COMMUNICABLE DISEASE CHART

** “REPORTABLE DISEASE” refers to individual cases; ALL OUTBREAKS should be reported to Orange County Public Health, phone 714-834-8180, fax 714-834-8196.

DISEASE INCUBATION SIGNS OF ILLNESS EXCLUDE FROM REPORTABLE NOTES

PERIOD ATTENDANCE DISEASE**

Athlete’s Foot Unknown Blisters & cracking of skin on feet, No No Teach importance of hygienic care of feet.
(Tinea pedis) usually between toes. Nails may be Rare before puberty; aggravated by heat and
affected (tinea unguium). sweating. Should not be allowed to go
barefoot or go in swimming or wading pools
with active lesions.
Boils/skin Variable Tender, red, warm nodule/pustule in Until active drainage stops No Hand washing and proper disposal of infected
abscesses (likely skin +/- purulent drainage; often and lesions can be covered. bandages and dressing. Avoid touching of
Staph, in particular mistaken for spider bite. lesions. Sanitize toilet seat after use if
MRSA) buttocks abscess.
Chickenpox 10-21 Days, Slight fever, rash consisting of blisters Until all lesions completely No, unless Vaccine required for school entry. Vaccine-
(Varicella) usually 14-16 that appear first on head, then spread to crusted over, usually by ~ 6 hospitalized or modified varicella may have many fewer
days body. Usually 2 or 3 crops of new days after onset of rash. death. lesions and atypical looking rash. Do not use
blisters in different stages; eventually Immunocompromised aspirin products in children, especially with
crusts over; itchy. children should be excluded chickenpox. Watch for signs of
for the duration of the superinfection of lesions (high fever, redness
vesicular eruption. or tenderness around lesions).
CMV Unknown Generally not apparent in young No No Standard precautions should be used with all
(Cytomegalovirus) children, or mononucleosis-like illness children as many young children excrete the
in adolescents and adults. virus while having no symptoms. Hand
washing and avoiding contact with urine,
Congenital defects if infected in utero saliva and nasal secretions should be
during pregnancy, especially first emphasized.
trimester.
Female employees of childbearing age should
be referred to their health care providers for
counseling and/or testing.
Common Cold 2-7 Days Runny nose (can be purulent), watery No, unless febrile then No Teach importance of washing hands and
(various viruses) eyes, general tired feeling, slight cough. exclude until afebrile. covering mouth when coughing or sneezing.
Fever usually absent or low-grade.
 DISEASE INCUBATION SIGNS OF ILLNESS EXCLUDE FROM REPORTABLE NOTES
PERIOD ATTENDANCE DISEASE**

Conjunctivitis 1-3 Days Pink or red eyes with purulent white or If purulent, until treatment No Children with nonpurulent conjunctivitis
(pink eye), purulent yellow discharge and crust, or matted started or cleared by (clear, watery eye discharge) need not be
eyelids on awakening. physician. excluded.
Fifth Disease 4-21 Days Mild fever, malaise, muscle aches No No Contagious period is greatest before onset of
(Parvovirus B19, initially, followed by redness of cheeks rash and probably not communicable after
Erythema (slapped cheek) appearance and lacy- onset of rash. More serious infections in
infectiosum) like rash on trunk and extremities 7-10 people with HIB, hemolytic anemias, or
days later. Rash fades but may recur immunosuppression, with prolonged
on exposure to sunlight or heat for infectious period. Refer exposed pregnant
several weeks. Adolescents and adults women to physician.
can get joint pain and arthritis.
Hand, foot & 3-6 Days Fever, malaise, sore mouth or throat, or Until afebrile. No Virus may be shed in the stool for several
mouth disease not eating well. Papulovesicular weeks. Emphasize hand washing after
lesions in mouth, on palms, fingers and changing diapers and using toilet.
(Coxsackievirus) soles of feet.
Head Lice Eggs hatch in 6- Itching and scratching of scalp. At end of day until after first No Second treatment of appropriate shampoo
10 days; mature Pinpoint white eggs (nits) on base of treatment. recommended in 7-10 days. Teach
(Pediculosis) adults in 2-3 hair shaft that will not flick off easily. importance of NOT sharing combs, hats and
weeks. coats. No nit policy NOT recommended by
AAP (2003 Red Book).
Hepatitis A 15-50 days, Gradual onset slight fever, tired feeling, For one week after onset of Yes All children aged 1 year and older in
usually ~28 days. appetite loss, stomachache, nausea jaundice or until released by California should receive hepatitis A vaccine
and/or vomiting followed by jaundice. health department. (2 doses, given 6 months apart). Teach
Young children may have mild case of importance of hand washing, especially after
diarrhea without jaundice or be changing diapers and using toilet.
asymptomatic. Symptomatic contacts should be excluded
from school and reported to the health
department. Immune globulin should be
given to family contacts, classroom contacts
for child care/preschool, and staff. Additional
immune globulin may be recommended
depending on number of cases and toilet-
training status of cases.
Hepatitis B 45-160 days, Acute: nonspecific symptoms of No, but exclusion may be Yes All children should be vaccinated against
usually ~90 days hepatitis (appetite loss, nausea, considered in children with HBV. Staff with potential for exposure to
malaise) and/or jaundice. aggressive behavior (biting), blood should be vaccinated pre-exposure.
generalized dermatitis, or a Standard precautions should reduce risk of
Chronic: usually asymptomatic in bleeding problem. infection. Prompt evaluation and treatment
children. after any percutaneous or mucosal exposure to
blood or bloody body fluids is recommended
Hepatitis C 2 weeks – 6 Acute: Most asymptomatic, but can get No Yes No vaccine available. Standard precautions
months; average mild symptoms of hepatitis and should reduce risk of infection. Prompt
6-7 weeks jaundice. evaluation after any percutaneous or mucosal
exposure to blood or bloody body fluids is
 DISEASE INCUBATION SIGNS OF ILLNESS EXCLUDE FROM REPORTABLE NOTES
PERIOD ATTENDANCE DISEASE**

Chronic: Usually asymptomatic. recommended.

Herpes simplex 2 days – 2 weeks First infection usually asymptomatic No, unless first infection No Cover any skin lesions. Children or staff with
(cold sores) but may have fever, ulcers on the gums (with multiple oral lesions lesions should not kiss or nuzzle others and
and oral mucosa, vesicles around the +/- fever) and drooling. should not share food or drinks.
mouth, and swollen lymph nodes under
the jaw line. Recurrent infections
usually have just single or group of
vesicles around the mouth, occasionally
on fingers.
Impetigo 7-10 days for Small blisters on skin that open and Until 24 h after antibiotics No Keep lesions covered. Emphasize hand
Strep, variable become honey-crusted; no fever or started. washing and not touching lesions.
for Staph surrounding redness.
Influenza 1-3 days Fever, cough, muscle aches, myalgia; Until afebrile No Teach importance of washing hands and
can have runny nose, sore throat, and covering mouth when coughing or sneezing.
abdominal symptoms too (especially in Children, especially with influenza, should
young children). NOT be given aspirin because of the risk of
Reyes syndrome. As of the 2004-2005
influenza season, vaccination is recommended
for ALL children aged 6-23 months.
Measles 8-12 days. Fever, cough, runny nose, Until 4 days after onset of Yes Exposed people may need immune globulin
conjunctivitis; red rash a few days later. rash. and/or vaccine. Vaccine (MMR) part of
(Rubeola) routine childhood vaccinations (@ 12-15
months and 4-6 years).
Meningitis, Depends on Fever, headache, stiff neck, vomiting, Until 24 hours after Yes Close contacts may need prophylaxis
bacterial bacteria; sleepiness, irritability, sensitivity to antibiotics started. depending on bacteria and situation. Hib (H.
meningococcus light. flu) and pneumococcal vaccines part of
1-10 days, routine childhood immunizations (2, 4, 6, 12-
usually < 4 days. 15 months, 4-6 years).
Meningitis, viral 3-6 days Fever, headache, stiff neck, vomiting, Until afebrile and cleared by Yes
(usually sleepiness, irritability, sensitivity to MD.
enterovirus) light; may have rash.
Meningococcal 1-10 days, Fever, rash, chills +/- symptoms of Until 24 hours after Yes Close contacts will need prophylaxis.
infections usually < 4 days meningitis as described above. antibiotics started.
(Neisseria
meningitides;
meningitis,
sepsis/blood-
stream infections)
Mononucleosis 30-50 days Fever, sore throat, swollen lymph Until afebrile. No Avoid contact sports and rough play if spleen
(usually EBV) nodes; symptoms usually not prominent enlarged.
infants and young children.
Mumps 12-25 days, Swelling of salivary glands, usually the Until 9 days after onset of Yes Vaccine (MMR) part of routine childhood
usually 16-18 parotid glands. parotid gland swelling. vaccinations (@ 12-15 months & 4-6 years).
days
 DISEASE INCUBATION SIGNS OF ILLNESS EXCLUDE FROM REPORTABLE NOTES
PERIOD ATTENDANCE DISEASE**

Pneumococcal Variable Fever, cough, ear pain; symptoms of Until 24 hours after start of Yes Vaccine (pneumococcal conjugate/Prevnar)
infections meningitis as described above. antibiotics. part of routine childhood immunizations (@2,
(Streptococcus 4, 6, 12-15 months).
pneumoniae;
meningitis,
sepsis/bloodstream
infections,
pneumonia)
Ringworm (tinea Unknown Body—slightly red, well-demarcated Until treatment has begun. No Body—keep lesions covered. Scalp—ribbons,
corporis—body; itchy lesions, often circular with scaly combs, hairbrushes should not be shared.
tinea capitis— or pustular border. Scalp—patchy Caps, hats, and hair cuts or shaving of head
scalp) areas of scaling of pustules +/- hair are not necessary.
loss.
Rubella (German 14-23 days, Generalized rash with swollen lymph Until 6 days after onset of Yes Can cause congenital infection—pregnant
measles) usually 16-18 nodes and slight fever; adolescents and the rash. caregivers should be referred for counseling
days adults can have joint pain. +/- testing. Congenitally infected infants
should be considered infectious for at least 1
year unless serial cultures of nasopharynx and
urine are negative. Vaccine (MMR) part of
routine childhood vaccinations (@ 12-15
months & 4-6 years).
Salmonellosis 1-2 days Sudden onset of diarrhea, often with Until diarrhea resolves. (If Yes Teach importance of hand washing, especially
(non-typhoid) fever, abdominal pain, sometimes Salmonella typhi (typhoid after changing diapers and using toilet.
vomiting. fever) needs to be released Frequently a foodborne infection.
by health department). Symptomatic contacts should be excluded
from school and reported to the health
department.
Scabies First infection 4- Small raised red bumps or blisters on Until treatment has been No Teach about transmission. Caregivers and
6 weeks; repeat skin with severe itching. completed. household contacts with prolonged close
infection 1-4 personal contact may benefit from
days. prophylactic treatment. Clothing worn next to
skin and bedding should be washed or
removed and stored for >4 days.
Shigellosis 1-7 days; usually Sudden onset of diarrhea, often with Until asymptomatic. Yes Teach importance of hand washing especially
2-4 days fever, vomiting and bloody stools. after changing diapers and using toilet.
Exclude from shared water-play areas.
Symptomatic contacts should be excluded
from school and reported to the health
department.
Shingles Not applicable Grouped vesicles localized in area of Only if unable to be covered No Very uncommon in children.
(chickenpox virus) skin, occasionally with pain, no fever. completely.
 DISEASE INCUBATION SIGNS OF ILLNESS EXCLUDE FROM REPORTABLE NOTES
PERIOD ATTENDANCE DISEASE**

Strep throat and 2-5 days Fever, sore throat often with enlarged, Until at least 24 hours after No Consult physician regarding family contacts
scarlet fever tender lymph nodes in neck. Scarlet antibiotics are started and who are symptomatic.
fever-producing strains of bacteria afebrile.
cause a diffuse fine red rash that
appears 1-3 days after onset of sore
throat.
Tuberculosis 2-12 weeks Gradual onset of tiredness, cough, loss Until under treatment and Yes All close contacts should have TB skin tests
of appetite, fever, night sweats, and released by health (PPD). Young children usually not
failure to gain weight. department. contagiousness but infection signifies likely
contagious adult contact. Antibiotic
prophylaxis indicated for newly positive
reactions.
Whooping cough 6-21 days, Low-grade fever, runny nose & cough Until 5 days after Yes Vaccine (DTaP) part of routine childhood
usually 7-10 lasting about 2 weeks, followed by appropriate therapy started immunizations (2, 4, 6, 15 months, 4-6 years).
(Pertussis) days onset of paroxysmal coughing spells or 21 days after cough onset Tdap now recommended for adolescents
and ―whoop‖ on inspiration; may if not treated. (starting at age 11 years) and adults.
present just as prolonged cough, Antibiotic prophylaxis of family contacts of
especially in older children and adults. cases usually recommended. Observation of
exposed children and staff for 21 days; if
symptomatic, contacts should be referred for
evaluation and excluded.

No set of recommendations can cover all situations. Consult with a pediatrician, the health department, or individual school district policies when in doubt.

The information contained within this guide is based on the latest recommendations addressing health and safety in group care settings from the following organizations (January 2006): American Academy of
Pediatrics and the Orange County Public Health (Epidemiology).