Download Guidelines for Communicable Diseases in Schools

Guidelines for Prevention
and Management of
Infectious Diseases
in Schools
Information for Schools in Waterloo Region
Produced by:
Region of Waterloo Public Health
Infectious Disease Program
Revised: October 2014
Table of Contents
Introduction
1.0
Reporting
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
Important Phone Numbers
Legal Reporting Requirements
Confidentiality
Public Health Role
Enforcement of Immunization of School Pupils Act
Most Common Reportable Diseases in Schools
Reporting High Absentee Rates
Chickenpox Reporting
2.0
Exclusion Guidelines
2.1
2.2
2.3
Chickenpox Exclusion
Children who are Immune-Suppressed
Exclusion Guidelines for Infectious Disease in Schools (Charts)
3.0
Serious Illnesses due to Infectious Diseases
3.1
Serious Illness in School Settings
4.0
Infection Prevention Measures
4.1
4.2
Routine Practices
Prevention of Blood-borne Infections
5.0
Pregnancy and Common Childhood Infections
5.1
5.2
5.3
Introduction
Fact Sheet - Fifth Disease and Pregnancy
Fact Sheet - Chickenpox and Pregnancy
6.0
Appendices
List of Reportable Diseases
Monthly Chickenpox Report Form
Wash your hands/Clean your Hands (alcohol based rub) Poster
Cover Your Cough – Poster
3
4
5
6
6
7
7
8
9
10
10
11
22
23
26
28
29
31
34
35
36
38
2
Introduction
Almost one in five persons living in Waterloo Region either attend or work in a school or
day care setting. The daily mix of students and staff provides numerous opportunities
for germs to be passed between everyone in these settings, and especially from child to
child. Children are natural explorers of their environments, play closely together and
readily share their possessions, food and germs.
Preventing and controlling the spread of infections that can be associated with these
types of settings starts with information.
This manual has been designed to provide information to staff about common infections
and to assist in preventing of further transmission of the illness in the school setting.
These guidelines will provide information on:
•
•
•
•
•
Which diseases are reportable to Public Health
Role of schools and Region of Waterloo Public Health (PH) personnel in
reporting and follow-up of diseases
General disease prevention information
Exclusion recommendations for students with infectious diseases
Information sheets that can be copied and shared as needed
We hope you will continue to find these guidelines to be a helpful resource and tool to
use in your school and we look forward to receiving your feedback
For more information and/or to give feedback:
Region of Waterloo Public Health, Infectious Diseases Reporting Line:
519-575-4400 ext. 5275
Helpful websites:
This entire document and further information including infectious diseases, vaccines
and hand hygiene can be found on our Region of Waterloo Public Health website at:
www.regionofwaterloo.ca/ph
Further reliable, current information and printable fact sheets on common childhood
infections can be found at the Canadian Pediatric Society website:
www.cps.ca
→ Caring for Kids → Illnesses and Infections
3
1.0
Reporting
1.1 Important Public Health Phone Numbers
(TTY 519-575-4608)
Infectious Diseases Reporting Line:
519-575-4400, ext. 5275
For reporting diseases designated in the guidelines or to obtain general information.
Respiratory Intake Line:
519-575-4400, ext. 5506
For reporting of respiratory outbreaks, high absentee rates due to respiratory illness or
to obtain general information.
Health Protection & Investigation Division
Public Health Inspector on-call line:
519-575-4400, ext. 5147
For reporting diseases designated in the guidelines, enteric outbreaks or to obtain
information on cleaning/sanitation guidelines, water quality and safe food handling.
Emergency After-hours or Weekend Reporting
519-575-4400
After 4:30 p.m. weekdays; all day weekends and holidays for urgent issues requiring
notification of public health.
Region of Waterloo Public Health 519-575-4400
(for referral to all Region of Waterloo Public Health programs and services)
All reportable diseases are to be reported by telephone to the Region of Waterloo
Public Health, using the telephone numbers listed in these guidelines.
Telephone reporting allows a consistent and timely response to any questions or
disease outbreaks in schools and assists in preventing further spread of the disease
within both the school and the surrounding community.
4
1.2
Legal Requirements for Reporting
Student Illness
School personnel are legally required to report infectious diseases on the reportable
disease list (see Appendices) that may have been diagnosed in students at the school.
The Health Protection and Promotion Act, R.S.O. 1990, c. H.7, Section 28 states:
“The principal of a school who is of the opinion that a pupil in the school has or
may have a communicable disease shall, as soon as possible after forming the
opinion, report thereon to the medical officer of health of the health department in
which the school is located.”
The Health Protection and Promotion Act allows for the following information to be
reported to Public Health in respect to a pupil with an infectious disease:
1.
2.
3.
4.
Name and address in full
Date of birth in full
Sex
Name and address in full of the school that the pupil attends
It is not necessary for school personnel to confirm a diagnosis of a reportable infectious
disease with the physician of a student prior to reporting the disease to the Health
Department. The Region of Waterloo Public Health staff will confirm and follow up all
information with the physician and case or family.
Staff Illness
The Ontario Health Protection and Promotion Act does not require that principals report
illness of staff members to Public Health. There may be circumstances when it would
be important for Public Health Staff to be aware of an illness in a staff member (such as
pertussis/ whooping cough) so that classroom notification may occur.
In these cases, the permission of the staff member to share this information should be
obtained prior to reporting the information to Public Health. Alternatively, the staff
member can be given the option to report the information themselves so that the
appropriate follow-up or investigation can occur.
However, reportable diseases in all persons of all ages are also reported to public
health by laboratories and physicians. In circumstances where a staff person has a
reportable disease, Public Health will be aware and take appropriate action if indicated
in order to protect other staff and students.
5
1.3
Confidentiality
When dealing with health information, everyone has a right to privacy. Personal
information can only be gathered and used in a restricted way and the identity of pupils
or staff will not be released to the community or to other individuals at the school.
The Medical Officer of Health (MOH) is the Health Information Custodian for Region of
Waterloo Public Health. The MOH and all persons who act as agents of the MOH (all
public health staff) have the responsibility to ensure that personal health information is
collected, used, stored and shared with full regard for the protection of privacy and the
confidentiality of personal health information.
1.4
Public Health Role
The Infectious Disease Program and the Health Protection & Investigation Program
share responsibility under the Health Protection and Promotion Act for receiving reports
of infectious diseases from physicians, laboratories or schools and providing the
appropriate follow-up or outbreak control measures to prevent the further spread of the
disease in the school or community. Depending on the disease, these measures may
include one or more of the following:
•
•
•
•
•
Review of immunization status of students in a classroom or throughout the
school
An information letter to parents, students and staff
Legal exclusion by order of the Medical Officer of Health of certain students from
the school who are not appropriately or fully immunized or whose medical
conditions may put them at a high risk if they develop a reportable disease (e.g.,
students undergoing chemotherapy)
A recommendation for certain students and staff to receive specific preventive
antibiotics or immunization
An antibiotic clinic or immunization clinic on-site at the school for students or staff
if needed
The definition of an outbreak varies with each infectious disease, for example; one case
of measles in a school constitutes an outbreak.
6
1.5 Enforcement of Immunization of School Pupils Act (ISPA)
The Immunization of School Pupils Act requires that students attending schools in
Ontario be immunized against tetanus, diphtheria, polio, measles, mumps, rubella, and
as of July 2014, pertussis, meningococcal disease and chickenpox. The chickenpox
vaccine will only be required for children born on or after January 1, 2010 and who have
not already had the infection. Under the Act, Region of Waterloo Public Health
(ROWPH) is required to maintain immunization records of all students in public and
Catholic schools. Between March and June of each year, ROWPH enforces the ISPA,
reviews immunization records of all students and can suspend, for up to 20 days,
students who have “incomplete” or “no immunization history”.
Parents may decide because of medical, religious or philosophical reasons not to
immunize their child. The ISPA allows for exemptions based on medical or philosophical
grounds. A notarized Statement of Conscience or Religious Belief Affidavit must be
signed and on file at Public Health. It is parents' responsibility to provide proof of
immunization or exemption to Public Health.
For more information, please call the Immunization Information Line at
519-575-4400, ext. 13007.
1.6
Most Common Reportable Diseases in Schools
The Health Protection and Promotion Act list a number of reportable diseases or
diagnoses. School personnel will most commonly encounter only a few of these
reportable diseases in students or staff in the school setting. The majority of illnesses
are of a non-reportable nature.
Physicians, hospitals and laboratories are also required to report all reportable
infectious diseases. The more serious infectious diseases, such as meningitis and
group A strep, are most often reported directly from the hospital.
Listed below are the diseases most commonly reported from schools:
Chickenpox
Diarrhea
Pertussis
Respiratory Illness
Public Health requires the total number of cases by age group in
a school to be reported monthly
If several students in a class are affected
Whooping Cough
High absentee rates – often due to influenza
7
1.7
Reporting high absentee rates
Influenza is a common infection in schools during the influenza season each year and
may cause a sudden increase in absentee rates.
Schools are not required to report cases of influenza in individual students or staff
members, but are requested to report when absentee rates rise significantly (especially
during the traditional influenza season between November to April).
Automated Reporting:
Since the spring of 2009, reporting of absentee rates has been done centrally at
both the Waterloo Catholic District School Board and Waterloo Region District
School Board for those schools reporting their daily absentee information
through Trillium. This data is reported the next day to Public Health.
Public Health staff will contact any schools reporting elevated absentee rates to
determine if the absences are due to illness or other factors.
Telephone Reporting:
Public and private schools may continue to report increased absentee rates by
telephone to the Region of Waterloo Public Health at 519-575-4400, ext. 5275 or to
our Respiratory Outbreak Desk at 519-575-4400, ext. 5506, especially if a school is
not reporting absentee data to the Board office on a daily basis. Private schools
may also call directly to report increased absentee rates.
Increased absentee rates in school children are often a first indication that influenza (or
occasionally norovirus) has appeared in the community. Reporting this type of
absenteeism from schools helps Public Health in surveillance for this disease and in
alerting health care facilities in the area to increase their preparation.
Schools may also report any clusters of illness (e.g. – several students in a classroom
who are away with diarrhea, nausea or vomiting) and Public Health will investigate as
appropriate to ensure there is no food or water-related issues.
8
1.8
Chickenpox Reporting
Reporting Aggregate Number of Cases:
The Ministry of Health requests that the total number (aggregate number) of chickenpox
cases by age group be reported to each month when cases of this disease occur in a
school. This information is valuable in establishing rates of infection in different age
groups and will be especially important with the increased use of the chickenpox
vaccine.
**** (See Attached Appendices – Chickenpox Monthly Reporting Form)
AGE
NUMBER OF CASES
1-4
5-9
10-14
15-19
20-24
25-29
30-39
40-49
50-59
60 +
Monthly aggregate reports may be made by FAX or by phone to Public Health – see
Appendices
Reporting an Individual Case:
An individual case of chickenpox is legally reportable in the following circumstances:
•
•
•
A pupil was hospitalized due to chickenpox
A pupil develops serious complications due to chickenpox (encephalitis,
pneumonia etc)
A pupil passed away due to complications of chickenpox
An individual case report may be made by calling the Infectious Diseases
Program at 519-575-4400, ext. 5275.
9
2.0 Exclusion Guidelines
2.1
Chickenpox Exclusion – 1999 Recommendations remain in
effect
CHILDREN WITH MILD CHICKENPOX MAY RETURN TO SCHOOL OR DAY CARE
AS SOON AS THEY FEEL WELL ENOUGH TO PARTICIPATE IN NORMAL
ACTIVITIES, REGARDLESS OF THE STAGE OF THE RASH
They do not need to stay home for the previously recommended five days after onset of
rash, or until the rash has dried. Children with more severe cases or those who are not
completely well (who continue to run a fever or have infected lesions) must stay home.
This is a province wide change in policy adopted by the Ontario Ministry of Health, and
follows the recommendations from the Canadian Pediatric Society. Research shows
that by the time the rash appears, it is too late to stop the spread of the disease.
Chickenpox is most infectious one to two days before the rash and when children feel
most ill.
If there are any concerns or questions, please feel free to contact or refer parents to the
Region of Waterloo Public Health – Infectious Diseases Line at 519-575-4400, ext.
5275.
2.2
Children who are Immune-Suppressed
Parents of students who have immune-suppressing medical conditions or who are
receiving treatments that may alter their ability to fight an infection are advised by the
cancer and transplant centers to speak with their child’s teacher regarding exposure to
infectious diseases.
School staff are responsible for informing parents or children who are immunesuppressed when there is chickenpox activity in the school, especially if it is in the same
classroom. If there has been significant exposure, these children will receive a
preventative injection called VZIG, usually at the hospital. Children who are immunesuppressed include those with leukemia or other cancers, or who have had organ
transplants such as a liver or a kidney transplant.
10
Managing Infections – Exclusion Guidelines for Child Care Providers and Schools
Region of Waterloo Public Health October 2014
DISEASE
CHICKENPOX
CONJUNCTIVITIS
(PINK EYE – bacterial or
viral)
HOW TO
RECOGNIZE
HOW IT
SPREADS
WHEN IT IS
CONTAGIOUS
REPORT TO
PUBLIC
HEALTH
WHAT TO
DO WITH
THE CHILD
INTERVENTION
FOR
CONTACTS
Fever, fatigue,
and loss of
appetite
followed by
the
appearance of
small spots
which start off
pink in color
then change
to blisters
before crusts
form.
Runny, red
eyes plus
crusted
discharge.
Contact with
infected
person or
contact with
items of linen
and clothing
which have
been
contaminated
from the
blisters.
Usually 1-2
(could be up to
5) days before
rash appears
until all blisters
become dry.
Most infectious
before rash
and when child
is ill.
Yes
* May return
as soon as
well enough
to
participate
normally in
all activities
Parents of
children who are
immunesuppressed (e.g.,
cancer
treatment,
leukemia, organ
transplant, etc.)
should be
informed of
exposure in the
classroom.
Direct or
indirect
contact
(articles
contaminated
could be
tissue, towel,
door handle,
clothing).
Bacterial:
Infectious until
24 hours of
appropriate
antibiotic
treatment
received.
Viral:
Infectious as
long as there is
eye discharge
.
If bacterial,
child can
return after
24 hours of
appropriate
antibiotic
treatment.
If viral, no
need to
exclude
unless there
is an
outbreak.
No
Call:
519-5754400, ext.
5275
No
CALL PUBLIC HEALTH
519-575-4400, EXT 5275 FOR
MORE INFORMATION IF ANY
CONTACT IS:
• Pregnant
• See fact sheet
*This recommendation from the Canadian Paediatric Society and the Ontario Ministry of Health came into effect in 1999. Exclusion of children
for 5 days from onset of rash does not slow down the spread of chickenpox. Children are most infectious 1-2 days before the rash and when
feeling ill.
NOTE: School staff are still responsible for informing parents of immune-suppressed children when there is chickenpox activity in the
school.
DISEASE
HOW TO
RECOGNIZE
HOW IT
SPREADS
WHEN IT IS
CONTAGIOUS
REPORT TO
PUBLIC HEALTH
WHAT TO DO
WITH THE CHILD
INTERVENTION
FOR CONTACTS
DIARRHEA
Frequent
loose, watery
or bloody
stools.
Contact with
contaminated
food, water,
soiled articles
or fecally
contaminated
hands.
For duration of
illness. In
some instances
a carrier state
may persist for
several
months.
Yes - ONLY if
number of cases
are more than
usual. Call
519-575-4400,
ext. 5147
No
FIFTH DISEASE
Low fever;
distinctive
rash begins
with “slapped
cheek”
appearance,
changes to
lace-like body
rash on arms
then legs
(may become
worse when
exposed to
sunlight or
heat). Rash
may last for
weeks or
sometimes
months.
Primarily by
secretions
from nose
and throat.
Primarily before
onset of rash,
until after
appearance of
rash.
No
Send child home if
two or more
episodes and stay
home until
diarrhea has
stopped for 24
hour period. For
certain other types
of diarrhea, the
exclusion period is
longer. Please
contact 519-5754400, ext. 5147 for
more information.
No need to stay
home. Once the
rash appears a
child is no longer
infectious.
Only for pregnant
contacts.
CALL PUBLIC HEALTH
519-575-4400, EXT 5275 FOR
MORE INFORMATION IF
ANY CONTACT IS:
•
•
Pregnant
See fact sheet or refer
to Board Policies
Outbreaks
lasting 2- 6
months may
occur every
3- 5 years in
a community
12
DISEASE
FOOD POISONING
GIARDIASIS
HAND, FOOT &
MOUTH DISEASE
HOW TO
RECOGNIZE
HOW IT
SPREADS
May include one
or several
symptoms such as
nausea, vomiting,
diarrhea or others.
Onset may be
gradual or sudden.
Consumption
of food or
water
containing any
organism
which causes
food poisoning
or person to
person
spread. See
Diarrhea
Section of this
chart.
Contact with
contaminated
water, food,
soiled articles
or fecally
contaminated
hands.
Person to
person spread
most common.
Direct contact
with nose and
throat
discharges
and feces of
infected
persons. No
isolation is
required, as
spread is
difficult to
prevent.
Symptoms can
include chronic
diarrhea (pale
greasy stools),
fatigue, weight
loss, stomach
pain. May have
organism present
but not have
symptoms.
Small ulcers in
mouth, (mildly
painful), mild
fever, small water
spots on the
palms, soles, and
between fingers
and toes, or
buttocks. Mainly
in children 6
months to 4 years.
WHEN IT IS
CONTAGIOUS
Varies but
especially
when
symptoms
present.
Entire period of
infection
REPORT TO
PUBLIC
HEALTH
Yes
Call
519-575-4400,
ext. 5147 to
arrange for
collection of
specimens of
stool, and
suspect food.
Yes
Call
519-575-4400,
ext. 5147
During the
acute stage of
illness
(incubation
period is 3 to 5
days). Several
weeks if in the
stools.
No
WHAT TO DO
WITH THE
CHILD
INTERVENTION
FOR
CONTACTS
Stay home until
symptoms are
gone.
No
CALL PUBLIC HEALTH
519-575-4400, EXT 5275
FOR MORE INFORMATION
IF ANY CONTACT IS:
Physician may
prescribe
medication on
a case by case
basis.
Stay home until
free of
symptoms for
24 hours. Do
not go
swimming until
free of
symptoms for
14 days (e.g.,
in a pool)
Return when
fever returns to
normal range.
Physician may
prescribe
medication on a
case by case
basis.
No
13
DISEASE
HOW TO
RECOGNIZE
HOW IT
SPREADS
HEADLICE
(Pediculosis)
Presence of lice or
nits (eggs) in hair;
head scratching.
HEPATITIS A
Fever, jaundice
(yellowing of skin
and eyes), loss of
appetite, nausea,
tiredness. Children
may not show
symptoms.
Spreads
easily through
head to head
contact. May
be spread
indirectly
through
sharing head
clothing,
brushes, and
clips, etc.
Consumption
of
contaminated
water or food;
contact with
fecally
contaminated
hands; sexual
transmission
Blood to
blood contact
with carrier or
case; sexual
transmission.
HEPATITIS B
IMPETIGO
Fever, jaundice
(yellowing of skin
and eyes), loss of
appetite, nausea,
tiredness.
Infected lesions are
pustules on the
skin that burst and
form thick yellow
crusts, often
around mouth,
nose, diaper area,
arms and lower
part of legs.
Contact with
infected
person or
articles.
Often spread
on hands.
WHEN IT IS
CONTAGIOUS
REPORT TO
PUBLIC
HEALTH
WHAT TO DO
WITH THE
CHILD
INTERVENTION
FOR
CONTACTS
Public Health
does not have a
role in
management or
enforcement
issues. However,
you can access
the information
line by dialing
519-575-4400,
ext. 2286
Yes
As long as lice
or eggs remain
alive on the
person.
No
Refer to child
care/school
policy regarding
management of
pediculosis in
students and
classrooms.
For 14 days
from the date of
onset of
symptoms. If
jaundice
develops, until 7
days after the
onset of
jaundice.
From weeks
before onset to
months or years
after recovery.
May be
infectious for life
(if person is a
carrier).
While there is
pus in the sores
or 24-48 hours
after treatment
begins.
Yes
After
consultation with
Public Health.
Call 519-5754400, ext. 5275
Yes
Call 519-5754400
No
CALL PUBLIC HEALTH
519-575-4400, EXT 5275
FOR MORE
INFORMATION IF ANY
CONTACT IS:
Close contacts
may be a
candidate for
immunization.
No exclusion
normally
required. Call
519 575-4400
for more
information.
Yes
Stay home until
24 hours after
antibiotic
treatment
begins.
No
Call 519-5754400 for more
information.
14
DISEASE
HOW TO
RECOGNIZE
INFLUENZA
Sudden onset of
fever; chills;
headache; muscle
aches; cough.
MEASLES
Fever; cough; eyes
red and sensitive to
light; red blotchy
rash lasting for at
least 3 days,
appearing on the
face first and then
spreading to other
parts of the body.
MENINGOCOCCAL
MENINGITIS
or
MENINGOCOCCEMIA
MENINGITIS
(other bacterial such as
pneumococcal)
Fever; vomiting;
lethargy; headache;
stiff neck and back;
pinpoint purple rash
on skin as illness
progresses.
Fever; vomiting;
lethargy;
headache;
stiff neck and back.
HOW IT
SPREADS
WHEN IT IS
CONTAGIOUS
Contact with
secretions
from nose,
throat or
mouth.
Contact with
infected
person
(coughing
and
sneezing) or
articles soiled
with
discharge
from nose
and throat.
Extremely
infectious.
3-5 days from
onset of
symptoms in
adults; up to 7
days in children.
3-5 days before
onset of rash
until 4 days
after.
By direct
contact with
secretions
from nose,
throat or
mouth.
Up to 7 days
prior to the start
of symptoms
until 24 hours
after starting
proper
antibiotics.
Yes
Immediately call
519-575-4400,
ext. 5275
Exclusion of
incompletely or
non-immunized
students or atrisk students
from school until
up to 2
incubation
periods after last
case.
Yes – for those
with direct
contact with
saliva of the
case.
Not contagious
to others.
Yes
No
Most cases
occur as
single cases.
Varies.
REPORT TO
PUBLIC
HEALTH
WHAT TO DO
WITH THE
CHILD
INTERVENTION
FOR
CONTACTS
No
Stay home until
symptoms
resolve.
Not generally.
Yes
Stay home for at
least 4 days
after rash onset.
Yes – see next
column for atrisk contacts.
Immediately call
519-575-4400,
ext. 5275
CALL PUBLIC HEALTH
519-575-4400, EXT 5275
FOR MORE
INFORMATION IF ANY
CONTACT IS:
• Immunesuppressed
•
•
•
•
•
•
Pregnant
On chemotherapy
Immunesuppressed due to
other reasons
Not immunized
Immunized before
st
1 birthday
Public Health will
assess exposed
persons to
determine if
preventive
antibiotic and
immunization is
needed
519-575-4400,
ext. 5275
15
DISEASE
MENINGITIS
(Viral)
MONONUCLEOSIS
(Mono)
MUMPS
HOW TO
RECOGNIZE
Fever; vomiting;
lethargy;
headache; stiff
neck and back.
Fever, sore
throat; tender,
enlarged glands
in neck.
Generally mild
disease in
children.
Fever, swelling
and tenderness
of one or both
sides of face.
HOW IT
SPREADS
By secretions
from nose,
throat or mouth
or from fecally
contaminated
hands.
May be a rare
complication of
chickenpox,
mumps,
measles or other
viral infections.
Direct or indirect
contact with
saliva. i.e.,
kissing, sharing
utensils or toys.
Contact with
infected person
or articles soiled
with discharge
from mouth,
nose or throat.
WHEN IT IS
CONTAGIOUS
Not contagious
to others.
REPORT TO
PUBLIC
HEALTH
Yes
519-575-4400,
ext. 5275
WHAT TO DO
WITH THE
CHILD
Stay home until
child is well
enough to
return.
INTERVENTION
FOR
CONTACTS
No
There is no
contact follow-up
or intervention for
this type of
meningitis.
Most infectious
when ill, but can
be prolonged for
a year or more.
No
Return as long
as child is well
enough.
No
From 7 days
before swelling
and possibly up
to 9 days after
(minimal after 5
days).
Yes
Stay home until
5 days after
onset of
swelling.
Yes – see next
column for at-risk
contacts.
Exclusion of
incompletely or
non-immunized
students or atrisk students
from school until
up to 2
incubation
periods after last
case.
519-575-4400,
ext. 5275
CALL PUBLIC HEALTH
519-575-4400, EXT
5275 FOR MORE
INFORMATION IF ANY
CONTACT IS:
•
Not immunized
16
DISEASE
HOW TO
RECOGNIZE
HOW IT
SPREADS
WHEN IT IS
CONTAGIOUS
PERTUSSIS (Whooping
Cough)
Initial mild cold
symptoms
followed by
irritating dry
hacking cough.
Coughing
becomes
paroxysmal
(spasms, often
with highpitched “whoop”)
within 1 - 2
weeks; coughing
paroxysms may
be followed by
vomiting or
gagging.
Cough is often
worse at night
and may last 1 2 months or
longer.
Anal itching;
disturbed sleep,
irritability; and
sometimes
secondary
infection of the
scratched skin.
Worms may be
seen at anus.
Contact with
infected person
(coughing and
sneezing) or
articles soiled
with discharge
from nose,
mouth or throat.
From beginning
of mild cold
symptoms to 3
weeks after
onset of
coughing
spasms if not
treated with
antibiotics or 5
days after
beginning
treatment with
antibiotics.
Yes
Direct transfer of
eggs by hand
from rectum to
mouth or
indirectly
through clothing,
bedding, food,
or other articles
contaminated
with eggs. Eggs
can survive up
to 3 weeks in
environment.
Can be up to 2
weeks after
treatment
begins.
No
PINWORMS
REPORT TO
PUBLIC
HEALTH
519-575-4400,
ext. 5275
WHAT TO DO
WITH THE
CHILD
INTERVENTION
FOR
CONTACTS
Stay home for 3
weeks from the
onset of cough
or until cough
stops or 5 days
after starting
antibiotics
(whichever
occurs first).
Yes
No exclusion
required.
Assessment and
treatment of
household
contacts may be
recommended in
some
circumstances.
CALL PUBLIC HEALTH
519-575-4400 EXT 5275
FOR MORE
INFORMATION IF ANY
CONTACT IS:
•
•
Pregnant
Infants under 1
year
17
DISEASE
HOW TO
RECOGNIZE
HOW IT
SPREADS
WHEN IT IS
CONTAGIOUS
RINGWORM
a) scalp
Skin infection;
scaly; mildly
itchy rings. Hair
breaks off
leaving bald
spot.
Direct or indirect
contact with skin
and scalp lesion.
Person to
person or animal
to human.
No
Can attend once
treatment has
started.
No
RINGWORM
b) body
Flat, spreading
ring-shaped
area, moist or
crusted.
Reddish around
edges with white
scales in centre.
Direct contact
with lesions or
contaminated
clothing, floors,
shower stalls,
benches.
Person to
person or animal
to human.
As long as
lesions are
present and
viable spores
persist on
contaminated
materials.
Same as above.
No
No
ROSEOLA
Fever; rash
(usually 2 days
or less) begins
as fever
subsides.
Viral infection
which may be
spread by direct
contact with
droplets from
persons carrying
the virus
(not very
contagious).
During fever
phase and
possibly by
persons who
shed virus
without any
symptoms.
No
Can attend once
treatment has
started. Keep
child from gym
and swimming
pools until
treatment is
completed.
Avoid direct
contact sports
(e.g., wrestling)
until treatment is
completed.
Return if child is
well enough.
Most commonly
occurs in
children under 2
years of age.
REPORT TO
PUBLIC
HEALTH
WHAT TO DO
WITH THE
CHILD
INTERVENTION
FOR
CONTACTS
CALL PUBLIC HEALTH
519-575-4400, EXT 5275
FOR MORE
INFORMATION IF ANY
CONTACT IS:
No
18
DISEASE
RUBELLA
(German Measles)
SCABIES
SCARLET FEVER
HOW TO
RECOGNIZE
HOW IT
SPREADS
WHEN IT IS
CONTAGIOUS
Mild fever; cold
symptoms;
swollen neck
glands; rash.
Contact with
infected person
or articles soiled
by body
secretions
(nose, throat,
mouth).
From 1 week
before until up to
1 week after
onset of rash.
Yes
Lesions round
finger webs,
wrists, elbows,
skin folds,
armpits, lower
portion of
buttocks,
beltline.
Itching more
intense at night.
Usually direct
skin-to-skin
contact.
Through clothing
only if the
infected person
wore it
immediately
beforehand.
Until all mites
are destroyed,
usually after 1–2
treatments.
No
Fever;
headache; sore
throat;
vomiting/fine red
rash that feels
like sandpaper;
flushing of
cheeks; white
area around
mouth.
It is a form of
streptococcal
disease –
usually through
direct contact
with infected
person or large
respiratory
droplets. May
occur as
individual cases
or cause
outbreaks.
For 24 hours
after starting
antibiotics.
No
(Strep throat
with a sunburnlike rash on the
body)
REPORT TO
PUBLIC
HEALTH
519-575-4400,
ext. 5275
WHAT TO DO
WITH THE
CHILD
INTERVENTION
FOR
CONTACTS
Stay home until
7 days after
onset of rash.
Yes – see next
column for at-risk
contacts.
Exclusion of
incompletely or
non-immunized
students or atrisk students
from school until
up to 2
incubation
periods after last
case.
Yes
Stay home until
the day after
treatment.
Stay home until
24 hours after
starting
antibiotics
treatment.
CALL PUBLIC HEALTH
519-575-4400, EXT.
5275 FOR MORE
INFORMATION IF ANY
CONTACT IS:
•
•
Pregnant
Not immunized
Consult family
physician:
possible
preventative
treatment of
those with
extensive direct
skin-to-skin
exposure.
No
19
DISEASE
STREP THROAT
HOW TO
RECOGNIZE
HOW IT
SPREADS
Fever; sore
throat; redness
and white spots
on throat.
Usually through
direct contact
with respiratory
droplets
(coughs,
sneezes) with
infected person.
Until 24 hours
after starting
antibiotic.
No
Stay home until
24 hours after
starting
antibiotics
treatment.
No
Usually occurs
as an isolated
case – spread is
extremely rare
but slightly
increased for
family members
exposed to
saliva or
drainage from
case.
Until 24 hours
after starting
antibiotic.
Yes
Intensive
medical
treatment
required.
Yes – for those
with direct
contact with
saliva of case or
household
contacts.
Most common in
children ages 6
to 12.
STREPTOCOCCAL
INFECTIONS –
INVASIVE
A very rare form
of streptococcal
infection causing
Necrotizing
Fasciitis (a deep
muscle & skin
infection) or
Sepsis
(overwhelming
infection of the
blood).
WHEN IT IS
CONTAGIOUS
REPORT TO
PUBLIC
HEALTH
519-575-4400,
ext. 5275
WHAT TO DO
WITH THE
CHILD
INTERVENTION
FOR
CONTACTS
CALL PUBLIC HEALTH
519-575-4400, EXT 5275
FOR MORE
INFORMATION IF ANY
CONTACT IS:
20
DISEASE
TUBERCULOSIS
(TB)
HOW TO
RECOGNIZE
Pulmonary
(lungs)
Cough for more
than 3 weeks,
fatigue, fever,
weight loss,
night sweats.
Extra-pulmonary
(outside of
lungs)
Weight loss,
feeling unwell,
swollen gland(s),
or other
symptoms
depending on
location of
infection. TB
can occur in
almost any part
of the body.
HOW IT
SPREADS
On droplets in
the air expelled
when a person
with active
pulmonary TB
coughs or
sneezes.
WHEN IT IS
CONTAGIOUS
REPORT TO
PUBLIC
HEALTH
WHAT TO DO
WITH THE
CHILD
INTERVENTION
FOR
CONTACTS
Only Pulmonary
TB is
contagious.
Can spread from
when cough
symptoms begin
until
approximately 2
weeks after
treatment is
begun or as
advised by
physician.
Contagiousness
of these cases
varies greatly –
requires close
and prolonged
exposure
(household
contact). Extrapulmonary or
latent
tuberculosis is
not contagious
to others.
Yes
Region of
Waterloo Public
Health staff and
physician will
advise regarding
length of
exclusion.
Region of
Waterloo Public
Health staff will
advise as to
whether follow-up
is necessary for
contacts in
classroom.
CALL PUBLIC HEALTH
519-575-4400, EXT 5275
FOR MORE
INFORMATION IF ANY
CONTACT IS:
Fact Sheets:
Current fact sheets on common childhood infections are available from the Canadian Pediatric Society at:
www.cps.ca
→ Caring for Kids → Illnesses and Infections
21
3.0 Serious Illnesses or Death Due to Infectious Diseases
3.1
Serious Illnesses in School Settings
A sudden severe illness or death within the school community due to an infectious
disease is very rare. When such cases do happen though, there is always a natural
concern around whether or not other classmates or staff may also become ill or are at a
risk of carrying or acquiring the infection. Public Health maintains close communication
with school and board administrative staff in these situations to provide information and
assist in the development of any communication if needed.
The introduction of childhood vaccines to prevent meningococcal disease and
pneumococcal infections has thankfully reduced the risk of these very serious illnesses
in students in recent years.
Since the early 1990’s, a more serious form of streptococcal (“strep”) infection called
invasive group A strep (sometimes referred to as “flesh eating disease”) has reemerged as a rare cause of severe and sometimes life-threatening illnesses.
These serious streptococcal infections are extremely rare in children but they may
sometimes occur as a complication after another illness such as recent chickenpox or
respiratory infection. The risk for further transmission in school settings is very low in
these cases. Such infections tend to occur as isolated cases and are not transmitted by
the type of casual contact that normally occurs in a school setting.
In the event that a student or staff member is diagnosed with one of these serious
infections, the Region of Waterloo Public Health will provide more specific information,
letters or fact sheets as required and in coordination with school communication
personnel or traumatic events teams. Please also refer to your board communication
protocols.
22
4.0 Infection Prevention Measures
Good hygiene provides protection against acquiring many infections. This includes
encouraging everyone, including students and staff members, to cover one’s mouth
when coughing or sneezing, disposing of any used tissues in the garbage and washing
hands after using a tissue or coming into contact with secretions from the mouth or
nose. People must also avoid sharing anything that comes into contact with their mouth
(drinks, straws, cigarettes, lipstick, lip balm, mouth guards, etc.).
4.1
Routine Practices – an overview
Routine practices are a combination of actions or practices that should be used when
providing first aid or care for anyone. Routine practices are based on the idea that
every person is treated as if they have an infection that could be passed to
others. If people treat others as if they have an infection, and protect ourselves, then
the chances of being exposed to an illness are smaller.
Routine practices include:
• Hand washing
• Barrier precautions (gloves or masks)
• Cleaning
• Personal hygiene
The sections following contain very practical steps that anyone can take in a school
setting, to reduce the risk of acquiring or passing germs.
4.1.1 Personal Hygiene products
While most personal hygiene actions will occur at home, the following supplies and
products can support hygiene practices while in the school setting:
•
•
•
•
•
•
Soap
Toilet paper
Alcohol-based hand rub
Paper towels
Tissues
Garbage bags or disposal units
23
4.1.2 Hand Washing
Regular and thorough washing of hands with soap and water is one of the most
effective ways of keeping ourselves healthy and stopping the spread of infection to
others. Properly washing hands will physically remove germs that have been picked up
through daily activity before they can be transferred to our mouths, nose or eyes (which
are common entry points for germs into our bodies). When hands are not visibly soiled
and hand washing facilities are not immediately available, alcohol-based hand rub can
be used to kill germs on the hands.
When to wash hands
Hands should be washed for at least 15 seconds (the time it takes to sing “Happy
Birthday” twice) in the following situations:
•
•
•
•
•
•
•
•
Whenever hands are visibly dirty
Before and after providing care or first aid to a person where contact with blood
or body fluids may occur
Before and after meals or snacks
Before and after preparing food
Before putting on disposable or reusable gloves for first aid or cleaning and after
removing gloves
After using the toilet
After blowing your nose
After handling pets or animals
How to wash hands
•
•
•
•
•
•
Use warm water to wet your wrists and hands
Add enough soap to get a good lather when you rub your hands together
Scrub your palms and the areas between fingers and the thumb. Scrub for at
least 15 seconds.
Rinse your hands in warm water until the soap lather is gone. Rinse from the
wrist down to the fingertips.
Dry your hands using a paper towel (or your own clean towel)
Use a paper towel or clean towel to turn off the water taps so that you do not recontaminate you clean hands
What kind of hand soap is best?
Regular soap is best bet for daily routine washing. The most important action of soap is
to physically remove the dirt and germs from hands through the scrubbing action.
Antibacterial soaps are not recommended for routine hand washing. Their use should
be restricted to specific healthcare settings and patients.
24
Liquid soap that can be dispensed with a pump is most hygienic. Bar soap should not
be shared between persons.
What about alcohol-based hand rubs or gels?
Alcohol-based hand rubs (ABHR) or gels are very effective in killing most germs and
can be very useful when soap and water are not available. ABHR will, within 15
seconds, kill up to 99.99 percent of the common germs that may cause illness.
The recommended alcohol concentration for hand rubs is at least 62%. These hand
rubs are now available in a variety of sizes including small individual containers or larger
pump-action containers that can be shared.
To use alcohol-based hand rubs:
• Hands should be dry and have no visible dirt
• Squirt a quarter-sized portion of hand ABHR into the palm of one hand
• Rub ABHR over the surface of both hands and between fingers
• Continue rubbing until hands are dry (about 15 seconds)
4.1.3 Barrier Protection
Using a barrier such as a tissue or glove physically prevents germs from being spread
to you or others and the risk of infection is avoided.
Tissues:
Tissues should be handy and available for persons to cover their nose and mouth when
coughing or sneezing. Once a tissue is used, it should be thrown in the garbage and
hands should be washed immediately (or an alcohol-based hand rub applied if hands
are not visibly soiled).
Gloves:
Gloves should be used whenever there may be contact with another person’s body
fluids (e.g., saliva, blood, mucous, stool). Single use disposable gloves provide a
barrier between the skin of your hands and the potentially contaminated body fluids. It
also protects the other person from germs that might be on your hands.
It is important to wash hands before and after using gloves, even when gloves are
disposed of immediately. The process of taking off contaminated gloves can sometimes
result in transferring germs to your own hands, so washing hands after use should be
as important as using the gloves.
Heavy duty rubber gloves that are re-usable or shared are often provided for
environmental cleaning tasks. These gloves should be cleaned thoroughly after the
25
activity for which they were used and hands should also be washed before and after
donning these gloves.
Protective Clothing:
In some situations, an apron, gown or even a separate set of clothes may be used in
situations where direct contact with body fluids is likely to occur.
These items should be removed carefully and taken home to be laundered or gently
placed in a laundry bin (if provided) for cleaning. Normal laundry cycles and detergent
are effective in removing and disabling any germs.
4.2
Prevention of Blood-borne infections
Blood-borne infections are very rare in children and the risk for transmission in school
settings remains extremely low. However, it is important to assume that all blood is
potentially infectious and use the following practices when there is a possibility of
contact with blood or blood-tinged body fluids.
School personnel come into contact with blood or other potentially infectious body fluids
in the course of providing first aid or caring for a student with a bleeding nose etc. The
key steps in handling blood or other body fluids that contain visible blood or any objects
that have been contaminated with blood include:
1. Wash your hands:
Hand washing remains the best defense against any infection, including bloodborne infections. If at all possible, wash hands before and after exposure to
blood or any other body fluids and before and after removing gloves. Washing
with plain soap and water or alcohol-based hand rub is effective.
2. Wear Gloves:
Wear disposable gloves whenever applying first aid or cleaning up blood or body
fluid spills from surfaces. Clean, non-sterile vinyl or latex gloves protect any
open areas on hands that could be exposed to blood. It is important to wash
hands well after removal of gloves.
3.
Clean Contaminated Surfaces:
Wearing gloves, immediately wipe up spills of blood with paper towels and
dispose of them into a plastic lined garbage receptacle. Wash the area with hot
water and a household cleaner and then rinse. Apply a specially made solution
of household bleach (mix 1 part bleach to 9 parts water) to the area and leave
the solution on the surface for 10 minutes and then wipe the area dry. For carpet
or upholstered surfaces a low level disinfectant (check the label) may be used
26
instead. The carpet should be cleaned with an industrial carpet cleaner as soon
as possible following spot disinfection.
4. Dispose of Contaminated Articles:
Contaminated tissues, paper towels, etc.: Dispose of any blood-soiled articles
into a plastic bag and then tie it at the top. Dispose of bag in the garbage.
Laundry: Wearing gloves, rinse blood-stained laundry in cold water but do not
remove body fluids by spraying with water. Launder using a regular laundry
detergent with household bleach (according to product instructions and where
suitable for fabrics) and a normal machine wash and dry. If unable to launder on
site, place the contaminated laundry in a plastic bag and then tie it shut for
transport home. A second outer bag is recommended only if the bag is leaking.
If contaminated clothing is brought to community dry cleaners the item should be
appropriately labeled and the cleaning personnel should be informed.
Sharps: Any object that could break, cut or puncture the skin can be considered
a “sharp”. Examples are needles, blades, knives or broken glass. Used needles,
lancets or an object that has caused a puncture of a person’s skin must be
considered contaminated and handled with caution.
•
•
•
•
Wear gloves when handling sharps
Dispose of sharps in a puncture resistant container and secure with the lid
(glass containers should not be used)
Dispose of any sharps according to workplace procedures
Diabetic syringes and lancets must be disposed of in approved biohazard
containers which are available at designated pharmacies
For further guidelines, please refer to the applicable Health and Safety Policies for your
school board.
Posters
Hand hygiene posters (laminated) are available from Public Health by calling the main
number at 519-575-4400 and asking for the Resource Centre. They may also be
printed from these guidelines or the ROWPH website.
In addition, Cover your Cough posters are available for printing from these guidelines or
the ROWPH website. Copies are not available through the Resource Centre.
See Appendices to view these posters.
27
5.0 Pregnancy and Common Childhood Infections
5.1
Pregnancy and Infectious Diseases
Infectious diseases or exposures during pregnancy may require additional consideration
or medical advice and follow-up.
Women working in settings where infections are common should speak with their
physician, nurse practitioner or midwife regarding whether or not there may possible
risks for them if they are exposed to or develop certain infections. Testing ahead of
time may be helpful in determining if the woman may already be immune to some of the
diseases that may be of concern during pregnancy.
Additional information can be obtained from the Region of Waterloo Public Health –
Reproductive Health Program at 519-575-4400.
Several fact sheets have been included with these guidelines for reference.
5.2
Fifth Disease and Pregnancy (Parvovirus B19, Erythema
Infectiosum)
Please see attached fact sheet and refer to your Board policies
5.3
Chickenpox and Pregnancy
Please see attached fact sheet and refer to your Board policies
28
29
30
31
32
APPENDICES
33
Reportable Diseases 2014
The following specified Reportable Diseases (Ontario Regulations 559/91 and
amendments under the Health Protection and Promotion Act) are to be reported to
the local Medical Officer of Health:










Acquired Immunodeficiency Syndrome (AIDS) S
Amebiasis H
Acute Flaccid Paralysis I
Anthrax H
Botulism H
Brucellosis H
Campylobacter Enteritis H
Chancroid I
Chickenpox (Varicella) I
Chlamydia Trachomatis Infection S
Cholera H
Clostridium difficile associated disease (CDAD)
outbreaks in public hospitals H
Cryptosporidiosis H
Cyclosporiasis H
Diphtheria I
Encephalitis, including:
i.
primary, viral I
ii.
post-infectious I
iii.
vaccine-related I
iv.
subacute sclerosing panencephalitis I
v.
unspecified I
Food Poisoning, all causes H
Leprosy I
 Listeriosis H
Lyme Disease H
Malaria I
 Measles I
 Meningitis, acute
bacterial I
 i.
ii.
viral I
iii.
other I
Mumps I
Ophthalmia neonatorum I
 Paralytic Shellfish Poisoning H
 Paratyphoid fever H
Pertussis (Whooping Cough) I
 Plague H
Pneumococcal disease, invasive I
 Poliomyelitis, acute I
Psittacosis / Ornithosis H
 Q Fever H
 Rabies H
 Respiratory Infection Outbreaks in
 Gastroenteritis, institutional outbreaks H
 Giardiasis, except asymptomatic cases H
Gonorrhea S
 Group A Streptococcal Disease, invasive I

Group B Streptococcal Disease, neonatal I


 Haemophilus Influenza b Disease, invasive I
 Hantavirus Pulmonary Syndrome H




Hemorrhagic Fever, including:
i.
Ebola virus disease I
ii.
Marburg virus disease I
iii.
other viral causes I
 Hepatitis, viral
Hepatitis A I
 i.
ii.
iii.
Hepatitis B S
Hepatitis C S





Influenza I
 Lassa Fever H
 Legionellosis H
Institutions I
Rubella I
Rubella, congenital syndrome I
Salmonellosis H
Severe Acute Respiratory Syndrome
(SARS) I
Shigellosis H
Smallpox I
Transmissible Spongiform Encephalopathy
including
i. Creutzfeldt-Jakob Disease, all types I
Syphilis S
Tetanus I
Trichinosis H
Tuberculosis I
i. active infection
ii. latent infection (positive TB skin test)
Tularemia H
Typhoid Fever H
Verotoxin – producing E. coli infection
indicator conditions include Hemolytic Uremic
Syndrome (HUS) H
West Nile Virus Illness (WNV) I
Yellow Fever I
Yersiniosis H
Reporting to Region of Waterloo Public Health - Weekdays 8:30 - 4:30pm
I – Infectious Diseases & Tuberculosis Control 519-575-4400, ext. 5275
H – Health Protection & Investigation 519-575-4400, ext. 5147
S – Sexual Health & Harm Reduction 519-883-2267
Fax # 519-883-2248
Emergency after hours/weekends/holidays #: 519-575-4400
34
Note: disease marked  (and respiratory infection outbreak in institutions) should be
reported to the Medical Officer of Health. (Other diseases are to be reported by the
next business day.)
FAX or Phone
Chickenpox Cases
Monthly Reporting Form
Name of Facility Reporting: _______________________________________________
Contact Name ___________________________ Phone Number _________________
For Month _________________________ Year: ______________________________
Please report all cases of chickenpox identified for the month in each of the following
age groups:
Age Group
Number of Chickenpox
Cases
<1 year
1-4
5-9
10-14
15-19
20-24
25-29
30-39
40-49
50-59
60+
Age Unknown
Reporting Options at the end of each month:
FAX a copy of this form to 519-883-2248 or PHONE the information to 519-575-4400,
ext. 5275.
35
36
37
38