard infected articles.
Wash hands immediately after handling of discharges, feces or other infected articles.
POSSIBLE COMPLICATIONS
None.
SPECIAL WARNINGS
None.
VACCINE AVAILABILITY
None.
Contact Jefferson County Department of Health, 930-1440, or physician with any related questions concerning hand,
foot, and mouth disease.
35
HEPATITIS A (Infectious hepatitis)
BACKGROUND
Hepatitis A (formerly known as infectious hepatitis) is a liver disease
caused by a specific virus. The disease is fairly common and usually
affects school-aged children and young adults showing no or mild
symptoms. It occurs sporadically and in epidemics. Once an individual
recovers from hepatitis A, he or she is immune for life and does not
continue to carry the virus.
REPORTABLE (GROUP A OR B)
Group A: report within 24 hours to county or state health department.
INFECTIOUS AGENT(S)
Hepatitis A virus (HAV).
MODE OF TRANSMISSION
The hepatitis A virus enters through the mouth, multiplies in the body
and is passed in the feces. The virus can then be carried on an infected
person's hands and can be spread by direct contact, or by consuming food
or drink that has been handled by the individual (fecal-oral). In some
cases, it can be spread by consuming water contaminated with
improperly treated sewage.
OCCURRENCE
Worldwide; any age group.
SYMPTOMS
Fatigue, poor appetite, fever and vomiting. Urine may become darker in
color, and then jaundice (a yellowing of the skin and whites of the eyes)
may appear. The disease is rarely fatal and most people recover in a few
weeks without complications. Infants and young children tend to have
very mild symptoms and are less likely to develop jaundice than are older
children and adults. Not everyone who is infected will have all of the
symptoms.
INCUBATION PERIOD
2 to 6 weeks.
CONTAGIOUS PERIOD
About 1 week before symptoms appear until about 10 days after jaundice
appears.
EXCLUSION
Depends on individual case. Consult your local health department or
physician for advice.
PREVENTION / CONTROL MEASURES
•
•
•
•
•
The single most effective way to prevent spread is careful handwashing after using the toilet.
Infected people should not handle foods during the contagious period.
Hepatitis A vaccine is given at 12 and 18 months of age. Vaccination is recommended for day care center
attendance in Alabama.
Hepatitis A vaccine is recommended for employees of child care centers.
Household members or others in close contact with an infected person should call a doctor or health department
to obtain a shot of immune globulin which minimizes their chances of becoming ill.
POSSIBLE COMPLICATIONS
None.
SPECIAL WARNINGS
None.
VACCINE AVAILABILITY
Available. See Control/Prevention Measures.
Contact Jefferson County Department of Health, 930-1440, or your physician with any related questions concerning
hepatitis A.
36
HEPATITIS B
BACKGROUND
Hepatitis B (formerly known as serum hepatitis) is a fairly common liver
disease.
REPORTABLE (GROUP A OR B)
Group B: report within 7 days to county or state health department.
INFECTIOUS AGENT(S)
Hepatitis B virus (HBV).
MODE OF TRANSMISSION
Hepatitis B can be found in the blood, and to a lesser extent in saliva,
semen and other body fluids of an infected person. It is spread by direct
contact with infected body fluids. Hepatitis B virus is not spread by
casual contact.
OCCURRENCE
Worldwide; any age group; people in custodial care (in settings such as
developmental centers) and certain household contacts of an infected
person are among those at highest risk.
SYMPTOMS
Fatigue, poor appetite, fever, vomiting and occasionally joint pain, hives
or rash. Urine may become darker in color, and then jaundice (yellowing
of the skin and whites of the eyes) may appear. Some individuals may
experience few or no symptoms. Some may develop hepatocellular
carcinoma or cirrhosis.
INCUBATION PERIOD
Six weeks to 6 months; usually within 3 months.
CONTAGIOUS PERIOD
Several weeks before symptoms appear and for several months
afterward. Some people become lifetime carriers.
EXCLUSION
None unless there is the possibility of blood exposure (child bites
frequently, hemophiliac, child has open sores, etc.).
PREVENTION / CONTROL MEASURES
•
•
•
•
•
•
•
•
Hepatitis B carriers should follow standard hygiene practices to ensure that close contacts are not directly
contaminated by their blood or other body fluids.
Carriers must not share razors, toothbrushes or any other object that may become contaminated with blood.
It is important for carriers to inform their dentist and health care providers.
A vaccine to prevent hepatitis B has been available for several years. It is safe, effective and is recommended for
people in high-risk settings who have not already been infected.
In addition, susceptible household members, particularly sexual partners, should be immunized with the hepatitis
B vaccine.
Hepatitis B vaccine is given to children at 2, 4, and 6 months of age. Vaccination is recommended for day care
center attendance in Alabama.
A special hepatitis B immune globulin is also available for people who are exposed to the virus.
In the event to exposure to hepatitis B, consult a doctor or the local health department.
POSSIBLE COMPLICATIONS
None.
SPECIAL WARNINGS
None.
VACCINE AVAILABILITY
Available. See Prevention/Control Measures.
Contact Jefferson County Department of Health, 930-1440, or your physician with any related questions concerning
hepatitis B.
37
HUMAN IMMUNODEFICIENCY VIRUS (HIV) / AIDS
BACKGROUND
Human immunodeficiency virus is the virus that causes AIDS (Acquired
Immune Deficiency Syndrome). HIV has yet to be identified in day care
centers; however, since this disease is spread by blood and certain body
fluids, precautions should be taken in order to reduce the likelihood of
spread.
REPORTABLE (GROUP A OR B)
Group B: report within 7 days to county or state health department.
INFECTIOUS AGENT(S)
Human immunodeficiency virus (HIV).
MODE OF TRANSMISSION
Direct contact with blood, semen, vaginal fluids, and breast milk of an
infected person. Most children acquire the disease during pregnancy or
childbirth and others acquire the disease through blood transfusions.
Adults acquire the disease through sexual contact, sharing intravenous
drug needles, and blood transfusions.
OCCURRENCE
Worldwide; any age group.
SYMPTOMS
HIV lowers the immune system’s ability to fight infections so the
symptoms will depend on the type of infection acquired.
INCUBATION PERIOD
6 months to 15 years.
CONTAGIOUS PERIOD
Lifetime.
EXCLUSION
Specific guidelines should be followed in determining whether or not a
child should be excluded from a day care setting. Children that have not
been assessed by medical specialists should be excluded until doing so.
Children that have open sores or bleed unexpectedly should be excluded.
Staff that are infected should be excluded if their blood or body fluids are
at risk of being exposed.
PREVENTION / CONTROL MEASURES
•
•
•
•
Sharing toothbrushes should not be allowed.
Clean and disinfect any contaminated surfaces.
Use standard precautions when dealing with all blood and body fluids clean up.
Use proper handwashing techniques.
POSSIBLE COMPLICATIONS
More serious complications due to normal childhood diseases; death.
SPECIAL WARNINGS
Parents need to consider the possibility of their child becoming more
seriously ill from common childhood diseases such as chickenpox and
measles before placing them in day care. Physician consultation should
occur to address this matter.
VACCINE AVAILABILITY
None.
Contact Jefferson County Department of Health, 930-1440, or your physician with any related questions concerning
human immunodeficiency virus (HIV).
38
IMPETIGO
BACKGROUND
Impetigo is a skin disorder commonly seen in newborns. Impetigo is the
most commonly found staphylococcal disease acquired in a nursery
setting.
REPORTABLE (GROUP A OR B)
Not reportable.
INFECTIOUS AGENT(S)
Different strains of Staphylococcus aureus.
MODE OF TRANSMISSION
Usual mode of transmission is by touching sores. Spread to peripheral
areas occurs by cracking open lesions.
OCCURRENCE
Worldwide; any age group.
SYMPTOMS
Itchy lesions that are sticky and oozing and occur mainly in the diaper
area but may spread to other places on the body.
INCUBATION PERIOD
4 to 10 days.
CONTAGIOUS PERIOD
As long as lesions are producing discharge.
EXCLUSION
Until treatment has been in effect for at least 24 hours.
PREVENTION / CONTROL MEASURES
•
•
Use proper handwashing techniques after contact with lesions.
Cover lesions if possible.
POSSIBLE COMPLICATIONS
Not typical; however, breast abscess, staphylococcal pneumonia,
septicemia, meningitis and brain abscess have been documented.
SPECIAL WARNINGS
None.
VACCINE AVAILABILITY
None.
Contact Jefferson County Department of Health, 930-1440, or your physician with any related questions concerning
impetigo.
39
HEAD LICE (Pediculis capitis)
BACKGROUND
Head lice are small insects about the size of a sesame seed and are
usually light brown but can vary in color. They move quickly and shy
away from light, making them difficult to see. Diagnosis is most often
made on the basis of finding nits (eggs). Nits are tiny, grayish-white or
yellowish-white oval specks attached to hairshafts. As the female louse
deposits her eggs (3-4 per day), she cements them to the hairs, and unlike
dandruff, nits will not wash off or brush off. Nits may be found
throughout the hair, but are most often located at the nape of the neck,
behind the ears, and frequently on the crown of the head.
REPORTABLE (GROUP A OR B)
Not reportable.
INFECTIOUS AGENT(S)
Pediculis capitis.
MODE OF TRANSMISSION
Head lice are incapable of hopping, jumping, or flying and are primarily
acquired by coming in direct contact with an infested person. However,
wearing clothing (such as a hat, coat, or scarf) recently worn by an
infested person; using a contaminated comb or brush; or lying on
contaminated furniture, carpeting or bedding; can also result in
infestation.
OCCURRENCE
Worldwide; any age group.
SYMPTOMS
Itching that occurs when lice bite and suck blood from the scalp is the
primary symptom of infestation, although not everyone will experience
itching. Often red bite marks or scratch marks can be seen on the scalp
and neck.
INCUBATION PERIOD
It may take as long as two to three weeks or longer for a person to notice
the intense itching associated with this infestation.
CONTAGIOUS PERIOD
Head lice can be spread as long as lice or eggs remain alive on the
infested person.
EXCLUSION
After treatment and no more live lice are found.
PREVENTION / CONTROL MEASURES
•
•
•
•
•
Machine wash all washable clothing and bed linens which have been in contact with the infested person during
the last 3 days.
Articles should be washed in HOT water and dried in a HOT dryer.
Non-washables can be vacuumed or dry cleaned.
Rugs, upholstered furniture and mattresses should be carefully vacuumed to pick up any living lice or nits
attached to fallen hairs.
The use of insecticide sprays is not recommenced and strongly discouraged as they may be harmful to family
members and pets and are of questionable benefit.
POSSIBLE COMPLICATIONS
None.
SPECIAL WARNINGS
None.
VACCINE AVAILABILITY
None.
Contact Jefferson County Department of Health, 930-1440, or your physician with any related questions concerning
head lice.
40
LYME DISEASE (Lyme borreliosis)
BACKGROUND
Lyme disease is caused by a bacterial infection transmitted by certain
Ixodid ticks. Lyme disease may cause symptoms affecting the skin,
nervous system, heart and/or joints of an individual. Reinfection is
possible with Lyme disease. The first cluster of disease cases associated
with this infectious agent was discovered near Lyme, Connecticut, giving
it its name.
REPORTABLE (GROUP A OR B)
Group B: report within 7 days to county or state health department.
INFECTIOUS AGENT(S)
Borrelia burgdorferi, a spirochete (a certain classification of bacteria).
MODE OF TRANSMISSION
The bacteria that causes Lyme disease is part of the natural cycle of ticks
that feed on animals such as mice, opossums, dogs or deer. During
certain stages of the tick life cycle, especially the nymph, ticks can feed
on humans. If the tick is infected with the bacteria, it can cause an
infection in humans. Cases of Lyme disease have also been reported in
dogs and horses. Person-to-person spread of Lyme disease does not
occur.
OCCURRENCE
In the United States; endemic from Georgia to Massachusetts, the upper
Midwest, and in Oregon and California; affects all age groups. People
who spend time outdoors in tick-infested environments are at an
increased risk of exposure. Most cases have reported an exposure to ticks
in their woodland/brush habitat during the warmer months, but cases
have been reported during every month of the year.
SYMPTOMS
Starts as a circular reddish rash expanding around or near the site of the
tick bite. Multiple rash sites may occur. During the rash stage, or
occasionally prior to the rash, other symptoms such as fever, headache,
fatigue, stiff neck, muscle and/or joint pain may be present. These may
also last for several weeks. Many cases develop without sign of a rash.
INCUBATION PERIOD
Within a month of exposure.
CONTAGIOUS PERIOD
No contagious period known.
EXCLUSION
None.
PREVENTION / CONTROL MEASURES
•
•
•
•
Repellents containing DEET applied to skin or clothing may prevent tick attachment.
DEET-containing products should be applied sparingly and according to the instructions.
The control of rodents around the home may be helpful.
If exposed to tick-infested areas, family members should help to check body surface for attached ticks.*
POSSIBLE COMPLICATIONS
If left untreated, within a few weeks to months after the rash onset,
complications such as meningitis, facial palsy or heart abnormalities may
occur. Swelling and pain in the large joints may recur over many years.
SPECIAL WARNINGS
Special precautions to prevent exposure to ticks should be used, such as
wearing light colored clothing and tucking pants into socks and shirts
into pants.
41
VACCINE AVAILABILITY
None.
*To remove an attached tick, grasp with tweezers or forceps as close as possible to attachment (skin) site, and pull
upward and out with firm and steady pressure. If tweezers are not available, use fingers shielded with tissue paper or
rubber gloves. Do not handle the tick with bare hands. Be careful not to squeeze, crush or puncture the body of the
tick which may contain infectious fluids. After removing the tick, thoroughly disinfect the bite site and wash hands.
An antibiotic ointment should be applied to the bite area. See or call a doctor if there is a concern about incomplete
tick removal. It is important that a tick be removed as soon as discovered. Check after every two to three hours of
outdoor activity for ticks attached to clothing or skin. If removal occurs within several hours after attachment, the risk
of tick-borne infection is reduced.
Contact Jefferson County Department of Health, 930-1440, or your physician with any related questions concerning
Lyme disease.
42
MEASLES (Rubeola)
BACKGROUND
Measles is an acute and highly contagious viral disease capable of
producing epidemics. Measles is more common in winter and spring and
is one of the most readily transmitted communicable diseases. Permanent
immunity is acquired after contracting the disease.
REPORTABLE (GROUP A OR B)
Group A: report within 24 hours to county or state health department.
INFECTIOUS AGENT(S)
Measles virus, a member of the genus Morbillivirus.
MODE OF TRANSMISSION
Measles is spread by direct contact with nasal or throat secretions of
infected people or, less frequently, by airborne transmission.
OCCURRENCE
Worldwide; any age group. Generally, pre-school children, adolescents,
young adults and inadequately immunized individuals comprise the
majority of measles cases in the United States.
SYMPTOMS
Measles symptoms generally appear in two stages. In the first stage, the
individual may have a runny nose, cough and a slight fever. The eyes
may become reddened and sensitive to light while the fever consistently
rises each day. The second stage begins on the third to seventh day,
consisting of a temperature of 103-105oF and a red blotchy rash lasting
four to seven days. The rash usually begins on the face and then spreads
over the entire body. Koplik spots (little white spots) may also appear on
the gums and inside of the cheeks.
INCUBATION PERIOD
8 to 13 days.
CONTAGIOUS PERIOD
5 days prior to and 4 days after rash onset.
EXCLUSION
At least 4 days after rash appears.
PREVENTION / CONTROL MEASURES
•
•
Maintaining the highest level of immunizations against measles is the best preventive measure.
Two doses of measles vaccine are required. The first dose should be given as measles, mumps, rubella (MMR) at
age 12 months and the second MMR must be given between ages 4-6 (prior to entering kindergarten).
POSSIBLE COMPLICATIONS
Pneumonia occurs in up to 6 percent of reported cases and accounts for
60 percent of deaths attributed to measles. Encephalitis (inflammation of
the brain) may also occur. Other complications include middle ear
infections and convulsions. Measles is more severe in infants and adults.
SPECIAL WARNINGS
Measles introduced into refugee populations has disaster implications
with high fatality rates.
VACCINE AVAILABILITY
Readily available. See Prevention/Control Measures.
Contact Jefferson County Department of Health, 930-1450, or your physician with any related questions concerning
measles.
43
MENINGOCCOCAL DISEASE (meningococcal meningitis, meningococcemia)
BACKGROUND
Meningococcal disease is a severe bacterial infection of the bloodstream
and/or the meninges (the thin lining covering the brain and spinal cord).
It is a relatively rare disease and usually occurs as a single isolated event.
Clusters of cases or outbreaks are rare in the United States. Highest
incidence occurs in winter and spring.
REPORTABLE (GROUP A OR B)
Group A: report within 24 hours to county or state health department.
INFECTIOUS AGENT(S)
Neisseria meningitidis.
MODE OF TRANSMISSION
The meningococcus germ is spread by close direct contact with nose or
throat discharges of an infected person. Many people carry this particular
germ in their nose and throat without any signs of illness, while others
may develop serious symptoms.
OCCURRENCE
Worldwide; any age group. Most common in infants and children and in
males more than females.
SYMPTOMS
Most people do not become seriously ill; but those who do may develop
fever, headache, vomiting, stiff neck, and a rash. Up to 25 percent of
patients who recover may have chronic damage to their central nervous
system. The disease is occasionally fatal.
INCUBATION PERIOD
2 to 10 days; but usually within 5 days.
CONTAGIOUS PERIOD
From the time a person is first infected until the germs are no longer
present in discharge from the nose and throat. The duration varies
according to treatment.
EXCLUSION
Until treatment has begun and child can participate in daily activities.
PREVENTION / CONTROL MEASURES
•
•
•
Only people who have been in close contact (household members, intimate contacts, health care personnel
performing mouth-to-mouth resuscitation, day care center playmates, etc.) need to be considered for preventive
treatment.
Such people are usually advised to obtain a prescription for rifampin or a sulfa drug from their physician or the
health department.
Casual contact, as might occur in a regular classroom, office or factory setting, is not usually significant enough
to cause concern.
POSSIBLE COMPLICATIONS
None.
SPECIAL WARNINGS
Outbreak implications may occur when people are housed in crowded
living conditions, such as barracks and institutions.
VACCINE AVAILABILITY
Presently, there is a vaccine that will protect against some strains of
meningococcus. It is routinely recommended for all children at 11-12
years of age and unvaccinated children entering high school.
Contact Jefferson County Department of Health, 930-1440, or your physician with any related questions concerning
meningococcal disease.
44
MONONUCLEOSIS (infectious)
BACKGROUND
Infectious mononucleosis is a viral disease that affects certain blood
cells. Most cases occur sporadically with outbreaks rare. While most
people are exposed to the Epstein-Barr virus, the virus that causes
mononucleosis, at some time in their lives, very few go on to develop the
symptoms of infectious mononucleosis. The disease is rarely fatal.
REPORTABLE (GROUP A OR B)
Not reportable.
INFECTIOUS AGENT(S)
Epstein-Barr (EB) virus.
MODE OF TRANSMISSION
The virus is spread by person-to-person contact, via saliva (on hands or
toys, or by kissing). In rare instances, the virus has been transmitted by
blood transfusion.
OCCURRENCE
Worldwide; any age group. In developing countries, people are exposed
in early childhood when they are not likely to develop noticeable
symptoms. In developed countries such as the United States, the age of
first exposure may be delayed to older childhood and young adult age
when symptoms are more likely to result. For this reason, it is recognized
more often in high school and college students.
SYMPTOMS
Fever, sore throat, swollen lymph nodes and feeling tired. Duration is
from one to several weeks. Sometimes the liver and spleen are affected.
INCUBATION PERIOD
4 to 6 weeks.
CONTAGIOUS PERIOD
Prolonged; one year or more.
EXCLUSION
Until child can participate in daily activities.
PREVENTION / CONTROL MEASURES
•
•
•
•
Avoid activities involving the transfer of body fluids (commonly saliva) with someone who is currently or
recently infected with the disease.
Use proper handwashing techniques after contact with saliva or other contaminated items.
Clean and disinfect items that are contaminated.
No specific treatment available.
POSSIBLE COMPLICATIONS
None.
SPECIAL WARNINGS
None.
VACCINE AVAILABILITY
None.
Contact Jefferson County Department of Health, 930-1440, or your physician with any related questions concerning
mononucleosis.
45
MUMPS
BACKGROUND
Mumps is an acute viral, systemic disease characterized by fever,
swelling and tenderness of one or more of the salivary glands. Mumps
occurs less frequently than other common childhood communicable
diseases. The greatest risk of infection occurs among older children.
Mumps is more common during winter and spring. Immunity acquired
after contraction of the disease is usually permanent.
REPORTABLE (GROUP A OR B)
Group B: report within 7 days to county or state health department.
INFECTIOUS AGENT(S)
Mumps virus, a member of the genus Paramyxovirus.
MODE OF TRANSMISSION
Mumps is transmitted by direct contact with saliva and discharges from
the nose and throat of an infected individual.
OCCURRENCE
Worldwide; any age group but usually occurs in children between the
ages of 5 and 15 years.
SYMPTOMS
Fever, swelling and tenderness of one or more of the salivary glands,
usually the parotid (located just below the front of the ear).
Approximately one-third of infected people do not exhibit symptoms.
INCUBATION PERIOD
16 to 18 days; with a range of 14 to 25 days.
CONTAGIOUS PERIOD
7 days prior to and 9 days after onset of symptoms. A person is most
contagious 48 hours prior to the appearance of symptoms.
EXCLUSION
Children should not attend school during their infectious period, which
includes from the 12th through the 25th day after exposure.
PREVENTION / CONTROL MEASURES
•
•
The single most effective control measure is maintaining the highest possible level of immunization in the day
care center and community.
Two doses of mumps vaccine are required. Mumps vaccine is aministered in combination with measles and
rubella vaccine (MMR). The vaccine is given at 12 months of age. A booster dose of MMR is given at 4-6 years
of age prior to entering kindergarten (5K).
POSSIBLE COMPLICATIONS
Swelling of the testicles occurs in 15-25 percent 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 cord). Other complications include arthritis,
kidney involvement, inflammation of the thyroid gland and breasts, and
deafness.
SPECIAL WARNINGS
None.
VACCINE AVAILABILITY
Available. See Prevention/Control Measures.
Contact Jefferson County Department of Health, 930-1450, or your physician with any related questions concerning
mumps.
46
ORAL HERPES
BACKGROUND
Oral herpes, or cold sores, are common among both children and adults.
They are usually acquired at a young age and recur throughout one’s life.
Infections of the eyes, fingers and central nervous system may also occur
with the herpes simplex virus.
REPORTABLE (GROUP A OR B)
Not reportable.
INFECTIOUS AGENT(S)
Herpes simplex virus type 1 (HSV-1).
MODE OF TRANSMISSION
Direct person-to-person contact with infected saliva or sores.
OCCURRENCE
Worldwide; any age group.
SYMPTOMS
Blisters on the lips or face that contain fluid. Crusting and healing occur
within several days after initial infection.
INCUBATION PERIOD
2 to 12 days.
CONTAGIOUS PERIOD
Unknown; but may be from 5 to 7 days to months after exposure.
EXCLUSION
Only necessary for children with active lesions who have no control over
oral secretions.
PREVENTION / CONTROL MEASURES
•
•
•
•
Proper handwashing techniques after contact with saliva or sores.
Wear gloves when coming in contact with sores, as in applying medication.
Avoid kissing or other contact of a person with active lesions.
Clean and disinfect contaminated surfaces.
POSSIBLE COMPLICATIONS
Chronic eczema, meningoencephalitis.
SPECIAL WARNINGS
Fatal infections in newborn infants.
VACCINE AVAILABILITY
None.
Contact Jefferson County Department of Health, 930-1440, or your physician with any related questions concerning
oral herpes.
47
PERTUSSIS (Whooping cough)
BACKGROUND
Pertussis, or whooping cough, is a highly contagious disease involving the
respiratory tract. It is caused by a bacterium that is found in the mouth, nose
and throat of an infected person. One attack does not
necessarily
confer lifelong immunity.
REPORTABLE (GROUP A OR B)
Group A: report within 24 hours to county or state health department.
INFECTIOUS AGENT(S)
Bordetella pertussis, the pertussis bacillus.
MODE OF TRANSMISSION
Pertussis is primarily spread by direct contact with discharges from the nose
and throat of an infected individual. Older siblings or adults who may be
harboring the bacteria in their nose and throat can bring the disease home and
infect an infant in the household.
OCCURRENCE
Worldwide; any age group. Seventy-five percent of reported cases occur in
children under five years of age and 50 percent of these are in children under
one year of age.
SYMPTOMS
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
characterized by episodes of numerous, rapid coughs followed by a crowing
or high pitched whoop. A thick, clear mucus may be discharged. These
episodes may recur for one to two months and are more frequent at night.
Older people or partially immunized children generally have milder
symptoms.
INCUBATION PERIOD
5 to 10 days; but as long as 21 days.
CONTAGIOUS PERIOD
7 days following exposure to three weeks after the onset of coughing
episodes. This time is reduced to 5 to 7 days with antibiotic treatment.
EXCLUSION
Until receipt of at least 5 days of a 14-day treatment with antibiotics.
PREVENTION / CONTROL MEASURES
•
•
•
•
The single most effective control measure is maintaining the highest possible level of immunizations in the community.
Pertussis vaccine is required. The vaccine is given in combination with diphtheria and tetanus. The American Academy
of Pediatrics and the Advisory Committee on Immunization Practices recommends that DTaP (diphtheria, tetanus, and
acellular pertussis) vaccine be given at 2, 4, 6 and 12 months of age and again at 4- 6 years of age.
Treatment of cases with certain antibiotics can shorten the contagious period.
People who have or may have pertussis should stay away from young children and infants until properly treated.
POSSIBLE COMPLICATIONS
Complications of pertussis may include pneumonia, middle ear infection,
loss of appetite, dehydration, seizures, encephalopathy (inflammation of the
brain), apnea episodes (brief cessation of breathing) and death.
SPECIAL WARNINGS
Epidemic implications if introduced in populations with large numbers of
unimmunized children.
VACCINE AVAILABILITY
Available. See Prevention/Control Measures
Contact Jefferson County Department of Health, 930-1450, or your physician with any related questions concerning
pertussis.
48
PINWORMS
BACKGROUND
Pinworms is the most common worm infection in the United States. It
usually occurs in families, however it does not discriminate between
genders or seasons. Those most affected are pre-school and school-aged
children, their mothers and those institutionalized.
REPORTABLE (GROUP A OR B)
Not reportable.
INFECTIOUS AGENT(S)
Enterobius vermicularis, an intestinal nematode.
MODE OF TRANSMISSION
Direct contact by hand from the anus to the mouth with infected eggs.
Indirect contact of clothes, bed linens, food or other infected articles may
occur.
OCCURRENCE
Worldwide; any age group.
SYMPTOMS
Often asymptomatic. Can sometimes be characterized by perianal
itching, sleep disturbances, irritability and vulvovaginitis.
INCUBATION PERIOD
Unknown.
CONTAGIOUS PERIOD
Typically 2 weeks or as long as the female is able to lay infective eggs.
EXCLUSION
Until treatment has been in affect for at least 24 hours.
PREVENTION / CONTROL MEASURES
•
•
•
•
Use personal hygiene and proper handwashing techniques after using the toilet.
Wash hands before and after food preparation or consumption.
Bathe daily for several days after beginning treatment.
Maintain clean conditions in bathroom areas.
POSSIBLE COMPLICATIONS
None.
SPECIAL WARNINGS
None.
VACCINE AVAILABILITY
None.
Contact Jefferson County Department of Health, 930-1440, or your physician with any related questions concerning
pinworms.
49
RESPIRATORY INFECTIONS (viral)
BACKGROUND
Different etiologic agents are responsible for respiratory viral infections.
These infections are more commonly known as colds. Most infections
occur during fall and winter.
REPORTABLE (GROUP A OR B)
Not reportable.
INFECTIOUS AGENT(S)
Various viruses.
MODE OF TRANSMISSION
Direct person-to-person contact with discharges from the nose or mouth
of an infected person.
OCCURRENCE
Worldwide; any age group.
SYMPTOMS
Sneezing, chills, runny nose, fever, muscle and joint aching, sore throat,
and coughing.
INCUBATION PERIOD
Up to 10 days.
CONTAGIOUS PERIOD
Shortly before symptoms begin to end of acute period.
EXCLUSION
Until fever is no longer present and child can participate in daily
activities.
PREVENTION / CONTROL MEASURES
•
•
•
•
Cover nose and mouth when sneezing and coughing.
Dispose of tissues properly.
Clean and disinfect any contaminated surfaces.
Use proper handwashing techniques after coughing or sneezing.
POSSIBLE COMPLICATIONS
None.
SPECIAL WARNINGS
None.
VACCINE AVAILABILITY
None.
Contact Jefferson County Department of Health, 930-1440, or your physician with any related questions concerning
respiratory infections (viral).
50
RESPIRATORY SYNCYTIAL VIRUS (RSV)
BACKGROUND
Respiratory syncytial virus (RSV) is a viral disease affecting the
respiratory tract. RSV is the most common cause of respiratory tract
diseases such as bronchitis and pneumonia in early infancy, with most
cases occurring within the first 2 years of life. RSV can seriously affect
those that are born prematurely or those with heart, lung, or immune
problems. RSV occurs seasonally in temperate zones, usually during
winter and early spring, but can also occur in sharp outbreaks.
REPORTABLE (GROUP A OR B)
Not reportable.
INFECTIOUS AGENT(S)
Respiratory syncytial virus (RSV).
MODE OF TRANSMISSION
Spread by direct contact of mouth or droplets from the mouth. Can be
spread indirectly by hands, eating utensils or other objects contaminated
with discharges from the respiratory tract of an infected person.
OCCURRENCE
Worldwide; any age group.
SYMPTOMS
Fever, chills, headache, general aching, and anorexia.
INCUBATION PERIOD
1 to 10 days.
CONTAGIOUS PERIOD
Several days before and after active disease is seen; this can be several
weeks.
EXCLUSION
Until fever is no longer present.
PREVENTION / CONTROL MEASURES
•
•
•
•
Cover mouth and nose when coughing or sneezing.
Use personal hygiene and frequent handwashing.
Properly dispose of contaminated tissues.
Clean and disinfect any contaminated items.
POSSIBLE COMPLICATIONS
None.
SPECIAL WARNINGS
Children and infants with certain medical problems should not be
exposed to the disease.
VACCINE AVAILABILITY
None.
Contact Jefferson County Department of Health, 930-1440, or your physician with any related questions concerning
respiratory syncytial virus (RSV).
51
REYE SYNDROME
BACKGROUND
Reye syndrome is not a disease but a “syndrome" or combination of signs
and symptoms which occur in children. Reye syndrome is considered a
medical emergency, so a physician should be notified immediately if the
symptoms occur after a viral illness. Early medical treatment and
hospitalization may reduce the chances of coma and death.
REPORTABLE (GROUP A OR B)
Not reportable.
INFECTIOUS AGENT(S)
Unknown; associated with viral illnesses (such as chickenpox and
influenza) and aspirin use.
MODE OF TRANSMISSION
Although the cause of the syndrome remains unknown, most cases
follow a common viral illness, most frequently influenza or chickenpox.
This is NOT a contagious disease; however the severity of it warrants
immediate attention in day care centers.
OCCURRENCE
Unknown.
SYMPTOMS
Unexpected vomiting, lethargy, confusion, irritability, or aggressiveness
in children recovering from a viral illness. Fever and jaundice (a
yellowing of the skin and whites of the eyes) are not usually present.
INCUBATION PERIOD
Unknown.
CONTAGIOUS PERIOD
None.
EXCLUSION
Until child can participate in daily activities.
PREVENTION / CONTROL MEASURES
•
•
•
Parents should NOT give aspirin or any other salicylate-containing medication to children with influenza or
chickenpox.
Contact physician immediately should any of the above symptoms occur. Immediate action needs to take place.
Children and teenagers should not be allowed to take any medicine before consulting with their parents.
POSSIBLE COMPLICATIONS
Coma or death can occur without immediate treatment.
SPECIAL WARNINGS
If the symptoms of Reye syndrome are present, get medical advice
immediately.
VACCINE AVAILABILITY
None.
Contact Jefferson County Department of Health, 930-1440, or your physician with any related questions concerning
Reye syndrome.
52
RINGWORM
BACKGROUND
Ringworm is a skin infection caused by a fungus that can affect the scalp,
skin, fingers, toenails, or feet. Since so many species of fungus can cause
ringworm, infection with one species will not make a person immune to
future infections.
REPORTABLE (GROUP A OR B)
Not reportable.
INFECTIOUS AGENT(S)
Various organisms including
Epidermophyton floccosum.
MODE OF TRANSMISSION
Transmission of these fungal agents can occur by direct skin-to-skin
contact with infected people or pets, or indirectly by contact with items
such as hair clippers, hair from infected people, and shower stalls or
floors.
OCCURRENCE
Worldwide; any age group. Children are more susceptible to certain
varieties while adults may be more affected by other varieties.
SYMPTOMS
Ringworm of the scalp usually begins as a small pimple which becomes
larger in size leaving scaly patches of temporary baldness. Infected hairs
become brittle and break off easily. Occasionally, yellowish cuplike
crusty areas are seen. With ringworm of the nails, the affected nails
become thicker, discolored and brittle, or they become chalky and
disintegrate. Ringworm of the body appears as flat, spreading ringshaped areas. The edge is reddish and may be either dry and scaly or
moist and crusty. As ringworm spreads, the center area clears and
appears normal. Ringworm of the feet appears as a scaling or cracking of
the skin especially between the toes.
INCUBATION PERIOD
Unknown for most of these agents. Ringworm of the scalp is usually seen
10 to 14 days after contact and ringworm of the body is seen 4 to 10 days
after initial contact.
CONTAGIOUS PERIOD
As long as active lesions are found.
EXCLUSION
Until treatment has been in effect for at least 24 hours.
Microsporum,
Trichophyton,
and
PREVENTION / CONTROL MEASURES
•
•
•
Towels, hats and clothing of the infected individual should not be shared with others.
Young children who are infected should minimize close contact with other children until effectively treated.
When multiple cases occur, seek advise from your local health department.
POSSIBLE COMPLICATIONS
None.
SPECIAL WARNINGS
None.
VACCINE AVAILABILITY
None.
Contact Jefferson County Department of Health, 930-1440, or your physician with any related questions concerning
ringworm.
53
ROSEOLA
BACKGROUND
Children ages six months to three years are most commonly
affected by this disease. Roseola is a rash disease that is not
highly communicable. Those that are exposed to roseola acquire
immunity to the disease. Roseola appears mostly in spring or
summer.
REPORTABLE (GROUP A OR B)
Not reportable.
INFECTIOUS AGENT(S)
Human herpesvirus 6.
MODE OF TRANSMISSION
Unknown.
OCCURRENCE
Unknown.
SYMPTOMS
Sudden fever that can get as high as 104oF, convulsions, and a
rash that appears around the 3rd to 5th day as the fever is
disappearing. The rash resembles small, bumpy, rose-pink spots
that start on the chest and abdomen. The rash usually lasts one
to two days. Some people are asymptomatic.
INCUBATION PERIOD
5 to 15 days.
CONTAGIOUS PERIOD
Unknown; the period during fever and before rash appears is
suspected.
EXCLUSION
Until fever is no longer present.
PREVENTION / CONTROL MEASURES
None
POSSIBLE COMPLICATIONS
None.
SPECIAL WARNINGS
None.
VACCINE AVAILABILITY
None.
Contact Jefferson County Department of Health, 930-1440, or your physician with any related questions concerning
roseola.
54
RUBELLA (German measles)
BACKGROUND
Rubella is a viral disease characterized by slight fever, rash and swollen
lymph nodes. Most cases are mild. Rubella occurs more frequently in
winter and spring. Immunity acquired after contracting the disease is
usually permanent.
REPORTABLE (GROUP A OR B)
Group B: report within 7 days to county or state health department.
INFECTIOUS AGENT(S)
Rubella virus.
MODE OF TRANSMISSION
Rubella is spread by direct contact with nasal or throat secretions of
infected individuals.
OCCURRENCE
Worldwide; any age group. In unvaccinated populations, rubella is
primarily a childhood disease. Where children are well-immunized,
adolescent and adult infections become more evident.
SYMPTOMS
Rubella is a mild illness which may present few or no symptoms.
Symptoms may include a rash, slight fever, joint aches, headache,
discomfort, runny nose and reddened eyes. The lymph nodes just behind
the ears and at the back of the neck may swell causing some soreness
and/or pain. The rash, which may be itchy, first appears on the face and
progresses from head to foot lasting about three days. As many as half of
all rubella cases occur without a rash.
INCUBATION PERIOD
16 to 18 days; with a range of 14 to 23 days.
CONTAGIOUS PERIOD
From 7 days before to 7 days after rash onset.
EXCLUSION
Until 7 days after onset of rash.
PREVENTION / CONTROL MEASURES
•
•
•
Maintaining high levels of rubella immunization in the community is critical to controlling the spread.
Controlling the spread of rubella is needed primarily to prevent the birth defects caused by Congenital Rubella
Syndrome (CRS). Therefore, women of childbearing age should have their immunity determined and receive the
rubella vaccine if needed.
Rubella vaccine is required at 12 months of age and is given in combination with measles and mumps vaccine. A
booster dose is required at 4-6 years of age prior to entering kindergarten.
POSSIBLE COMPLICATIONS
Rubella is dangerous because of its ability to damage an unborn baby.
Infection of a pregnant woman may result in miscarriage, stillbirth or the
birth of an infant with abnormalities which may include deafness,
cataracts, heart defects, liver and spleen damage and mental retardation.
CRS occurs among at least 25 percent of infants born to women who
have had rubella during the first trimester of pregnancy.
SPECIAL WARNINGS
None.
VACCINE AVAILABILITY
Available. See Prevention/Control Measures.
Contact Jefferson County Department of Health, 930-1440, or your physician with any related questions concerning
rubella.
55
SALMONELLOSIS
BACKGROUND
Salmonellosis is a bacterial infection that generally affects the intestinal
tract and occasionally the bloodstream. It is one of the more common
causes of gastroenteritis. Most cases occur in the summer months and are
seen as single cases, clusters or outbreaks. Salmonella are widely
distributed in the food chain and environment. The organisms often
contaminate raw meats, eggs, unpasteurized milk and cheese products.
Other sources of exposure may include contact with infected pet turtles,
pet chicks, dogs and cats.
REPORTABLE (GROUP A OR B)
Group B: report within 7 days to county or state health department.
INFECTIOUS AGENT(S)
The two most common serotypes are Salmonella typhimurium and
Salmonella enteritidis.
MODE OF TRANSMISSION
Salmonella are spread by eating or drinking contaminated food or water
or by contact with infected people or animals.
OCCURRENCE
Worldwide; any age group. It is more recognized in infants and children.
SYMPTOMS
Mild or severe diarrhea, fever and occasionally vomiting.
INCUBATION PERIOD
1 to 3 days after exposure.
CONTAGIOUS PERIOD
Several days to many months; as long as present in the stool.
EXCLUSION
Until diarrhea is no longer present.
PREVENTION / CONTROL MEASURES
•
•
•
•
•
•
•
•
•
•
Always treat raw poultry, beef and pork as if they are contaminated and handle accordingly.
Wrap fresh meats in plastic bags at the market to prevent blood from dripping on other foods.
Refrigerate foods promptly; minimize holding at room temperature.
Cutting boards and counters used for preparation should be washed immediately after use to prevent crosscontamination with other foods.
Avoid eating raw or undercooked meats.
Ensure that the correct internal cooking temperature is reached, particularly when using a microwave.
Avoid eating raw eggs or undercooked foods containing raw eggs.
Avoid using raw milk.
Encourage careful handwashing before and after food preparation.
Make sure children, particularly those who handle pets, attend to handwashing.
POSSIBLE COMPLICATIONS
Bloodstream infections can be quite serious, particularly in the very
young or elderly.
SPECIAL WARNINGS
Special consideration must be given to food handlers, health care workers
and children in day care. Epidemic implications possible with mass
feeding and poor sanitation. Prevent dehydration.
VACCINE AVAILABILITY
None.
Contact Jefferson County Department of Health, 930-1440, or your physician with any related questions concerning
salmonellosis.
56
SCABIES
BACKGROUND
Scabies is a fairly common infestation of the skin caused by a mite.
Scabies mites burrow into the skin producing pimple-like irritations or
burrows. Clusters of cases, or outbreaks, are occasionally seen in nursing
homes, institutions and child care centers.
REPORTABLE (GROUP A OR B)
Not reportable.
INFECTIOUS AGENT(S)
Sarcoptes scabiei, a mite.
MODE OF TRANSMISSION
Scabies are transferred by direct skin-to-skin contact. Indirect transfer
from undergarments or bedclothes can occur only if these have been
contaminated by infected people immediately beforehand. Scabies can
also be transmitted during sexual contact.
OCCURRENCE
Worldwide; any age group.
SYMPTOMS
Intense itching particularly at night. The areas of the skin most affected
by scabies include the webs and sides of the fingers, around the wrists,
elbows and armpits, waist, thighs, genitalia, nipples, breasts and lower
buttocks.
INCUBATION PERIOD
2 to 6 weeks in people who have not previously been exposed to scabies
infestations. People who have had a previous infestation with scabies
mites may show symptoms within 1 to 4 days after subsequent reexposures.
CONTAGIOUS PERIOD
Until mites and eggs are destroyed by treatment.
EXCLUSION
Until treatment has been in effect for at least 24 hours.
PREVENTION / CONTROL MEASURES
•
•
Avoid physical contact with infested individuals and their belongings, especially clothing and bedding.
Health education on the life history of scabies, proper treatment and the need for early diagnosis and treatment of
infested individuals and contacts is extremely important.
POSSIBLE COMPLICATIONS
None.
SPECIAL WARNINGS
Outbreak implications in overcrowded situations.
VACCINE AVAILABILITY
None.
Contact Jefferson County Department of Health, 930-1440, or your physician with any related questions concerning
scabies.
57
SHIGELLOSIS
BACKGROUND
Shigellosis is a bacterial infection affecting the intestinal tract. It is a
fairly common disease usually seen in the summer and early fall and may
occur as single cases or outbreaks.
REPORTABLE (GROUP A OR B)
Group B: report within 7 days to county or state health department.
INFECTIOUS AGENT(S)
Shigella consists of four species: Group A, Shigella dysenteriae; Group
B, Shigella flexneri; Group C, Shigella boydii; and Group D, Shigella
sonnei.
MODE OF TRANSMISSION
Shigella germs are found in the intestinal tract of infected people who
may contaminate food or water. The Shigella germ is spread by eating or
drinking contaminated food or water or by direct contact with an infected
person. Shigella may also be transmitted by swimming in contaminated
water.
OCCURRENCE
Worldwide; any age group. Those who may be at greater risk include
children in day care centers, foreign travelers to certain countries,
institutionalized people and active homosexuals.
SYMPTOMS
Mild or severe diarrhea, often with fever and traces of blood or mucous
in the stool. Some infected people may not show any symptoms.
INCUBATION PERIOD
1 to 7 days; but usually within 2 to 3 days.
CONTAGIOUS PERIOD
1 to 2 weeks.
EXCLUSION
Until treatment is complete and 2 stool cultures taken 24 hours apart are
negative.
PREVENTION / CONTROL MEASURES
•
•
Since germs are passed in feces, the single most important prevention activity is careful handwashing after using
the toilet.
Clean and disinfect any contaminated surfaces.
POSSIBLE COMPLICATIONS
Convulsions may appear in young children.
SPECIAL WARNINGS
Special considerations must be given to food handlers, health care
workers and children in day care. Outbreak implications possible in
areas where there is poor sanitation, both personal and environmental.
VACCINE AVAILABILITY
None.
Contact Jefferson County Department of Health, 930-1440, or your physician with any related questions concerning
shigellosis.
58
SHINGLES (Herpes zoster)
BACKGROUND
Shingles is a localized infection due to the varicella zoster virus, the same
virus that causes chickenpox. It occurs only in people who have had
chickenpox in the past. Most people who have shingles have only one
episode with the disease in their lifetime. Those with impaired immune
systems (people with AIDS, cancer or leukemia, for example) may suffer
repeated attacks.
REPORTABLE (GROUP A OR B)
Not reportable.
INFECTIOUS AGENT(S)
Varicella zoster virus, (VZ virus or VZV), a member of the herpesvirus
family.
MODE OF TRANSMISSION
A person must have already had chickenpox in the past to develop
shingles. Contact with an infected individual does not cause another
person’s dormant virus to reactivate. However, the virus from shingles
patients may cause chickenpox in someone who has not had it before.
OCCURRENCE
Worldwide; any age group.
SYMPTOMS
First sign is often a tingling feeling on the skin, itchiness or a stabbing
pain. After several days, a rash appears beginning as a band or patch of
raised dots on the side of the trunk or face. It then develops into small,
fluid-filled blisters which begin to dry out and crust over within a few
days. When the rash is at its peak, symptoms can range from mild to
extreme and intense pain. The rash and pain usually disappear within
three to five weeks.
INCUBATION PERIOD
The virus lies dormant and can reactivate many years later.
CONTAGIOUS PERIOD
1-2 days before the onset of rash and continuing until all lesions are
crusted.
EXCLUSION
Until sores are dried or if they can be covered, no exclusion is necessary.
PREVENTION / CONTROL MEASURES
•
Immunization with the varicella (chickenpox) vaccine may lower the likelihood of development.
POSSIBLE COMPLICATIONS
Shingles is not usually dangerous to healthy individuals although it can
cause great misery during an attack. Anyone with shingles on the upper
half of their face, no matter how mild, should seek medical care at once.
There is some danger that the virus could cause damage to the eye
resulting in blindness. Complications are rare but may include partial
facial paralysis (usually temporary), ear damage or encephalitis
(inflammation of the brain).
SPECIAL WARNINGS
Do NOT give aspirin to a child with shingles due to the possible
development of Reye syndrome. Contact physician if shingles appears on
the upper half of the face.
VACCINE AVAILABILITY
Individuals immunized with the chickenpox vaccine may be less likely to
develop shingles in later life. Zoster (Shingle) vaccine is recommended
for adults age 60 or older.
Contact Jefferson County Department of Health, 930-1450, or your physician with any questions concerning shingles.
59
STREP THROAT / SCARLET FEVER
BACKGROUND
Both strep throat and scarlet fever are common illnesses among children.
The majority of the time these illnesses are not serious; however,
complications may develop if proper treatment is not administered.
REPORTABLE (GROUP A OR B)
Not reportable.
INFECTIOUS AGENT(S)
Streptococcus bacteria.
MODE OF TRANSMISSION
Direct person-to-person contact with discharges from an infected person.
OCCURRENCE
Worldwide; any age group.
SYMPTOMS
Sudden fever, sore throat, headache, swollen glands, and abdominal
cramps. Occasionally vomiting and nausea occur. Scarlet fever occurs
with a rash appearing on the neck, chest, in the folds of the armpit,
elbow, groin and inner thigh.
INCUBATION PERIOD
1 to 3 days.
CONTAGIOUS PERIOD
Until 24 hours of treatment has been administered.
EXCLUSION
Until fever is no longer present and treatment has been in effect for at
least 24 hours.
PREVENTION / CONTROL MEASURES
•
Consult physician if child does not feel well or develops a sore throat.
POSSIBLE COMPLICATIONS
If proper treatment is not administered, rheumatic fever, kidney disease
and other serious illnesses may result.
SPECIAL WARNINGS
None.
VACCINE AVAILABILITY
None.
Contact Jefferson County Department of Health, 930-1440, or your physician with any related questions concerning
strep throat/scarlet fever.
60
TUBERCULOSIS (TB)
BACKGROUND
Tuberculosis (TB) affects the lungs in the majority of cases; however it
has been known to affect other parts of the body. Without proper
treatment, TB can become a serious illness.
REPORTABLE (GROUP A OR B)
Group A: report within 24 hours to county or state health department.
INFECTIOUS AGENT(S)
Mycobacterium tuberculosis bacteria.
MODE OF TRANSMISSION
Airborne transmission of droplets from the sneezing and coughing of an
infected person.
OCCURRENCE
Worldwide; any age group.
SYMPTOMS
Tiredness, weight loss, fever, night sweats, sometimes coughing, and
chest pain. Symptoms get progressively worse without treatment.
INCUBATION PERIOD
2 to 10 weeks.
CONTAGIOUS PERIOD
As long as TB bacteria is found in the sputum. Effective treatment
usually eliminates the organism within a few weeks. TB of the lung and
larynx are the only communicable types.
EXCLUSION
Until physician determines the child is no longer contagious.
PREVENTION / CONTROL MEASURES
•
Test for TB if a person has been exposed.
POSSIBLE COMPLICATIONS
None.
SPECIAL WARNINGS
None.
VACCINE AVAILABILITY
None.
Contact Jefferson County Department of Health, 930-1440, or your physician with any related questions concerning
tuberculosis (TB).
61
VARICELLA (Chickenpox)
BACKGROUND
Varicella is a highly communicable disease occurring most frequently in
Jefferson County in winter and early spring. Mild or inconspicuous
infections occasionally occur in children.
REPORTABLE (TYPE A OR B)
Group B: report within 7 days to county or state health department. See
Appendix I for Varicella Case Report form.
INFECTIOUS AGENT(S)
Varicella zoster virus, (VZ virus or VZV), a member of the herpesvirus
family.
MODE OF TRANSMISSION
Varicella is transmitted to others by direct person-to-person contact, by
droplet or airborne spread of discharges from an infected person's nose and
throat, or indirectly through articles freshly soiled by discharges from an
infected person's lesions. The scabs themselves are not considered infectious.
OCCURRENCE
Worldwide; any age group.
SYMPTOMS
Sudden onset of slight fever, feeling tired and weak, soon followed by an
itchy blister-like rash. The blisters eventually dry, crust over and form scabs
and tend to be more common on covered than on exposed parts of the body.
Blisters may appear on the scalp, armpits, trunk, on the eyelids and in the
mouth.
INCUBATION PERIOD
13 to 17 days; with a range of 11 to 21 days.
CONTAGIOUS PERIOD
5 days from onset of rash to not more than 6 days after the appearance of the
first lesion. This period may be longer with altered immunity conditions.
EXCLUSION
For at least 5 days after onset of rash or until blisters become dry.
PREVENTION / CONTROL MEASURES
•
•
•
The best method to prevent further spread of chickenpox is for individuals infected with the disease to remain home and
avoid exposing others who are susceptible.
One dose of Varicella vaccine is required for all children 12 months of age and older. A booster dose is recommended
at 4 years of age.
To protect high-risk newborns and immunodeficient patients from exposure, a shot of varicella zoster immune globulin
(VZIG) is effective in modifying or preventing disease if given within 96 hours after exposure to a case of chickenpox.
POSSIBLE COMPLICATIONS
Reye syndrome has been a potentially serious complication associated with
clinical chickenpox. Newborn children (less than one month old) whose
mothers are not immune and those with impaired immune function may
suffer severe, prolonged, or fatal chickenpox.
SPECIAL WARNINGS
DO NOT GIVE ASPIRIN TO A CHILD WITH CHICKENPOX since
there is a possible connection with Reye Syndrome. Avoid unnecessary
exposure of nonimmune newborns and immunodeficient children to
chickenpox.
VACCINE AVAILABILITY
Available. See Prevention/Control Measures.
Contact Jefferson County Department of Health, 930-1450, or your physician with any related questions concerning
varicella (chickenpox).
62
YEAST INFECTIONS (Thrush)
BACKGROUND
Oral thrush is a bacterial infection that usually affects the superficial
layers of the mucous membranes. It is a common, usually innocuous
(having no adverse effect), infection that appears within the first couple
of weeks after birth.
REPORTABLE (TYPE A OR B)
Not reportable.
INFECTIOUS AGENT(S)
Candida albicans and Candida tropicalis as well as other species of
Candida.
MODE OF TRANSMISSION
Thrush is spread by direct contact with discharge from the mouth, skin,
vagina and feces of infected individuals. It can be passed during
childbirth from mother to infant.
OCCURRENCE
Worldwide; any age group.
SYMPTOMS
Ulcers that form in the esophagus, gastrointestinal tract or bladder.
INCUBATION PERIOD
Varies; but typically 2-5 days.
CONTAGIOUS PERIOD
During the presence of active lesions.
EXCLUSION
None.
PREVENTION / CONTROL MEASURES
•
•
•
•
Use proper handwashing techniques after contact with lesions.
Clean and disinfect any contaminated items.
Prevention of thrush is done by discovering and treating vaginal candidiasis during the third trimester of
pregnancy.
Discovery of thrush in the mouth and early treatment can help avoid systemic infections.
POSSIBLE COMPLICATIONS
Those with diabetes mellitus, cancer chemotherapy, and certain immune
deficiencies may predispose individuals to candidiasis.
SPECIAL WARNINGS
None.
VACCINE AVAILABILITY
None.
Contact Jefferson County Department of Health, 930-1440, or your physician with any related questions concerning
yeast infections (thrush).
63
YERSINIOSIS
BACKGROUND
Yersiniosis is a bacterial infection that affects the intestinal tract and,
rarely, the bloodstream. Most cases are seen in the cooler months,
generally between November and January.
REPORTABLE (GROUP A OR B)
Group B: report within 7 days to county or state health department.
INFECTIOUS AGENT(S)
Yersinia enterocolitica.
MODE OF TRANSMISSION
Yersinia enterocolitica is most often acquired by eating contaminated
food, especially raw or undercooked pork products or drinking
contaminated
unpasteurized
milk
or
untreated
water.
Occasionally Y. enterocolitica infection occurs after contact with infected
animals. On rare occasions, it can be transmitted as a result of the
bacterium passing from the stools or soiled fingers of one person to the
mouth of another person. This may happen when basic hygiene and
handwashing habits are inadequate.
OCCURRENCE
Worldwide; any age group. Infections are uncommon in the United
States.
SYMPTOMS
Fever, abdominal pain, and diarrhea, which is often bloody.
INCUBATION PERIOD
4 to 6 days; with a range of 1 to 14 days.
CONTAGIOUS PERIOD
A few days to a few weeks; as long as Yersinia enterocolitica is found in
the stool.
EXCLUSION
Until diarrhea is no longer present.
PREVENTION / CONTROL MEASURES
•
•
•
•
•
•
Avoid eating raw or undercooked pork.
Consume only pasteurized milk or milk products.
Refrigerate foods promptly; minimize holding at room temperature.
Wash hands with soap and water before eating and preparing food, after contact with animals, and after handling
raw meat.
After handling raw chitterlings, clean hands and fingernails scrupulously with soap and water before touching
infants or their toys, bottles, or pacifiers. Someone other than the foodhandler should care for children while
chitterlings are being prepared.
Prevent cross-contamination in the kitchen:
• Use separate cutting boards for meat and other foods.
• Carefully clean all cutting boards, counter-tops, and utensils with soap and hot water after preparing raw
meat.
• Dispose of animal feces in a sanitary manner.
POSSIBLE COMPLICATIONS
None.
SPECIAL WARNINGS
None.
VACCINE AVAILABILITY
None.
Contact Jefferson County Department of Health, 930-1440, or your physician with any related questions concerning
Campylobacteriosis.
64
SECTION IV.
QUICK REFERENCE SUMMARY CHART OF INFECTIOUS
DISEASES
Symptom
Disease
Symptom
Disease
Respiratory
Conjunctivitis (pinkeye)
Enteroviruses (nonpolio)
Measles
Pertussis (whooping cough)
Respiratory infections (viral)
Respiratory syncytial virus (RSV)
Streptococcal sore throat
Tuberculosis
Colds
Diarrheal/
Cramps
Campylobacteriosis
E. coli O157:H7
Enteroviruses
Giardiasis
Hepatitis A
Norovirus
Rotavirus
Salmonellosis
Shigellosis
Yersiniosis
Symptom
Disease
Symptom
Disease
Rashes/Skin
Conditions
Enteroviruses (nonpolio)
Fifth disease
Hand, Foot, and Mouth Disease
Impetigo
Lice (head)
Lyme disease
Measles
Meningococcal disease
Oral herpes (cold sores)
Ringworm
Roseola
Rubella (German measles)
Scabies
Scarlet fever
Shingles
Varicella (Chickenpox)
Yeast infection (thrush)
Multisymptom/
Other
Cytomegalovirus (CMV)
Ear infections
Hib
Hepatitis A
Hepatitis B
HIV/AIDS
Lyme disease
Meningococcal Disease
Mononucleosis
Mumps
Pinworms
Reye syndrome
Rubella (adults)
65
Mode of Spread
Disease
Infectious Agent(s)
Symptoms/Signs
Incubation Period
Exclusion Guidelines
Reportability
Airborne/
Respiratory
(spread by throat, nose,
and mouth droplets)
Chickenpox
Varicella zoster virus
(VZ virus)
Sudden slight fever; tiredness; itchy,
blister-like rash; blisters dry and crust
over; blisters more common on covered
than exposed parts of the body.
13 to 17 days;
usually 11 to 21 days.
At least 5 days after
onset of rash or when
blisters become dry.
Report within
7 days.
Cytomegalovirus
(CMV)
Herpesvirus 5
Lethargy; convulsions; sore throat;
jaundice; most do not present with
symptoms.
3 to 12 weeks.
None.
Not
reportable.
Enterovirus
Coxsackieviruses;
Echoviruses;
Enteroviruses
Sore throat; fever; rash; nausea;
vomiting; diarrhea.
3 to 6 days.
Until diarrhea is no longer
present.
Not
reportable.
Fifth disease
Parvovirus B19
Low grade fever; tiredness; red rash
appears on cheeks “slapped cheek”;
moves to the rest of the body.
4 to 20 days after
rash development.
Until child can participate
in daily activities.
Not
reportable.
Hand, Foot and Mouth
Coxsackievirus group A:
types 4, 5, 9, and 10; and
enterovirus 71
Sudden fever; sore throat; small
grayish oral lesions on the cheeks and
gums; lesions may appear on palms,
soles or fingers.
3 to 5 days.
Until fever is no longer
present.
Not
reportable.
Haemophilus influenzae
type b (Hib)
Haemophilus influenzae
type b bacteria
Fever; nausea; vomiting; sometimes
other symptoms occur with other
parts of the body.
Less than 10 days;
usually 2 to 4 days.
Until fever is no longer
present and child can
participate in daily activities.
Report within
24 hours.
Measles
Measles virus
Two stages: FIRST: runny nose; cough;
slight fever; SECOND: fever of 103-105
degrees F; red, blotchy rash usually
beginning on the face and spreading to
the rest of the body; Koplik (white spots)
may appear on gums and cheeks.
8 to 13 days after
exposure.
At least 4 days after rash
appears.
Report within
24 hours.
Meningococcal disease
Neisseria meningitidis
Some may have fever; headache;
vomiting; stiff neck; rash; some have
chronic nerve damage; occasionally
death occurs.
2 to 10 days after exposure;
usually within 5 days.
Until treatment has begun
and child can participate
in daily activities.
Report within
24 hours.
Mumps
Mumps virus
Fever; swelling; tenderness of one
or more of the salivary glands; some
do not show symptoms.
16 to 18 days; with a range
of 14 to 25 days.
Not during infectious period;
from the 12th to the 25th day
after exposure.
Report within
7 days.
66
Mode of Spread
Disease
Infectious Agent(s)
Symptoms/Signs
Incubation Period
Exclusion Guidelines
Reportability
Airborne/
Respiratory
(spread by throat, nose
and mouth droplets)
Pertussis
(Whooping cough)
Bordetella pertussis
Sneezing; runny nose; low-grade fever;
mild cough, usually at night and may
recur for one to two months.
5 to 10 days; but as long
21 days.
Until received at least 5 days
of a 14-day treatment.
Report within
24 hours.
Respiratory infections
(viral)
Various viruses
Sneezing; runny nose; fever; sore throat;
chills; sough; muscle ache.
Up to 10 days after
exposure.
Until fever is not longer
present and child can
participate in daily activities.
Not
reportable.
Respiratory syncytial
virus (RSV)
Respiratory syncytial
virus (RSV)
Fever; shills; headache; general
aching; anorexia.
1 to 10 days.
Until fever is no longer
present.
Not
reportable.
__________________
Rubella
(German measles)
Rubella virus
Few or no symptoms may be
present; rash; slight fever; joint aches;
headache; discomfort; runny nose;
reddened eyes; rash may be itchy and at
first appear on the face, then progressing
from head to foot.
16 to 18 days; with a range
14 to 23 days.
Until 7 days after onset
of rash.
Report within
7 days.
Strep throat/
Scarlet fever
Streptococcus
bacteria
Sudden fever; sore throat; swollen glands;
headache; abdominal cramps; vomiting;
rash occurs with scarlet fever.
1 to 3 days after
exposure.
Until fever is no longer
present and treatment has
been in effect for at least
24 hours.
Not
reportable.
Tuberculosis
Mycobacterium
tuberculosis
bacteria
Tiredness; weight loss; cough; fever;
night sweats; chest pain.
2 to 10 weeks after
exposure.
Until physician determines
the child is no longer
contagious.
Report within
24 hours.
Blood/Body Fluids Hepatitis B
(fresh cuts and sores)
Direct Contact
(with skin, saliva,
urine, or discharge
from infected
person)
Hepatitis B virus
(HBV)
Fatigue, poor appetite; fever;
2 to 6 months after
None unless there is the
Report within
vomiting; joint pain; hives; rash;
exposure; usually within
possibility of blood exposure.
7 days.
dark urine; jaundice; some show no
3 months.
symptoms.
Human
Immunodeficiency
Virus (HIV)
Human
Immunodeficiency
Virus (HIV)
Depends on the type of infection that
occurs; lowers the immune system’s
ability to fight infections.
6 months to 15 years
after exposure.
See individual fact sheet.
Report within
7 days.
Cytomegalovirus
(CMV)
Herpesvirus 5
Lethargy; convulsions; sore throat;
jaundice; most do not present with
3 to 12 weeks.
None.
Not
reportable.
symptoms.
67
Mode of Spread
Disease
Infectious Agent(s)
Symptoms/Signs
Incubation Period
Direct Contact
(with skin, saliva,
urine, or discharge
from infected
person)
Conjunctivitis
(Pinkeye)
Various agents
Discharge from one or both eyes;
pink conjunctiva; eye pain.
24 to 72 hours.
Impetigo
Different strains of
Staphylococcus
aureus
Lesions that are sticky and yellow;
itchy.
Lice (head)
Pediculis capitis
Mononucleosis
(infectious)
Exclusion Guidelines
Reportability
Until treatment has
been in effect for at
least 24 hours and child can
participate in daily activities.
Not
reportable.
4 to 10 days.
Until treatment has been
in effect for at least 24 hours
Not
reportable.
Itching on scalp; red bite marks
and scratches on neck and scalp.
2 to 3 weeks to
notice itching.
After treatment and no more
live lice are found.
Not
reportable.
Epstein-Barr virus
(EBV)
Fever; sore throat; swollen glands;
feeling tired.
4 to 6 weeks after
exposure.
Until treatment has begun
and child can participate
in daily activities.
Not
reportable.
Oral Herpes
(cold sores)
Herpes simplex
virus type 1
(HSV-1)
Blisters on the lips and mouth that
are full of fluid; become crusty
within a few days.
2 to 12 days.
Only those with active
lesions present who have
no control over oral secretions.
Not
reportable.
Pinworms
Enterobius
vermicularis
Often asymptomatic; perianal itching;
sleep disturbances; irritability;
vulvovaginitis.
Unknown.
Until treatment has been
in effect for at least 24 hours.
Not
reportable.
Ringworm
Microsporum;
Trichophyton;
Epidermophyton
floccosum
and various other
species
SCALP: pimple that becomes larger and
leaves scaly patches of temporary baldness;
yellowish-crusty areas; NAILS: become
thicker, discolored, brittle; BODY: flatspreading ring-shaped areas that may be
dry and scaly or moist and crusted.
Scalp: 10 to 14 days after
contact
Body: 4 to 19 days after
contacts
Until treatment has been
in effect for at least 24 hours.
Not
reportable.
Scabies
Sarcoptes scabiei
Itching, particularly at night; mostly affects 2 to 6 weeks in those with
webs and sides of fingers; around wrists;
no history; 1 to 4 days in
elbows; armpits; waist; thighs; genitalia;
those with a history.
nipples; breasts; lower buttocks.
Until treatment has been in
effect for at least 24 hours.
Not
reportable.
Yeast infections
(thrush)
Candida albicans;
Candida tropicalis
Ulcers in the esophagus, GI tract;
bladder; mouth.
None.
Not
reportable.
_
68
Varies; usually 2 to 5 days.
Mode of Spread
Disease
Infectious Agent(s)
Symptoms/Signs
Incubation Period
Exclusion Guidelines
Reportability
Fecal Oral
(ingestion of
contaminated
foods or water)
Campylobacteriosis
Campylobacter
jejuni
Mild or severe diarrhea; fever;
blood in stool; vomiting; abdominal
cramps.
2 to 5 days; with a
range of 1 to 10 days.
Until diarrhea is no longer
present.
Report within
7 days.
Diarrhea (no specific
pathogen)
Various agents
Frequent, loose or watery stools;
vomiting; fever; abdominal cramps.
24 to 72 hours.
Until diarrhea is no longer
present.
Not
reportable.
E. coli O157:H7
O157:H7
Watery stool with blood; fever;
abdominal pain; some people
are asymptomatic.
48 hours; with a range
of 12 to 60 hours.
Until pathogen is not
present in the stool.
Report within
7 days.
Enterovirus
Coxsackieviruses;
Echoviruses;
Enteroviruses
Sore throat; fever; rash; nausea;
vomiting; diarrhea.
3 to 6 days.
Until diarrhea is no longer
present.
Not
reportable.
Giardiasis
Giardia lamblia
Mild or severe diarrhea; abdominal
cramps; nausea; some people are
asymptomatic.
5 to 25 days; usually
within 10 days.
Until treatment has been in
effect for at least 24 hours.
Report within
7 days.
Hand, Foot, and Mouth
Coxsackievirus group A:
types 4, 5, 9, and 10; and
enterovirus 71.
Sudden fever; sore throat; small
grayish oral lesions on the cheeks and
gums; lesions may appear on palms,
soles or fingers.
3 to 5 days.
Until fever is no longer
present.
Not
reportable.
Hepatitis A
Hepatitis A virus (HAV)
Fatigue, poor appetite; fever;
vomiting; dark urine; sometimes
jaundice; some show no symptoms.
2 to 6 weeks after exposure
Depends on individual case.
Consult your local health
department or physician
for advice.
Report within
24 hours.
Norovirus
Norovirus
Watery diarrhea; nausea; vomiting;
abdominal cramps; headache; lowgrade fever.
24 to 48 hours; with a
range of 10 to 50 hours.
Until diarrhea is no longer
present.
Not
reportable.
Rotavirus
Rotavirus
Fever; vomiting; diarrhea; sometimes
24 to 72 hours.
Until diarrhea is no longer
Not
dehydration and death in younger
present.
reportable.
persons.
______________________________________________________________________________________________________________________________________________________________
69
Mode of Spread
Fecal Oral
(ingestion of
contaminated
foods or water)
Disease
Infectious Agent(s)
Symptoms/Signs
Incubation Period
Exclusion Guidelines
Reportability
Salmonellosis
Salmonella typhimurium;
Salmonella enteritidis
Mild or severe diarrhea; fever;
vomiting.
1 to 3 days after exposure.
Until diarrhea is no longer
present.
Report within
7 days.
Shigellosis
Shigella species 4 Group types
Mild or severe diarrhea; fever; traces
1 to 7 days after exposure;
Until treatment is complete
Report within
of blood or mucous in the stool; some
usually within 2 to 3 days.
and 2 stool cultures taken
7 days.
people are asymptomatic.
24 hours apart are negative.
______________________________________________________________________________________________________________________________________________________________
Mild or sever diarrhea; fever; blood
1 to 14 days after exposure;
Until diarrhea is no longer
Report within
in the stool.
Usually within 4 to 6 days.
present.
7 days.
_______________________________________________________________________________________________________________________________________________________________
No Direct Personto-Person Contact
Yersiniosis
Yersinia enterocolitica
Ear infection
Bacteria and virus
Earache; fever; irritability; sometimes
drainage occurs; some people are
asymptomatic.
Unknown.
Until fever is no longer
present and child can
participate in daily activities.
Not
reportable.
Lyme disease
Borrelia burgdorferi
Circular reddish expanding rash
around bite marks; fever; headache;
fatigue; stiff neck; joint pain.
Within a month of
exposure.
None.
Not
reportable.
Reye syndrome
Unknown; associated
with chickenpox and
influenza and aspirin use.
Vomiting; lethargy; confusion;
irritability; aggressiveness.
Unknown.
Until child can participate
in daily activities.
Not
reportable.
Roseola
Human herpesvirus 6
Sudden fever; rash that resembles small,
bumpy, rose-pink spots beginning on
the chest and abdomen; some people are
asymptomatic.
5 to 15 days after exposure.
Until fever is no longer
present.
Not
reportable.
Shingles
Varicella zoster virus
(VZ virus)
Tingling feeling on the skin; itchiness;
Virus can lay dormant for
stabbing pain; rash develops; small fluid- years.
filled blister that dry out within a few days.
Until sores have dried or
can be covered; no exclusion
is necessary.
Report within
7 days.
70
_
SECTION V.
SAMPLE LETTERS TO PARENTS
A.
Updated Blue Form Request
B.
Giardiasis
C.
Hepatitis A
D.
Head Lice
E.
Hib 1
F.
Hib 2
G.
Meningococcal Disease
H.
Pertussis (Whooping Cough)
I.
Shigellosis
J.
Varicella (Chickenpox)
71
UPDATED BLUE FORM REQUEST
Date
Dear Parent or Guardian of
,
Your child’s,
, State of Alabama Certificate of Immunization
(Blue Form) expires on
. On this date, your child is due for his/her next
immunizations. Please be sure that when you child is immunized, you are given a new blue slip
(State of Alabama Certificate of Immunization IMM 50).
According to the State of Alabama, Department of Human Resources Minimum Standards,
Section 5, a.(2), “each child under five years of age and five year olds who are not in
public/private school kindergarten should have an unexpired State of Alabama Certificate of
Immunization (ADPH-IMM-50) on file in the center prior to the child’s admission.”
By the end of the month, please present the new blue form to the center. Thank you for you
cooperation.
Sincerely,
72
GIARDIASIS
Dear Parent(s) and Day Care Staff,
Recently a child who attends
Day Care developed an illness called giardiasis.
Giardiasis is an intestinal infection caused by the parasite, Giardia lamblia. It is a very common
disease and can be spread from one person to another on hands contaminated with feces or
through contaminated water. Children are infected more frequently than adults because their
handwashing skills are not well developed.
The best way to prevent infection is very thorough handwashing after bowel movements or
diapering children and before and after eating or preparing food.
The symptoms of giardiasis include diarrhea, abdominal cramping, bloating, frequently loose and
foul smelling greasy stools, and poor appetite. If your child develops any of these symptoms,
please contact his/her physician for testing and treatment. Containers and specimen processing
through the county health department are available at no cost.
If you have any questions, please contact your physician or the Jefferson County Department of
Health.
Sincerely,
73
HEPATITIS A
Dear Parent(s) and Day Care Staff,
Recently a child who attends
Day Care developed an illness called hepatitis A.
Hepatitis A is a viral disease characterized by fever, weakness, loss of appetite, nausea,
abdominal discomfort and jaundice. The virus is shed in the feces of infected persons. It is easily
transmitted among young children, especially those in diapers. Young children, even when
infected, often do not show signs and symptoms of the disease, but nevertheless can transmit the
virus to others such as household members. Older persons are more likely to develop symptoms.
When a case of hepatitis A occurs in a day care center attended by children in diapers, the
Alabama Department of Public Health recommends that all children and staff of the center
receive an injection of immune globulin (IG) to prevent further spread of the disease. These
recommendations correspond to those of the American Academy of Pediatrics and the Centers
for Disease Control. Please contact you child's physician immediately for a prescription for this
injection. A public health nurse from
County Health Department will
administer IG at the day care center on
. Please bring your prescription and
the signed parental consent form (attached) to the day care center by that day. It may be
necessary for your child to receive an injection of IG in order to continue attending the day care
center. If you choose to go to your family doctor for the injection, please bring a statement from
the doctor indicating that IG has been given.
Because the hepatitis A virus is shed in feces, the single most important prevention activity is
very thorough handwashing. Handwashing should be done after bowel movements, after
diapering children, and before and after preparing food.
Adverse reactions to the injection are extremely rare. Some discomfort at the site of injection
may occur. IG may interfere with the response to certain other immunizations. Therefore routine
measles, mumps, and rubella (MMR) immunizations should be deferred for 3 months. IG
preferably should not be administered for at least 2 weeks after receiving MMR. If this is
necessary, however, then a repeat dose of MMR should be given 3 months later.
Please complete the attached form and return it to the day care center by
.
If you have any questions, please contact your physician or the Jefferson County Department of
Health.
Sincerely,
74
HEPATITIS A IG PERMISSION FORM
1. I have read the above information about immune globulin (IG) and give my permission for
my child to receive the injection of IG, prescribed by my child's doctor or a health
department doctor and administered by a public health nurse, at the
Day Care Center for prophylaxis against hepatitis A.
Child's weight
Age
Date
Parent's signature
2. Additional information requested by the Health Department.
a. Number of persons in household
.
b. Has anyone in the household, family or close friend, been diagnosed with hepatitis A
during the last 6 months
Yes No
c. If yes, please give names, date of illness, and relationship to child.
Names
Date of Illness
75
Relationship
HEAD LICE
Dear Parent(s),
Head lice (Pediculus capitis) are a common problem in Alabama school children. Head lice occur in all
socio-economic levels regardless of age, gender, or standards of personal hygiene. They are highly
communicable and difficult to prevent, but if parents take the responsibility to check the entire family
often, these parasites can be controlled. Head lice infestation, although not a disease, is often a frustrating
problem to deal with, but the following information should help you identify and treat head lice safely and
thoroughly.
HEAD LICE FACTS
Lice are small insects about the size of a sesame seed and are usually light brown but can vary in color.
They move quickly and shy away from the light, making them difficult to see. Diagnosis is most often
made on the basis of finding nits (eggs). Nits are tiny, grayish-white or yellowish-white oval specks
attached to hairshafts. It was previously believed that all nits were found a quarter-inch from the scalp,
but new evidence has been introduced suggesting that viable (live) nits may be found at any distance from
the scalp. As the female louse deposits her eggs (3-4 per day), she cements them to the hairs, and unlike
lint or dandruff, they will not wash off or blow away. Nits may be found throughout the hair, but are most
often located at the nape of the neck, behind the ears, and frequently on the crown. It helps to use a
magnifying glass and natural light when looking for them.
Head lice are incapable of hopping, jumping, or flying and are primarily acquired by coming in direct
contact with an infested person. However, wearing clothing (such as a hat, coat or scarf) recently worn by
an infested person, using a contaminated comb or brush, or lying on contaminated furniture, carpeting or
bedding can also result in becoming infested.
SYMPTOMS OF INFESTATION
The itching that occurs when lice bite and suck blood from the scalp is the primary symptom of
infestation, although not everyone will experience itching Children seen scratching their heads frequently
should be examined at once. Often red bite marks or scratch marks can be seen on the scalp and neck.
TREATMENT OF THE INDIVIDUAL
Before one family member is treated, all should be examined. Those showing evidence of infestation
should all be treated at the same time. Individual treatment is a two-step process involving the use of a
pediculicidal product and a combing tool manufactured for the purpose of nit removal. Proceed as
follows:
1.
Use one of several louse remedies available at your pharmacy. Some are available by prescription
(*Kwell shampoo and Nix Cream rinse) and some can be purchased over the counter (Rid, A-200
and R & C shampoo). All these products must be used carefully, observing all safety guidelines.
Also consider (1) consulting your obstetrician if you are pregnant or nursing (whether treating
yourself or others); (2) consulting your physician before treating anyone with extensive cuts or
scratches on the head or neck, or anyone using other medications. DO NOT USE THESE
PRODUCTS ON INFANTS. LICE/NITS ON INFANTS SHOULD BE REMOVED
76
MANUALLY. READ ALL PACKAGE INFORMATION BEFORE USING THE
PRODUCTS.
2.
Remove child's shirt and provide a towel to cover the eyes (this is essential). Do not treat in the
bathtub or shower, but have the child lean over the sink (this confines the lice product to the
scalp/neck).
3.
Although it can take time and sometimes be difficult, remove all nits to insure complete
treatment. Most louse products do not kill all the nits, and survivors will hatch into crawling lice
within 7-10 days, generating a cycle of self-reinfestation. Even dead nits will cling to the hair and
cause uncertainty about reinfestation. A fine-toothed comb is helpful but many nits will have to
be stripped from the hair shaft. Grasp nits between the fingers and slide them off the hair shaft.
Note: All nits must be removed from hair before student can be returned to school or day care.
4.
Following nit removal, have child put on clean clothing.
5.
A daily nit check is advisable for at least 10 days following treatment and then checking should
become part of routine home hygiene. All products except Nix cream rinse require two
treatments: An initial treatment will kill adult and larval lice, but will not kill all the eggs. A
second treatment 7-10 days later, after any eggs left by the first treatment have hatched, will kill
the newly hatched lice before they mature and reproduce, and complete the treatment process.
TREATMENT OF PERSONAL ARTICLES AND ENVIRONMENT
1.
Machine wash all washable clothing and bed linens which have been in contact with the infested
person during the last three days. Articles should be washed in HOT water and dried in a HOT
dryer. Non-washable clothing can be vacuumed or dry cleaned. Articles that cannot be washed or
dry cleaned can be sealed in plastic bags for 10 days and then removed and dusted for any dead
nits or lice.
2.
Rugs, upholstered furniture and mattresses (and any other personal items that cannot be washed)
should be carefully vacuumed to pick up any living lice or nits attached to fallen hairs. The use of
insecticide sprays is not recommended and strongly discouraged as they may be harmful to family
members and pets and are of questionable benefit.
REPORTING CASES
Don't be embarrassed to notify your child's school or day care so other parents can be alerted to a possible
outbreak. Also notify your child's playmate's parents. Parental cooperation will help control this problem.
*The prescription product, Kwell Shampoo, contains the pesticide Lindane. Lindane has the potential for
causing side effects if overuse or accidental ingestion should occur.
Sincerely,
77
Hib 1 (One Case)
Dear Parent(s) and Day Care Staff,
Recently a child who attends the
class at
Day
Care
developed an illness caused by the bacteria (germ) Haemophilus influenza type b (Hib).
Infections caused by this bacteria are not as contagious as certain viral illnesses (such as measles
or chickenpox), but occasionally this infection can be transmitted from person-to-person among
certain close contacts. Many children and adults carry this germ in their nose or throat without
any sign of illness. Others may develop serious diseases such as meningitis (swelling of the
covering of the brain and spinal cord), bacteremia (infection in the blood), cellulitis (infection in
the skin tissues), epiglottis (swelling of the epiglottis in the throat), and pneumonia. These Hib
infections are more common and usually more severe in children less than 4 years of age. For
more information about Hib disease, please see the attached fact sheet.
When a case of Hib occurs in a day care center where there are children less than 2 years of age
who have not completed the Hib vaccine series, the Alabama Department of Public Health
recommends that the classroom contacts of the case receive preventive therapy with the
antibiotic rifampin.
Please contact your physician immediately. Inform him/her that one other child in your child’s
class has developed Hib and that the health department recommends rifampin.
Rifampin is not recommended for pregnant women because its effect on the fetus has not been
established. Rifampin may reduce how well oral contraceptives work. Consideration should be
given to using alternative contraceptive measures while taking rifampin. This medication may
cause the urine, feces, saliva, sputum, sweat, and tears to turn red/orange. This is normal and no
cause for alarm. Soft contact lenses should not be worn while taking rifampin because
discoloration of the lenses may occur.
If your child develops symptoms of Hib disease (fever, headache, nausea, vomiting, stiff neck,
unusual sleepiness, weakness or difficulty breathing) it is very important that you seek medical
attention immediately.
If you have any questions, please contact your physician or the Jefferson County Department of
Health (930-1450).
Sincerely,
78
Hib 2 (Two Cases)
Dear Parent(s) and Day Care Staff,
Recently two children who attend the ____________________ class at _________________
Day Care developed an illness caused by the bacteria (germ) Haemophilus influenzae type b
(Hib). Infections caused by this bacteria are not as contagious as certain viral illnesses (such as
measles or chickenpox), but occasionally this infection can be transmitted from person-to-person
among certain close contacts. Many children and adults carry this germ in their nose or throat
without any sign of illness. Others may develop serious diseases such as meningitis (swelling of
the skin tissues), epiglottis (swelling of the epiglottis in the throat), and pneumonia. These Hib
infections are more common and usually more severe in children less than 4 years of age. For
more information about Hib disease, please see the attached fact sheet.
When a case of Hib occurs in a day care center where there are children less than 2 years of age
who have not completed the Hib vaccine series, the Alabama Department of Public Health
recommends that the classroom contacts of the case receive preventive therapy with the
antibiotic rifampin.
Please contact your physician immediately. Inform him/her that two other children in your
child’s class have developed Hib and that the health department recommends rifampin. Your
child may not return to class until he/she starts on rifampin. Do not take your child to another
center.
Rifampin is not recommended for pregnant women because its effect on the fetus has not been
established. Rifampin may reduce how well oral contraceptives work. Consideration should be
given to using alternative contraceptive measures while taking rifampin. This medication may
cause the urine, feces, saliva, sputum, sweat, and tears to turn red/orange. This is normal and no
cause for alarm. Soft contact lenses should not be worn while taking rifampin because
discoloration of the lenses may occur.
If your child develops symptoms of Hib disease (fever, headache, nausea, vomiting, stiff neck,
unusual sleepiness, weakness or difficulty breathing) it is very important that you seek medical
attention immediately.
If you have any questions, please contact your physician or the Jefferson County Department of
Health (930-1450).
Sincerely,
79
MENINGOCOCCAL DISEASE
Dear Parent(s) and Day Care Staff,
Recently a child who attends ___________________ Day Care developed meningococcal
disease. This is a severe bacterial infection of the blood or meninges (a thin membrane covering
the brain and spinal cord). It is a relatively rare disease and usually occurs as a single isolated
event, but occasionally will occur in a close contact. The meningococcal germ can be transmitted
person-to-person among close contacts. Many people carry the germ in their nose and throat
without any signs of illness, while others may develop serious symptoms.
The Alabama Department of Public Health, Division of Epidemiology, has established
recommendations to address this problem. These recommendations correspond to those of the
American Academy of Pediatrics and the Centers for Disease Control and Prevention.
When a case of meningococcal disease occurs, the Alabama Department of Public Health
recommends that close contacts of the case, including household contacts and day care contacts,
receive preventive therapy with the antibiotic rifampin.
Rifampin is not recommended for pregnant women because its effect on the fetus has not been
established. However, a physician can give pregnant women a shot of ceftriaxone. Oral
contraceptives may not work. Alternative contraceptive measures should be used while taking
rifampin. This medication may cause the urine, feces, sputum, sweat and tears to turn red/orange.
This is normal and no cause for alarm. Soft contact lenses should not be worn while taking
rifampin because permanent discoloration may occur.
Please notify your child’s physician immediately of the child’s exposure to meningococcal
disease and the health department’s recommendation that your child receive rifampin
prophylaxis. Request a prescription for rifampin.
It is important that you seek medical attention immediately if your child develops symptoms of
meningococcal disease (fever, headache, nausea, vomiting, stiff neck or unusual sleepiness).
If you have any questions, please contact your physician or the Jefferson County Department of
Health (930-1450).
Sincerely,
80
PERTUSSIS (WHOOPING COUGH)
Date:
Dear Parent/Guardian,
You have received this letter because a child with pertussis (Whooping Cough) has been identified as
having been in close contact with your child. Pertussis is a highly contagious disease that is spread to
others by contact with respiratory droplets such as coughing.
Pertussis begins with symptoms similar to the common cold, such as runny nose, mild sore throat,
minimal or no fever, and a mild, dry cough. The cough gradually becomes more severe over 1-2 weeks
and may result in a long series of coughs followed by a whooping noise as the person struggles to breathe.
The cough is often worse at night. Vomiting may be a consequence of these episodes and the person may
be left exhausted after the coughing spell.
The Centers for Disease Control and Prevention (CDC) recommend antibiotic treatments for all close
contacts and household members of a pertussis case-patient, regardless of age and vaccination status.
CDC defines a close contact as anyone who had face-to-face contact or shared a confined space for a
prolonged period of time with an infected person or had direct contact with respiratory secretions from a
symptomatic person.
Please consider the following recommendations from the Alabama Department of Public Health (ADPH):
1. If your child has any of the above symptoms, please have your child evaluated by his or her
health care provider in order to receive antibiotics for treatment. Antibiotics received early can
help your child get well faster and lower the chances of spreading the disease to others.
2. Even though the disease may be milder in older persons, those who are infected may transmit the
disease to other susceptible persons, including unimmunized or incompletely immunized infants.
When possible, young infants should be kept away from people with a cough. Cover your mouth
and nose when coughing or sneezing, and always wash your hands with soap and water after
sneezing or coughing.
3. If you have children or close contacts in your home under the age of 7 years who have not been
completely immunized, we recommend you speak with your child’s health care provider about
making sure your child’s shots are up-to-date.
4. Adolescents, adults, and children who are unmimmunized or partially immunized may be
asymptomatic; therefore it is important to seek the attention of your healthcare provider for
treatment if you or anyone in your household has had close contact with the child with pertussis.
If you have any questions, please contact your physician or the Jefferson County Department of Health at
(205) 930-1450, option 5.
Thank you for assistance and attention to this matter.
Sincerely,
81
SHIGELLOSIS
Dear Parent(s) and Day Care Staff,
Recently, a child who attends
Day Care developed a diarrheal illness
caused by the bacteria (germ) Shigella. Shigella is a fairly common disease and may occur as a
single case or in an outbreak. Shigella bacteria are found in the intestinal tract of infected
persons. The bacteria is passed in the feces and may contaminate food or water. Direct person-toperson spread may also occur and is a common mode of transmission in day care centers,
especially among those in diapers.
The symptoms of shigellosis are diarrhea, nausea, vomiting, abdominal cramps, and sometimes
fever. The stools may contain blood and mucous. For more information about Shigella, please
see the enclosed fact sheet.
When Shigella occurs in a day care center or day care home, the Alabama Department of Public
Health recommends that center attendees and staff who are positive for Shigella are excluded
from the center until diarrhea has ceased and two successive stool specimens are negative for
Shigella. These specimens should be collected 24 hours or more apart and no sooner than 48
hours following discontinuation of antibiotics. Center attendees and staff who are symptomatic
with diarrhea should also be excluded from the center until diarrhea has ceased and they test
negative for Shigella. These recommendations correspond to those of the Centers for Disease
Control and are designed to prevent further spread of infection. The single most important
prevention activity is very thorough handwashing after bowel movements or diapering children
and before eating or preparing food.
If your child has diarrhea please contact you physician. Containers and specimen processing
through the health department are available at no cost.
If you have any questions, please contact your physician or the Jefferson County Department of
Health.
Sincerely,
82
VARICELLA (CHICKENPOX)
Dear Parent/Guardian,
Recently one or more children with a reported case of chickenpox (varicella) have been
identified in your child’s classroom or among children with whom he/she has spent time or
shared common activities. Chickenpox is very contagious and easily passed from one person to
another. Before a vaccine became available, chickenpox resulted in about 10,000 hopitalizations
and about 100 deaths a year in the US. Cases can be more severe in adults. A single dose of
chickenpox vaccine is about 85% effective in reducing the chance a person will develop
chickenpox, and currently fewer than 10 deaths occur a year in the US. However, even among
children who received one dose of chickenpox vaccine, it is not uncommon for mild cases of
chickenpox to occur. Therefore, it is possible there will be additional cases at the school. New
cases occur around 10 to 21 days after exposure to a contagious case.
An unvaccinated child who develops chickenpox usually has an itchy rash that changes from
spots to bumps to blisters and then forms scabs in 4 to 7 days. There might be several hundred
sores. Fever and feeling badly might occur 1 to 2 days before the rash breaks out. A vaccinated
child who later develops chickenpox usually has a milder disease with fewer than 50 sores and
only a few blisters. Scabs may form sooner, and fever is often absent.
Children with chickenpox are contagious for 1 to 2 days before the rash starts and until all the
blisters have formed scabs, usually 4 to 7 days after the rash first formed. Please be aware that
your child could develop chickenpox. Any child who develops symptoms or signs of
chickenpox should be kept home from school until all of the sores have formed scabs and
the child feels better.
Two doses of chickenpox vaccine are now recommended routinely for all children. Therefore, if
your child has received just one dose of chickenpox vaccine, you should go to your doctor
or clinic so your child can get the second dose. Unless there are reasons your child is
exempt from vaccinations, he/she should get the first dose of vaccine if he/she has not yet
received it. Vaccine given within 3 days of exposure and possibly up to 5 days can prevent
disease.
If your child has not been vaccinated because of medical reasons, your child’s doctor should
advise whether or not your child should be excluded from school to lessen the chance of catching
chickenpox. Otherwise, vaccine-exempt children may continue to attend school. As for all
children, if signs or symptoms of chickenpox develop, the unvaccinated child should be
promptly excluded from attendance at day care.
Thank you for your attention to this matter. Additional information can be found at
http://www.adph.org/immunization. If you have questions, call your child’s day care center, your
child’s pediatrician, or the Jefferson County Department of Health at 930-1450, option 5.
Sincerely,
83
SECTION VI.
IMMUNIZATIONS
A.
Alabama Immunization Law
B.
Copy of Current Immunization Schedule
C.
Example of Blue Form
D.
Exemptions
E.
F.
1.
Medical Exemption from Immunization
2.
Religious Exemption from Immunization
Explanation of Blue Form Compliance Requirements
1.
Certificate of Excellence
2.
Tickler System for Monitoring Blue Forms
3.
Letter to Parents Requesting Updated Form
Instructions on When, Where, and How Children Can Get Free
Shots
84
ALABAMA IMMUNIZATION LAW
Effective July 1, 1993, the Alabama Certificate of Immunization (ADPH-F-IMM-50), also known as the
Blue Form, will be the required immunization form. By July 1, 1993, each child under five years of age
and five year olds who are not enrolled in public/private school kindergarten must have an unexpired
Alabama Certificate of Immunization on file at the center or one of the following conditions shall be met:
An unexpired Alabama Certificate of Medical Exemption (ADPH-F-IMM-50) shall be on file in the
center; or
Where immunizations are waived on religious grounds, an Alabama certificate of Religious Exemption
(ADPH-F-IMM-52) shall be on file in the center.
The recording of shots on the Child’s Medical Report-Day card (DHR-DFC-624 Rev. 7/88) will not be
acceptable after July 1, 1993. Only the UNEXPIRED ALABAMA Certificate of Immunization is
acceptable.
COPY OF CURRENT IMMUNIZATION SCHEDULE
See Appendix II.
EXAMPLE OF BLUE FORM
See Appendix III.
EXEMPTIONS
1.
Medical Exemption from Immunization
Must be signed by a physician and must not have reached the expiration date. Can be found on
the back side of the blue form. See Appendix IV.
2.
Religious Exemption from Immunization
Call 205-930-1450 to make appointment. Form may only be obtained at the health department.
See Appendix V.
85
EXPLANATION OF BLUE FORM COMPLIANCE REQUIREMENTS
1.
Certificate of Excellence
See Appendix VI.
2.
Tickler System for Monitoring Blue Forms
The day care tickler system will help you determine when your preschool-aged enrollees are due
for their next immunizations. The State of Alabama Certificate of Immunization (Blue Form) has
an expiration date on the top right hand corner that indicates the date when the child’s next shots
are due. Day care regulations require that each parent present an unexpired blue slip to the center
prior to the child’s entry.
The card file is easy to set-up and use.
3.
1)
Write one child’s name on one 5” X 3” index card. Copy the expiration date found on the
right hand corner of the blue form onto the index card.
2)
Each box should have two “5 X 3” monthly guide sets. You should color code one guide
set to be for the current year and color code the other set to be used for the following
year. For example, the red color coded guide set will be used to file index cards with
Expiration date in 1997, while the yellow color coded set will be used to file those that
expire during 1998.
3)
File each index card under the month of expiration.
4)
At the end of each month check the index cards for the next month for those children
whose blue slips will expire. For example, on June 26, check the index cards which are
filed under July. Notify each parent whose child needs a new blue slip and that they must
present a new blue slip by the end of the month. Also, check that particular month for
those children whose parents were notified about the blue slip, but never gave the center
an up-to-date slip. Document the date that you discussed the immunizations with the
parent(s) or guardian(s) to the index card. Once you have received the new blue form,
write the expiration date on the index card and refile under the appropriate date.
5)
If you have not received a blue slip by the end of the month for the child, send a second
warning letter to the parent or guardian. The letter should state that this is the second
warning and if no updated blue slip is presented within two weeks, per state law, the child
must be excluded from the day care.
Letter to Parents Requesting Updated Blue Form
See Section V, Sample Letters to Parents, page 72.
86
INSTRUCTIONS ON WHEN, WHERE, AND HOW CHILDREN
CAN GET FREE SHOTS
Residents of Jefferson County can receive immunizations at any one of the seven Jefferson County
Department of Health Center locations. These centers offer shots during regular clinic hours (call the
number below for more information) and walk-ins are always welcome. There is a registration fee
required, however this is based on a sliding scale. No one will be denied immunizations due to lack of
financial ability.
There are also eight community based Tot Shots clinics located throughout Jefferson County that offer
free shots to children through age 18. Some of these community clinics are open after hours and offer the
vaccines required for day care and school. Blue forms (Imm-50) are also prepared at these sites.
Please see Appendix VII, visit our website at www.jcdh.org, or call (205) 930-1450 for more information
about the time and location most convenient for you.
87
SECTION VII.
GLOSSARY
AIRBORNE – Suspended in, transported by, or spread by air, as an infectious disease or pathogen.
BACTERIAL – Pertaining to or caused by bacteria.
COMMUNICABLE DISEASE – A disease which is capable of being transmitted from one infected
person, animal, or contact to a susceptible person.
CONTACT – A person or animal that has been in association with an infected person or animal or a
contaminated environment.
CONTAMINATION – The presence of an infectious agent on a body surface, in clothes, bedding, toys,
surgical instruments, dressings or other inanimate articles including water and food.
DIARRHEA – Loose, frequent stools different from a person's usual pattern. Diarrhea is often defined as
3 or more loose stools within a 24-hour period. Diarrhea can be characterized with adjectives like bloody,
watery and malodorous.
DISINFECTION – Killing of infectious agents outside the body by direct exposure to chemical or
physical agents.
EPIDEMIC – (adj.) Occurring suddenly, clearly in numbers in excess of normal expectancy.
EPIDEMIC – (n.) A recent or sudden excess of cases (three or more) of a specific disease or clinical
symptom.
ETIOLOGIC AGENT – In an infectious disease, the microorganism that is the cause of the illness.
EXPOSURE – An opportunity of contact with or acquisition of an etiologic agent. The condition in
which an individual comes in contact with a disease or health condition in a manner such as to allow
transmission of said disease or health condition.
FOODBORNE OUTBREAK – Occurrence of two or more cases of similar illness among persons who
had a common exposure to a food. Single cases are rare; however, with important diseases, such as
trichinosis and botulism, single cases are considered outbreaks.
IMMUNITY – The resistance usually associated with the presence of antibodies or cells having a
specific action on the microorganism concerned with a particular infectious disease.
INCUBATION PERIOD – The length of time between exposure to the agent and the development of
illness.
INFECTIOUS DISEASE – A disease that is attributed to a microbiologic agent which establishes an
infection in a person. Not all infectious disease are communicable from one person to another.
88
ISOLATION – The restriction of free movement of a person or persons to prevent the spread of a
notifiable disease by ordering confinement to a particular building or part thereof or the restriction of said
individual to a facility specifically designated for the confinement of persons who may be infectious and
possibly capable of transmitting a notifiable disease.
LOWER GASTROINTESTINAL SYMPTOMS – Usually refers to abdominal pain or cramps,
flatulence and diarrhea.
MICROORGANISM – A microscopic organism; those of medical interest include bacteria, viruses,
fungi, and protozoa.
OUTBREAK – See EPIDEMIC.
QUARANTINE – The forced isolation or restriction of free movement of a person or persons to prevent
the spread of a notifiable disease or health condition. Quarantine may refer to the restriction of access to
or egress from any building, place, property or appurtenance.
SIGNS – Abnormalities of an illness that are observable, usually by a trained health care professional. An
elevated temperature is a sign of fever.
SOURCES – The point of introduction of an infectious agent in an outbreak situation. For example, a
particular hen flock might be the source in a Salmonella enteritidis outbreak.
SYMPTOMS – Subjective feelings of illness experienced by the sick person.
UPPER GASTROINTESTINAL SYMPTOMS – Usually refers to nausea, vomiting and heartburn.
VECTOR – An organism (as an insect) that transmits a pathodgen from one organism to another. Ticks
are vectors of Lyme disease.
VEHICLE – An inanimate object on which the causative agent is transferred to an individual. For
example, roast beef can be a vehicle for Staphylococcus aureus toxin.
VIRAL – Pertaining to, caused by, or of the nature of a virus.
VIRULENCE – The degree of pathogenecity of a microorganism as indicated by the severity of the
disease produced.
89
SECTION VIII.
LIST OF REFERENCES
Alabama State Epidemiology Manual.
American Academy of Pediatrics. Red Book: 2006 Report of the Committee on Infectious Diseases.
Pickering LK, ed. 27th ed. Elk Grove Village, IL: American Academy of Pediatrics, 2006.
American Public Health Association. Control of Communicable Diseases in Man. Benenson, AS, ed. 15th
ed. Washington, DC: American Public Health Association, 1990.
Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preventable
Diseases. Atkinson W, McIntyre L, Wolfe S, eds. 12th ed. Washington DC: Public Health Foundation,
2009.
Centers for Disease Control and Prevention. What Day Care Center Directors Can Do to Stop Disease in
Child Day Care Centers. Atlanta: U.S. Department of Health and Human Services, 1984.
Centers for Disease Control and Prevention. What You Can Do to Stop Disease in Your Child’s Day Care
Center. Atlanta: U.S. Department of Health and Human Services, 1984.
Centers for Disease Control and Prevention. What You Should Know About Contagious Disease in the
Day Care Setting. Atlanta: U.S. Department of Health and Human Services, 1984.
Hennepin County (MN) Community Health Department. Infectious Disease in Child Care Settings:
Information for Directors, Caregivers, and Parents or Guardians. Godes JR & Braun JE, eds. 5th ed.
Minneapolis: Hennepin County (MN) Community Health Department, 2003.
Webster’s New Encyclopedic Dictionary. New York: Black Dog and Leventhal Publishers, 1993.
90
SECTION IX.
DAYCARE PREPAREDNESS PLANNING GUIDE
Emergency Preparedness Planning Resource Guide for
Daycare Providers
The Emergency Preparedness and Response Division of the Jefferson County Department of Health
educates and encourages its citizens to take some simple steps to prepare for and respond to potential
emergencies, including natural disasters and terrorists attacks. This preparedness planning resource guide
is directed to day care providers and facility managers. No matter where a daycare facility is located or
how large it is, children, staff and even parents may be at risk as a result of a natural or human-caused
disaster.
For more information, please contact the Jefferson County Emergency Preparedness Division at 205-9301440 or visit our website at www.jcdh.org.
Resources
National Association of Child Care Resource & Referral Agencies (NACCRRA)
• www.naccrra.org/disaster (In search box type: Is Child Care Ready?)
• Is Child Care Ready?: A Disaster-Planning Guide for Child Care Resource & Referral Agencies
o This guide is a practical toolkit for Child Care Resource & Referral (CCR&R) agencies to
help child care programs – both in child care centers and providers’ homes – keep children
safe and their businesses open during and after natural disasters, terrorist attacks, chemical
emergencies, and other catastrophes.
• Disaster Preparation: A Training for Child Care Centers
o This guide is designed to assist CCR&Rs and others in training child care centers on disaster
preparedness. It includes specific activities for training individuals who direct and work in
child care centers.
• Disaster Preparation: A Training for Family Child Care Providers
o This guide is intended to assist CCR&Rs and others in training family child care providers on
disaster preparedness. It includes activities for training individuals who care for children in
their homes.
• Emergency Planning Forms
o The user-friendly forms offer templates for child care providers and others to use to fully
prepare for disasters.
Emergency Response Planning for Child Care Providers Toolkit
• www.montgomerycountymd.gov/content/hhs/phs/APC/childcaremanual.pdf
• This toolkit is designed to prepare childcare providers for emergency events and to assist in the
recovery effort by helping children cope with the traumatic event. A train-the-trainer guide is
included along with a CD that contains Microsoft PowerPoint presentations. You can download this
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toolkit for free or order hard copies for a fee on the NACCHO website. The Montgomery County web
address will take you directly to the free PDF version.
Emergency/Disaster Preparedness for Child Care Programs
• nrc.uchsc.edu/SPINOFF/EMERGENCY/Emergency.htm
• This template was adapted from Caring for Our Children, National Health and Safety Performance
Standards: Guidelines for Out-of-Home Child Care. This template was a joint collaborative project of
the American Academy of Pediatrics, the American Public Health Association, and National
Resource Center for Health & Safety in Child Care.
National Child Care Information Center (NCCIC)
• www.nccic.acf.hhs.gov/emergency/
• The NCCIC Child Care Resources for Disasters and Emergencies website brings together information
and key resources about emergency preparedness, disaster response, and recovery that relate
specifically to child care.
Head Start Disaster Preparedness Workbook
• www.cphd.ucla.edu/headstart.html
• This workbook is designed to guide Head Start programs through the development and
implementation of comprehensive disaster plans. It is based on information obtained directly from
Head Start personnel regarding their disaster preparedness and planning needs.
Ready to Respond Emergency Preparedness Plan:
• www.brighthorizons.com/talktochildren/docs/emergency_plan.doc
• This plan covers medical emergencies, natural disasters, utility disruptions, fire emergencies,
hazardous materials, bomb threats, violent situations, parent/guardian issues, hostage situations, and
missing children.
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