Germ Illustration

Infectious Disease Guide and When to Exclude Children

Skin and Scalp Infections

DiseaseSymptomsHow it is SpreadContagious PeriodExclusionReport to Public Health
Chicken Pox/VaricellaSudden onset of mild fever. Small red pimples which develop into blisters in successive crops then become encrusted. Usually affects face, hands, neck, and extremities.Spread by air or by touching blisters. Person-to-person with direct contact with droplets from the nose and throat.1-2 days before onset of rash until all lesions are crusted.YES – return when well enough to participate in all activities. Should avoid play with sand, water and play dough to prevent secondary infection.Yes. Notify parents of immunocompromised children.
Herpes Simplex
(Cold Sores)
Painful ulcers in/on mouth area. May have fever.By direct contact especially to saliva of carriers.For several weeks during first infection and intermittently thereafter when cold sores return.No – unless extensive mouth lesions and
drooling. Should be well enough to participate normally in all activities.
No
ImpetigoThick yellow crusted lesions or blisters usually around face or exposed parts of body.Person-to-person by direct contact with blisters or personal items.From onset of rash until one day after start of treatment with antibiotics or until all blisters have dried.YES – until antibiotic treatment has been taken for one full day.Only if 2 or more cases occur.
Ringworm Depending on type, may cause circular lesions on skin or scalp. Lesions may have slightly raised red edges and may be scaly and itchy. Other types of ringworm may affect the skin between the toes (Athletes Foot) or the nails.Direct or indirect contact with lesions on infected persons or animals, or contaminated articles such as combs, hairbrushes, etc.While rash is present.YES – until seen by health care provider and treatment started.No
ScabiesVery itchy rash. Usually appears on fingers, elbows, armpits, and abdomen. More itchy at night. May appear as tiny red bumps, scratch marks or white curvy, thin lines.Person-to-person direct contact with skin or personal items. Requires prolonged, close and intimate contact.Until treated.YES – until first treatment has been applied.Only if 2 or more cases occur.
Head LiceItchy scalp. Small silvery eggs (nits) attached to base of hairs near the root, especially at nape of neck and behind ears.Person-to-person through direct contact with infested persons or by contact with infested personal items.Until mites and eggs are destroyed by treatment. May need 2 treatments 1 week apart.No public health exclusion. Manage as per facility policy.No
ShinglesLooks like chicken pox but usually appears on 1 part of the body.Direct contact with saliva or rash can cause chicken pox. Shingles cannot be spread person-to-person.May be up to 1 week after lesions appear.YES – return when well enough to participate in all
activities. Should avoid play with sand, water and play dough to prevent secondary infection.
No

Gastrointestinal Infections

DiseaseSymptomsHow it is SpreadContagious PeriodExclusionReport to Public Health
Campylobacter Fever, vomiting, diarrhea, abdominal cramps, headache, loss of appetite. Occasionally weakness, fatigue, blood in stool occur.Bacteria excreted in stool. Undercooked poultry, beef or other food, unpasteurized milk, or contaminated water may be source of infection. Contact with manure of livestock or infected pets may also be a source.For duration of diarrhea. If untreated, 2 to 7 weeks.YES – until diarrhea is gone and child is symptom free for 24 hours.Yes
DiarrheaIncrease in frequency of loose or watery stools. Often accompanied by vomiting and fever.Germ excreted in stool of infected persons. Spread directly from person-to-person, or indirectly from hands of staff and children, objects, surfaces, food, or water contaminated with germs. Sometimes spread by pets and livestock.For duration of diarrhea or longer.YES – until no diarrhea for 48 hours or health care provider determines child is not infectious.Report 3 or more children having diarrhea occurring within 48 hours, or any case of bloody diarrhea.
Escherichia coli
(E. coli 0157:H7)
Diarrhea may have blood in stool, abdominal cramps, headache, no appetite, fatigue, weakness. Fever is an uncommon symptom.Spread through food or water contaminated with human or animal feces or direct contact with manure. Person-to-person spread is possible. Undercooked meat and unpasteurized dairy or fruit juice may be sources.For duration of the diarrhea.YES – until no diarrhea or other symptoms and 2 negative stool cultures have been obtained.Yes
GiardiaMost children have no symptoms. May have loss of appetite, vomiting, abdominal cramps, diarrhea, foul-smelling mucousy stool, excessive gas, fatigue, or weight loss.Parasite in stool of infected persons. Spread person-to-person or through contact with infected livestock, their manure or food/water contaminated with manure.Often months, or while having symptoms.YES – until 24 hours symptom free. Emphasize hand washing.Yes
Hepatitis AMost children have no symptoms. May have fever, loss of appetite, nausea, vomiting, muscle ache, fatigue, jaundice (yellow colour in skin and eyes).Virus excreted in stool of infected persons. Spread person-to-person. May also be spread in contaminated food or water.2 weeks before and 1 week after onset of jaundice.YES – up to 2 weeks. Consult with health care provider.Yes
Norovirus
(Norwalk virus)
Nausea, vomiting, watery diarrhea, abdominal cramps, headache, low-grade fever.Virus excreted in stool of infected persons. Spread from person-to-person and contact with contaminated surfaces. Contaminated food/water and shellfish may be source of infection.During illness and 48 hours after last symptom.YES – Until 48 hours after last symptom.Yes. Report outbreaks of 3 or more children with symptoms.
RotavirusFever and vomiting precede watery diarrhea. Dehydration may occur rapidly.Virus excreted in stool of infected persons and by air. Person-to-person spread is common.For duration of diarrhea. Usually 3 to 8 days.YES – until 48 hours after diarrhea and vomiting have stopped.Yes. Report outbreaks of 3 or more children with symptoms.
SalmonellaSudden onset of headache, vomiting, and fever. Followed by diarrhea, abdominal pain and mucousy stool.Acquired mainly from food, especially eggs and egg products, beef, poultry, unpasteurized milk. Rodents, reptiles, animals, and birds also carry salmonella.For duration of diarrhea or longer.YES – until diarrhea is gone and no other symptoms for 24 hours.Yes
ShigellaDiarrhea, fever, blood, and/or mucus in stool, abdominal cramps.Bacteria excreted in stool of infected persons. Spread person-to-person. Spread in contaminated food, water or milk.For duration of diarrhea. Highly infectious. If
untreated, up to 4 weeks.
YES – until 24 hours with no diarrhea or other symptoms and 2 negative stool cultures have been obtained.Yes
YersiniaWatery diarrhea, cramps, fever, nausea, headaches, and vomiting. Children are most susceptible.Bacteria excreted in stool of infected persons. Spread person-to-person and contact with birds, puppies and kittens.For duration of diarrhea or other symptoms. If untreated, 2 to 3 months.YES – until 24 hours with no diarrhea or other symptoms.Yes
CryptosporidiumWatery diarrhea, cramps, vomiting, mild fever, fatigue, no appetite.Parasite in stool of infected person or animal. Person-to-person spread. Contact with infected animal or manure, contaminated food or recreational water.For duration of diarrhea.
Symptoms may come and go for weeks.
YES – until 24 hours with no diarrhea. Emphasize hand washing as parasite is in stool for several weeks after no symptoms.Yes

Other Infections

DiseaseSymptomsHow it is SpreadContagious PeriodExclusionReport to Public Health
Coxsackie A
(Hand/Foot/Mouth Disease)
Fever, headache, sore throat, small blisters on palms, soles and inside of mouth. Loss of appetite.Viruses are spread by direct contact with stool and/or saliva. Outbreaks most often in summer and fall.During acute stage of illness. Virus may remain in stool for 4 weeks after onset of illness and in saliva for only a few days.No – unless too ill to participate in normal activities.No
Conjunctivitis
(Pinkeye)
Bacteria – purulent discharge, red matted eyes, with discomfort.
Viral – clear discharge, red eye and mild or no discomfort.
Spread person-to-person by contact with discharges from eyes or upper respiratory tract when sharing personal items of infected person.Bacteria – infectious until 24 hrs. of appropriate antibiotic treatment.
Viral – infectious as long as there is eye discharge.
Most often it is viral and self limiting. If child is well enough to attend and can comply with hand hygiene, then no exclusion is necessary.No
Fifth Disease
(Human Parvovirus)
Mild, usually no fever. “Slapped cheek” rash on face followed in 1 to 4 days by lace-like rash on trunk and legs. Rash may come and go for 1 to 3 weeks (worse with sunlight or heat).Direct contact with respiratory secretions.4 – 20 days. Infectious for several days before the rash, and one week after.No – as long as child is well enough to participate.No – exposure may be a concern to non-immune pregnant women.
Hepatitis BSymptoms may be absent or may consist of: lack of appetite, nausea, vomiting, tiredness, abdominal pain, and/or yellowing of the skin.Virus found in blood, semen and vaginal fluids. Can be spread by unprotected sex, blood contact, bites, and from mother to baby at birth.From weeks before onset to months or years after recovery from illness. May be infectious for life.NoYes. Immediately report any bites that cause bleeding. Hepatitis B vaccine and/or immune globulin may be indicated for close contacts under special circumstances.
MeaslesFever, cough, runny nose, inflamed eyes for 1-3 days before onset of rash. Rash is large red spots which often join together. Starts on face and spreads down the body.Very infectious. Spread through air, direct contact with throat and nose discharge.4 days before onset of rash until 4 days after onset of rash.YES – until at least 4 days after onset of rash.Yes – measles must be diagnosed by a health care provider.
Meningitis Severe headache, fever, vomiting, stiff neck, drowsiness, confusion, coma. May develop a red pin-point rash.Spread by direct contact with droplets and discharge from nose and throat. Requires close, direct contact, such as sharing objects which have touched the mouth. Can be bacterial or viral.Bacterial – until treated with antibiotics for 24 hours.Viral – Many causes are not contagious, however some are. Emphasize handwashing.YES – until fully recovered and feeling well enough to
participate.
Yes. In some
circumstances, people in close contact may require antibiotics. Infrequently,
vaccinations may be required in the schools.
MumpsFever, headache, swollen face. Tenderness of salivary glands.Spread from person-to-person through the air, and direct contact with saliva.7 days before swelling to 9 days after swelling.YES – for 5 days from onset of swelling.Yes – mumps must be diagnosed by a health care provider.
Roseola Infantum
(Exanthema Subitum – Sixth Disease)
Mild upper respiratory illness followed by high fever. Small red spots appear on trunk and body once fever subsides. Rash lasts 1-2 days and fades quickly.Spread by tiny drops from nose and throat of infected person.Can spread before symptoms appear.No – unless too ill to participate.No
Rubella
(German Measles)
Mild fever, headache, tiredness, runny nose and eyes. Small bump swelling behind ear on upper neck may appear 5-10 days before rash. Fine, flat rash that starts on the face, becomes generalized in 24 hrs. and lasts about 3 days.Spread from person to person by nose and mouth secretions from the ill person. There is risk of severe damage to fetus if a pregnant woman gets rubella during the first half of the pregnancy.7 days before onset of rash to 7 days after onset of rash.YES – for 7 days after onset of rash.Yes – rubella must be diagnosed by a health care provider.

Respiratory Infections

DiseaseSymptomsHow it is SpreadContagious PeriodExclusionReport to Public Health
Common ColdRunny nose and eyes, sneezing, sore throat, cough, chills, body ache and sometimes fever.Through coughs and sneezes; indirect spread by contaminated hands, objects and surfaces.Between 24 hours before onset and for 5 days after onset.No – as long as child can participate in usual acitivities.No – unless outbreak is suspected.
Ear Infections
(Otitis Media)
Earache or irritability, fever and cold symptoms.Does not spread.Not infectious.No – unless child too ill to participate in activities.No
InfluenzaSudden onset of fever, chills, headache, generalized aches and pains, loss of appetite, cough, runny nose. Normally lasts 2 – 7 days.Spreads through coughs and sneezes, and direct contact with contaminated hands and objects.Until 3-7 days after onset of symptoms.YES – for 5 days after onset of symptoms or until symptom free, whichever is shorter.Yes – if diagnosed by a health care provider.
Strep Throat/Scarlet FeverFever, sore throat. General discomfort and tender glands on the neck. In scarlet fever, rash develops on neck, chest, underarms, elbow, groin, and inner surface of the thighs. Face looks flushed. Rash feels like fine sandpaper and skin peels during recovery.Person-to-person by respiratory droplets and direct contact with patient; rarely through indirect
contact with objects.
If untreated, 10-21 days. With adequate treatment risk of spread normally ends within 24 hours.YES – until 24 hours after treatment is started and child feels well enough to participate.No
Whooping Cough
(Pertussis)
Begins as cold with runny nose and cough. Cough gets gradually worse and occurs in spasms and sometimes followed by whooping sound, gagging or vomitting. Face may be red or purple during coughing spells.Easily spread from person-to-person by droplets through cough and sneezes.If not treated, until 3 weeks after onset of illness, or up to 5 days after treatment begins.YES – until 5 days
after start of antibiotics or 3 weeks if no treatment given. Contacts may need antibiotics or vaccine.
Yes – if diagnosed by a health care provider.

Last modified: February 19, 2020