Chapter 11, Preventing Communicable Diseases

This section of the manual covers childhood diseases and ways to prevent or control their spread to other children or staff members in the child care center. Control of these communicable diseases is important for several reasons: An increasing number of children attend child care, most diseases spread more easily in areas with a number of people and children are more susceptible than adults to many diseases.

For each disease, the manual will describe the disease, how it spreads, its symptoms, its incubation period (the time between development of the disease and the appearance of the first symptoms), its communicable period (the period in which it can be passed to others) and suggestions for preventing or controlling its spread.

UNIVERSAL PRECAUTIONS

Universal Precautions are to be used when handling any bodily secretions (urine, nasal/oral secretion, stool, or blood).

  • Gloves are to be worn when touching blood and bodily fluids, mucous membranes or non‑intact skin.
  • Gloves are to be changed after contact with each child.
  • Masks and protective eye wear should be worn during procedures that are likely to generate droplets of blood or other bodily fluids to prevent exposure of mucous membranes of mouth, nose and eyes.
  • Gowns should be worn during procedures that are likely to generate splashes of blood or bodily fluid.
  • Precautions should be taken to prevent puncture injuries.
  • All skin surfaces exposed to blood or other bodily fluids should be washed immediately and thoroughly.
  • Equipment for mouth-to-mouth emergency resuscitation should be readily available.

GOOD HAND WASHING PREVENTS THE SPREAD OF INFECTIONS!

There are four basic reservoirs for infections and diseases in the child care center:

  1. Intestinal Tract
  2. Respiratory System
  3. Skin
  4. Bodily Fluids (drool, blood, nose or eye discharge)
     
Book Chapter: 

Diseases Spread Through the Intestinal Tract

Child care centers that accept diapered children are at the greatest risk for the spread of diseases such as infectious diarrhea. Diseases that spread through contact with stool are among the most common in child care centers.

Children washing handsThese diseases are spread in several ways. Young children who are diapered usually do not wash their hands and are in frequent contact with each other. Child care providers also spread the germs when they do not wash their hands thoroughly after changing diapers or after helping a child in the bathroom.

Because intestinal tract illnesses are so easily spread, good hand washing is especially important. Children and staff members should be taught to consider all stools to be infectious.

Thorough HAND WASHING alone may reduce the incidence of diarrhea in child care centers by as much as 50 percent.

Some simple rules to prevent the spread of all intestinal tract diseases are:

  • Encourage frequent and thorough hand washing for staff and children.
  • Consider using gloves when changing diapers.
  • Do not allow staff members who prepare the food to change diapers.
  • Separate children into three groups if possible: infants, diapered children and toilet-trained children. Try to have each staff member work with only one group of children.
  • Disinfect diaper-change areas after every diaper change.
  • Change diapers only in diapering area.
  • Separate diapering area from food storage, preparation and eating area.
  • Wash hands after diapering, helping a child in the bathroom and before preparing or eating food.
  • Wash the child’s hands after he or she goes to the bathroom.
  • Clean and disinfect diapering areas, potty chairs, toilets and toys daily or when soiled.

Regularly scheduled environmental cleaning, e.g., vacuuming, sweeping, dusting and washing, is essential to the prevention of infectious agents. Standard household cleaning materials are adequate for most environmental surfaces; however ALWAYS follow manufacturing instructions to prevent potential toxicity from the cleaners.

Contaminated nonfood surfaces: Mix 1/2 to 3/4 cup bleach in 1 gallon water  Saturate area with the solution (contaminated material plus cleansing agent or bleach); leave the bleach solution on the surface(s) for few minutes, then thoroughly rinse with clean water and dry with a clean cloth. Tap water can be used as the rinse if the water source is from a municipal water system.

If the area is saturated with blood or blood products, then the solution should be 1-1/2 cups of bleach per gallon of water.

For mouthed toys or eating utensils: Boil either using a dishwasher or soak items for 2 minutes in a bleach solution of 1/2 cup bleach to 1 gallon of water. Then, rinse items thoroughly with clean water and air-dry. Bleach will corrode metal.

Infants should not be given shared, non-washable soft toys that may be contaminated with infectious secretions.

Prepare new solution daily because it loses its ability to kill germs over time.

  • Soiled diapers should be stored in covered containers (preferably with a foot-operated lid), away from food and material used by children and staff.
  • Stool from cloth diapers should be emptied in the toilet. Diapers should be placed in plastic bags, stored and sent home each day with the child.

The diaper-changing surface should be covered with a smooth, moisture resistant, cleanable cover.

DIARRHEA

What is it?

Diarrhea is characterized by an increase in the usual number of stools, and they are loose, watery and unformed. Diarrhea can be caused by many different infectious germs, including bacteria, viruses or parasites. The three most common are Shigella, Giardia, and Rotavirus. Since child care providers will not know the specific cause of the diarrhea, you should treat all diarrheas as if they resulted from a contagious organism.

How does it spread?

It is spread as the result of direct contact with infected stool or objects (e.g., toys, eating utensils, etc.) contaminated with infected stool. Infectious germs from the stool can be spread when contaminated hands, food or objects are placed in the mouth. When people do not wash their hands well after using the bathroom, changing diapers or helping a child go to the bathroom, the germs stay on their hands and can be spread to food, drink or objects, and eventually to others’ mouths. These germs are then swallowed, and multiply in the intestine and cause an infection.

What are the symptoms?

Depending on the cause of the diarrhea, symptoms can include: fever; loose, watery stools, bad-smelling stools, gas, stomach cramps, nausea, lack of appetite, possible weight loss, stools with blood or mucus and/or vomiting. This can lead to dehydration in the child. Dehydration is characterized by:

  • Decreased urine output; child does not pee or wet diaper for six hours
  • Tongue, lips, inside of mouth dry
  • No tears when child cries
  • Dry skin
  • Child appears thirsty
  • Sunken eyes; sunken soft spot on heads in infants
  • Child does not move around much or show interest in things around him/her

What is the incubation period?

The length of time depends on the infectious germ or virus – usually one day to three weeks.

What is the period of communicability?

Diarrhea can spread as long as infectious germs are present in the stool.

STEPS TO TAKE FOR DIARRHEA SYMPTOMS:

  • Treatment for diarrhea should be determined by the parent and a physician. Call early to prevent dehydration.
  • Separate and exclude children and staff from child care center who have diarrhea until they are seen by their health care provider.
  • Tell parents to inform the health care provider that their child attends a child care center and whether or not any other children or child care staff are ill with diarrhea. This information will influence whether the physician obtains a stool culture and notifies the health department.
  • Notify the health department if the child is diagnosed with a reportable disease (e.g., E Coli, Salmonella, Shigella, etc.).
  • Notify the health department if there is more than one child or staff person at the child care center with symptoms of diarrhea.
  • You can contact the local health unit or call 501-661-2893.
  • Since certain infections require follow-up stool specimens before returning, the health department will authorize the date a child or staff member can return to the child care center.
  • Encourage that young infants receive the rotavirus vaccine.

Children or child care staff who have been excluded for diarrhea may return to the child care center if the following criteria are met:

  1. The individual(s) must be diarrhea-free (no symptoms).
  2. If the health department is involved with the investigation, they will authorize the date of return after a determination is made that the diarrhea is not a health hazard to other children and staff at the child care center.
  3. If a health care provider was seen, you may wish to request a note from the physician.
  4. Reeducate staff about hand washing and diapering procedures that may prevent the spread of disease.


HEPATITIS A

Contact the local health unit for medical recommendations or call 501-661-2893.

What is it?

Hepatitis A is a viral infection that causes inflammation of the liver and spreads throughout the intestinal tract. Hepatitis A is very contagious and quickly spreads in groups of children, although the major victims of the outbreaks are not the children but their adult contacts (such as child care providers or parents).

How does it spread?

Hepatitis is usually spread by the stool‑to‑mouth method, since the hepatitis A virus is passed out of the body in stool. It can also be spread by stool‑contaminated food, drink or objects such as toys. The virus is not found in urine or saliva, and lives for only a short time in blood. It spreads quickly in groups of small children who aren’t toilet trained and who cannot wash their own hands.

What are the symptoms?

Young children with hepatitis A may have no symptoms or may have a mild, flu‑like illness. The virus spreads silently among the children and usually becomes evident only when it infects adult contacts. Adults who have hepatitis A may feel sick for a longer period and have loss of appetite, yellowing of the skin and whites of their eyes (jaundice), dark brown urine, nausea, loss of appetite, and fever or tiredness.

What is the incubation period?

Two to six weeks (15-50 days) after a person is exposed to the virus

What is the period of communicability?

From two weeks before to ten days after the onset of the symptoms

How can I prevent or control the spread of the disease

Notify and consult with the local health unit in your area or call 501-661-2893.

  • Exclude children and adults with acute hepatitis A from child care centers for at least 10 days after the onset of the illness. Their date of return will be determined by the local health unit.
  • Notify all parents if a child or staff member is diagnosed with hepatitis A.
  • There is no treatment for hepatitis A once you have the infection; however, the illness may be prevented by a protective shot of immune globulin (IG) (if given within two weeks of exposure to the virus) or hepatitis A vaccine.
  • The health department will offer and administer IG or hepatitis A vaccine if officials determine it is appropriate treatment.
  • For long-term protection, a hepatitis A vaccine is now available for children ages 1 year and up. The health department does provide hepatitis A vaccine for children 12 months through age 18 years old, or it can be obtained from a private physician if a parent chooses.
  • Thorough hand washing is the best way to prevent the spread of infectious diseases found in the intestinal tract.
  • Clean and disinfect contaminated areas, such as diapering areas, toys, potty chairs and toilets daily or when soiled. (The hepatitis A virus may survive on these areas for weeks.)

NOTE: Control of hepatitis A in a child care center does not include closing the center.

PINWORMS

What is it?

Pinworms are intestinal worms that infect primarily preschool and school-aged children (although they can infect adults as well). The worm usually enters the body as an egg through contaminated food. It hatches and develops in the intestine. A pinworm is tiny and resembles a white thread that comes through the rectum at night and lays eggs around the opening of the rectum.

How does it spread?

Pinworms can be spread when infected children scratch the rectal area. The eggs laid by the pinworm are transferred to their hands, and if their hands aren’t washed properly, the eggs may be spread to food or other objects and eventually will be swallowed. Pinworms can also be spread through contact with contaminated clothing or bedding.

What are the symptoms?

Pinworms cause rectal itching (especially at night when the pinworm comes out and lays its eggs); white, thread‑like worms in stools and sleeplessness caused by the itching.

What is the incubation period?

Four to six weeks

What is the period of communicability?

As long as the eggs are present.

How can I prevent or control the spread of the disease?

  • The infected child should be excluded until treatment has begun.
  • All parents and staff members should be notified so they can watch the child for symptoms of pinworms.
  • Washing hands after going to the bathroom and after contact with the rectal area, and before eating and preparing foods is the best way to prevent the spread of pinworms.
  • Keep fingernails short.
  • Contaminated bedding and clothing should be changed daily and washed in hot water.
  • To prevent the spread of pinworms, each child should have their own sheets and sleeping supplies.
Book Chapter: 

Diseases Spread Through the Respiratory System

Another group of diseases common in child care groups is respiratory infections. These diseases are spread through droplets from nose, eye or throat secretions. Respiratory tract illnesses range from the common cold to more serious illnesses such as whooping cough or bacterial meningitis.

Respiratory diseases can spread through the air when a person coughs, sneezes, speaks or blows his or her nose. They can also be spread by objects contaminated with saliva or nasal secretions. In fact, an infected person often spreads the disease before coming down with symptoms.

The spread of many of these diseases can be avoided by thorough hand washing after coming in contact with secretions and potentially contaminated objects. Proper disposal of soiled tissues is also important.

Some simple rules to stop the spread of all respiratory system diseases are:

  • Hand washing and cleanliness are the best ways to prevent the spread of these diseases.
  • Wash hands thoroughly after contact with nose, throat and eye secretions, and before preparing and eating food.
  • Do not allow food to be shared.
  • Wash and disinfect mouthed toys daily.
  • Use disposable towels and tissues.
  • Dispose of tissues in a covered container.

THE COMMON COLD

What is it?

A “cold” is the most common viral illness in children. There are more than 100 viruses that cause colds.

How does it spread?

Droplets from the nose, eye or throat, and direct contact with these infected secretions. When an infected person talks, coughs, sneezes or blows his nose, infectious droplets get into the air where they can be breathed in by another person. Droplets also can land on objects such as toys, countertops or food, and can be mouthed or touched by another person. These viruses can survive for hours on most surfaces.

Hand‑to‑mouth contact is the most frequent means of spreading a cold.

What are the symptoms?

Symptoms of a cold include a stuffy or runny nose, sore throat, coughing, sneezing, watery eyes, fever, fatigue and irritability.

What is the incubation period?

One to three days

What is the period of communicability?

A person can spread a cold shortly before symptoms begin and for the duration of the symptoms. The viruses are most infectious during the 24 hours before the onset and during the peak of the symptoms.

How can I prevent or control the spread of the infection?

  • There is no need to exclude children and staff who have colds, unless they have significant fever.
  • Children should be allowed to return to the child care center after the fever has been gone for 24 hours.
  • Good hand washing after sneezing or coughing, or when in contact with any secretions is the first line of defense.
  • Cover mouth with tissue when coughing and sneezing, then dispose of tissue immediately.
  • Clean and disinfect mouthed toys daily or when soiled. Try to avoid sharing of toys when colds are present.
  • Do not give aspirin for fever control. Reye’s Syndrome has been known to result from giving aspirin to children.
  • There is no treatment that can cure a “cold.” Therefore, rest, fluids and medication are used to relieve the symptoms.

STREP THROAT

What is it?

“Strep throat” is a bacterial infection characterized by a red and painful throat. Strep throat occurs most frequently in children older than 3 years, during the colder months and in crowded situations. Since viruses can also cause similar symptoms, children should be seen by a physician for an accurate diagnosis and treatment.

How does it spread?

Through nose and throat secretions of the infected person. It is easily spread within the family and, therefore, easily spread in a child care setting.

What are the symptoms?

The common symptoms of strep throat are a red, painful throat; fever; swollen neck glands and a headache.

What is the incubation period?

One to three days

What is the period of communicability?

Strep throat can be spread until at least 24 hours (and in rare cases, 48 hours) after treatment has begun.

How can I prevent or control the spread of the disease?

  • A child or staff member with a severe sore throat and/or other symptoms of strep throat should be sent home. They need to be seen by a physician or health care provider for a rapid strep test or a throat culture and/or treatment.
  • A child with a positive strep test or culture should be excluded from the child care center until 24 hours after antibiotic treatment is begun.

Prevent the spread of strep throat by following good hand-washing techniques.

  • Thoroughly wash your hands after wiping or blowing noses, after contact with any nose, throat or eye secretions and before preparing or eating food.
  • Do not allow food to be shared.
  • Wash and disinfect mouthed toys at least once every day, more often if necessary.
  • Teach children and staff to cough or sneeze into their shoulder or sleeve or into a tissue, which must be properly disposed of. Then wash hands thoroughly.
  • Use disposable towels and tissues.

CHICKEN POX

Contact the local health unit for medical recommendations or call 501-661-2893.

What is it?

Chicken pox is a very common, contagious childhood disease.

How does it spread?

Through droplets of fluid expelled from the mouth and nose during sneezing or coughing, or by direct contact with the chicken pox blisters.

What are the symptoms?

The major symptom is small blisters, usually on the chest, back, arms, legs and face. These blisters cause extreme itching. Scratching them can cause an infection and can spread the blisters. Symptoms can also include fever, a generalized achy feeling and headache one to three days before the rash/vesicles appear.

POST-IMMUNIZATION “Breakthrough”

A small percentage of chicken pox cases can occur in previously vaccinated persons. This is called a “breakthrough” rash with only a few lesions that resemble insect bites. The same rules for exclusion from child care centers apply for these cases.

What is the incubation period?

Ten to twenty-one days after exposure

What is the period of communicability?

From one to two days before the child “breaks out” until all blisters/vesicles are dried and crusted over

How can I prevent or control the spread of the infection?

  • Exclude the child/staff from the child care center until all blisters/vesicles are dried.
  • Children with a compromised immune system should be seen promptly by a physician (e.g., any child taking steroid medication, any child who has ever been treated for cancer or leukemia, or any child with AIDS).
  • When a pregnant woman who has not had chicken pox is exposed, she should contact her physician immediately.
  • Child care providers who have not had chicken pox should consult a physician if they are exposed to the illness.
  • Aspirin is not recommended because of its possible link with Reye’s Syndrome.
  • Chicken Pox Vaccine (Varivax) is routinely given to children 12 months of age and older.
  • The best way to prevent the spreading of chicken pox is through good hand-washing and cleaning procedures.
  • Contact the health department for instructions about notifying  parents/guardians if there is a case of chicken pox in your child care facility.

SHINGLES (Herpes Zoster)

Shingles infection is a reactivation of the varicella zoster virus (chicken pox).

Anyone who has had chicken pox can develop shingles if their immune system becomes weak from factors such as aging, injury, illness, etc.

Exposure to shingles will not cause shingles. However, if a person has not had the chicken pox disease or the chicken pox vaccine, that person may develop chicken pox from exposure to shingles.

MENINGITIS

Contact the local health unit for medical recommendations or call 501-661-2893.

What is it?

Meningitis is an infection of the covering over the brain and the spinal cord. This disease is one of the most serious illnesses, affecting 1 child in every 400 under the age of 5. It can be caused by either viruses or bacteria, including Haemophilus influenzae type B (HIB), pneumococcus or meningococcus. Young children are at the greatest risk for acquiring meningitis.

How does it spread?

By respiration or stool from the infected child

What are the symptoms?

Symptoms include stiff neck, fever, vomiting, tiredness, headache, irritability, poor feeding, listlessness and inability to tolerate bright light. If untreated, meningitis can lead to coma, shock and death.

There are two types of meningitis, viral (“aseptic”) and bacterial. It is important to know whether meningitis is caused by a virus or bacteria because the severity of the illness and the treatments differ.

Although they exhibit most of the same symptoms, viral meningitis is generally less severe and clears up without specific treatment.

Bacterial meningitis can be quite severe and can result in brain damage, even death. Bacterial meningitis requires antibiotic treatment.

What is the incubation period?

One to ten days

What is the period of communicability?

Meningitis can be spread until 24 hours after treatment has begun.

How can I prevent or control the spread of the infection?

  • Meningitis is a medical emergency, and the child should be seen immediately by a physician.
  • Contact the Arkansas Department of Health for appropriate medical recommendations for children, staff and notification of parents.
  • Starting at age 2 months, HIB vaccine and pneumococcus (Prevnar or PCV13) vaccine are routinely given to infants and children to prevent certain types of bacterial meningitis.
  • Require that children are up to date on their immunizations. The HIB and pneumococcus (PCV13) vaccines are recommended vaccines for children.
  • For certain types of meningitis, antibiotics may be ordered by a physician for the children and staff who have close contact with the affected child.
     
Book Chapter: 

Diseases Spread Through Direct Contact (Touching)

Direct contact may easily spread infections in child care settings. A child or staff member can get these diseases simply by touching the infected area of another person’s body, secretions, or personal objects. Because of the inquisitive nature of young children, these infections spread easily in a child care setting.

Some simple rules to stop the spread of diseases that are spread by direct contact are:

  • Thoroughly wash hands after contact with possibly infectious secretions.
  • Dispose of tissues properly.
  • Use soap; disposable liquid soap dispensers are preferred.
  • Never use the same tissue, towel or washcloth for more than one child.
  • Wash, then disinfect toys at least daily.
  • Each child should have his/her own sleeping mat and sheets.
  • Do not allow children to share personal items such as brushes, combs, blankets, hats or clothing.
  • Store each child’s dirty clothing separately in plastic bags. Do not launder children’s clothing at the center.
  • Wash and cover all sores, cuts or scrapes promptly.
  • Report anything abnormal to the parents.

LICE

What are they?

Lice are small insects that live on the scalp and hair. The adult louse lays its eggs (nits) at the root of the hair where they become firmly attached. Lice may not be visible, but the eggs (nits) can be seen sticking to the hair shafts.

How do they spread?

By direct contact with the infected person or with personal objects such as hats, combs, bedding or clothing. Lice are not spread by pets, and cannot jump or fly.

What are the symptoms?

Itching is the most common symptom of head lice. Tiny pear‑shaped white eggs covering the roots of the hair may be seen. Often, red bite marks or scratch marks can be seen on the child’s scalp and neck. In some cases, there could be excoriations, secondary infections and lymphadenopathy present.

What is the incubation period?

Seventeen to twenty-five days

What is the period of communicability?

Until treatment has begun

How can I prevent or control the spread of the infection?

  • Infected children should be excluded until the morning after their first treatment. The risk of transmission is promptly reduced by treatment.
  • Proper treatment consists of shampoos or special lotions made for the purpose of killing lice. These products are available over the counter. A second treatment, 7‑10 days later, is usually recommended. Follow recommendations made by the shampoo instruction label.
  • Learn to recognize nits and regularly check children’s hair.
  • Avoid sharing hair care items such as brushes or combs, and items such as towels, bedding, clothing and hats.
  • Hang children’s clothing in individual lockers or on assigned coat hooks.
  • Check children for nits frequently throughout the year. Families of those children who were infected should also be checked.
  • All combs and brushes should be boiled for 10 minutes or soaked for 1 hour in 2 percent Lysol solution or pediculicide shampoo.
  • Vacuum floors, furniture and mattresses to get rid of lice.

SCABIES

What are they?

Scabies is a skin infection caused by a mite (a small insect of the spider family).

How does it spread?

By direct contact with an infected person. The mites can survive only a few days off the body and cannot jump or fly.

What are the symptoms?

A rash with severe itching, mostly at night, is the most common symptom of scabies. In children, the rash is most likely to appear on the head, neck, palms and soles of the feet, or between the fingers. The characteristic mite burrow consists of a short, wavy, dirty line on the skin.

What is the incubation period?

Two weeks to two months, depending on whether the infected person has had scabies before.

What is the period of communicability?

Scabies can be spread from the time a person acquires the mites until 24 hours after treatment begins.

How can I prevent or control the spread of the infection?

  • Temporarily exclude the child from the center until the day after treatment begins.
  • Treat infected children with medications that are effective against mites.
  • It might be necessary to treat the other children and caregivers in the child’s group as well as family members.
  • Wash in hot water all washable items belonging to the center that came into contact with the child’s skin 72 hours prior to treatment. Dry on hot cycle.
  • Place difficult to wash items in tightly closed plastic bags for four days
  • Vacuum any carpet or upholstered furniture.

IMPETIGO

What is it?

Impetigo is a contagious bacterial skin infection. It often occurs on the lips or nose but can occur anywhere on the body.

How does it spread?

By direct contact with the sores; sometimes it can be spread from secretions from the nose and throat.

What are the symptoms?

Common symptoms of impetigo are honey-crusted sores and a rash that looks oozy, red, round and itches. Tiny blisters form around the nose or mouth that ooze and then form scabs.

What is the incubation period?

One to ten days (usually five days)

What is the period of communicability?

Impetigo can be spread until sores are healed or the child has been on antibiotics for 24 hours.

How can I prevent or control the spread of the infection?

  • Parents should contact their physician for diagnosis and treatment.
  • Exclude the child until 24 hours after treatment has begun or until sores are healed.
  • Wash the child’s rash with soap and water. Put some type of covering over it in order to prevent spread.
  • The child’s hands should be washed frequently (especially after contact with the sores) with soap and water.
  • Change towels, linens and clothes at least daily.
  • Avoid using towels and linens used by the child.

RINGWORM

What is it?

Ringworm is a fungal infection of the skin and hair. Although ringworm is not serious and is easily treated, it is unattractive and irritating.

How does it spread?

By direct contact with infected skin or when a person comes in contact with contaminated objects. This can include animals, soil, towels, bedding, etc.

What are the symptoms?

The characteristic rash, or ringworm, is round with red or gray scaly patches. The edges may be raised, reddish and itchy. The center often looks like normal skin. On the scalp, the infection often begins as a small patch and eventually causes temporary hair loss. It may progress to patches of scaling and baldness.

What is the period of communicability?

Ringworm can be spread as long as the infected lesions are present.

How can I prevent or control the spread of the infection?

  • Refer the child to the physician for a diagnosis and treatment.
  • An infected child should be excluded only until treatment has begun.
  • Parents and staff members should be notified if more than one person develops ringworm.
  • The child care should be kept clean, dry and cool, since ringworm fungi grow in a moist, warm environment.
  • Children should not share personal items such as hats, combs, towels or bedding.
  • Good personal hygiene should be practiced.

CONJUNCTIVITIS (PINKEYE)

What is it?

Conjunctivitis is an inflammation of the conjunctiva (membrane covering the eyeball). It can be caused by either a virus or bacterial infection.

How does it spread?

Through direct contact with infected secretions of the eye, nose and throat. It can also be spread when staff members wash or dry an infected child’s face and use the same towel on another child.

What are the symptoms?

The most common symptom of conjunctivitis is pink around the white parts of the eyes. The infected eyes also produce tears and discharge, pus and may itch or be swollen. Often the child’s eyelids stick together in the morning because of the secretions during sleep.

What is the incubation period?

One to three days

What is the period of communicability?

Pinkeye can be spread until the active infection passes (for viral) or until 24 hours of treatment (for bacterial).

How can I prevent or control the spread of the infection?

  • Refer the child to the physician for proper diagnosis, particularly if there is yellow or heavy eye discharge.
  • If pinkeye is caused by a bacterial infection *and requires antibiotic eyedrops, exclude the child until after treatment begins.
  • Use a separate cloth and towel to wash each child’s face.
  • Practice good hand washing after every contact with children’s eyes.
  • Dispose of contaminated tissues properly.
  • Clean with soap and water, and disinfect mouthed toys or toys that come in contact with the children’s eyes daily or when soiled.
  • Keep the child’s eyes wiped free of discharge and wash hands after contact with the child’s eyes.
  • Teach children to wash their hands after wiping their eyes and to try to avoid rubbing their eyes.

Note: The AAP says specifically NOT to exclude a child with nonpurulent conjunctivitie.
 

Book Chapter: 

Diseases Spread Through Bodily Fluids

(BODY SECRETIONS or BLOOD)

Some very serious illnesses are spread through contact with infected bodily fluids. Fortunately, these diseases are not common in child care centers. But they are so serious that staff members should be acquainted with them and with ways to prevent them.

The viruses that cause illnesses can be spread when blood containing the virus enters the blood stream of another person. This can happen when the skin is punctured or when an infected mother transmits the infection to her newborn infant during the birth process.

Some simple rules to help prevent the spread of diseases due to blood contact:

  • Treat all blood secretions as if they were infectious.
  • Use disposable gloves when handling blood or items soiled by blood or bodily fluids (urine, feces, vomitus, saliva or nasal secretions).
  • Clean all blood spills promptly and then disinfect the area with a bleach solution.

CYTOMEGALOVIRUS (CMV)

What is it?

CMV is a common virus that is harmless to most people, but it is the leading cause of congenital viral infections transmitted through pregnant women to their developing fetuses. Thus, CMV is a concern mainly to the women in the child care center and to mothers in their childbearing years who have children attending the child care center.

If a pregnant woman who has never had CMV becomes infected, especially during the first trimester, the fetus may also become infected. If this happens, the fetus may suffer mental retardation, hearing loss, seizures or blindness. It is estimated that 10‑80 percent of children in child care centers excrete CMV in their urine (depending on their age).

How does it spread?

CMV is present in the urine, saliva, blood, tears, stools, cervical secretions and semen of infected individuals. Transmission of CMV results from close personal contact with infected individuals, often children or sexual partners. A pregnant woman can transmit the virus to her developing fetus and can also transmit the virus to the newborn in the birth canal. Mothers can also transmit the virus in their breast milk. Transmission can also occur through the transfusion of infected blood products.

Contagion between children may occur by sharing mouthed objects or toys that have infected saliva on them, since CMV virus has been found on toys. Another source is contact with urine or stool when changing the child’s diapers. This virus can be spread from one person to another if good hand-washing techniques are not utilized after changing diapers. CMV has been shown to spread in child care centers, most often from toddlers who lack control of bodily secretions.

What are the symptoms?

In most cases, CMV causes no symptoms. Occasionally, children or adults with CMV will experience mononucleosis‑like symptoms such as fever, swollen glands and fatigue.

What is the incubation period?

Unknown

What is the period of communicability?

The virus may be present in the urine or saliva for an indefinite period.

How can I prevent or control the spread of the infection?

  • Children known to have CMV do not need to be excluded from the child care center, since other children may also have CMV.
  • Since most infected children will not be identified, saliva and urine should always be treated as potentially infectious.
  • Child care providers should always practice good personal hygiene. This includes frequent hand washing, especially after changing diapers, assisting in the bathroom or coming into contact with a child’s saliva or other bodily secretions.
  • Kissing any child on the mouth should be minimized, especially if the child is known to have CMV.
  • Routinely clean and disinfect items contaminated with saliva or urine using a strong bleach solution of 1/2 to 3/4 cup of bleach in 1 gallon of water. Leave the solution in contact with the surface for a few minutes, then thoroughly rinse with clean water and dry with a clean cloth.
  • Do not allow sharing of personal items that may have been contaminated with blood or bodily fluids such as tooth brushes, washcloths or toys.
  • There is no need to report CMV.
  • Pregnant women should avoid hands-on contact with infants with congenital CMV infections.
     
Book Chapter: 

Instructions for Reporting Communicable Diseases

to the Arkansas Department of Health

The “Rules and Regulations Pertaining to Communicable Disease Control” adopted by the Arkansas State Board of Health in 1977 pursuant to the authority conferred by Act 96 of 1913 (Arkansas statutes, 1947, Section 82-110) Section III, states “The responsibility for reporting certain communicable diseases is the duty of EVERY physician, practitioner, nurse, superintendent or manager of a dispensary, hospital, clinic, nursing or extended care home and laboratory personnel examining human specimens resulting in the diagnosis of notifiable diseases or any person in attendance on a case of  any disease or conditions declared notifiable.”

The following diseases (suspected or confirmed) are to be reported immediately to the Arkansas Department of Health.  They are of special importance or may indicate a bioterrorism event.

Anthrax Botulism Hepatitis-A Meningococcal Inf.
Pertusss Plague Q-Fever SARS
Smallpox Tularemia Typhus Viral Hemorrhagic Fevers
Emerging Threat Agents

TO REPORT DISEASES IMMEDIATELY VIA TELEPHONE,
CALL 501-661-2893 (Local/Pulaski Co. – 8 a.m.-4:30 p.m., M-F)
AFTER HOURS AND ON WEEKENDS, PLEASE CALL 1-800-554-5738

The following diseases of public health significance are to be reported to the Arkansas Department of Health within 24 hours of diagnosis.  Reports should include:  1) the reporter’s name, location and phone number; 2)  the name and onset date of the disease;  3) the patient’s name, address, phone number, age, sex and race;  4) the attending physician’s name, location and phone number;  5) any pertinent clinical, laboratory, and treatment information.  Report by Fax to 501-661-2428;  24-hour  answering machine 800-482-8888;  in person to 501-661-2893.

The following bacterial isolates must be submitted to the State Health Department Laboratory for further testing:

Aids
Blastomycosis
Brucellosis
CD4+ T-Lymphocyte Count
Campylobacteriosis
Chancroid
Chlamydial infections
Cholera
Congenital Rubella Syndrome
Congenital Syphilis
Creutzfeld-Jakob Disease
Cryptosporidiosis
Cyclosporiasis
Diphtheria
Ehrlichiosis
Encephalitis, all types
Enterotoxigenic E. coli
Food poisoning, all types
Giardiasis
Gonorrhea
Haemophilus influenzae, invasive    
   disease
Hantavirus Pulmonary Syndrome
Hemolytic-Uremic Syndrome
HbsAg-positive pregnant female
Hepatitis (type A, B, C or
   Unspecified Histoplasmosis)
HIV (Human Immunodeficiency
   Virus)
Influenza (viral type, if known)
Influenza deaths in persons
   < 18 years old
Kawasaki Disease
Legionellosis
Leprosy (Hansen’s disease)
Listeriosis
Lyme Disease
Malaria
Measles (Rubeola)
Meningitis
Mumps
Poliomyelitis
Psittacosis
Rabies, animal
Rabies, human
Rheumatic fever

 

Rocky Mountain Spotted Fever
Rubella
Salmonellosis (including Typhoid)
Shigellosis
Streptococcal Disease, invasive,
   group A
Strep. Pneumoniae, Invasive,
   Indicate if antibiotic resistant
Syphilis**
Tetanus
Toxic Shock Syndrome
Toxoplasmosis
Tuberculosis
Vancomycin-resistant enterococci
Varicella (chicken pox)
West Nile Virus
Yellow Fever

REPORTABLE OCCUPATIONAL
DISEASES AND OTHER CONDITIONS

Asbestosis
Blood Lead Levels*
Byssinosis
Chemical Poisoning, All Types***
Pesticide Poisoning
Pneumoconiosis (Coal Workers)
Mesothelioma
Silicosis

REPORT ANY UNUSUAL DISEASES OR OUTBREAKS THAT MAY REQUIRE PUBLIC HEALTH ASSISTANCE

* Blood lead levels over 10 ug/dl for patients 14 years or younger and levels over 25 ug/dl for patients 15 years old and up.

**Any woman infected with AIDS, HIV or Syphilis who is pregnant must be so reported indicating the trimester of pregnancy. This applies each time the woman becomes pregnant.

***Includes chemical agents of  terrorism

Neisseria meningitidis; Salmonella sp.; Enterotoxigenic E. coli; Listeria sp.; Staph. aureus, vancomycin resistant or intermediate susceptible; outbreak-related Campylobacter sp. and Shigella sp., or on request; Haemophilus influenzae (invasive).

TO REPORT DISEASES IN THE SECOND LIST ABOVE, PLEASE CALL THE NONEMERGENCY DISEASE-REPORTING SYSTEM AT  1-800-482-8888  OR FAX A DISEASE REPORT TO 1-501-661-2428
 

Book Chapter: 

Quick Guide To Communicable Disease Control

Quick Guide to Communicable Diseases Control

Quick Guide to Communicable Diseases Control

Quick Guide to Communicable Diseases Control

Quick Guide to Communicable Diseases Control

Quick Guide to Communicable Diseases Control

Report all cases of communicable diseases to the local health unit or call 501-661-2893.

Book Chapter: