Download Infectious diseases ‐ a guide for teachers

 Infectious diseases ‐ a guide for teachers
Health, safety, security, and contract management section
Belfast Office
Infectious diseases Contents Introduction 1 Athletes foot (tinea pedis) 2 Chickenpox (varicella) 3 Cold sores (herpes simplex) 5 Conjunctivitis Diarrhoea and or vomiting 6 7 E. Coli (escherichia coli enteritis) and Haemolytic Uraemic Syndrome 8 Flu (influenza) 9 German measles (rubella) 10 Giardiasis 11 Glandular fever (Infectious mononucleosis) 12 Hand, foot and mouth disease 13 Head lice (pediculosis) 14 Hepatitis A 15 Hepatitis B 16 Hepatitis C 18 Impetigo 20 Measles 21 Meningitis not due to meningococcal disease 22 Meningococcal meningitis/septicaemia 24 Molluscum contagiosum 25 MRSA 26 Mumps 27 Infectious diseases Ringworm (tinea) 28 Roseola infantum (exanthem subitum) 29 Salmonella 30 Scabies 31 Scarlet fever 32 Shigella (Bacillary dysentery) 33 Slapped cheek or Fifth disease 34 Threadworms (enterobiasis, oxyuriasis, pinworms) 35 Tonsillitis 36 Tuberculosis 37 Warts (verruca vulgaris) 38 Whooping cough (pertussis) 39 Conclusion and reporting procedure 41 Useful contacts 42 Infectious diseases Introduction Infectious diseases are now the world’s biggest killers of children and young adults (World Health Organisation Infectious Diseases Report 1999). As stated in the report, most deaths from infectious diseases occur in developing countries (the countries with the least money to spend on health care). However, infectious diseases are also a problem for industrialised countries as well because of:  A rapid increase in air travel. Diseases can be rapidly transported from one continent to another in a matter of hours.  The level of immunisation coverage dropping. This can lead to a reintroduction of a disease into a country once free of it e.g. an outbreak of polio in Albania, Greece and the Federal Republic of Yugoslavia in 1996.  Huge increases in mass population movements over the past decade. Refugees and displaced people are especially vulnerable to infectious disease and their movement can help spread infectious diseases into new areas. In July 1999 the Government published its action plan, the White Paper “Saving Lives: Our Healthier Nation”, for improving the health of everyone but especially the worst off. In this plan the Government set targets for reducing the number of deaths due to cancer, heart disease and stroke, accidents, and suicides. As well as these key targets one of the important health issues that action is to be taken on is communicable diseases. One of the three key settings for implementing the Government’s health strategy is healthy schools (focusing on children). The Health Promotion Agency has produced a poster “Guidance on infection control in schools and other childcare settings”, which gives some quick guidance on the control of the more common and more important infections encountered in schools. Copies of the poster can be downloaded from the HPA website at www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1274087715902 This booklet provides additional background information on the infectious diseases listed in the HPA’s poster. It is not intended as a guide to diagnosis, which should only be undertaken by an appropriately qualified health professional. 1 Infectious diseases Athletes foot (tinea pedis) Athletes foot is a skin disease caused by a fungus, usually occurring between the toes. The feet provide a warm, dark, and humid environment, which encourages fungal growth. The warmth and dampness around swimming pools, showers and locker rooms has made the condition common amongst people practising lots of sports, hence the name athlete’s foot. It is a very common skin disease especially amongst teenagers and adult males. It is less common in women and children under twelve. Causes Several fungus varieties cause athletes foot, and sometimes more than one is present at the same time. The condition may be complicated by a secondary infection with bacteria, which take advantage of damaged skin. Symptoms A person with athlete’s foot has an itchy, scaly, dry rash on the bottom and sides of their feet and between the toes. The initial stage of infection usually lasts 1‐10 days. Treatment There are creams, powders, and sprays available, which can be bought over the counter. These work by killing the fungus and need to be applied until the skin seems to be back to normal, and then for a further two weeks to eradicate all the remaining fungal spores. Recommended time to be kept away from school It is not recommended that a child should be kept away from school as this is not a serious condition and transmission generally requires prolonged exposure and is probably rare in schools. 2 Infectious diseases Chickenpox (varicella) Chickenpox is a common illness. It occurs mainly in autumn and winter, and it is spread by inhalation of droplets of mucus and saliva breathed from the mouth and nose of infected people. It is usually a childhood illness and lifelong immunity to it is developed as a result. Adults who never contracted chickenpox as a child are therefore not immune and can catch it. Causes The varicella zoster virus (VZV) causes chickenpox. Symptoms A rash generally appears two days after general cold like symptoms and fever. The rash starts on the chest and back and spreads to cover the whole body over two days. Spots start as red patches, develop a clear blister and then scab over. Treatment Keeping cool best treats the itching. Calamine lotion, anti‐histamines and sodium bicarbonate in a cool bath may all be tried. Keeping the skin clean may help the spots becoming infected. As with all fevers it is important to drink plenty, and regular paracetamol will help reduce the fever and discomfort. Spots may occur inside the mouth, and a mouthwash can be more comfortable than brushing the teeth. Recommended time to be kept away from school The recommended exclusion time is five days from start of skin eruption. Chickenpox can be a serious infection and is extremely contagious. Patients are infectious for up to five days after the onset of the rash. There are no reports of patients being infectious after this time. Comments 1. Although children have traditionally being excluded until all spots have healed or crusted this practice is not supported by any published studies. Patients are most infectious around the onset of the illness. 2. Some patients transmit the infection before the onset of the disease so exclusion at the onset of chickenpox will not always prevent secondary cases. 3. There is a high risk of infection in children with immune deficiencies. If exposed the parent/carer should be informed promptly and further medical advice sought. 4. Chickenpox during pregnancy can affect the unborn child. If a female member of staff is exposed to chickenpox early in pregnancy (first 20 weeks) or very late in 3 Infectious diseases pregnancy (last three weeks), she should promptly inform her GP or whoever is giving her antenatal care who can do a blood test to check she is immune. 4 Infectious diseases Cold sores (herpes simplex) Cold sores, which usually occur on the face (mainly around the lips but is can occur on any part of the skin), are due to a virus infection called Herpes Simplex. Causes Certain things may cause an attack such as:  Another viral infection such as cold or influenza;  A fever for any reason;  Physical or mental stress; and  Over exposure to wind or sunlight. Symptoms The first symptom is either tingling or itchiness of the area of skin where the infection is developing usually around the lips but it can occur in any part of the skin. The itchiness/tingling is followed by blisters, which soon burst open to leave open sores. The sufferer usually feels under the weather. The virus may be caught first during childhood and then it lives in the nerves and remains dormant. Recommended time to be kept away from school None as although herpes simplex is infectious cold sores are generally a mild self‐
limiting disease. Comments 1. Exclusion would not be effective because about 20% healthy young children shed herpes simplex virus at any one time. These children transmit the virus to susceptible children. 2. If exclusion was attempted an unacceptably long exclusion period would be required because children with primary infections shed the virus in their saliva for up to 8 weeks. 3. Many healthy children excrete the virus at some time without having a “sore”. 4. Avoid kissing and contact with the sores. 5 Infectious diseases Conjunctivitis Conjunctivitis is an inflammatory condition of the conjunctiva, the clear transparent membrane that covers the white of the eye and lines the eyelids. Causes There are several causes, but the two most common are bacteria and viruses. Symptoms Sore, gritty, red eyes, and discharge which may be watery or sticky, depending on the cause. This makes the eyes sticky in the mornings. Treatment Bacterial conjunctivitis is easily treated with antibiotic drops or ointment. There is no direct treatment for viral conjunctivitis. It will gradually clear up on its own, but the doctor may prescribe antibiotic drops or ointment to prevent a secondary bacterial infection occurring. Recommended time to be kept away from school None because conjunctivitis is generally not a serious condition and transmission is uncommon in schools. Comments 1. The Health Protection Service should be informed if an outbreak occurs. 2. Most forms of conjunctivitis are spread by physical contact. Outbreaks are therefore more common in younger children, e.g. in nurseries. 6 Infectious diseases Diarrhoea and or vomiting Diarrhoea and vomiting can be caused by gastroenteritis, which is an infection that causes stomach upset. It is usually contacted from contaminated food, but it can be passed directly from person to person. Causes It may be caused by a number of different bugs including viruses (such as rotavirus or norwalk virus), parasites (such as amoeba or giardia) and bacteria (such as salmonella or campylobacter). Symptoms The main symptoms include diarrhoea, vomiting, nausea, abdominal pain and fever. Different bugs cause different symptoms, but the same bug can cause different symptoms in different people. Treatment Most people will get better with no treatment. For some infections antibiotics may even increase the length of the illness. One or two of the less common bugs may require specific treatment. Recommended period to be kept away from school A child should be kept away from school until diarrhoea and vomiting has settled (if there has been neither for the previous 48 hours). Comments 1. Usually there will be no specific diagnosis and for most conditions there is no specific treatment. 2. A longer period of exclusion may be appropriate for children under age 5 and older children unable to maintain good personal hygiene. E. Coli (escherichia coli enteritis) and Haemolytic Uraemic Syndrome 7 Infectious diseases Verocytotoxin producing Escherichia coli (VTEC) are bacteria, which can cause illness ranging from mild diarrhoea to severe inflammation of the large intestine. There are several different VTEC bacteria and the most commonly occurring one is called E. coli 0157. Causes VTEC are found in the gastrointestinal tract of some cattle and other domesticated animals. Transmission to humans occurs through eating contaminated foodstuffs particularly beef products, such as undercooked beefburgers or beef mince. Milk and vegetables have sometimes been associated with cases. Infection may follow contact with infected animals particularly on farms and animal sanctuaries. Symptoms Diarrhoea is the most common symptom produced by VTEC infections. This is usually mild and settles within two weeks. However, sometimes it can be more severe with abdominal pain and bloody diarrhoea. Around half of all those affected have blood in their stools. Some people may not show any symptoms. A very small number of cases develop what is called haemolytic uraemic syndrome (HUS), which is a form of acute kidney failure. HUS is a more likely complication in children and requires admission to hospital for treatment. The clotting mechanism of the blood may be affected but this is very rare indeed. Recommended time to be kept away from school Should be excluded for 48 hours from the last episode of diarrhoea. Further exclusion may be required for some children until they are no longer excreting. Comments 1. Further exclusion may be required for young children under five and those who have difficulty in adhering to hygiene practices. 2. This guidance may also apply to some contacts who may require microbiological clearance. 3. Please consult the Health Protection Service for further advice. 8 Infectious diseases Flu (influenza) Influenza is a severe form of respiratory tract infection with generalised bodily symptoms. It spreads around the world in epidemics and is responsible for much ill health as well as many deaths. Causes A virus that attacks our body cells resulting in various manifestations depending on the strain of the virus causes influenza. New mutations of the virus arise all the time and unfortunately immunity against one strain (which is conferred by exposure or immunisation) does not protect against other strains. In the era of rapid air transport the world‐wide spread of a new type of influenza can be extremely fast. Symptoms The symptoms are similar to cold symptoms but they start more rapidly and rather more violently, with higher fever and severe aches and pains, often in the back and muscles. This may be associated with severe headache, cough and as a result of the fever, intermittent sweating and shivering. Sometimes there is a gastrointestinal element with vomiting and diarrhoea. Treatment Unfortunately there is no cure so the best thing to do is:  Stay at home;  Drink plenty of fluids;  Take symptom relief with paracetamol, aspirin, ibuprofen or other anti‐
inflammatory drugs to help with fever, aches and pains; and  Take decongestants, cough medicines, gargles, lozenges, etc to help with other symptoms. Recommended time to be kept away from school Until recovered. Comments 1. It would be advisable for children with compromised immunity to have immunisations. 9 Infectious diseases German measles (rubella) Although German measles is generally not a serious disease in young children, it can be more severe in older children. If the disease is transmitted to a pregnant woman who is not immune to rubella it may cause abnormalities in the foetus. It is a notifiable disease i.e. doctors must report cases to the Health Protection Service. Causes German measles (or rubella) is caused by a virus. Symptoms Symptoms include a rose coloured rash and often a slight fever, sore throat and swelling of the lymph glands behind the ears. The rash, which lasts from one to four days, first appears on the face and spreads rapidly to the chest, limbs and abdomen. German measles is most common among teenagers and young adults. A child may have few symptoms. Treatment There is no specific treatment for German measles. Recommended time to be kept away from school It is recommended that a child should be kept away from school for six days from the onset of the rash. Comments 1. Exclusion will not be fully effective in preventing further cases because most viral shedding occurs before the onset of the rash. 2. Most schoolchildren in the United Kingdom are immune as a result of MMR vaccination. Rubella is now uncommon. 3. If a woman who may be pregnant and is unsure of her rubella immunity comes into contact with rubella, she should inform her GP promptly. 10 Infectious diseases Giardiasis Giardiasis is a diarrhoeal illness. Infection is often spread by not properly washing hands after bowel movements, or before preparing foods. Giardia may also be transmitted through contaminated water. Causes It is caused by a parasite, Giardia lamblia Symptoms Many children infected with giardia have no symptoms. Other children may have diarrhoea, gas, stomach aches, fatigue and weight loss. Treatment Specific antibiotic treatment is available. Recommended time to be kept away from school 24 hours from last episode of diarrhoea. Comments 1. Make sure that all children and adults practice good hand washing technique. 2. Exclude any child or adult with acute diarrhoea. 11 Infectious diseases Glandular fever (Infectious mononucleosis) Glandular fever occurs most often in teenagers and young adults. It is also known as infectious mononucleosis, which refers to the fact that there are an increased number of mononuclear cells in the blood. These cells are in fact lymphocytes (a type of white blood cell), which are fighting the virus infection. Diagnosis can be confirmed by a blood test. Causes The Epstein Barr virus causes glandular fever. Symptoms The most common symptoms are fatigue, sore throat, fever, faint rash and enlargement of the glands in the neck. Tonsillitis is also possible. Many people have glandular fever without noticing any symptoms at all. Treatment As with most virus infections there is no specific treatment. Most people will recover very quickly after a few days rest. Treatment is used to relieve symptoms. Paracetamol will help the sore throat and aching in the muscles and bring down the temperature. Sometimes the throat may become very swollen and drugs may be needed to reduce the swelling. Recommended time to be kept away from school None as glandular fever is generally not a serious condition in schoolchildren and transmission is uncommon in the school setting. Comments 1. Exclusion would be impractical because the virus is excreted for many months after the initial illness. 2. Often the illness is caught from someone who has no symptoms. 3. Glandular fever will get better on its own whether any treatment is given or not. 12 Infectious diseases Hand, foot and mouth disease Hand, foot and mouth disease usually affects children less than 10 years but can occur in adults. Causes Hand, foot and mouth disease is caused by a virus. Symptoms The illness usually starts suddenly with a sore throat, fever and blisters may develop in the inside of the mouth and throat. Blisters may also appear on the palms, fingers and soles. Treatment There is no specific treatment for this infection. The infected person will get better without treatment. The blisters in the mouth usually clear within 4 to 6 days and the blisters on the body usually last for 7 to 10 days. Recommended time to be kept away from school None. Hand, foot and mouth disease is not a serious disease in children of school age. Comments Contact the Health Protection Service if a large number of children are affected. Exclusion may be considered in some circumstances. 13 Infectious diseases Head lice (pediculosis) Head lice are parasitic insects called Pediculus humanus capitis, which only live on the heads of people. There are three forms of head lice:  Nits are head lice eggs. The oval, yellowy white eggs are hard to see and may be confused with dandruff. They attach themselves to the hair shaft and take about a week to hatch. The eggs remain after hatching and many nits are in fact empty egg cases.  Nymphs hatch from the nits. The baby lice look like the adults, but are smaller. They take about seven days to mature to adults and feed on blood to survive.  Adults are about the size of a sesame seed. They have six legs and are tan to greyish white. The legs have hook like claws to hold onto the hair with. Adults can live up to thirty days and feed on blood. Symptoms A person with head lice may feel a tickling or itching feeling of something moving in the hair. Most people only realise that they have head lice after the itch has developed, which can take from one week to 2‐3 months after initial infection. Itching may occur as an allergic reaction to the bites. Sores can develop due to scratching and can become infected. Treatment A diagnosis of head lice can only be made if a living, moving louse is found. Detection combing by parents/family members according to instructions is the best method of diagnosis. Chemical treatments are available, but must only be given after a doctor or experienced nurse has made a diagnosis. Close contacts of patients living in the same house are usually checked and treated if they have contacted head lice. Recommended time to be kept away from school Keeping children away from school is not warranted because head lice is a mild condition and exclusion has not been shown to be effective in preventing transmission. Comments Treatment is recommended for children with head lice, but only in cases where live lice have definitely been seen. 14 Infectious diseases Hepatitis A Hepatitis A is a disease that affects the liver. It occurs most often in school children and young adults. It may also be known as infectious hepatitis. It is a different disease from Hepatitis B. It is a notifiable disease i.e. doctors must report cases to the Health Protection Service. Causes A virus causes Hepatitis A. Symptoms The illness usually begins with a sudden onset of fever, feeling unwell, loss of appetite, nausea and stomach pain. This is followed within a few days with jaundice (a yellow discolouration of the whites of the eyes and often the skin). Children may have mild infections without the jaundice. Treatment There is no specific treatment for Hepatitis A. Most patients can be looked after at home. Recommended time to be kept away from school Exclude until seven days after onset of jaundice or seven days after symptom onset if no jaundice. Comments The Health Protection Service will advise on control measures. 15 Infectious diseases Hepatitis B Hepatitis B is a disease that causes inflammation of the liver. It is quite different from Hepatitis A. It is transmitted in 3 ways – by sexual contact, blood contact (e.g. sharing equipment for injecting drugs) and from an infected mother to her child. Hepatitis B is not common in Britain. It is a notifiable disease i.e. doctors must report cases to the Health Protection Service. Causes Hepatitis B is caused by a virus. Symptoms The main symptom is jaundice – yellowish skin or eyes. People can also feel a bit tired and achy. Some people with hepatitis B infection do not develop any of these symptoms and continue to feel well. Treatment Most people with hepatitis B infection will get better on their own without any treatment apart from rest. Some people will get better from their own jaundice and symptoms but will still have the virus in their blood. These people should attend their doctor regularly to have their liver tests checked and discuss treatment. Recommended time to be kept away from school None Comments Hepatitis B and C and HIV are bloodborne viruses that are not infectious through casual contact. Universal precautions will minimise any possible danger of spread of hepatitis B (see cleaning up body fluid spills). Cleaning up body fluid spills – universal precautions 1. Spills of body fluids: blood, faeces, nasal and eye discharges, saliva and vomit, must be cleaned up immediately. 2. Wear disposable gloves and aprons. Wear goggles if there is a risk of splashing to the face. 3. Clean and disinfect any surfaces on which body fluids have been spilled using a product that combines both a detergent and disinfectant. Use as per manufacturer’s instructions and ensure that it is effective against bacteria and viruses and suitable for use on the affected surface. 4. Discard fluid contaminated material in a clinical waste bag along with disposable gloves and aprons. 16 Infectious diseases 5. Never use mops for cleaning up blood and body fluid spillages. Use disposable paper towels 6. Ensure that contaminated clothing is hot laundered. Use PPE when handling soiled linen. 7. Children’s soiled clothing should be bagged to go home, never rinsed by hand. 17 Infectious diseases Hepatitis C Hepatitis C causes inflammation of the liver. It is different from the hepatitis A and hepatitis B viruses. The main way it is now transmitted is by blood to blood contact (e.g. sharing equipment for injecting drugs). While the existence of a non‐A, non‐B viral cause of hepatitis linked to blood transfusion had been suspected it has only been possible to test for its presence since 1991. All blood donors are now routinely screened and all blood products for transfusion are heat treated to kill the virus. It may also be passed on via unprotected sex and from an infected mother to her baby at birth. It is a notifiable disease i.e. doctors must report cases to the Health Protection Service. Causes A virus causes hepatitis C. Symptoms The symptoms of hepatitis C infection are generally mild and flu‐like. Very few people develop jaundice or nausea. The majority of people are unaware of the infection and continue to feel well. Treatment Some people with hepatitis C infection will get better of their own without any treatment. Unfortunately, quite a high proportion will continue to carry the virus in their blood, which may cause slow, ongoing liver damage. These people are encouraged to attend their doctor regularly so that they can have blood tests to check that their liver is working normally. Recommended time to be kept away from school Hepatitis C is not infectious in normal school situations. Comments Hepatitis B and C and HIV are bloodborne viruses that are not infectious through casual contact. Universal precautions will minimise any possible danger of spread of hepatitis C (see cleaning up body fluid spills). Cleaning up body fluid spills – universal precautions 1. Spills of body fluids: blood, faeces, nasal and eye discharges, saliva and vomit, must be cleaned up immediately. 2. Wear disposable gloves and aprons. Wear goggles if there is a risk of splashing to the face. 18 Infectious diseases 3. Clean and disinfect any surfaces on which body fluids have been spilled using a product that combines both a detergent and disinfectant. Use as per manufacturer’s instructions and ensure that it is effective against bacteria and viruses and suitable for use on the affected surface. 4. Discard fluid contaminated material in a clinical waste bag along with disposable gloves and aprons. 5. Never use mops for cleaning up blood and body fluid spillages. Use disposable paper towels 6. Ensure that contaminated clothing is hot laundered. Use PPE when handling soiled linen. 7. Children’s soiled clothing should be bagged to go home, never rinsed by hand. 19 Infectious diseases Impetigo Impetigo is a skin infection. Causes A bacterium is the source of impetigo. Symptoms Impetigo commonly affects the face, particularly around the nose and mouth, with initial redness, which can develop into weeping spots and then crusts. Young children are more likely to get impetigo and they may become quite miserable, irritable and feverish and have difficulty in feeding. The spots will heal up without scarring. Treatment Antibiotics can be helpful in many cases. These can be prescribed in the form of tablets or syrup. Recommended time to be kept away from school A child should be excluded from school until skin lesions are healed and crusted or 48 hours after commencing antibiotic treatment. Comments Antibiotic treatment speeds healing and reduces the infectious period. 20 Infectious diseases Measles Measles is an acute infection, which is now rare in the UK because of the high levels of immunisation. It is usually a childhood infection and is most common in the 1‐4 year old age group in children who have not been immunised. However, you can catch measles at any age. It is caught through direct contact with an infected person or through the air when he or she coughs or sneezes. Epidemics often coincide with school terms when there is much more close contact between children. It is a notifiable disease i.e. doctors must report cases to the Health Protection Service. Causes Measles is a viral infection. Symptoms Symptoms develop 9‐11 days after becoming infected and last up to 14 days from the first signs to the end of the rash. Measles usually begins with one or more of the following symptoms: a fever, conjunctivitis, a cough and or spots on the cheek or in the mouth. Three to seven days later a red blotchy rash appears, which spreads from the face down wards over the neck and body. The rash consists of flat red or brown blotches, which can flow into each other. This rash lasts 4‐7 days. There can also be diarrhoea, vomiting and abdominal pain. Treatment There is no specific treatment for measles. The patient should drink lots of clear fluid to replace body water lost through fever. Paracetamol can be used to reduce the fever. Recommended time to be kept away from school Four days from onset of rash. Comments 1. There is a high risk of serious infection in patients with immune deficiencies. If exposed to measles the parent/carer should be informed promptly and further medical advice sought. 2. Most schoolchildren in the United Kingdom are immune as a result of the MMR vaccination. Measles is now rare and most children diagnosed as having measles do, in fact, have other viral infections. 3. Exclusion may not be fully effective because patients shed virus and are infectious before the onset of the rash. 21 Infectious diseases Meningitis not due to meningococcal disease Meningitis is an inflammation of the lining surrounding the brain and spinal cord (the meninges). The two main types of meningitis are viral and bacterial. Viral meningitis is much more common and is rarely life threatening, but it can make people very weak. Bacterial meningitis is fairly uncommon, but it can be extremely serious. It is fatal in one in ten cases and one in seven survivors are left with a serious disability such as deafness or brain injury. It is a notifiable disease i.e. doctors must report cases to the Health Protection Service. Causes The commonest causes of viral meningitis are Coxsackie and echoviruses. Meningitis can also develop as a result of infection with herpes simplex, measles, polio or chickenpox. One of the main types of bacterial meningitis is pneumococcal. Haemophilus influenzae type b (Hib), which was recently a major cause of bacterial meningitis, has now been almost eliminated by vaccination of infants. It rarely occurred after the age of four. Caused by the bacterium Streptococcus pneumoniae, pneumococcal meningitis usually occurs in older adults and young children. It causes about a tenth of bacterial cases. The bacteria are commonly found in the respiratory tract and may be transferred by the bloodstream or as a result of an infection in the inner ear or sometimes through a tiny fracture or defect in the linings of the brain. Symptoms High temperature, fever, vomiting, sometimes diarrhoea, severe headache, neck stiffness (unable to touch the chin to the chest), dislike of bright lights, drowsiness, joint or muscle pains, fitting, a rash and the patient may be confused or disorientated. Treatment Antibiotics can not help viral meningitis and treatment is based on good nursing care. Recovery is normally complete, but headaches, tiredness and depression may persist for weeks or even months. Urgent treatment with antibiotics is essential for someone with bacterial meningitis. The sooner they are diagnosed and treated, the greater the chance there is they will make a full recovery. Recommended time to be kept away from school Until recovered. Comments 1. The Health Protection Service will advise on any action needed. 22 Infectious diseases 2. There is no reason to exclude siblings or other close contacts of a case. 23 Infectious diseases Meningococcal meningitis/septicaemia Meningococcal meningitis is an inflammation of the lining surrounding the brain and spinal cord. It is the most common bacterial form in the UK, accounting for more than half the cases. There are several different groups. Group B is the most common (around two thirds of cases), followed by group C (one third). Most cases are isolated incidents, but clusters of cases (i.e. two or more cases) have been recorded. Septicaemia (blood poisoning) is associated with meningococcal meningitis. It is a notifiable disease i.e. doctors must report cases to the Health Protection Service. Causes Meningococcal meningitis is caused by the bacterium Neisseria meningitidis. If meningococcus invades the body, it enters the throat, gets into the bloodstream and travels via the blood to the meninges. In some cases the bacteria multiply in the blood and this results in septicaemia before the bacteria can infect the meninges. In other cases infection in the blood and the meninges develops at the same time and these patients get both meningitis and septicaemia. In a minority of cases, it seems the body can stop the bacteria multiplying in the blood but not in the meninges, and these patients develop meningitis. Symptoms These are headache, light hurting the eyes, stiff neck, fever, vomiting and feeling flu like. With septicaemia a rash appears under the skin, which may start anywhere on the body as a cluster of tiny spots, which look like pinpricks in the skin. If untreated these gradually get bigger and become multiple areas of obvious bleeding under the skin surface, like fresh bruises. Treatment Urgent treatment with antibiotics is essential for both bacterial meningitis and septicaemia. The sooner patients are diagnosed and treated, the greater the chance there is they will make a full recovery. Recommended time to be kept away from school Until recovered. Comments 1. Generally, there is no reason to exclude siblings and other close contacts of a case. 2. The Health Protection Service will advise on any action needed. 24 Infectious diseases Molluscum contagiosum Molluscum contagiosum is a skin disease with small lumps. Causes This condition is as a result of a virus. Symptoms The infected person has small, pale, pearly, raised spots that may occur anywhere on the body except the palms and soles. The number of spots varies from person to person. They often enlarge and may join together. Treatment The lesions usually go away after a few months but may persist for up to two years. A doctor can remove the contents of the lesions or freeze them. This may shorten the course of the infection. If the lesions become inflamed and red they may have a secondary bacterial infection and may need local antibiotic treatment. Recommended time to be kept away from school None Comments Molluscum contagiosum is a self‐limiting condition. 25 Infectious diseases MRSA MRSA stands for methicillin‐resistant Staphylococcus aureus, some strains of which may be resistant to several antibiotics. MRSA behave in the same way as ordinary S. aureus and do not cause different or more serious infections. Staphylococcus aureus is carried in the nose of 20‐40% of normal healthy people, and is also commonly found on people’s skin, usually without causing harm. The only risk from MRSA is for those individuals who are immune compromised or have skin access (open wounds, eczema, and psoriasis), which is why it is most often found in hospitalised patients. Causes Staphylococcus aureus is a type of bacterium. Symptoms The only way of confirming MRSA is by examination of a specimen by a laboratory, e.g. a wound or skin swab. Many people are colonised with MRSA, which means that they carry the organism on their skin, or in the nose, or in the back of the throat, but show no signs of illness. Infection results in a fever and inflammation. Wound and skin infections, pneumonia and “blood poisoning” may also develop. Treatment All strains of MRSA are sensitive to at least one antibiotic and most are sensitive to three or more so that treatment is always available should an infection occur. Sometimes suitable antibiotics cannot be swallowed and must be given by injection. Treatment for colonisation without symptoms of infection is not usually necessary, but is sometimes treated with special antibiotic ointments to the nose and or washing with special antibacterial preparations. Recommended time to be kept away from school It is not necessary to exclude a child from school. If good hygiene precautions are followed, MRSA carriers are not a hazard to others including their family, babies, children and pregnant women. Comments 1. Good hygiene, in particular handwashing and environmental cleaning, are important to minimise any danger of spread. 2. Contact the Health Protection Service if further information is required. 26 Infectious diseases Mumps Mumps is an infection, which typically causes enlargement of the two salivary glands in the cheeks at the angle of the jaw. This gives an appearance rather like a hamster with food in its cheeks. It is a notifiable disease i.e. doctors must report cases to the Health Protection Service. Causes A virus known as myxo virus causes mumps. Symptoms A person will have fever, swelling and tenderness of one or more salivary glands in the neck and possibly mouth and throat. This can occur in one or both sides of the neck. The illness can be confirmed by a saliva test. Treatment There is usually no specific treatment. All that is required is treatment of the symptoms, with Paracetamol, regular rinsing of the mouth and plenty to drink. Recommended time to be kept away from school A child should be excluded from school for five days from the onset of swollen glands. Comments 1. Exclusion may not be fully effective because the virus is excreted and is often passed on before the diagnosis is made. 2. Mumps can be a serious infection, especially in older children. 3. Even though most children should be immune as a result of vaccination, outbreaks have been reported in vaccinated secondary school children. 27 Infectious diseases Ringworm (tinea) Ringworm is an infection of the skin. Causes It is a fungal infection. Symptoms It typically appears as flat, spreading, ring shaped patches. The edges are usually reddish and may be dry and crusted or moist and crusted. As each ring spreads, the middle clears leaving more normal looking skin. On the scalp, it can cause patches of baldness. Treatment A doctor will prescribe either a lotion or a course of anti‐fungal tablets. Recommended time to be kept away from school There is no need to keep a child away from school. Comments 1. Ringworm is not a serious condition. 2. Transmission usually requires prolonged exposure and is probably rare in schools. 3. Effective treatment is available and is recommended. 28 Infectious diseases Roseola infantum (exanthem subitum) Roseola infantum is an acute illness of infants and very small children. Causes The usual cause is the human herpesvirus type 6. Symptoms It is characterised by a high fever and the appearance of a flat, reddish skin rash either with the fever or as the fever settles. Treatment The treatment is of the symptoms, including measures to reduce the fever to keep the child comfortable. Recommended time to be kept away from school None as roseola infantum is not a serious condition. Comments None 29 Infectious diseases Salmonella Salmonella is an infection that may be mild and involve only the intestinal tract, or it may be severe and involve other parts of the body as well. The source of the infection is contaminated food or water, or close contact with other human beings carrying the infection. Anyone can get it but it is more common in infants and children. Causes A gram‐negative bacillus, a germ of the salmonella genus, causes salmonella. Symptoms The symptoms are mild to severe diarrhoea, fever and occasional vomiting. Symptoms appear 1‐3 days after exposure. Treatment Most people recover without any treatment. Fluids are required to prevent dehydration. Generally antibiotics and antidiarrheals are not needed. Recommended time to be kept away from school For children below 5 years of age advice should be sought from the Health Protection Service. Children of 5 years of age and above should be excluded for 24 hours from the last episode of diarrhoea. Comments 1. Excretion of salmonella is prolonged in young children. The duration of shedding in older children and adults is much shorter. 2. The risk of transmission is much higher in nurseries and day care centres than in schools and colleges. 3. There is little or no data on the effectiveness of different lengths of exclusion. 4. A longer period of exclusion may also be appropriate for older children who are unable to maintain good personal hygiene. 30 Infectious diseases Scabies Scabies is a skin infection that can be uncomfortable but is not a serious disease. Causes The cause of this infection is a mite. Symptoms The main symptom is itching, which is often worst after a hot bath and in bed at night. There can also be a rash on the wrists, around the finger webs and toes, between the thighs and on the trunk, especially around the waist. Sometimes there are small raised pimples or patches of crusty skin. The burrows of the mites, particularly those of the female, which are larger, can often be seen, especially in the skin on the sides and webs of both fingers and toes. In small children the signs of infestation may appear anywhere on the body. The rash does not indicate where to find the mite on the body as it is caused by an immune (allergic) reaction. As such it is classically symmetrical with correspondence on either side of the midline, which assists with recognition. Treatment Scabies lotions are available from chemists. Recommended time to be kept away from school Child can return after first treatment. Comments 1. Household and close contacts require treatment. 31 Infectious diseases Scarlet fever Scarlet fever is a fairly common childhood illness, which is characterised by a rash. It is a notifiable disease i.e. doctors must report cases to the Health Protection Service. Causes It is caused by bacteria (streptococci), which more often cause a sore throat alone. Symptoms The main symptoms include a nasty sore throat and fever. The rash is a fine, raised, red rash (feels like sandpaper), which disappear momentarily when pressed. It appears most commonly on the neck, chest, under the arms, elbows and inner thighs. The rash does not usually affect the face, which is flushed. During convalescence, the skin usually peels on the finger and toes. Treatment Penicillin reduces the length of the illness and the possibility of rare complications. There are alternatives for people allergic to penicillin. Recommended time to be kept away from school Child can return 24 hours after commencing appropriate antibiotic treatment. Comments 1. Scarlet fever can be a serious condition, and outbreaks occasionally occur in nurseries and schools. 2. Patients are not infectious after 4 days of antibiotic therapy. 32 Infectious diseases Shigella (Bacillary dysentery) Shigella is a germ (one of the bacteria) that causes an infectious disease of the bowel. Causes The germs must be swallowed to cause disease. They are often spread when people do not wash their hands with soap and water after using the toilet. People who get the germs on their hands can infect themselves by eating, smoking, or touching heir mouths. They can also spread the germs to anyone or anything that they touch, even food, which if not cooked thoroughly, can make others sick. Symptoms The most common symptoms are diarrhoea, fever, nausea, vomiting and stomach cramps. In rare cases, young children with the disease can have seizures. Symptoms usually appear 1‐7 days after exposure. Treatment Antibiotics can be used and fluids are required to prevent dehydration. Recommended time to be kept away from school Should be excluded for 48 hours from the last episode of diarrhoea. Further exclusion may be required for some children until they are no longer excreting. Comments 4. Further exclusion may be required for young children under five and those who have difficulty in adhering to hygiene practices. 5. This guidance may also apply to some contacts who may require microbiological clearance. 6. Please consult the Health Protection Service for further advice. 33 Infectious diseases Slapped cheek or Fifth disease Slapped cheek is usually mild, occurring in small outbreaks among children, particularly in the spring. More than half of adults have been infected in the past and are now immune. Causes The virus human parvovirus causes slapped cheek disease. Symptoms Children with it develop a characteristic red rash on the cheeks, just as though they have been slapped. This is followed by a lace like rash on the body and limbs, which may last up to three weeks often fading but returning when exposed to sunlight or heat. Treatment No treatment is usually necessary. Recommended time to be kept away from school It is not recommended that a child should be kept from school. Comments 1. Slapped cheek is a minor illness in most children. 2. Although outbreaks do occur in schools, exclusion would be ineffective as nearly all transmission takes place before the child becomes unwell. 3. Parvovirus infection can affect the unborn child. If a woman is exposed in pregnancy, she should promptly inform whoever is giving her antenatal care. 4. Parvovirus infection may also be serious in children with haematological disorders such as sickle cell disease, and in children with immune suppression. Parents/carers should be informed promptly if they are exposed to slapped cheek disease, and further medical advice sought. 34 Infectious diseases Threadworms (enterobiasis, oxyuriasis, pinworms) Threadworms are a very common problem especially in children. 40% of children below the age of 10 years are infected with threadworms. They are generally harmless and live in the bowel and around the bottom. They are tiny white worms about half an inch long, which look like threads of white cotton, hence the name threadworms. Causes Threadworms spread by producing large numbers of tiny eggs that are so small they can not be seen with the naked eye. They are present in house dust; they stick to clothing, carpets, towels and bed linen; they can also be picked up from contact with someone who already has worms. Symptoms The most common sign is scratching the bottom, particularly at night. This may be associated with disturbed sleep and irritability and so the scratching may not be noticed. Some sufferers show no signs of infection. Treatment Threadworms are very easy to treat. Suitable tablets and sachets for all the family are available from chemists. All the family should be treated at the same time as threadworms can spread very easily. Recommended time to be kept away from school There is no reason to keep a child off school. Comments 1. Most transmission occurs within families and among those sharing sleeping accommodation. Transmission is probably uncommon in schools. 2. Effective treatment is available. 35 Infectious diseases Tonsillitis The tonsils are fleshy clusters of tissue that lie in two bands on either side of the back of the throat. Tonsillitis is an inflammation of the tonsils that usually occurs as part of a pharyngitis (throat infection). When not infected, tonsils help prevent infection in the sinuses, mouth, and throat from spreading to other body parts. Causes It is caused by a viral or bacterial infection of the tonsils. Doctors differentiate between the two by taking a throat culture (painless swab of the back of the throat). Usually the throat culture is designed to find Group A streptococci since these bacteria are the kind that most commonly cause bacterial throat infections. In about 30% of throat cultures, streptococci are found, and the infection is presumed to be a strep infection. In the remaining 70% of throat cultures that are negative for strep, the cause of the throat infection is most probably a virus. Symptoms The illness usually begins with a sudden sore throat, with pain on swallowing. There may a loss be loss of appetite, malaise (a general ill feeling), chills, and fever as high as 104F. Glands in the neck and at the angle of the jaw may be swollen and tender. Treatment Tonsillitis that is caused by a bacterial infection can be treated with antibiotics, but tonsillitis that is caused by a viral infection can not. Giving paracetamol, liquids and soft foods can treat symptoms. A cool mist humidifier can add moisture to the air and will help to soothe the child’s throat. Recommended time to be kept away from school Tonsillitis is not usually a serious condition so no exclusion is necessary. Comments 1. Transmission appears to be uncommon in schools. 2. Most cases are due to viruses and do not need an antibiotic. 36 Infectious diseases Tuberculosis Tuberculosis (TB) is quite a rare disease in the United Kingdom. It is a notifiable disease i.e. doctors must report cases to the Health Protection Service. Causes It is an infection caused by the bacterium mycobacterium tuberculosis. Symptoms Symptoms of TB are extremely varied and usually depend upon which part of the body is affected. Symptoms that can occur with TB are fever and loss of weight. TB of the lung (pulmonary TB) can give symptoms of cough with phlegm (sometimes with blood in it), breathlessness, fever and loss of appetite and weight. TB of the lymph glands will cause enlargement of the glands. TB affecting other parts of the body (most commonly the kidneys, pelvis, bones or joints) will have different symptoms depending on the area of the body affected. Treatment Most people are completely cured by a course of antibiotics. Usually 3 or 4 antibiotics have to be taken together for a course of at least 6 months to treat pulmonary tuberculosis. Recommended time to be kept away from school Advice should be sought from the Health Protection Service. Comments 1. Tuberculosis generally requires prolonged close contact for transmission to occur. 37 Infectious diseases Warts (verruca vulgaris) Warts are non‐cancerous skin growths caused by a viral infection in the top layer of the skin or mucous membranes. Warts are most common in children and young adults. The skin anywhere on the body is involved, but warts are most likely to appear on the fingers, hands and arms. There are several different types of warts. Common warts usually grow around the nails, on the fingers and on the back of the hands. Foot warts are usually on the soles of the feet and are called plantar warts. Where plantar warts grow in clusters they are known as mosaic warts. Most plantar warts do not stick up above the surface like common warts because the pressure of walking flattens them and pushes them back into the skin. Flat warts are smaller and smoother than other warts. They tend to grow in great numbers, 20‐100 at any one time. They can occur anywhere, but in children are most common on the face. Causes Warts are caused by an invasion of the outer skin area (epidermis) by the papilloma virus. The virus stimulates some cells to grow more rapidly than normal. Symptoms A small raised bump on the child’s skin with the following characteristics:  Warts begin very small (1‐3mm) and grow larger;  Warts have a rough surface and clearly defined borders;  They are usually the same colour as the child’s skin but sometimes are darker;  Warts often appear on the child in a cluster around a “mother wart”;  Small black dots or bleeding points appear just below the warts surface; and  Warts are painless and don’t itch. Treatment Warts often disappear without treatment over a period of several months to years. If they are painful, very large or lots of them, then treatment such as mild salicylic acid painted on the wart, cyrotherapy (freezing) and electrosurgery (burning) might be necessary. Recommended time to be kept away from school As these are not serious infections a child can remain at school. Comments 38 Infectious diseases Transmission is generally low in schools, but care is needed with verrucas in swimming pools, gymnasiums and changing rooms. In these situations verrucas should be covered. 39 Infectious diseases Whooping cough (pertussis) Whooping cough is a respiratory infection that is most common in children but can occur at any age. It is a notifiable disease i.e. doctors must report cases to the Health Protection Service. Causes It is an infection that is caused by a bacterium known as Bordetella pertussis. Symptoms It can start off like an ordinary cold (catarrhal phase) for 7‐14 days, but tends to worsen with periods of uncontrolled coughing. These are associated with a “whooping” noise during breathing in between bursts of coughing and often carry on until the child actually vomits. These episodes frequently cause the child to go blue and can be very worrying for the onlooker. Between the periods or spasms of coughing the child seems fine. Often exercise or laughing brings on a spasm of coughing. The illness may last for a number of weeks. Treatment There is an antibiotic, which is quite effective for whooping cough, but this is seldom used except in severe cases. The main treatment is symptom relief such as paracetamol and steam inhalations. Some children may need to be nursed in hospital. Recommended time to be kept away from school Five days from commencing antibiotic treatment or 21 days from onset of illness if no antibiotic treatment. Comments 1. The Health Protection Service will organise any contact tracing necessary. 2. After treatment non‐infectious coughing may continue for many weeks. 3. It is preventable by vaccination. 40 Infectious diseases Conclusion The spread of infection can be to a large extent controlled by effective hand washing and good hygiene procedures. For example:  Always washing hands after using the toilet and before eating or handling food.  Ensuring that body fluid spills are cleaned up immediately.  Disinfecting contaminated areas.  Encouraging the use of handkerchiefs when coughing and sneezing.  Regularly cleaning the living quarters of animals in school.  Ensuring that there is are adequate and accessible washing facilities at farms, which schools visit.  Ensuring that children wash and dry their hands thoroughly after being in contact with animals and before eating, drinking or leaving the farm. Children who are unwell with an infectious disease should not be at school or nursery. Once they are better they should return to school unless they pose a risk to others. Reporting procedure Any school must take the following three steps once it has been confirmed that a pupil is suffering from an infectious disease. School Principal First step: contact Health Protection Duty Room Second step: contact Senior Clinical Medical Officer Third step: contact
Education officer (EA Belfast Region) 41 Infectious diseases Useful contacts Health Protection Duty Room Health Protection Service Public Health Agency Eastern Office 12‐22 Linenhall Street Belfast BT2 8BS Tel No: 0300 555 0114 Belfast Health and Social Care Trust School Health Services (Belfast and Castlereagh) Inver Villa, Knockbracken Healthcare Park Telephone number: 9056 5900 or 9056 5916 Beech Hall Wellbeing and Treatment Centre Telephone number: 9504 9981 Carlisle Health and Well‐Being Centre Telephone number: 08453 006650 42