Talk:Postnatal - Infectious Diseases School Exclusion
From Embryology
The following information is provided for educational purposes only.
These are NHMRC (2006) the recommended minimum periods of exclusion from schools, pre-schools and child care centres based on risk of infection but a child or staff member may need to stay at home longer than the exclusion period to recover from an illness. Different exclusion periods will apply to people whose work involves food handling.
Please refer to the original document.
| Condition | Exclusion of Case | Exclusion of Contacts |
| Amoebiasis (Entamoeba histolytica) |
Exclude until there has not been a loose bowel motion for 24 hours | Not excluded |
| Campylobacter | Exclude until there has not been a loose bowel motion for 24 hours | Not excluded |
| Candidiasis | See ‘Thrush’ | |
| Chickenpox (Varicella) |
Exclude until all blisters have dried.This is usually at least 5 days after the rash first appeared in unimmunised children and less in immunised children. | Not excluded. |
| Cytomegalovirus infection (CMV) |
Exclusion is NOT necessary | Not excluded |
| Conjunctivitis | Exclude until the discharge from the eyes has stopped unless doctor has diagnosed a non- infectious conjunctivitis. | Not excluded |
| Cryptosporidium infection | Exclude until there has not been a loose bowel motion for 24 hours | Not excluded |
| Diarrhoea (No organism identified) |
Exclude until there has not been a loose bowel motion for 24 hours | Not excluded |
| Diphtheria | Exclude until medical certificate of recovery is received following at least 2 negative throat swabs, the first swab not less than 24 hours after finishing a course of antibiotics followed by another swab 48 hours later. | Exclude contacts that live in the same house until cleared to return by an appropriate health authority. |
| German measles | See ‘Rubella’ | |
| Giardiasis | Exclude until there has not been a loose bowel motion for 24 hours | Not excluded |
| Glandular fever (Mononucleosis, EBV infection) |
Exclusion is NOT necessary | Not excluded |
| Hand, foot and mouth disease | Exclude until all blisters have dried | Not excluded |
| Haemophilus influenzae type b (Hib) | Exclude until the person has received appropriate antibiotic treatment for at least 4 days. | Not excluded |
| Head lice (Pediculosis) |
Exclusion is NOT necessary if effective treatment is commenced prior to the next day at child care (i.e. the child doesn’t need to be sent home immediately if head lice are detected). | Not excluded |
| Hepatitis A | Exclude until a medical certificate of recovery is received, but not before seven days after the onset of jaundice. | Not excluded |
| Hepatitis B | Exclusion is NOT necessary | Not excluded |
| Hepatitis C | Exclusion is NOT necessary | Not excluded |
| Herpes simplex (cold sores, fever blisters) |
Exclusion is not necessary if the person is developmentally capable of maintaining hygiene practices to minimise the risk of transmission. If the person is unable to comply with these practices they should be excluded until the sores are dry. Sores should be covered by a dressing where possible. | Not excluded |
| Human Immunodeficiency Virus (HIV/AIDS) |
Exclusion is NOT necessary. If the person is severely immunocompromised, they will be vulnerable to other people’s illnesses. | Not excluded |
| Hydatid disease | Exclusion is NOT necessary | Not excluded |
| Impetigo (school sores) | Exclude until appropriate antibiotic treatment has commenced. Any sores on exposed skin should be covered with a watertight dressing. | Not excluded |
| Influenza and influenza-like illnesses | Exclude until well | Not excluded |
| Legionnaires’ disease | Exclusion is NOT necessary | Not excluded |
| Leprosy | Exclude until approval to return has been given by an appropriate health authority | Not excluded |
| Measles | Exclude for 4 days after the onset of the rash | Immunised and immune contacts are not excluded.
Non-immunised contacts of a case are to be excluded from child care until 14 days after the first day of appearance of rash in the last case, unless immunised within 72 hours of first contact during the infectious period with the first case. All immunocompromised children should be excluded until 14 days after the first day of appearance of rash in the last case. |
| Meningitis (bacterial) | Exclude until well and has received appropriate antibiotics | |
| Meningitis (viral) | Exclude until well | Not excluded |
| Meningococcal infection | Exclude until appropriate antibiotic treatment has been completed | Not excluded |
| Molluscum contagiosum | Exclusion is NOT necessary | Not excluded |
| Mumps | Exclude for nine days after onset of swelling. | Not excluded |
| Norovirus | Exclude until there has not been a loose bowel motion or vomiting for 48 hours | Not excluded |
| Parvovirus infection (fifth disease, erythema infectiosum, slapped cheek syndrome) |
Exclusion is NOT necessary | Not excluded |
| Pertussis | See ‘Whooping Cough’ | |
| Respiratory Syncytial virus | Exclusion is NOT necessary | Not excluded |
| Ringworm/tinea | Exclude until the day after appropriate antifungal treatment has commenced | Not excluded |
| Roseola | Exclusion is NOT necessary | Not excluded |
| Ross River virus | Exclusion is NOT necessary | Not excluded |
| Rotavirus infection | Children are to be excluded from the centre until there has not been a loose bowel motion or vomiting for 24 hours. | Not excluded |
| Rubella (German measles) | Exclude until fully recovered or for at least four days after the onset of the rash | Not excluded |
| Salmonella infection | Exclude until there has not been a loose bowel motion for 24 hours | Not excluded |
| Scabies | Exclude until the day after appropriate treatment has commenced | Not excluded |
| Scarlet fever | See ‘Streptococcal sore throat’ | |
| School sores | See ‘Impetigo’ | |
| Shigella infection | Exclude until there has not been a loose bowel motion for 24 hours | Not excluded |
| Streptococcal sore throat (including scarlet fever) | Exclude until the person has received antibiotic treatment for at least 24 hours and feels well | Not excluded |
| Thrush (candidiasis) |
Exclusion is NOT necessary | Not excluded |
| Toxoplasmosis | Exclusion is NOT necessary | Not excluded |
| Tuberculosis (TB) | Exclude until medical certificate is produced from an appropriate health authority | Not excluded |
| Typhoid, Paratyphoid | Exclude until medical certificate is produced from an appropriate health authority | Not excluded unless considered necessary by public health authorities |
| Varicella | See ‘Chickenpox’ | |
| Viral gastroenteritis (viral diarrhoea) |
Children are to be excluded from the centre until there has not been a loose bowel motion or vomiting for 24 hours. | Not excluded |
| Warts | Exclusion is NOT necessary | Not excluded |
| Whooping cough (pertussis) |
Exclude until five days after starting appropriate antibiotic treatment or for 21 days from the onset of coughing. | Contacts that live in the same house as the case and have received less than three doses of pertussis vaccine are to be excluded from the centre until they have had 5 days of an appropriate course of antibiotics. If antibiotics have not been taken, these contacts must be excluded for 21 days after their last exposure to the case while the person was infectious. |
| Worms | Exclusion not necessary if treatment has occurred | Not excluded |
| Category | Tuberculosis | Diphtheria | Tetanus | Pertussis | Poliomyelitis | Measlesa | Rubella | Hib | Hepatitis B | Yellow fever | Meningococcal disease | Japanese encephalitis | Causative agent | Mycobacterium tuberculosis | Toxin-producing bacterium (Corynebacterium diphtheriae) | Toxin-producing bacterium (Clostridium tetani) | Bacterium (Bordetella pertussis) | Virus (serotypes 1, 2, and 3) | Virus | Virus | Bacterium (Haemophilus influenzae type B) | Virus | Virus | Neisseria meningitis groups A, B, C, Y, W135 | Virus |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Reservoir | Humans (some bovine) | Humans | Animal intestines; soil | Humans | Humans | Humans | Humans | Humans | Humans | Monkeys and humans | Humans | Birds and mammals | |||||||||||||
| Spread | Airborne droplet nuclei from sputum-positive persons | Close respiratory or cutaneous contact | Spores enter the body through wounds or the umbilical cord stump | Close respiratory contact | Fecal-oral; close respiratory contact | Close respiratory contact and aerosolized droplets | Close respiratory contact and aerosolized droplets | Close respiratory contact | Blood, perinatal, household, occupational, or sexual transmission | Bites by infected mosquitoes | Close respiratory contact | Bites by infected mosquitoes | |||||||||||||
| Transmission period | As long as sputum acid-fast bacilli are positive | Usually under two weeks; some chronic carriers | No person-to-person transmission | Usually under three weeks (starts before cough is apparent) | A few days before and after acute symptoms | Four days before rash until two days afterward | A few days before to seven days after rash; up to one year of age in congenitally infected | Chronic carriage for months | Up to lifelong chronic carriage and transmission | Infected individuals can transmit the disease when bitten by a mosquito vector during the viremic phase (the first three or four days of illness) | Chronic carriage for months | Unknown, rare cases for several months | |||||||||||||
| Subclinical infection | Common but not important in transmission | Common | No | Mild illness common: may not be diagnosed | More than 100 subclinical infections for each paralytic case | May occur in children under one, but relative minimal | Common | Common | Common, especially in infants | Common | Common | Common | |||||||||||||
| Duration of natural immunity | Not known; reactivation of old infection commonly causes disease | Lasting protective immunity not produced by infection; second attack possible | Lasting protective immunity not produced by infection; second attack possible | Incomplete and waning protection | Lifelong type- specific immunity | Lifelong | Lifelong | Uncertain; no protection against carriage and those previously infected may develop some disease (epiglottitis) | If develops, lifelong | Lifelong | Uncertain; no protection against carriage | Lifelong | |||||||||||||
| Risk factors for infection (for unvaccinated individuals) | High population densities in regions with historically poor control; low socioeconomic status; poor access to care; immunodeficiency; malnutrition; alcoholism; diabetes | Crowding; low socioeconomic status | Wound contaminated by soil; umbilical cord; agricultural work | Young age; crowding | Poor environmental hygiene and sanitation | Highly transmissible agent with nearly 100 percent infectivity except for isolated populations; crowding, low socioeconomic status | Highly transmissible; crowding; low socioeconomic status | Failure to breastfeed; crowding; low socioeconomic status; immune deficiency, including HIV | Carrier mother, sibling, or sex partner; multiple sex partners; intravenous drug use; unsafe injection practices | Young age; forest workers; season (late rainy season, early dry season) | Crowding; respiratory viral infections, especially influenza | Young age; forest workers; season | |||||||||||||
| Case-fatality rateb |
See [/books/n/dcp2/A1737/ chapter 16] |
2 to 20 percent | 25 to 90 percent | Up to 10 percent in infants and children | 2 to 10 percent | 0.05 to 10.0 percent | Less than 0.1 percent | Meningitis, 5 to 90 percent; pneumonia 5 to 25 percent | Acute, more than 1 percent; chronic; 25 percent (delayed) | 10 to 40 percent | Untreated 90 to 100 percent; treated 5 to 20 percent | 5 to 30 percent | |||||||||||||
| Vaccine (number of doses); route | BCG attenuated Mycobacterium bovis (1); intradermal | Diphtheria toxoid (three to five primary including booster doses in most countries); intramuscular | Tetanus toxoid (three to five in children, including booster doses in many countries; five for women of childbearing age; adult boosters for injury prevention); intramuscular | Killed whole-cell or acellular pertussis (three to five, including booster doses in most countries); intramuscular | Live (OPV) (three to four primary plus campaigns);c killed (IPV) (three to four) | Measles (two); subcutaneous | Rubella (one or two); subcutaneous | Capsular polysaccharide linked to protein Hib (three to five); intramuscular | Hepatitis B surface antigen (three to four); intramuscular | Yellow fever attenuated live virus (1 plus boosters); subcutaneous | Vaccines for A, C, Y, Wi35 only; unconjugated polysaccharides given subcutaneously or intramuscularly: one dose with repeat three to five years later for high-risk persons; conjugated: for C only or A, C, Y, + Wi35, one dose given intramuscularly | Live attenuated (two, China only); killed (two); booster commonly used but of uncertain value | |||||||||||||
| Vaccine efficacy | 0 to 80 percent for pulmonary tuberculosis; 75 to 86 percent for meningitis and miliary tuberculosis | More than 87 percent | More than 95 percent (more than 80 percent after two doses) in infants | 70 to 90 percent | OPV: more than 95 percent in industrial countries; 72 to 98 percent in developing countries; lower protection against type 3 than 1 and 2; IPV: more than 95 percent | 95 percent at 12 months of age; 85 percent at 9 months of age from one dose, more than 98 percent from two doses | 95 percent (at 12 months and up) | More than 95 percent for invasive disease | 75 to 95 percent; efficacy against chronic infection in infants born to carrier mothers; more than 95 percent for exposure at older ages | 90 to 98 percent | Unconjugated polysaccharides: poor efficacy under two years of age; conjugated polysaccharides: approximately 95 percent and up serogroup specific | Live attenuated: 90 percent (after one dose at one year); 94 to 100 percent (after two doses one to two months apart); inactivated: 80 percent (declining to 55 percent after one year; no decrease in another study) | |||||||||||||
| Duration of immunity after primary series | Unknown; some evidence that immunity wanes with time | Variable: probably around five years; longer in presence of natural boosting or booster doses | 10 years or more | Unknown; wanes with time | Presumed lifelong for both OPV and IPV, but unknown | Lifelong in most; rare cases of waning immunity after one dose, not two | Lifelong in most; presumed rare cases of waning immunity after one dose, not two | Unknown, but lasts for at least three years beyond period of greatest exposure | More than 15 years; further follow-up is continuing | For at least 10 years and possibly for life | Unconjugated wanes rapidly for children under five, more than three to five years for older children; conjugated uncertain | Unknown, may be lifelong | |||||||||||||
| Schedule | Given at or near birth in populations at high risk | Three-dose schedule recommended at 6, 10, and 14 weeks in developing countries for DTP vaccine; other schedules in common use; booster doses at 18 months and four to six years also suggested | Normally given as DTP vaccine to children; unimmunized pregnant women should be given two doses of tetanus toxoid or tetanus reduced diphtheria toxoid, and a total of five doses is required to provide protection through all childbearing years | Usually given in childhood as combination vaccine (DTP) | OPV: four doses (birth, 6, 10, and 14 weeks) in polioendemic countries; birth dose may be omitted elsewhere with fourth dose given later; supplemental doses (up to 10) given in national campaigns for eradication; IPV: three to four doses: 2, 4, 6 to 18 months, and four to six years | First dose at 9 or 12 to 15 months); a second opportunity to receive a dose of measles vaccine (either through routine [18 months or four to six years] or supplemental immunization activities) should be provided for all children | First dose at 12 to 15 months; when given, a second dose with measles vaccine | Three or four doses; usually given during the same visit as for DTP | Several schedules: at birth, 6, and 14 weeks; with first three doses of DTP; birth dose needed if mother is a carrier and recommended if perinatal transmission of hepatitis B is frequent; four doses total can be given although only three are required | One dose at 9 to 12 months with measles in countries where yellow fever poses a risk | Unconjugated: one dose at two years or older and second dose three to five years later for high risk; conjugate C: three doses at two, three, and four or two, four, and six months for infants; one dose for older children and adults; conjugate A, C, Y, Wi35 currently only approved for one dose at 11 years or older | Live: one year and two years; killed: days 0, 7, and 30 followed by booster two years later and then every three years | |||||||||||||
| Status as of the end of 2001 | 158 countries using BCG; 85 percent coverage | All countries; 78 percent coverage | Childhood: all countries; 78 percent coverage | All countries; 78 percent coverage | All countries; 79 percent routine, plus supplemental coverage | Routine first dose all countries, 77 percent coverage; second opportunity, 164 out of 192 countries | 110 countries in 2003 | 89 countries; global coverage less than 18 percent | 147 countries; global coverage 42 percent | 29 of 43 countries at risk using vaccine; 30 percent coverage in target population | European countries, Canada (and United States in 2005) | Southeast Asia | |||||||||||||
| Comments | Reasons for varying efficacy are multifactorial, including differences in vaccines | Recent trends to lower antibody levels in adults without booster doses because of waning immunity and less natural boosting | Five doses in adults provide protection for more than 20 years | Variability in whole cell vaccines; acellular vaccines used in some developed countries | Primary series gives incomplete protection in developing countries | Lower efficacy when maternal antibody present | Lower efficacy when maternal antibody present | None | Efficacy lower if injected into fat | None | None | None |
