Guidelines for Communicable Disease and Other Childhood Health Issues for Schools and Child Care Facilities (CCF)

This resource is intended to provide school principals, teachers, directors of child care facilities (CCFs) and health care professionals with guidelines on communicable disease prevention and control in schools and CCFs.

Any child who is ill and unable to participate fully in regular activities should be cared for at home.

Individuals who may have been exposed to a communicable disease and have specific health concerns, such as pregnancy and immunosuppression, may need to be assessed by a health care professional.

Proper hand hygiene is the most effective way to prevent the spread of communicable diseases.

October 2011

Ottawa Public Health Communicable Disease Program
613-580-6744, ext. 24224

Table of Contents:

Amebiasis
Bite (Animal)

Bite (Human)

Campylobacter

Candidiasis (Thrush, Diaper Rash)

Chickenpox (Varicella)

Cold Sores (Herpes)

Conjunctivitis-Bacterial (Pink Eye)

Conjunctivitis-Viral (Pink Eye)

Coxsackie Virus (Hand, Foot and Mouth Disease)

Crabs (Genital Lice)

Cryptosporidiosis

Diarrhea

Escherichia Coli 0157:H7 (E coli)

Eye Infection

Fifth Disease

Gastroenteritis: Institutional Outbreaks

Gastroenteritis Single Case

Genital Herpes

German Measles

Giardiasis (Beaver Fever)

Hand, Foot and Mouth Disease

Head Lice (Pediculosis)

Hepatitis A

Hepatitis B

Hepatitis C

HIV (Human Immunodeficiency Virus) / AIDS

Impetigo

Influenza

Lice (Pediculosis)

Measles (Red Measles)

Meningitis

Molluscum Contagiosum (Non-Plantar Warts)

Mononucleosis

Mumps

Norovirus (Norwalk-like Virus)

Paratyphoid fever

Parvovirus B19 (Fifth Disease; Erythema infectiosum, “Slapped Cheeks Syndrome”)

Pertussis (Whooping cough)

Pink Eye

Pinworms

Poison Ivy

Respiratory infection outbreak
Respiratory Syncytial Virus (RSV)
Ringworm (Tinea)

Roseola

Rubella (German Measles)

Salmonella

Scabies

Scarlet Fever

Shigella

Shingles (Herpes Zoster)

Streptococcal Infection (Strep Throat, Scarlet Fever)

Streptococcal Infection (Invasive Group A Strep)

Tuberculosis

Typhoid fever

Whooping Cough

Yersinia

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Amebiasis

Cause/Symptoms: Parasite. Abdominal distention and cramps, diarrhea or constipation, and rarely fever or chills. May be symptom free.

Transmission: Fecal-oral route. Food and water contaminated by an infected food handler or sewage.

Incubation: Few days to several months, commonly 2 to 4 weeks.

Period of Communicability: During the period that cysts are passed, which may continue for years.

Exclusion: CCFs: exclude symptomatic cases (attendees and staff, including food handlers), until 24 hours after diarrhea resolves or until 48 hours after completion of antibiotic treatment.

Reporting of Individual Cases: Report to 613-580-6744, ext. 26325 within 1 business day.

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Bite (Animal)

Cause/Symptoms: There is a risk of rabies from the bites of bats, cats, dogs, ferrets, groundhogs, muskrats, racoons, skunks and other wild mammals. Bites of gerbils, hamsters, mice, moles, rabbits and squirrels do not have to be reported unless the animal’s behaviour was very abnormal

Transmission: Animal saliva introduced by a bite or scratch

Incubation: Rabies: Usually 3-8 weeks; rarely as short as 9 days or as long as 7 years

Period of Communicability: Rabies: Rabid animals are infectious from the time the virus reaches the salivary glands and up until death. Death usually occurs within 1 week of onset of clinical signs

Exclusion: Not required

Reporting of Individual Cases: Report immediately to 613-580-6744, ext. 23806 (3-1-1 after hours) to begin rabies immunization, if needed, and/or to quarantine the biting animal, if available.

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Bite (Human)

Cause/Symptoms: If the skin is broken, there may be a risk of transmission of hepatitis B, hepatitis C, and HIV from an infected person.

Transmission: Contact of contaminated blood with a break in the skin or blood inside of the mouth.

Incubation: Depends on the cause

Period of Communicability: Depends on the cause

Exclusion: Not required

Reporting of Individual Cases: Not required unless the biting or bitten child is known to be infected with hepatitis B, hepatitis C or HIV. If so, report immediately to 613-580-6744, ext. 24224 (311 after hours).

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Campylobacter

Cause/Symptoms: Bacteria. Diarrhea, abdominal pain, fever, nausea and vomiting - may be mild to severe. Stools may contain blood.

Transmission: Fecal-oral route. Ingestion of undercooked meat (especially poultry), unpasteurized milk and contaminated water or by direct contact with fecal material from infected animals or people.

Incubation: 1 to 10 days. Period of Communicability - Variable, as long as organisms are being excreted; usually 2 to 7 weeks.

Exclusion: CCFs: exclude symptomatic cases (attendees and staff including food handlers), until symptom free for 24 hours.

Reporting of Individual Cases: Report to 613-580-6744, ext. 26325 within 1 business day

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Candidiasis (Thrush, Diaper Rash)

Cause/Symptoms: Fungus. Thrush: Thin white layer on tongue and inside of cheeks. May cause difficulty with feeding. Diaper rash or other skin rash: Well demarcated, red rash with white flaky border, usually in skin folds. Painful when comes in contact with urine

Transmission: Person-to-person by direct contact,

Incubation: Variable, 2 to 5 days for thrush in infants.

Period of Communicability: While lesions are present.

Exclusion: Not required.

Reporting of Individual Cases: Not required.

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Chickenpox (Varicella)

Cause/Symptoms: Virus. Fever. Blister-like rash occurs over 5 to 6 days. Scabs form after the blister stage. Rash usually appears first on the body, face and scalp, and then later spreads to the arms and legs.

Transmission: Person to person by direct contact with virus through droplet or airborne spread of blister fluid or respiratory secretions. Indirectly through freshly contaminated objects and surfaces.

Incubation: 2 to 3 weeks; commonly 14 to 16 days.

Period of Communicability: As long as 5 days, but usually 1 to 2 days before onset of rash, until all blisters are crusted, usually about 5 days after the onset of rash.

Exclusion: No exclusion, children can return with rash. Contact with immunocompromised individuals, susceptible pregnant women, particularly those in the third trimester, or newborns should be avoided.
Children should be seen by a physician as soon as possible if:

  1. fever (>38.3°C) lasts for more than 3 days or recurs,
  2. redness, swelling, and severe pain develop around a blister.

Reporting of Individual Cases: Report, by mail or fax, number of cases and ages, using the Chicken Pox Weekly Reporting Form, available online at ottawa.ca/health

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Cold Sores (Herpes)

Cause/Symptoms: Virus. Small blisters appear and then burst to form a crust. Sores are usually around the mouth but can be around the nose and eyes.
With the first infection, sores may be accompanied by fever, flu-like illness, and painful irritation.

Transmission: Person-to-person by saliva. Hand hygiene is important in preventing transmission.

Incubation: 2 to 12 days

Period of Communicability: While sores are apparent, however, virus may be transmitted even when no visible lesions are present.

Exclusion: Not required. If it is the first episode (severe symptoms): exclude only if child is drooling, until lesions are crusted over.

Reporting of Individual Cases: Not required

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Conjunctivitis-Bacterial (Pink Eye)

Cause/Symptoms: Bacteria. Pink or red conjunctiva (the white of the eye) with thick or crusty white or yellow discharge (pus), occasionally accompanied by fever.

Transmission: Person-to-person: by direct or indirect contact with eye secretions.

Incubation: 24 to 72 hours.

Period of Communicability: For duration of infection or until 24 hours of antibiotic treatment is completed.

Exclusion: Exclude until treated with antibiotic drops or ointment for 24 hours.

Reporting of Individual Cases: Not required.

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Conjunctivitis-Viral (Pink Eye)

Cause/Symptoms: Virus Pink conjunctiva (the white of the eye) with a clear, watery eye discharge. Often occurs at the same time as a cold.

Transmission: Person-to-person: by direct or indirect contact with eye secretions.

Incubation: 12 hours to 12 days.

Period of Communicability: For duration of infection.

Exclusion: No need to exclude, but encourage frequent hand hygiene.

Reporting of Individual Cases: Not required.

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Coxsackie Virus (Hand, Foot and Mouth Disease)

Cause/Symptoms: Virus. Sudden onset of fever, sore throat. Rash on the palms of the hands, the fingers, and on the soles of the feet, and sores inside the mouth. Usually occurs in children, particularly in the summer months.

Transmission: Person to person by direct contact with respiratory secretions and fecal-oral route.
Infection cannot be spread through contact with rash or sores.

Incubation: Usually 3 to 5 days.

Period of Communicability: During the acute stage of the illness (while experiencing symptoms).
Transmission via stools may persist for several weeks.

Exclusion: Not required.

Reporting of Individual Cases: Not required.

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Crabs (Genital Lice)

Cause/Symptoms: Small grey-brown insects and white eggs (nits) attached to pubic hairs. May spread to other areas where there is hair (head, eyebrows, underarms). Intense itching and skin redness.

Transmission: Person to person by direct skin to skin contact, sexual contact, or indirect contact with bedding, clothing, and towels.

Incubation: 6 to 10 days.

Period of Communicability: As long as lice or eggs remain alive on hair until treated.

Exclusion: Not required.

Reporting of Individual Cases: Not required.

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Cryptosporidiosis

Cause/Symptoms: Parasite. Frequent, non-bloody, watery diarrhea with abdominal cramps and pain, fatigue, vomiting, and weight loss. Loss of appetite and vomiting are relatively common among children. May be symptom free.

Transmission: Fecal-oral route, including person to person, animal to person, waterborne (recreational or drinking water) and foodborne transmission.

Incubation: 1 to 12 days with an average of 7 days.

Period of Communicability: From onset of symptoms up to several weeks after symptoms resolve.

Exclusion: CCFs: exclude symptomatic cases (attendees and staff, including food handlers), until 24 hours after diarrhea resolves. Cases are not to use recreational waters for 2 weeks after symptoms resolve.

Reporting of Individual Cases: Report to 613-580-6744, ext. 26325 within 1 business day.

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Diarrhea

See Gastroenteritis (Single Case).

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Escherichia Coli 0157:H7 (E coli)

Cause/Symptoms: Bacteria. Bloody or non-bloody diarrhea, severe abdominal cramps, vomiting, fatigue, malaise and dehydration. Symptoms usually last fewer than 5 days.

Transmission: Fecal-oral route, mainly by ingestion of contaminated food:

  • undercooked meat (especially hamburger) and poultry
  • unwashed raw vegetables ( lettuce, spinach, sprouts) and fruits
  • unpasteurized milk and apple juice/cider.

Contaminated drinking or recreational water.

Animal to person and person to person can occur.

Incubation: 1 to 8 days, usually 3 to 4 days.

Period of Communicability: 1 week or less in adults, but 3 weeks in one third of children.

Exclusion: CCFs: exclude all cases (attendees and staff, including food handlers) until 2 negative stool cultures are obtained, at least 24 hours apart or until 48 hours after the completion of antibiotics.

Reporting of Individual Cases: Report immediately to 613-580-6744, ext. 24224 (3-1-1 after hours).

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Eye Infection

See Conjunctivitis (Bacterial), Conjunctivitis (Viral).

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Fifth Disease

See Parvovirus B19.

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Gastroenteritis: Institutional Outbreaks

CCFs:
Defined as 3 or more cases in a specific class or program within a 4 day period. A case must meet at least 1 of the following criteria: 2 or more episodes of loose/watery bowel movements (conforms to the shape of the container) within 24 hours,OR 2 or more episodes of vomiting within 24 hours, OR 1 episode of loose/watery bowel movements and 1 episode of vomiting within 24 hours.
Schools:
Defined as a sudden or unusual increase in absenteeism due to similar symptoms in students/staff in a class or school in the same day OR >10% absenteeism due to similar symptoms in a school in the same day.

Cause/Symptoms: Bacteria, virus or parasite. Vomiting, diarrhea, abdominal pain, headache, fever.

Transmission: Depends on cause. Usually fecal-oral route or through food and water contaminated with bacteria, virus or parasite.

Incubation: Depends on cause.

Period of Communicability: Depends on cause.

Exclusion: Depends on cause, number of cases and source of infection. All outbreaks must be discussed with Ottawa Public Health.

Reporting of Individual Cases: Report immediately to 613-580-6744, ext. 24224 (3-1-1 after hours).

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Gastroenteritis Single Case

Gastroenteritis: single case of unknown cause 
A case is defined as having: 
2 episodes of vomiting, OR
2 episodes of diarrhea, OR
1 episode of vomiting and 1 episode of diarrhea within 24 hours.

Cause/Symptoms: Bacteria, virus or parasite. Vomiting, diarrhea, abdominal pain, headache, fever.

Transmission: Depends on cause. Usually fecal-oral route or through food and water contaminated with bacteria, virus or parasite.

Incubation: Depends on cause.

Period of Communicability: Depends on cause.

Exclusion: Exclude until 24 hours after diarrhea is resolved. If diarrhea recurs within 48 hours, recommend to parent/guardian that child be assessed by a physician to see if a stool culture is needed.
Exclude if vomiting 2 or more times in the previous 24 hours, unless the vomiting is determined to be caused by a non-communicable condition and the child is not in danger of dehydration

Reporting of Individual Cases: Not required. Exception: bloody diarrhea should always be reported.

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Genital Herpes

Cause/Symptoms: Virus. Painful sores on the skin around genitalia. With the first infection, sores may be accompanied by fever, flu-like symptoms and painful irritation.

Transmission: Sexually contact

Incubation: 2 to 12 days.

Period of Communicability: Usually while sores are apparent but virus may be transmitted even when no visible lesions are present.

Exclusion: Not required.

Reporting of Individual Cases: Not required.

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German Measles

See Rubella.

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Giardiasis (Beaver Fever)

Cause/Symptoms: Parasite. Chronic diarrhea, abdominal cramps, bloating, dehydration, fatigue and weight loss. May be symptom free.

Transmission: Fecal-oral route, most commonly through the ingestion of contaminated water or by direct person to person contact.

Incubation: 3 to 25 days or longer, usually 7 to 10 days.

Period of Communicability: Can be excreted in stool for months.

Exclusion: CCFs: exclude symptomatic cases (attendees and staff, including food handlers) until 24 hours after diarrhea resolves.
Cases should not use swimming pools, lakes or rivers for 2 weeks once diarrhea has stopped.

Reporting of Individual Cases: Report to 613-580-6744, ext. 26325 within 1 business day.

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Hand, Foot and Mouth Disease

See Coxsackie Virus.

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Head Lice (Pediculosis)

Cause/Symptoms: Colonization of the hair and skin by a parasitic insect. Head lice feed on human blood; itching from lice bites is common. Adult lice or eggs (nits) can be seen with the naked eye, often behind the ears and near the nape of the neck.

Transmission: Head lice are generally spread through direct head to head contact with an infested person; transmission by sharing bedding or clothing such as headwear is much less common.

Incubation: 7 to 12 days from the laying of eggs to the hatching of the first nymph.

Period of Communicability: Until treatment has been completed.

Exclusion: Exclude until the initial treatment is completed.

Reporting of Individual Cases: Not required.

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Hepatitis A

Cause/Symptoms: Virus. Fever, fatigue, nausea, jaundice (yellowing of skin), abdominal discomfort, dark urine, clay coloured stools. May be symptom free.

Transmission: Fecal-oral route, either by direct contact with an infected person or indirectly through ingestion of contaminated water or foods.

Incubation: 15 to 50 days, average 28 to 30 days.

Period of Communicability: Most infectious 2 weeks prior to and until 1 week after the onset of symptoms.

Exclusion: Exclude until 1 week after onset of symptoms.

Reporting of Individual Cases: Report immediately to 613-580-6744, ext. 26325 (or 3-1-1 after hours)

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Hepatitis B

Cause/Symptoms: Virus. Anorexia, fatigue, vague abdominal discomfort, joint pain, fever and jaundice. May be symptom free.

Transmission: Person to person by direct contact with infected body fluids, including sexual contact.

Incubation: 45 to 180 days, average 60 to 90 days.

Period of Communicability: Many weeks before onset of first symptoms and through the acute period of disease. Some people become carriers and remain contagious for life.

Exclusion: Not required.

Reporting of Individual Cases: Report to 613-580-6744 ext. 12580 within one working day.

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Hepatitis C

Cause/Symptoms: Virus. Most cases are usually asymptomatic or have mild illness; vague abdominal discomfort, nausea, vomiting and fatigue.

Transmission: Person to person primarily through blood-to-blood contact.

Incubation: 2 weeks to 6 months, most common 6 to 9 weeks.

Period of Communicability: From one or more weeks before onset of symptoms; most persons are probably infectious indefinitely.

Exclusion: Not required.

Reporting of Individual Cases: Report to 613-580-6744 ext. 12580 within one working day.

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HIV (Human Immunodeficiency Virus) / AIDS

Cause/Symptoms: Virus. Most cases will develop a short-term flu-like illness several weeks to months after infection. May lead to suppression of the immune system.

Transmission: Person to person by direct contact with infected body fluids, including sexual contact.

Incubation: Generally 1 to 3 months until HIV blood test is positive.

Period of Communicability: Begins early after onset of infection and extends throughout life.

Exclusion: Not required.

Reporting of Individual Cases: Report to 613-580-6744 ext. 12580 within one working day.

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Impetigo

Cause/Symptoms: Bacteria. Infection of the skin caused by Streptococcus or Staphylococcus bacteria; can follow a scrape or insect bite. It usually appears on the face or exposed skin as a rash with a cluster of red bumps or blisters, which may ooze or form a honey-coloured crust.

Transmission: Person to person by direct and indirect contact with fluid from blisters. It is very contagious and should be treated at once.

Incubation: Variable.

Commonly 1 to 10 days.

Period of Communicability: From onset of rash until 24 hours of treatment with oral or topical antibiotics.

Exclusion: Exclude until 24 hours after the initiation of antibiotic treatment.

Upon return, any draining or open blisters must be covered with a clean dry bandage.

Reporting of Individual Cases: Not required.

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Influenza

Cause/Symptoms: Virus.  May include sudden fever, non-productive cough, headache, muscle soreness, fatigue, runny nose, sore throat. Children may also have nausea, vomiting and diarrhea. May also be asymptomatic.

Transmission: Person to person by direct contact or indirect contact with contaminated surfaces and objects.

Incubation: 1 to 3 days.

Period of Communicability: 24 hours prior to onset of symptoms lasting up to 7 days.

Exclusion: Exclude for 5 days after the onset of symptoms, or until fever free and feeling better, whichever is shorter.

Reporting of Individual Cases: Not required.

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Lice (Pediculosis)

See Head Lice.

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Measles (Red Measles)

Cause/Symptoms: Virus. Fever, runny nose, cough, drowsiness, irritability and red eyes. Small white spots appear on the inside of the mouth and throat. Then, 3 to 7 days after initial symptoms a red blotchy rash appears on the face and progresses down the body.

Transmission: Person to person by direct contact or by airborne droplets. Highly contagious.

Incubation: 7 to 21 days, usually 10 days.

Period of Communicability: 4 days before to 4 days after the onset of rash.

Exclusion: Exclude for 4 days after the onset of rash.

Reporting of Individual Cases: Report immediately to 613-580-6744, ext. 24224 (3-1-1 after hours).

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Meningitis

Cause/Symptoms: Bacteria or virus. Young children may show a cluster of symptoms such as irritability, poor feeding, vomiting, fever, rash and excessive high-pitched crying. Older children and adults may experience severe persistent headache,

Transmission: Varies depending on cause of meningitis.

Incubation: Varies depending on cause of meningitis.

Period of Communicability: Varies depending on cause of meningitis.

Exclusion: All cases must be discussed with Ottawa Public Health.

Reporting of Individual Cases: Report immediately to 613-580-6744, ext. 24224 (3-1-1 after hours).

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Molluscum Contagiosum (Non-Plantar Warts)

Cause/Symptoms: Virus. Skin infection with small flesh-coloured or translucent bumps with sunken centre, most often on face, trunk, or limbs of children. Can be found on genitalia. May cause itchiness.

Transmission: Person to person by direct skin to skin contact or indirect contact, such as sharing clothes or towels.

Incubation: 2 to 7 weeks, but can be as long as 6 months.

Period of Communicability: Unknown, but probably as long as warts persist.

Exclusion: Not required.

Reporting of Individual Cases: Not required.

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Mononucleosis

Cause/Symptoms: Epstein-Barr Virus. Fever, sore throat, swollen lymph nodes in neck, fatigue.

Transmission: Person to person by direct contact with saliva.

Incubation: 4 to 6 weeks.

Period of Communicability: Prolonged; may persist up to 1 year or more.

Exclusion: Not required.

Reporting of Individual Cases: Not required.

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Mumps

Cause/Symptoms: Virus. Fever, swelling and tenderness of salivary glands slightly above the angle of the jaw, on 1 or both sides.

Transmission: Person to person by direct contact with respiratory secretions or saliva.

Incubation: 14 to 25 days; average 16 to 18 days.

Period of Communicability: 7 days before to 9 days after symptoms develop.

Exclusion: Exclude for 5 days from the onset of swelling.

Reporting of Individual Cases: Report to 613-580-6744, ext. 24224 within 1 business day.

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Norovirus (Norwalk-like Virus)

See Gastroenteritis: outbreaks

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Paratyphoid fever

Cause/Symptoms: Bacteria. Fever, headache, malaise, anorexia, infrequent stools and possible rash on trunk.

Transmission: Fecal-oral route, either by direct contact with an infected person or indirectly through ingestion of contaminated water or foods.

Incubation: 1to10 days.

Period of Communicability: From onset of initial symptoms, and up to 2 weeks after.

Exclusion: CCFs: exclude all cases (attendees and staff, including food handlers), until 3 consecutive stool specimens are negative.

Reporting of Individual Cases: Report immediately to 613-580-6744, ext. 26325 (3-1-1 after hours).

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Parvovirus B19 (Fifth Disease; Erythema infectiosum, “Slapped Cheeks Syndrome”)

Cause/Symptoms: Virus. Fever, headache, malaise, anorexia, infrequent stools and possible rash on trunk.

Transmission: Person to person by direct or indirect contact with respiratory secretions; mother to fetus.

Incubation: 4 to 14 days; can be as long as 21 days.

Period of Communicability: 1 week before onset of rash.

Exclusion: Not required since no longer infectious once rash appears.

Infected children with sickle cell or other forms of chronic anemia and pregnant personnel are advised to consult with their health care provider.

Reporting of Individual Cases: Not required

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Pertussis (Whooping cough)

Cause/Symptoms: Bacteria. Repeated bouts of violent coughing, which may end with a high-pitched inspiratory whoop and/or vomiting. May last 1 to 2 months.

Transmission: Person to person by direct contact with respiratory secretions.

Incubation: 5 to 21 days, usually 7 to 10 days

Period of Communicability: Until 3 weeks after onset of symptoms or until 5 days of antibiotic treatment is completed.

Exclusion: Exclude for 3 weeks after onset of cough or until completion of 5 days of antibiotic treatment.

Reporting of Individual Cases: Report to 613-580-6744, ext. 24224 within 1 business day.

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Pink Eye

See Conjunctivitis (Bacterial)Conjunctivitis (Viral).

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Pinworms

Cause/Symptoms: Worm. Itching around the anal area.

Transmission: Fecal-oral route or indirectly from contaminated items such as bedding, clothing, toilet seats or toys.

Incubation: 1 to 2 months or longer.

Period of Communicability: Until treatment is initiated.

Exclusion: Exclude until treatment initiated.

Reporting of Individual Cases: Not required.

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Poison Ivy

Cause/Symptoms: Plant toxin. Redness and blisters in linear pattern, where skin was exposed.

Extremely itchy. Washing the exposed area immediately decreases the severity of symptoms.

Transmission: Direct skin contact with any part of the plant.

Incubation: A few minutes to several days.

Period of Communicability: Not contagious after the toxin has been washed from the skin or clothing.

Exclusion: Not required.

Reporting of Individual Cases: Not required.

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Respiratory infection outbreak

CCFs: A respiratory outbreak exists when there is 15% or more people (children and /or staff) sick or absent with acute respiratory illness occurring on the same day within the facility.

Schools: A sudden or unusual increase in absenteeism due to illness with similar symptoms in students/staff in a class or school on the same day OR >10% absenteeism due to illness with similar symptoms in a school on the same day.

Cause/Symptoms: Bacteria or virus.

Symptoms may include:

  • Runny or stuffy nose or sneezing
  • Sore throat, hoarseness or difficulty swallowing
  • Dry cough
  • Fever/abnormal temperature, chills may or may not be present
  • Swollen or tender glands in the neck
  • Fatigue
  • Muscle aches
  • Loss of appetite
  • Headache.

Transmission: Person to person by direct or indirect contact with respiratory secretions.

Incubation: Varies according to cause.

Period of Communicability: Varies according to cause.

Exclusion: Exclude for 5 days after the onset of symptoms, or until fever free and feeling better, whichever is shorter.

Reporting of Individual Cases: Report immediately to 613-580-6744, ext. 24224 (3-1-1 after hours).

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Respiratory Syncytial Virus (RSV)

Cause/Symptoms: Virus. Can cause colds, bronchiolitis, bronchitis, croup, pneumonia, and ear infections. Most common in children < 2 years old

Transmission: Person to person by direct or indirect contact with respiratory secretions.

Incubation: 2 to 8 days, usually 4 to 6 days.

Period of Communicability: Usually 3 to 8 days from onset of symptoms, but may continue for as long as 3 to 4 weeks.

Exclusion: Not required.

Reporting of Individual Cases: Not required.

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Ringworm (Tinea)

Cause/Symptoms: Fungus. Flat, well demarcated, red, circular patches with scaly or crusted border on the skin or scalp. The patches are often itchy.

Transmission: Person to person by direct skin to skin contact or indirectly from contact with contaminated objects or surfaces.

Incubation: 10 to 14 days for scalp; 4 to 10 days for other areas.

Period of Communicability: As long as lesions are present or until treatment is initiated.

Exclusion: Exclude until treatment has been initiated.

Reporting of Individual Cases: Not required.

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Roseola

Cause/Symptoms: Virus. Sudden onset of fever lasting 3-5 days, followed by fine, pink rash on trunk and body.

Transmission: Person to person by direct contact with respiratory secretions.

Incubation: 9 to 10 days.

Period of Communicability: Unknown; probably communicable during the fever phase and before the rash appears.

Exclusion: Not required.

Reporting of Individual Cases: Not required.

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Rubella (German Measles)

Cause/Symptoms: Virus. Low-grade fever, headache, malaise, runny nose, red eyes, enlarged tender neck nodes. Rash starts on the face, spreads in 24 hours and lasts 3 days.

Transmission: Person to person by direct contact with respiratory secretions. Highly contagious.

Incubation: 14 to 21 days

Period of Communicability: For about 1 week before the rash starts until 7 days after the onset of the rash.

Exclusion: Exclude for 7 days after onset of the rash.

Reporting of Individual Cases: Report immediately to 613-580-6744, ext. 24224 (3-1-1 after hours).

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Salmonella

Salmonella paratyphi (See paratyphoid fever)
Salmonella Typhi (See Typhoid fever).

Cause/Symptoms: Bacteria. Symptoms include sudden onset of headache, fever, abdominal pain, diarrhea, nausea and sometimes vomiting.

Transmission: Fecal-oral route, either by direct contact with an infected person or indirectly through ingestion of contaminated food.

Pets (iguanas, turtles, sometimes cats and dogs) and farm animals are another common source of infection.

Incubation: 6 to 72 hours, usually 12 to 36 hours.

Period of Communicability: Up to several weeks or months after onset of symptoms.

Exclusion: CCFs: exclude symptomatic cases (attendees and staff, including food handlers) until symptom free for 24 hours.

Reporting of Individual Cases: Report to 613-580-6744, ext. 26325 within 1 business day.

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Scabies

Cause/Symptoms: Caused by a mite burrowing under the skin. Rash appears as bumps, patches or tiny red lines, usually between fingers and toes, and in skin folds. Intense itching, especially at night.

Transmission: Direct skin to skin contact or indirect contact by sharing clothes or towels.

Incubation: 2 to 6 weeks.

Period of Communicability: From onset of symptoms until treated.

Exclusion: Exclude until treatment has been completed.

Reporting of Individual Cases: Not required.

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Scarlet Fever

See Streptococcal Infection

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Shigella

Cause/Symptoms: Bacteria. Watery diarrhea, which may contain blood, fever, nausea, vomiting, abdominal cramps. May be symptom free.

Transmission: Fecal-oral route, either by direct contact with an infected person or indirect contact with contaminated surfaces, ingestion of contaminated water or food; or sexual contact.

Incubation: 1 to 6 days; usually 1 to 3 days.

Period of Communicability: 1 week if treated with antibiotics, up to 4 weeks if not.

Exclusion: CCFs: exclude all cases (attendees and staff, including food handlers) until 2 consecutive stool samples or rectal swabs are negative.

Reporting of Individual Cases: Report immediately to 613-580-6744, ext. 24224 (3-1-1 after hours).

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Shingles (Herpes Zoster)

Cause/Symptoms: Virus. Reactivation of latent varicella (chickenpox) infection in the nerve endings. Characterized by pain and a blistering rash usually localized to one area of the body.

Transmission: It is only possible to get chickenpox from someone with shingles through direct contact with vesicle fluid of the patient with shingles.

Incubation: 2 to 3 weeks; commonly 14 to 16 days.

Period of Communicability: Until blisters are crusted over.

Exclusion: Not required.

Reporting of Individual Cases: Not required.

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Streptococcal Infection (Strep Throat, Scarlet Fever)

Cause/Symptoms: Bacteria. Strep Throat: Very sore and red throat, fever. Scarlet Fever: High fever, vomiting, "sandpaper" skin rash, "strawberry tongue", red cheeks and whiteness around mouth. During convalescence, skin on hands and feet may peel.

Transmission: Direct or indirect contact with respiratory secretions.

Incubation: Usually 1 to 3 days.

Period of Communicability: From onset of symptoms until 24 hours after antibiotic treatment initiated.

10 to 21 days if untreated.

Exclusion: Exclude until 24 hours after treatment is initiated.

Reporting of Individual Cases: Not required.

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Streptococcal Infection (Invasive Group A Strep)

Cause/Symptoms: Necrotizing fasciitis: Fever, localised redness, swelling, blister formation, and intense pain. Redness spreads very quickly. Toxic Shock Syndrome: Sudden onset of high fever, vomiting, diarrhea, rash, muscle pains, and shock. Can be fatal.

Transmission: Direct or indirect contact with respiratory secretions or with discharge from wounds.

Incubation: Usually 1 to 3 days.

Period of Communicability: From onset of symptoms until 24 hours after antibiotic treatment initiated.

Exclusion: Exclude until 24 hours after treatment is initiated.

Reporting of Individual Cases: Report immediately to 613-580-6744, ext. 24224 (3-1-1 after hours).

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Tuberculosis

Cause/Symptoms: Mycobacterium tuberculosis. If TB disease is in the lungs: cough, loss of weight, fever, night sweats, fatigue. If TB disease is outside of the lungs: symptoms vary depending on where the disease is located.

Transmission: If TB disease is in the lungs: person to person via airborne bacteria. If TB disease is outside of the lungs: not contagious.

Incubation: Several weeks to years for someone to develop TB disease.

Period of Communicability: Varies

Exclusion: OPH manages all cases of TB disease and notifies schools and CCFs if exclusion is required.

Reporting of Individual Cases: Report within one working day to 613-580-6744, ext. 24224.

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Typhoid fever

Cause/Symptoms: Bacteria. Low grade fever, headache, malaise, myalgia, dry cough, anorexia, nausea, and abdominal discomfort. Constipation is more common than diarrhea in adults but diarrhea is more common in children.

Transmission: Fecal-oral route. Direct contact with contaminated water, shellfish, particularly oysters, milk, ice-cream, raw fruit and vegetables grown in fields fertilized with fecal matter.

Incubation: From 3 days to over 60 days; usual range is 8-14 days.

Period of Communicability: Variable. Usually 1 to 2 weeks.

Exclusion: CCFs: exclude all cases (attendees and staff, including food handlers) until 3 consecutive stool specimens are negative.

Reporting of Individual Cases: Report immediately to 613-580-6744, ext. 24224 (3-1-1 after hours).

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Whooping Cough

See Pertussis (Whooping cough).

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Yersinia

Cause/Symptoms: Bacteria. Diarrhea, fever, abdominal pain, headache, and in some cases, a rash.

Transmission: Fecal-oral route. Direct contact with infected people or animals such as puppies or kittens or indirect contact with contaminated food and water.

Incubation: 3 to 7 days, usually under 10 days.

Period of Communicability: Usually 2-3 weeks.

Exclusion: CCFs: exclude all cases (attendees and staff, including food handlers) until 24 hours after diarrhea resolves, or 48 hours after completion of antibiotic therapy.

Reporting of Individual Cases: Report within one working day to 613-580-6744, ext. 24224.

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