TABLE OF CONTENTS GUIDE TO INFECTIOUS DISEASES FOR SCHOOLS AND DAY CARE CENTERS CHICKENPOX COMMON COLD 1-2 CONJUNCTIVITIS CROUP DIARRHEAL DISEASES CAMPYLOBACTERIOSIS 3-4 GIARDIASIS SALMONELLOSIS SHIGELLOSIS 5-6 YERSINIOSIS FIFTH DISEASE FLU 7-8 GERMAN MEASLES 8-9 HAND, FOOT AND MOUTH DISEASE HEAD AND BODY LICE 9-10 HEPATITIS A 10-11 HEPATITIS B 11-12 IMPETIGO 12 MEASLES 12-13 MENINGITIS (BACTERIAL) 13-14 MENINGITIS (ASEPTIC-VIRAL) 14 MONONUCLEOSIS 15 MUMPS 15-16 RINGWORM 16 SCABIES 17 SCARLET FEVER 17-18 THRUSH 18 Allegheny County Health Department Divisions of Infectious Diseases Phone (412) 578-8060 TUBERCULOSIS 19 WHOOPING COUGH (PERTUSSIS) 19-20 WORMS 20-21 SEXUALLY TRANSMITTED DISEASES GONORRHEA 21-22 CHLAMYDIA 22-23 SYPHILIS 23-24 PRINT CLOSE ANIMAL BITES 24-25 CHICKENPOX (Varicella) INCUBATION AND SYMPTOMS METHODS OF SPREAD Direct contact with an infected person, or indirectly by contact with articles freshly soiled by discharge from nose and throat of the infected person MINIMUM CONTROL MEASURES Infectious Agent: Varicella - Zoster Virus (herpesvirus 3) Incubation: 2-3 weeks, usually 13-17 days; may be prolonged after passive immunization against varicella and in the immunodeficient Symptoms: Sudden onset of slight fever, skin rash consisting of small blisters which leave scabs Eruptions occur in crops Pimples, blisters and scabs may all be present at the same time Period of Communicability: Usually 24 hours before onset of symptoms and until days after onset Control: Exclude from school/center until child is able to resume normal activities CONJUNCTIVITIS METHODS OF SPREAD Direct contact with or droplet/airborne spread of respiratory secretions of an infected person (Pink Eye) INCUBATION AND SYMPTOMS MINIMUM CONTROL MEASURES Period of Communicability: As long as days, but usually 1-2 days before onset of rash/blisters, and until all vesicles are dry Infectious Agents: Haemophilus influenzae, Streptococcus pneumoniae, et al Incubation: Usually 24-72 hours Control: Exclude from school/center for days from the last crop of vesicles, or until vesicles become dry Concurrent Disinfection: Disinfect articles soiled by discharge from the nose and throat, and from lesions OTHER INFORMATION Children with leukemia or otherwise immunocompromised are at increased risk for complications Symptoms: Eyes are red, watery, itchy and sensitive to light; eyelids are frequently swollen METHODS OF SPREAD Direct contact with eye and upper respiratory tract discharges of infected persons, or indirectly by contact with contaminated articles of person infected, including eye makeup applicators and multiple dose eye medication droppers MINIMUM CONTROL MEASURES COMMON COLD INCUBATION AND SYMPTOMS Incubation: 12-72 hours, usually 48 hours Period of Communicability: Duration of active infection Control: Exclude from school/center until 24 hours after start of appropriate treatment, or until physician certifies as non-infectious Symptoms: Irritated throat, watery discharge from nose and eyes, sneezing, chills and general body discomfort -1- -2- CROUP INCUBATION & SYMPTOMS Incubation: Variable, depending upon causative agent Symptoms: Acute respiratory infection which involves the larynx, trachea and bronchi, and causes severe respiratory distress METHODS OF SPREAD Direct contact with an infected person, or indirectly by contact with articles freshly soiled by discharge from nose and throat of the infected person MINIMUM CONTROL MEASURES Period of Communicability: Duration of active disease Control: Exclude from school/center until symptoms are gone or physician authorizes return METHOD OF SPREAD By ingestion of the organism in food or in unpasteurized milk or water; from contact with infected pets (especially puppies and kittens) or farm animals Person-to-person transmission has been reported in day care when children are in diapers (i.e., incontinent of stool) MINIMUM CONTROL MEASURES Period of Communicability: Throughout the course of infection, usually from several days to several weeks Individuals not treated with antibiotics excrete the organism for as long as 2-7 weeks Control: Children attending or employees associated with day care, preschool, Headstart or nurseries may not attend the center if they are symptomatic To minimize the risk of transmission, emphasize thorough handwashing by children and staff before eating and after toilet use and diaper changes Persons handling and preparing food should give particular attention to handwashing OTHER INFORMATION GIARDIASIS Medical attention may be necessary DIARRHEAL DISEASES This Section has been prepared for the most common diarrheal diseases If your school/center is experiencing an outbreak of diarrhea, please contact the Health Department while waiting for a confirmation of a specific disease NOTE: The Health Department is to be notified immediately of any person in the school/center diagnosed with any of the following diseases: PROPER HANDWASHING IS THE MOST EFFECTIVE MEANS OF PREVENTING THE SPREAD OF DIARRHEAL DISEASES CAMPYLOBACTERIOSIS INCUBATION & SYMPTOMS INCUBATION & SYMPTOMS Infectious Agent: Giardia lamblia Incubation: 5-25 days or longer; median 7-10 days Symptoms: It is common not to have symptoms However, symptoms may include chronic diarrhea, abdominal cramps, bloating, frequent loose, pale and greasy stools, fatigue and weight loss METHOD OF SPREAD Person-to-person transmission occurs via the fecal/oral route May also be spread by ingestion of water or food contaminated with feces MINIMUM CONTROL MEASURES Period of Communicability: Entire period of infection Infectious Agents: Campylobacter jejuni, et al Incubation: Usually 3-5 days, with a range of 1-10 days Symptoms: Diarrhea, abdominal pain, fever, nausea, vomiting, and a general feeling of sickness -3- Control: Children or employees associated with day care, pre-school, Headstart, or nurseries may not attend the center if they are symptomatic To minimize the risk of transmission, emphasize thorough handwashing by children and staff before eating and after toilet use and diaper changes Persons handling and preparing food should give particular attention to handwashing -4- SALMONELLOSIS INCUBATION & SYMPTOMS Infectious Agent: Salmonella enteritidis, S typhimurium, et al Incubation: 6-72 hours, usually 12-36 hours Symptoms: Sudden onset of headache, abdominal pain, diarrhea, nausea, and sometimes vomiting Dehydration, especially among infants, may be severe Fever is almost always present METHODS OF SPREAD Exposure to feces of infected animals, including household pets; ingestion of contaminated food or water, undercooked foods, or improperly stored foods Likelihood of transmission from person to person is greatest when diarrhea is present This occurs chiefly in very young children (i.e., less than year) METHOD OF SPREAD Person-to-person contact either by direct or indirect transmission Individuals most responsible for the spread of disease are those who fail to thoroughly wash hands and under fingernails after bathroom use They may then spread infection to others directly by physical contact or indirectly by contaminating food Flies may transfer the organism onto a non-refrigerated or improperly covered food item MINIMUM CONTROL MEASURES Period of Communicability: Entire period of infection Individuals without symptoms may transmit the disease Control: Children or employees associated with day care, pre-school, Headstart or nurseries may not attend the center until they have been cleared by the Health Department To minimize the risk of spread, emphasize thorough handwashing by children and staff before eating and after toilet use and diaper changes Persons handling and preparing food should give particular attention to handwashing MINIMUM CONTROL MEASURES Period of Communicability: Throughout the course of infection; extremely variable, usually several days to several weeks (Temporary carrier state occasionally continues for months, especially in infants.) Control: Children or employees associated with day care, pre-school, Headstart or nurseries may not attend the center if they are symptomatic To minimize the risk of spread, emphasize thorough handwashing by children and staff before eating and after toilet use and diaper changes Persons handling and preparing food should give particular attention to handwashing SHIGELLOSIS INCUBATION & SYMPTOMS Infectious Agent: genus Shigella Incubation: 12-96 hours (usually 1-3 days), and up to one week for S dysenteriae Symptoms: Characterized by diarrhea, fever and nausea, sometimes vomiting and cramps YERSINIOSIS INCUBATION & SYMPTOMS Infectious Agent: genus Yersinia Incubation: Usually 3-7 days, generally under 10 days Symptoms: Acute, watery diarrhea (especially in young children), fever, headache, pharyngitis, anorexia, vomiting Method of Spread: Eating and drinking food and/or water that has been contaminated with feces, or by contact with infected persons or animals MINIMUM CONTROL MEASURES Period of Communicability: At least as long as symptoms are present, usually 2-3 weeks Untreated cases may excrete the organism for 2-3 months Control: Children or employees associated with day care, pre-school, Headstart or nurseries may not attend the center if they are symptomatic To minimize the risk of spread, emphasize thorough handwashing by children and staff before eating and after toilet use and diaper changes Persons handling and preparing food should give particular attention to handwashing END OF DIARRHEAL DISEASES -5- -6- FIFTH DISEASE (Erythema Infectiosum) INCUBATION & SYMPTOMS Infectious Agent: Parvovirus B19 Incubation: Variable; from 4-20 days until development of rash Symptoms: Characteristic is a striking erythema of the cheeks (slappedface appearance), followed in 1-4 days by a lace-like rash on trunk and extremities which fades but may reappear Differentiation from rubella and scarlet fever is often necessary METHODS OF SPREAD METHODS OF SPREAD Direct contact with an infected person through droplet spread of nose and throat secretions; primarily spread among crowded populations in enclosed spaces Rarely, influenza may be transmitted by air-borne particles MINIMUM CONTROL MEASURES Period of Communicability: Probably 3-5 days from clinical onset in adults; up to days in young children Control: Exclude from school/center until symptoms are gone OTHER INFORMATION Routine immunization is NOT recommended for children Contact with infected respiratory secretions GERMAN MEASLES MINIMUM CONTROL MEASURES Period of Communicability: Greatest before onset of rash, probably not communicable after onset of rash (Rubella) INCUBATION & SYMPTOMS Control: Children with Fifth Disease NOT need to be excluded from school since they are not contagious once the rash occurs Concurrent Disinfection: Routine handwashing and proper disposal of tissues used while sneezing, coughing and nose blowing are indicated to reduce the spread of Fifth Disease FLU (Influenza) INCUBATION & SYMPTOMS Infectious Agents: Influenza virus types A, B and C Infectious Agent: genus Rubivirus Incubation: 16-18 days, with a range of 14-23 days Symptoms: Skin rash and mild fever Glands at back of head behind ear and along back of neck are often enlarged Up to half the infections occur without evident rash METHODS OF SPREAD Infection is by droplet spread, contact with nasopharyngeal secretions, or direct contact with infected person MINIMUM CONTROL MEASURES Incubation: Short, usually 1-5 days Period of Communicability: Highly communicable from a few days before to at least days after the onset of rash Symptoms: Abrupt onset of fever, chills, headache and sore muscles Runny nose, sore throat and cough are common Nausea, vomiting and/or diarrhea may occur, particularly in children Control: Exclude from school/center for at least days after the onset of rash -7- -8- OTHER INFORMATION Suspected cases should be reported by phone to the Health Department Immunization of all children attending school is required by law While mild in children, the disease when contracted by a pregnant woman may cause serious consequences to the unborn child HAND, FOOT AND MOUTH DISEASE (HFMD) Symptoms: Irritation and itching of scalp or body; presence of small light grey insects and/or their eggs (nits) which are attached to the base of the hairs METHODS OF SPREAD Direct contact with an infected person and indirect contact with their personal belongings, especially clothing and headgear MINIMUM CONTROL MEASURES INCUBATION & SYMPTOMS Infectious Agent: primarily, coxsackievirus A-16 (CA16); also, enterovirus 71 (EV71) Incubation: Usually 3-7 days Symptoms: Generally, mild fever, malaise, mouth ulcers and a rash, often blisters, located on palms, soles and buttocks Fever begins first, then 1-2 days later mouth ulcers and rash appear Period of Communicability: While lice or nits remain alive on the infested person or in clothing Control: Exclude from school/center until adequately treated and until judged noninfectious by the child's physician or by the school/center nurse OTHER INFORMATION When a student is found with head lice, all family members should be inspected and treated All students in infested classrooms should be inspected and those infested should be excluded METHODS OF SPREAD HEPATITIS A Direct person to person contact with nose and throat secretions and feces of infected people MINIMUM CONTROL MEASURES (HAV) INCUBATION & SYMPTOMS Period of Communicability: At the time of acute illness phase The viruses may persist in feces for several weeks Control: Enteric precautions should be observed and good personal hygiene, including thorough handwashing practiced Disinfect contaminated surfaces and wash soiled clothing Exclude from school if ill HEAD AND BODY LICE (Pediculosis capitas) (Pediculosis corpora) INCUBATION & SYMPTOMS Infectious Agent: hepatitis A virus Incubation: 15-50 days, average 28-30 days Symptoms: Usually abrupt onset with loss of appetite, fever, abdominal pain, nausea and fatigue Jaundice may follow in a few days METHODS OF SPREAD Person to person contact by fecal/oral route: contaminated water and food ingestion of feces- MINIMUM CONTROL MEASURES Infectious Agents: Pediculosis capitis, P humanus Incubation: The eggs of lice may hatch in one week and sexual maturity is reached approximately 8-10 days after hatching -9- Period of Communicability: Most highly communicable during the last half of incubation period and continuing for a few days after onset of jaundice Most cases are probably noninfectious after the 1st week of jaundice -10- Control: For proven hepatitis A, enteric precautions should be observed: emphasize thorough handwashing for children and staff before eating and after toilet use and diaper changes Exclusion from school/center is decided on a case by case basis Food handlers with known or suspected hepatitis A may not work with food until a physician clears the person for work OTHER INFORMATION Control: Educate about transmission methods Infected persons should be under a physician's care IMPETIGO INCUBATION & SYMPTOMS Infectious Agent: Staphylococcus aureus; Group A Streptococcus Consult the Health Department for assistance and guidance in controlling the disease within the school/center HEPATITIS B Incubation: Staphylococcus aureus: commonly 4-10 days, can be variable and indefinite Streptococcus: 1-3 days Symptoms: Blister-like lesions which later develop into pustules of irregular shape (HBV) METHODS OF SPREAD INCUBATION & SYMPTOMS Infectious Agent: hepatitis B virus Incubation: 45-180 days, average 60-90 days Symptoms: Onset is gradual, with loss of appetite, vague abdominal discomfort, nausea, vomiting, joint aches and rash May progress to jaundice Fever may be mild or absent Some infected persons may be asymptomatic Direct contact with draining sores or soiled bandages Stress good personal hygiene, emphasizing thorough handwashing MINIMUM CONTROL MEASURES Period of Communicability: From onset of symptoms until sores are healed Control: Exclude from school/center until sores are no longer draining and the child is judged noninfectious by the nurse or the child's physician METHODS OF SPREAD OTHER INFORMATION The virus is found in almost all body secretions; however, only blood and blood products, saliva, semen, and vaginal fluids have been shown to be infectious Transmission occurs through contaminated needles, (i.e IV, IM, subcutaneous or intradermal use, including accidental needle sticks); sexual exposure (either homosexual or heterosexual); perinatally; and occasionally by sharing razors or toothbrushes with an infected person Early detection and adequate treatment are important in preventing spread Infected individuals should use separate towels and wash cloths; sores should be bandaged and dressings should be disposed of as any infectious material MEASLES Fecal/oral transmission has not been demonstrated MINIMUM CONTROL MEASURES (Rubeola) Period of Communicability: Highly communicable many weeks before the onset of first symptoms and remains infectious through the acute clinical course of the disease A person who is a chronic carrier may remain infectious for life INCUBATION & SYMPTOMS Infectious Agent: Measles virus Incubation: 7-18 days, usually 10 days -11- -12- Symptoms: Acute, highly communicable disease with fever, cough, runny eyes and nose, followed by a dark red elevated rash that occurs in patches MINIMUM CONTROL MEASURES Period of Communicability: Up to 24 hours after initiation of antibiotic therapy Penicillin does not eradicate organisms from nasopharynx METHODS OF SPREAD Direct contact with secretions of nose and throat of infected persons; indirectly airborne and by articles freshly soiled with secretions of nose and throat Control: Exclude from school/center until adequately treated Student must be under a physician's care OTHER INFORMATION MINIMUM CONTROL MEASURES Period of Communicability: From slightly before the onset of symptoms to days after rash appears Notify the Health Department immediately if a case occurs in the school Household and nursery school contacts may need to receive antibiotic therapy Classroom contacts are usually NOT candidates for antibiotic therapy Control: Exclude from school/center until at least days after the rash appears MENINGITIS OTHER INFORMATION Suspected cases should be reported by phone to the Health Department Immunization of all children attending school is required by law Notify the Health Department if a case occurs in the school/center Measles is one of the most readily transmitted communicable diseases MENINGITIS (Bacterial) (Aseptic-Viral) INCUBATION & SYMPTOMS Infectious Agent: Wide variety of infectious viruses Incubation: Varies with causative agent Symptoms: Common, acute disease with sudden onset of fever, intense headache, nausea, forceful vomiting, stiff neck Behavioral changes may occur, including irritability or sluggishness INCUBATION & SYMPTOMS METHODS OF SPREAD Infectious Agent: Meningococcal meningitis, Haemophilus influenzae Varies with causative agent Incubation: 2-10 days, commonly 2-4 days (Haemophilus influenzae 2-4 days; Meningococcal meningitis 3-4 days) Symptoms: Acute disease with sudden onset of fever, intense headache, nausea, forceful vomiting, stiff neck and, frequently, a petechial rash Behavioral changes may occur, including irritability or sluggishness MINIMUM CONTROL MEASURES Period of Communicability: Varies with causative agent Control: Exclude from school/center until child's physician certifies able to return METHODS OF SPREAD OTHER INFORMATION Direct contact with secretions of nose and throat of infected persons or carriers -13- Aseptic meningitis is generally a less serious disease than bacterial meningitis -14- MONONUCLEOSIS INCUBATION & SYMPTOMS Infectious Agent: Epstein-Barr virus OTHER INFORMATION Immunization of all children attending school is required by law Notify the Health Department if a case occurs in the school/center The disease may have serious complications in adults Incubation: 4-6 weeks RINGWORM Symptoms: Fever, sore throat, swollen lymph glands (Scalp, Skin and Feet) METHODS OF SPREAD INCUBATION & SYMPTOMS Direct contact with saliva of infected person Infectious Agents: Microsporum; Trichophyton; Epidermophyton/Floccosum MINIMUM CONTROL MEASURES Use of hygienic measures, especially thorough handwashing Student may return to school/center when well enough to resume normal activities MUMPS INCUBATION & SYMPTOMS Infectious Agent: Mumps virus Incubation: 12-25 days, commonly 18 days Symptoms: Fever followed by painful swelling of salivary glands (under the jaw or in front of the ear) METHODS OF SPREAD Incubation: Scalp and beard 10-14 days; body 4-10 days; nails and feet unknown Symptoms: Scalp: Scaly patches of temporary baldness Infected hairs are brittle and break easily Skin: Flat, inflamed ringlike sores that may itch or burn Feet: Scaling or cracking of the skin especially between the toes, or blisters containing a thin watery fluid METHODS OF SPREAD Directly by contact with infected persons or animals or indirectly by contact with articles and surfaces contaminated by infected persons or animals MINIMUM CONTROL MEASURES Period of Communicability: As long as lesions are present By droplet spread and by direct contact with saliva of infected person MINIMUM CONTROL MEASURES Period of Communicability: 6-7 days before onset of swelling and up to days after swelling occurs Control: Exclude from school/center until swelling is gone, or until days from onset of swelling -15- Control: Skin and Scalp: Infected persons should be excluded from school/center until judged noninfectious by the nurse or the child's physician OTHER INFORMATION: Preventive measures are largely hygienic All household contacts, pets, and farm animals should be examined and treated if infected Scalp ringworm is seldom, if ever, found in adults -16- SCABIES INCUBATION & SYMPTOMS Infectious Agent: Sarcoptes scabiei, a mite Incubation: Symptoms occur 2-6 weeks after first infestation; symptoms associated with reinfestation may occur in 1-4 days Symptoms: Small raised areas of skin containing fluid, or tiny burrows under the skin (line-like), that appear frequently on finger webs, in the folds of wrists, elbows, armpits, thighs and belt line Itching is intense, especially at night METHODS OF SPREAD Direct or intimate contact with infected person or carrier, rarely by casual contact through transfer by objects or hands Explosive outbreaks of strep throat may follow drinking contaminated milk or eating contaminated food MINIMUM CONTROL MEASURES Period of Communicability: With adequate treatment, communicability is eliminated within 24 hours Control: Exclude from school/center until 24 hours after treatment is started OTHER INFORMATION METHODS OF SPREAD Direct skin to skin contact and, to a limited extent, from undergarments or bedding freshly contaminated by infected persons Early diagnosis and medical treatment are essential for the prevention of serious complications MINIMUM CONTROL MEASURES THRUSH Period of Communicability: Until student and household contacts have been adequately treated (usually one course of treatment, occasionally two, a week apart) Control: Exclude from school/center until student and household contacts have been treated adequately (single infection in a family is uncommon) (Candidiasis) INCUBATION & SYMPTOMS Infectious Agent: Candida albicans SCARLET FEVER (Streptococcal) INCUBATION & SYMPTOMS Incubation: Variable, but 2-5 days in infants Symptoms: Infection of the mouth or tongue that appears as a yellowishwhite coating Other organs of the body may be involved METHODS OF SPREAD Infectious Agent: Streptococcus pyogenes Incubation: Short, usually 1-3 days, rarely longer Symptoms: Strep Throat: Fever, sore and inflamed throat, pus spots on the back of the throat, tender and swollen glands of the neck There may be a minimum of symptoms Scarlet Fever: All symptoms that occur with strep throat as well as strawberry tongue and body rash High fever, nausea and vomiting may occur -17- Direct contact with secretions or excretions from infected areas MINIMUM CONTROL MEASURES Period of Communicability: Presumably for as long as lesions are visible Control: While it is not necessary to exclude the child from school/center, precautions should be taken in order to prevent contamination of toys and other objects -18- TUBERCULOSIS INCUBATION & SYMPTOMS Infectious Agent: Mycobacterium tuberculosis Incubation: Usually about 4-12 weeks from infection to demonstrable lesion on chest x-ray or positive tuberculin skin test Symptoms: Productive cough, unplanned weight loss, fever, fatigue, chest pain, and bloody sputum Symptoms: Begins with a mild cold and irritating cough which is worse at night Symptoms may at first be very mild Characteristic "whooping" develops in about weeks, and spells of coughing often end with vomiting METHODS OF SPREAD Direct contact with respiratory secretions of an infected person, or indirectly by contact with articles freshly soiled by discharge of infected person MINIMUM CONTROL MEASURES Period of Communicability: days or less after treatment is started If untreated, from days after exposure to weeks after onset of "whooping" METHODS OF SPREAD Exposure to bacilli in airborne droplets produced by those who have untreated pulmonary or laryngeal tuberculosis and who cough, sneeze, or sing the organism into the air for a prolonged period in an inadequately ventilated environment MINIMUM CONTROL MEASURES Control: Exclude from school/center until the student has received at least days of a minimum 14-day course of antibiotics OTHER INFORMATION Suspected cases should be reported by phone to the Health Department Period of Communicability: Until adequately treated with medications that change status from infectious to noninfectious (may be a few days to a few weeks) NOTE: A positive tuberculin skin test reaction DOES NOT IN ITSELF indicate infectious disease Control: Exclude from all public activities until noninfectious WORMS INCUBATION & SYMPTOMS Incubation: Varies, depending upon the kind of worm OTHER INFORMATION All close contacts should be evaluated by tuberculin skin testing If the tuberculin test is positive, chest x-ray and other evaluation and treatment may be required Symptoms: Varies, depending upon the kind of worm However, symptoms may include abdominal pain, anal itching to the point of disturbed sleep, irritability, local irritation due to scratching, diarrhea or constipation, nausea, vomiting, loss of appetite, weight loss, or anemia METHODS OF SPREAD WHOOPING COUGH (Pertussis) Varies, depending upon the kind of worm However, usually spread by contaminated feces, either directly or indirectly INCUBATION & SYMPTOMS Infectious Agent: Bordetella pertussis, a bacterium Incubation: Usually 6-20 days -19- -20- MINIMUM CONTROL MEASURES Period of Communicability: As long as worms are present Control: Exclude from school/center until adequately treated The child should receive medical attention Control: No reason to restrict attendance unless specifically recommended by physician or Health Department Pregnant females should be screened at first prenatal visit and in the 3rd trimester to prevent spread to newborns Sex partners should be referred for evaluation and treatment OTHER INFORMATION SEXUALLY TRANSMITTED DISEASES The bacterial STD's: gonorrhea, chlamydia, and syphilis, are reportable to the Health Department when diagnosed, and will be addressed in this manual However, the school nurse should be aware that sexually active students are vulnerable to the viral STD'S as well The viral STD's are genital herpes (HSV), HBV, genital warts (HPV) and HIV infection Complaints of genital growths, lesions or lumps may indicate a viral STD and a referral should be made to the Health Department STD clinic at 5788080 Students 13 years of age and older may be seen at the clinic without parental permission and at no charge Confidentiality of information must be assured in order to successfully care for patients and control transmission NONE of the STD's warrant removal from the school setting Sexually active teens are at risk for gonorrhea due to their reluctance to use condoms for disease prevention Sexually active students should be referred for STD screening and counseled about STD risk reduction behaviors Young children determined to have gonorrhea should be evaluated for suspected sexual abuse CHLAMYDIA INCUBATION AND SYMPTOMS Infectious Agent: Chlamydia trachomatis GONORRHEA INCUBATION AND SYMPTOMS Infectious Agent: Neisseria gonorrhoeae Incubation: Males - 3-9 days; Females - up to 30 days or longer Symptoms: Males experience thick yellow discharge and painful urination Females may have slight discharge or urinary pain, but are often asymptomatic Cramping and abdominal pain in females may indicate Pelvic Inflammatory Disease (PID), a serious complication that requires hospitalization METHOD OF SPREAD Vaginal, oral, or anal sexual contact Sites of infection include genitals, anus, or throat MINIMUM CONTROL MEASURES Period of Communicability: Communicable until treated May extend for long periods if asymptomatic and undetected No longer communicable after effective treatment -21- Incubation: Males - 7-30 days; Females - 7-60 days Both males and females may harbor chlamydia without symptoms for months Symptoms: Males may have burning on first urination and a watery discharge Itching or tingling may also occur Females usually have no recognized symptoms, however, any abnormal vaginal discharge may indicate chlamydia Cramping and abdominal pain in females indicate Pelvic Inflammatory Disease (PID), a serious complication requiring hospitalization PID may result in sterility METHOD OF SPREAD Vaginal, oral, or anal sexual contact Sites of infection include genitals, anus, or throat MINIMUM CONTROL MEASURES Period of Communicability: Communicable until treated May extend for long periods if asymptomatic No longer communicable after effective treatment Control: No reason to restrict attendance Pregnant females should be screened at first prenatal visit Sexual partners should be referred for evaluation and treatment -22- OTHER INFORMATION OTHER INFORMATION Chlamydial infection is the most common STD among sexually active teenagers Since symptoms are often absent, sexually active students should be referred for an exam and test for chlamydia Syphilis cases are on the rise due to sexual risk taking and unprotected sex among teens and young adults Also, persons who trade sex for money or drugs, usually crack cocaine, are at increased risk for syphilis Pregnant women with syphilis can infect their babies which can result in serious complications or fetal death Physicians are required by state law to screen pregnant women for syphilis on their first prenatal exam (a blood test) Syphilis, as well as gonorrhea and chlamydia infections, are nearly exclusively restricted to heterosexuals in Allegheny County Women and their children routinely suffer the consequences of STD's Young children diagnosed with syphilis should be evaluated for suspected sexual abuse SYPHILIS INCUBATION AND SYMPTOMS Infectious Agent: Treponema pallidum ANIMAL BITES Incubation: 10-90 days, average is 21 days The community should be made aware of the potential dangers of animal bites Ë Preventive rabies vaccination of dogs, cats and ferrets is required by Pennsylvania law Ë Control of all stray dogs and cats should be encouraged All domestic biting animals should be confined for a ten-day observation period Ë METHOD OF SPREAD Ë Ë Symptoms: The initial single lesion of syphilis (chancre) appears at the site of contact: genitals, anus, or mouth Chancres are painless and may be very small and go unnoticed After the chancre disappears, a rash may appear or flu-like symptoms occur Any unexplained rash should be investigated A typical rash is on the palms of the hands and soles of the feet and resolves without treatment in one to two months All attacks by wildlife should be considered as potential exposures to rabies Ë All animal bites must be reported to the Allegheny County Health Department so that an investigation of the case may be made Vaginal, oral, or anal sexual contact MINIMUM CONTROL MEASURES Period of Communicability: Infectious when symptomatic or up to one year's duration If untreated, syphilis enters a latent stage which may last many years No longer communicable after effective treatment Control: No reason to restrict attendance Follow-up exam and blood tests are required to confirm treatment success Sexual partners within the previous year should be referred for evaluation and treatment Pregnant females should be screened at first prenatal visit and again in the 3rd trimester to prevent congenital syphilis in the infant RECOMMENDATIONS TO SCHOOLS IF ANIMAL BITE OCCURS: Confine biting animal if possible Ë Try to obtain as complete a description as possible if the animal escapes Ë Give first-aid immediately by copious flushing of wound with water and soap or detergent Ë Refer for medical treatment Ë Report all animal bites to the Allegheny County Health Department Ë -23- Ë Work with animal control officials to keep dogs off school grounds as much as possible -24- IN HEALTH INSTRUCTION CLASSES REFERENCES a Teach the proper conduct toward animals to avoid being bitten b Emphasize the dangers in handling stray dogs, cats, and wild animals c Stress the necessity of students reporting bites of all animals, especially bats, raccoons, and skunks d Encourage immunization of pets Advisory Committee on Immunization Practices, Centers for Disease Control and Prevention, "Immunization Practices: Recommendations", Morbidity and Mortality Weekly Report, 199293 American Public Health Association and American Academy of Pediatrics Caring for Our Children: National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care Programs United States of America: Department of Health and Human Services, 1992 Benenson, Abram S., ed Control of Communicable Diseases Manual Washington D.C.: American Public Health Association, 1995 Committee on Infectious Diseases, American Academy of Pediatrics Health in Day Care: A Manual for Health Professionals Illinois: American Academy of Pediatrics, 1987 Committee on Infectious Diseases, American Academy of Pediatrics Report of the Committee on Infectious Diseases Illinois: American Academy of Pediatrics, 1991 Pennsylvania Department of Health Commonwealth of Pennsylvania Health Regulations Title 28 PA Code Chapter 27: Communicable and Noncommunicable Diseases Pennsylvania: Department of Health, 1992 Rev 8\98 -25- ... they are symptomatic To minimize the risk of transmission, emphasize thorough handwashing by children and staff before eating and after toilet use and diaper changes Persons handling and preparing... emphasize thorough handwashing by children and staff before eating and after toilet use and diaper changes Persons handling and preparing food should give particular attention to handwashing SHIGELLOSIS... they are symptomatic To minimize the risk of spread, emphasize thorough handwashing by children and staff before eating and after toilet use and diaper changes Persons handling and preparing