Talk:Postnatal - Infectious Diseases School Exclusion

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