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Infectious Diseases in Daycare Settings

Learn about surveillance, prevention, and enforcement of infectious diseases in daycare settings. Explore disease investigation, specific diseases, environmental cleaning, and preventative measures. Develop a basic knowledge of common diseases and how to prevent and control them.

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Infectious Diseases in Daycare Settings

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  1. Infectious Diseases in Daycare Settings Olmsted County Public Health Services Family Child Care, Inc. Workshop April 8th, 2019

  2. Objectives

  3. Minnesota Department of Health • Surveillance • Prevention and Response • Enforcement—Minnesota Communicable Disease Reporting Rule and Minnesota Statutes

  4. Olmsted County Public Health Services • Disease Investigation • Pertussis • Varicella • Measles • Mumps • GI Outbreaks • Consultation • Disease specifics • Environmental cleaning • Preventative measures • Guidelines

  5. Childcare Provider • Have a basic knowledge of the signs and symptoms of common diseases as well as how to prevent and control them • Report diseases to MDH or OCPHS via phone or fax • 507-328-7500 (OCPHS); 651-201-5414 (MDH) • Develop and enforce an exclusion policy • Sanitize and disinfect commonly touched surfaces • Encourage good handwashing

  6. Epi 101

  7. Infectious Disease Terminology • Germ—the thing that causes disease • Bacteria, Viruses, Parasites, Fungi • Transmission (Spread)—how the germs get from one person to another person • Incubation Period—the time from exposure to the germ/sick individual to the start of symptoms • Contagious (Infectious) Period—the timeframe in which a person can spread their illness

  8. Disease Investigation

  9. Case Report—What do we collect? • Who? • Age • Sex/gender • Race/ethnicity • Where? • School, daycare, sports, church groups • When? • Symptom onset • Travel dates • Dates attended activities

  10. Calculating Infectious Period

  11. Exposure Notifications and Interventions

  12. Common Infectious Diseases in Child Care Settings

  13. Conjunctivitis (Pink Eye) • Germ: • Viruses, bacteria, or allergens • Transmission: • Touching secretions from eyes, nose, or mouth • Incubation: • 1-3 days usually (1-12 days) • Symptoms: • Pink/red color in white of the eye(s); swelling of eyelid; watery eye; itching, irritation, and/or burning; discharge; crusting of eyelid or lashes • Duration: • Viral (7-14 days); Bacterial (2-5 days); Allergen (once allergen removed) • Contagious Period: • While symptoms are present

  14. Conjunctivitis: What’s the Difference?

  15. Conjunctivitis (Pink Eye) • Exclusions: • Until seen by doctor if bacterial with thick white or yellow discharge and eye pain • NO exclusion if clear, watery discharge without eye pain or fever • Prevention: • Cover nose and mouth when sneezing or coughing • Do not rub eyes • Do not share towels, eye drops, or other objects that come in contact with the eye • Handwashing • Clean and sanitize/disinfect objects such as toys, tables, door knobs

  16. Head Lice • Germ: • Louse • Transmission: • Head-to-head contact  CANNOT jump or fly • Sharing personal products such as combs, brushes, hats, hair ties • Incubation: • 7-10 days from eggs laid to hatch • Symptoms: • Itching of the head/neck, crawling lice, scratch marks on the head/back of neck • Duration: • 2 weeks • Contagious Period: • Until treated with lice killing products

  17. Head Lice • Exclusions: • None, but recommended to wait until first complete treatment • DO NOT recommend a “No Nit” policy—all lice do not need to be gone • Prevention: • Do NOT share hair products, accessories, or towels • Vacuum carpets, furniture, mattresses, and car seats thoroughly • Wash clothes, pillow cases, towels in hot water and on a hot dryer cycle • Un-washables can be sealed in a plastic bag • Don’t be surprised if you need to do a second treatment 7-10 days later

  18. Common Childhood Rashes: Name that Rash

  19. Varicella (Chickenpox)* • Germ: • Virus • Transmission: • Contact with blister fluid or secretions from the nose or mouth; coughing or sneezing • Incubation: • 10-21 days after exposure • Symptoms: • Red spots that turn into fluid-filled blisters; itchy; fever; tiredness; loss of appetite; headache • Duration: • 4-7 days • Contagious Period: • 1-2 days before rash onset until spots are dry and scabbed

  20. Varicella (Chicken Pox)* • Exclusion: • All blisters need to be dry and scabbed over (around 5 days after rash onset) • Prevention: • Cover nose and mouth when sneezing and coughing • Handwashing • Clean and disinfect objects and surfaces • Vaccination • Dose 1: 12-15 months • Dose 2: 4-6 years

  21. Measles* • Germ: • Virus • Transmission: • Airborne (can stay in air for 2 hours); touching secretions • Incubation: • 10-21 days (rash usually starts around day 14) • Symptoms: • High fever, cough, runny nose, watery eyes, red/brown rash on 3rd-7th day • Duration: • 4-7 days for rash • Contagious Period: • 4 days prior to rash to 4 days after rash

  22. Measles* • Exclusion: • Until 4 days after onset of rash • If exposed and unvaccinated, exclude for 21 days from LAST exposure. • Unless they received a vaccine within 72 hours or were given immune globulin within 6 days of exposure • Prevention: • Vaccine • Dose 1: 12 months • Dose 2: 4-6 years • Cover nose and mouth when coughing or sneezing • Handwashing • Clean and sanitize/disinfect surfaces and toys

  23. Hand, Foot, and Mouth Disease • Germ: • Virus • Transmission: • Fecal-oral—contact with stool from an infected person on hands, food, or objects; coughing/sneezing; contact with blisters (RARE) • Incubation: • 3-6 days • Symptoms: • Fever; reduced appetite; sore throat; small red ulcers in mouth, small red fluid-filled bumps on palms of hands, and soles of feet (knees, elbows, buttocks, genital area) • Duration: • 7-10 days • Contagious Period: • First week of illness most infectious, but can spread for several weeks after symptoms go away

  24. Hand, Foot, and Mouth Disease • Exclusion: • Until 24 hours after fever is gone and can resume routine activity • NOTE: sores and rash may still be present • Prevention: • Cover nose/mouth when sneezing and coughing • Handwashing • Clean and sanitize/disinfect objects and surfaces (toys, diaper changing area, and potty chairs)

  25. Ringworm • Cause: • Fungi • Transmission: • Touching rash; sharing objects (hats, combs, towels, pillows, bedding) • Incubation: • 7-21 days • Symptoms: • Flat, ring-shaped rash; as it spreads, the center becomes clear; itchy; “athletes foot”, patchy scaling or cracking skin on the foot • Duration: • 2-4 weeks • Contagious Period: • 24-48 hours after treatment

  26. Ringworm • Exclusion: • Until treatment started • No swimming, gym, or other close contact until lesions can be covered or 72 hours after treatment started • Prevention: • Do not share brushes, combs, towels, bedding, hats, etc.. • Handwashing • Have separate bedding and pillows for each child and wash in hot soapy water daily when an individual is infected

  27. Scabies • Germ: • Mites • Transmission: • Skin-to-skin contact; sharing bedding and towels • Incubation: • 2-6 weeks • Symptoms: • Tiny red bumps or blisters (usually between fingers, around wrist, elbows, and armpits); intense itching • Duration: • 2-3 weeks • Contagious Period: • Rash onset until 24 hours after treatment

  28. Scabies • Exclusion: • 24 hours after treatment • Prevention: • Wash bedding and towels in hot water and dry on high heat cycle • Vacuum furniture and carpeting

  29. Impetigo • Germ: • Bacteria • Transmission: • Direct contact with the sores; contact with contaminated objects (RARE) • Incubation: • 1-10 • Symptoms: • Red sores or blister with crusty brown discharge; itchy • Duration: • 2-4 weeks • Contagious Period: • Until sores are healed or 24 hours after antibiotics started

  30. Impetigo • Exclusion: • 24 hours after antibiotics started and sores drying/improving • Prevention: • Handwashing • Cover sores • Wear gloves when applying medication to the sores • Do not share towels, washcloths, or clothing • Clean and sanitize/disinfect toys and surfaces

  31. 5th Disease (Slapped Cheek Syndrome) • Cause: • Virus • Transmission: • Coughing or sneezing; touching secretions • Incubation: • 4-21 days • Symptoms: • Bright red rash on cheeks; fever; sore throat • Duration: • 3-7 days; may reoccur over several weeks • Contagious Period: • Just before rash onset until rash onset

  32. 5th Disease • Exclusion: • None—no longer infectious once rash begins • Prevention: • Handwashing • Cover nose and mouth when coughing or sneezing • Clean and sanitize/disinfect toys and surfaces

  33. Respiratory: Name that Cough

  34. Influenza vs.Cold vs. Pertussis

  35. Influenza • Germ: • Virus • Transmission: • Coughing or sneezing; touching secretions • Incubation: • 1-4 days (usually 2) • Symptoms: • Rapid onset of fever, chills, body aches, cough, runny nose, sore throat • Duration: • 3-7 days • Contagious Period: • 1 day before symptoms until symptoms resolve

  36. Influenza • Exclusion: • 24 hours after fever resolves • Child is well enough to perform normal activities • Prevention: • Yearly influenza vaccine • Cover nose and mouth when coughing or sneezing • Handwashing • Clean and sanitize/disinfect toys and surfaces • Stay home when sick

  37. Pertussis (Whooping Cough)* • Germ: • Bacteria • Transmission: • Coughing, sneezing, talking, and singing; touching secretions • Incubation Period: • 4-21 days after exposure (usually 7-10 days) • Symptoms: • Week 1-2: sneezing, runny nose, low-grade fever, cough • Symptoms Continued: • Week 2-6 (up to 10): Coughing in sudden, uncontrollable bursts, high-pitched whoop sound following coughing episode, gagging or vomiting after coughing episode, coughing often worse at night • Duration: • weeks to months  nicknamed the 100 day cough • Contagious Period: • Cough onset until either 3 weeks after cough onset or until 5 days of antibiotics taken

  38. Pertussis (Whooping Cough)* • Exclusion Policy: • If treated, 5 days antibiotics completed. • If not treated, 3 weeks of coughing has passed. • If exposed AND symptomatic, negative swab or 3 weeks of coughing has passed. • Prevention: • Vaccine @ 2, 4, and 6 months, 15-18 months, and 4-6 years • Cover nose and mouth when sneezing and coughing • Handwashing • Clean and sanitize/disinfect toys and surfaces

  39. Stomach Bugs

  40. Norovirus • Germ: • Virus • Transmission: • Fecal-oral • Incubation: • 12-48 hours • Symptoms: • Watery diarrhea, vomiting, fever, headache, fatigue, stomach cramps • Duration: • 1-3 days • Contagious Period: • Symptom onset to 72 hours after symptoms resolve

  41. Norovirus • Exclusion: • 24 hours after last bout of diarrhea or vomiting • Prevention: • Handwashing • Clean and sanitize/disinfect toys and surfaces

  42. E.coli* • Germ: • Bacteria • Transmission: • Fecal-oral • Incubation: • 1-8 days (usually 3-4 days) • Symptoms: • Watery diarrhea, stomach cramps, low grade fever; bloody diarrhea (O157) • Duration: • 5-10 days • Contagious Period: • Symptom onset until several weeks or months after symptom resolution

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