MANAGEMENT OF SELECTED CASUAL-CONTACT DISEASES | Administrative Guideline Manual

8450 - MANAGEMENT OF SELECTED CASUAL-CONTACT DISEASES

Diseases spread by airborne and/or direct contact with germs from sneezing, coughing, and speaking.

DISEASE	SYMPTOMS	INCUBATION PERIOD	CONTAGIOUS PERIOD	RETURN TO SCHOOL

ASEPTIC (VIRAL)	Fever, severe	Varies depending	Varies	Patients gradually too
MENINGITIS	headache, and	on virus or cause,	depending on	sick to attend school
	stiff neck	for enteroviral	virus or other	and can return when
		meningitis 3-6	organism	recovered
		days


2019 NOVEL CORONAVIRUS DISEASE (COVID-19)	Cough, shortness of breath, difficulty breathing, or at least two of the following symptoms: chills, shaking with chills, muscle pain, headache, sore throat, and loss of taste or smell. Symptoms can range from mild to severe and may appear up to 2 weeks after exposure to the virus, according to the CDC. Some people with COVID-19 don't display any symptoms.	Most estimates of the incubation period for COVID-19 range from 1-14 days, most commonly around 5 days	Persons infected may be contagious for days before they experience symptoms. On average, the time from exposure to symptom onset (known as the incubation period) is about 5 to 6 days. Current rule of thumb is to quarantine for at least 14 days from the time symptoms develop or 7 days after symptoms resolve - whichever is longer.	Students with COVID-19 who have stayed home (home isolated) can return to school under the following conditions: If student has not had a test to determine if s/he is still contagious, student can return to school after these three things have happened: no fever for at least 72 hours (that is three full days of no fever without the use of medicine that reduces fevers) AND other symptoms have improved AND at least 10 days have passed since symptoms first appeared. If student has had a test to determine if s/he is still contagious, student can return to school after these three things have happened: no fever (without the use of medicine that reduces fevers) AND other symptoms have improved AND student received two negative tests in a row, at least 24 hours apart. Students who DID NOT have COVID-19 symptoms but tested positive and have stayed home (home isolated) can return to school under the following conditions: If student has not had a test to determine if s/he is still contagious, student can return to school after these two things have happened: at least 10 days have passed since the date of student’s first positive test AND student continues to have no symptoms (no cough or shortness of breath) since the test. If student has had a test to determine if s/he is still contagious, student can return to school after: student received two negative tests in a row, at least 24 hours apart. **In all cases, follow the guidance of the student’s doctor and local health department. The decision to stop home isolation should be made in consultation with the student’s healthcare provider and state and local health departments. Some students, for example those with conditions that weaken their immune system, might continue to shed virus even after they recover.

DIPTHERIA	Fever, sore throat, gray or yellow membrane on the throat	1-10 days, usually 2-7 days Report to Health Department	2-6 months (without treatment)	Index Case: Excluded until 2 cultures 24 hours apart are negative Contacts: Observe, culture, and treat

(Erythema Infectiosum) FIFTH DISEASE	Facial "slapped-cheek" rash with "lacy" rash on trunk and limbs	Normally 4-14 days but up to 20 days	The week prior to appearance of rash.	Feverno longer present.

INFLUENZA	Fever greater than 100 degrees F, headache, tiredness, cough, sore throat, runny or stuffy nose, and muscle aches; nausea, vomiting, and diarrhea also can occur in children	1-3 days	1 day prior to symptoms through 7 days from clinical onset	Exclusion of the student should be based on the condition of the child and if there is a school policy that warrants exclusion for symptoms of influenza

*Some of this information was taken from the publication. Communicable Disease Summary Table. Indiana State Department of Health, 2017

INVASIVE PNEUMOCOCCAL DISEASE	Fever, chills, cough, pain in the chest, disorientation	Normally 1 - 3 days Report to Health Department	Until after 24 hours of antibiotic therapy	Fever no longer present.


MEASLES		Usually about 14 days (range of 7-21 days) Report to Health Department REMOVE FROM SCHOOL IMMEDIATELY	4 days before to 4 days after rash	Exclude until 4 days after rash onset. Contacts who are not immunized are excluded until proof of immunity is show or, if exempted, 21 days after last reported case.

MENINGOCOCCAL DISEASE (Meningococcal Meningitis or Meningococcemia)	Fever, severe headache, and stiff neck.	2 -10 days; commonly 3-4 days Report to Health Department	Until the meningococcus is no longer present in nasal/mouth discharge.	Requires doctor’s note for re‑admittance.

MUMPS (Infectious Parotitis)	Swelling and pain of the parotid gland, fever, mild URI symptoms	18 days (range of 12-25 days) EXCLUDE FROM SCHOOL Report to Health Department	2 days before through 9 days after swelling first appears.	Exclude 9 days after onset of symptoms. Susceptible contacts must be excluded until proof of immunity is provided or, if exempted, from the 12th to the 25th day from exposure.

PERTUSSIS (Whooping Cough)	Initial cough, coryza, eye irritation, leading to a progressive cough that comes in bursts, may be followed by a "whoop."	10 days (range of 4-21 days) Report to Health Department	From onset of cough and cold-like illness through 5 days of appropriate antibiotic therapy. If not on antibiotics, 21 days from the onset of the cough.	Symptomatic Index case: Exclude for 5 days while receiving appropriate antibiotic therapy Symptomatic Contacts of a Confirmed Case: Exclude for 5 days while receiving antibiotic therapy Asymptomatic Direct Contacts: Do not exclude asymptomatic contacts; They should receive prophylaxis.

RUBELLA (German Measles)	Characterized by a rash that often fades or turns red and is most evident after a hot shower. Symptoms can include fever, joint pain (in adolescents and adults), and enlarged and tender lymph nodes at the back of the neck; however, children often experience no other symptoms than the rash. Rubella is also the cause of significant congenital defects in infants whose mothers are exposed during pregnancy.	16-18 days (range of 12-23 days) Report to Health Department	7 days before to 7 days after rash onset.	Index Case: 7 days after rash onset. Susceptible Contacts: Students without proof of immunity or exempted shall be excluded until proof is provided or until 23 days after last reported case.

SCARLETT FEVER	Rash begins on upper chest and progresses to trunk, neck, and extremities within 24 hours. Pinkish-red pinhead spots that blanch under pressure and feel similar to sandpaper (can often be felt easier than seen). High fever, sore throat, and nausea. The tongue is covered with white “fur” before peeling and developing into strawberry tongue; diagnosis is made with positive throat cultures for strep.	Usually 1 - 3 days, rarely longer	Onset of symptoms until 24 - 48 hours after treated with antibiotics.	24 hours after beginning antibiotic therapy.

STREPTOCCOCAL SORE THROAT and SCARLET FEVER (Scarletina)	Fever, exudative tonsillitis or pharyngitis and tender cervical nodes; in addition, a fine-red rash occurs with scarlet fever.	Usually 1-3 days, rarely longer	Appropriate antibiotic treatment eliminates organism within 24 hours. In untreated, uncomplicated cases, 10-21 days or until under adequate antibiotic treatment for 24 hours.	24 hours after initiation of antibiotic therapy.

TUBERCULOSIS	Cough that lasts longer than 3 weeks, hemoptysis, night sweats, fever, pain in chest, weight loss or failure to gain weight, fatigue, chills, etc.	2-10 weeks for positive TST or IGRA; it can take decades for active disease to develop EXCLUDE FROM SCHOOL Report to Health Department	3 months prior to onset of symptoms until no longer infectious	Exclude until no longer infectious (usually at least 2 weeks after the initiation of antibiotic therapy that produces a significant reduction in symptoms) Requires a doctor’s note for re‑admittance.



VARICELLA (Chickenpox)	Fever, fatigue, followed by rash illness that progresses into itchy, fluid-filled blisters; “Breakthrough” cases appear as macular and papular lesions (small flat or raised red bumps).	10-21 days Report to Health Department	48 hours before rash until all lesions have crusted over or have faded in mild, “break-through” disease, usually 7 days.	Index case: When lesions are dry and crusted and no new eruptions. Susceptible Contacts: During an outbreak (greater than 5 linked cases in children under 13 or greater than 3 linked cases in children 13 years and older), exclude exposed contacts until proof of immunity is provided or for exempted persons 21 days after the rash onset of the last case.

Diseases spread by contact with tiny parasites on contaminated belongings of others.

BED BUGS	Presence of bed bug nymphs on adults or on students, student belongings, or in the classroom	Approximately 1 month to develop from egg to adult; school environment is not an ideal environment for this development due to lack of hosts at night	May be transferred at any time if present	Exclusion of students is not generally recommended, nonreportable condition

PEDICULOSIS CAPITIS (Head Lice)	Main symptom is itching of scalp; lice (or eggs) can be identified by close examination of scalp.	Eggs hatch in 7 days; with resultant lice able to multiply within 8-10 days after hatching.	As long as live lice are present or eggs in hair are within ¼ inch of scalp.	No applicable state laws for exclusion. Follow school policy.

PINWORMS	Perianal itching and disturbed sleep	1-2 months or longer	As long as gravid females discharge eggs on perianal skin; eggs remain infective in an indoors environment for about 2 weeks.	Exclusion not required.

RINGWORM	Small red bump or papule that spreads outward, taking on the appearance of a red, scaly outer ring with a clear center.	1-3 weeks	As long as lesions are present or viable fungus is present on contaminated objects and surfaces.	Generally students can attend school with ringworm infections as long as infected areas are covered.

TICK-BORNE INFECTIONS	Varies by specific disease, but generally includes fever, rash, muscle aches, fatigue, and headache	Lyme: 2 - 31 days, usually 7-10 days Rocky Mtn. Spotted Fever: 3 - 14 days Ehrlichiosis: varies but generally 7 - 14 days Report to Health Department	Not applicable	Exclusion not required.



Diseases spread by the fecal-oral route – contamination of food, drink or objects placed in the mouth.

CAMPYLOBACTERIOSIS	Diarrhea (sometimes bloody), stomach cramps, fever, nausea, and vomiting	2-5 days Report to Health Department	While symptomatic	May return when no longer symptomatic.

CLOSTRIDIUM DIFFICILE INFECTIONS: CDI (C. DIFF)	Watery diarrhea, fever, abdominal tenderness	Unknown	Spores survive in environment for weeks to months	After completion of C. Difficile diarrhea

CRYPTOSPORIDIOSIS	Watery diarrhea, stomach cramps, fever, nausea, slight fever, weight loss, and vomiting	7 days (range of 1-12 days) Report to Health Department	While shedding, up to several months	Exclude until completion of antiparasitic therapy

E. COLI INFECTION (Shigatoxin Producing and Hemolytic Uremic Syndrome: HUS)	Bloody or nonbloody diarrhea, stomach cramps, low-grade fever, nausea, weight loss, and vomiting	3-4 days (range of 2-10 days) Report to Health Department	While shedding, up to 3 weeks	May return 24 hours after symptoms end

GIARDIASIS	Diarrhea, gas, greasy stools that tend to float, bloating, stomach cramps, fever, nausea, and constipation.	7-10 days (range of 3-25 days) EXCLUDE FROM SCHOOL Report to Health Department	While shedding, up to several months.	Exclude until completion of effective antiparasitic therapy Requires doctor's note for re-admittance.

HAND, FOOT AND MOUTH DISEASE (VESICULAR STOMATITIS WITH EXANTHEMA)	Fever, malaise, sore throat, and red blister spots that turn into ulcers in the mouth	3-5 days	During illness up to several weeks	Exclude during acute illness or while child who has blisters drools from the mouth or has weeping lesions on hands.

HEPATITIS A	Diarrhea, nausea, vomiting, fatigue, stomach cramps, fever, dark urine, pale, clay-colored stool, loss of appetite, and jaundice.	28-30 days (range of 15-50 days) EXCLUDE FROM SCHOOL Report to Health Department	14 days before and 7 days after the onset of jaundice, or if jaundice does not occur, 7 days before and 14 days after the onset of symptoms.	Exclude from school during infectious period.

NOROVIRUS INFECTION	Watery diarrhea, stomach cramps, nausea, vomiting, headache, muscle aches, and fatigue	24-48 hours (range of 12-72 hours) EXCLUDE FROM SCHOOL Report to Health Department	While shedding, up to 72 hours after symptoms cease.	Exclude until symptoms are gone.

SALMONELLOSIS	Diarrhea, nausea, vomiting, stomach cramps, and fever	12-36 hours (range of 6-72 hours) Report to Health Department EXCLUDE FROM SCHOOL	While symptomatic.	Exclude until symptoms are gone. Exclude from certain activities based on Health Department recommendation.

SHIGELLOSIS	Diarrhea, blood, pus or mucus in the stool, sudden stomach cramps, nausea, vomiting, and fever.	24-72 hours (range of 12 hours - 5 days) EXCLUDE FROM SCHOOL Report to Health Department	While shedding, up to several weeks.	Exclude until: 1) 48 hours after effective antimicrobial therapy with susceptibility testing; or 2) one negative stool collected 24 hours after finishing antimicrobial therapy.


Diseases spread by direct skin contact with wounds or discharges from an infected person.

CONJUNCTIVITIS (Pink Eye)	Redness of eye involving tearing, irritation, swelling, and discharge	Bacterial: 1-3 days Viral: 12 hours - 3 days	Possibly up to 14 days but depending on cause	Exclusion recommended until examination by physician and then approved for readmission

HEPATITIS B	Malaise, fever anorexia, nausea, jaundice.	60 - 90 days	1 – 2 months before and after the onset of symptoms.	Exclusion not required.

HEPATITIS C	Nausea, vomiting, weight loss, fatigue, dark urine, pale stool, jaundice.	2 weeks - 6 months Report to Health Department	At least 1 week before onset of symptoms and for the rest of their lifetime.	Exclusion not required.

HIV/AIDS Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome	Initially viral flu-like symptoms; many years later (up to 10 years) swollen lymph nodes, fatigue, fever, night sweats, unexplained weight loss, other coinfections, chronic diarrhea.	Variable, 1 week - 10 years or longer Report to Health Department	Shortly after acquisition of the virus and for the rest of their life.	School children with HIV must be allowed to attend school and may be excluded only if permitted by I.C. 16-41-9-3 (i.e., a disease that is transmissible through normal school contacts or poses a substantial threat to health and safety of school community).

HUMAN PAPILLOMAVIRUS (HPV)	Most infections are asymptomatic, may develop warts (genital and/or non-genital); cancer may develop decades later	Unknown, but estimated to be 3 months to several years	Unknown, but thought to be communicable during acute and persistent infection.	Exclusion not required.

IMPETIGO	Skin lesions (red bumps) usually around the nose, mouth, or extremities; bumps break open and form a honey-colored crust.	1-3 days streptococcus infection and 4‑10 days staphylococcus infection	In untreated cases as long as drainage from lesions occurs.	Recommended to keep child home until 24 hours after antibiotic therapy has begun.



METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS (MRSA)	Abscesses, boils	Variable	Wound drainage very infectious	Student may be excluded if recommended by HCP or if drainage cannot be covered or contained with a dry covering.

Mononucleosis (Epstein-Barr Virus)	Fever, exudative pharyngitis, swollen glands	4-6 weeks	Indeterminate; could be for many months after infection.	Exclusion not recommended.





Scabies	Rash is manifested as crusts, vesicles, pustules, blisters, or tine papules that are usually very itchy. Most common in webs of fingers, hands, wrists, armpits, groin, and elbows.	First exposure, 2‑6 weeks; for subsequent infections, the incubation may be as short as a few days.	From time of infection until 1 day after treatment	Exclude from school until 1 day after treatment.

Sexually Transmitted Diseases	Infections can be asymptomatic, cause painful toileting, itching, discharges, blisters, sores, or a rash.	Variable from 1 week to a month Report to Health Department	Variable	No exclusion would be expected.

Shingles (Herpes Zoster)	Rash that develops lesions appearing along nerve pathways	Not applicable	If lesions are not covered, transmission of varicella disease may occur from 10-21 days following contact	Index Case: Exclude only if the site of infection cannot be covered. Susceptible Contacts: Do not exclude

West Nile Virus	Abrupt onset of fever, headache, myalgia, weakness, and often abdominal pain, nausea, or vomiting; most cases are asymptomatic.	Usually 3 - 15 days Report to Health Department	Humans are not infectious to other humans except through blood/organ donation.	Fever no longer present.

Additional information obtained from – Indiana State Department of Health http://www.in.gov/isdh/23291.htm "Communicable Disease Reference Guide for Schools: 2017 Edition", ISDH: Rash Illness Chart, ISDH: Quick Reference Chart.

Revised 11/10/09
Revised 8/8/11