Communicable Diseases at the Communicable Diseases at the Department of Public Health Department of Public Health

Refugee & Im m igrant Health TB Prevention & Control

Cryptospor idiumGiardia

W aterborne

S almonellaE . coli O 157:H7

N orovir us

Foodborne

LegionellaM eningit is

S A RS

Respiratory

RabiesLyme

W est N ile Vir usT ular emia

Zoonotic

EpidemiologyS urveillance

I nf r astr ucture

Emergency Preparedness

Epidem iology Program Im munization Program

Epidem iology and Imm unization HIV /AIDSSurveillance

STD Prevention Integrated Surveillance& Inform atics Services

Bureau of Com municable Disease Control

Settings for SpreadSettings for Spread

Household Day Care Center School Workplace

FactsFacts Approximately 1/5 of the U.S. population attends or works in

schools. (U.S. Dept of Ed, 1999) Some viruses and bacteria can live from 20 minutes up to 2

hours or more on surfaces like cafeteria tables, doorknobs, and desks. (Ansari, 1988; Scott and Bloomfield, 1989)

Nearly 22 million school days are lost annually due to the common cold alone. (CDC, 1996)

Addressing the spread of germs in schools is essential to the health of our youth, our schools, and our nation

Students need to get plenty of sleep and physical activity, drink water, and eat good food to help them stay healthy in the winter and all year.

Day Care CentersDay Care CentersConducive to the Spread of Infectious DiseasesConducive to the Spread of Infectious Diseases

Individual Characteristics Diapered infants & toilet trained children Body secretion control Normal infant behavior

oral environment exploration body part exploration biting

Pool of susceptibles Adult interaction

Day Care Centers Day Care Centers (cont.)(cont.)

Environmental Characteristics Staff:child ratios Crowded quarters/decreased air flow Contaminated toys Direct contact during play Common changing tables

Staff duties changing diapers preparing food

Look what I brought home from Look what I brought home from school, Mommy!!!school, Mommy!!!

Droplet or Respiratory Colds, chickenpox, flu,

parvovirus, strep Viral or bacterial

meningitis Fecal-oral

hepatitis A, shigella,salmonella, giardia, pinworms, coxsackievirus,

Direct contact impetigo, ringworm,

conjunctivitis, scabies, head lice

Infections in Day CareInfections in Day Care

Mode of Transmission

Bacteria Viruses Other (parasites, fungi, infestations)

Fecal-Oral

Campylobacter Salmonella, Shigella

E. coli O157:H7

Enteroviruses

Hepatitis A, Rotavirus Coxsackievirus, Polio

Giardia, Pinworms Cryptosporidium

Respiratory

Hib, Pertussis, TB Meningococcal Dis.

Group A Strep Diphtheria

Adenovirus, Influenzae

Measles, Parvovirus, RSV Rhinovirus, Varicella,

Mumps, Rubella, Roseola

Direct/Indirect

Impetigo

Conjunctivitis

Herpes simplex Conjunctivitis

CMV, Varicella

Lice, Scabies

Ringworm

Contact with blood/urine

CMV

Hepatitis B,C Herpes simplex, HIV

Contact with

Animals

Lyme Disease

Salmonella

Rabies, EEE

Ringworm

Disease TransmissionDisease Transmission

Direct Contact Respiratory or Droplet Bloodborne Fecal-Oral Zoonotic

Stop-spread guidelinesStop-spread guidelines(direct contact)(direct contact)

Follow handwashing & cleanliness guidelines Do not permit the sharing of personal items Provide individual storage areas for outer clothing

items Wash & cover sores, cuts & scrapes promptly and

keep infected eyes wiped dry Notify parents of rashes, sores, runny eyes and

itching for hcp referral

Stop-Spread GuidelinesStop-Spread Guidelines(fecal-oral)(fecal-oral)

Handwashing, handwashing, handwashing Attend to environmental cleaning & sanitation Keep track of # of cases of diarrhea Exclude students with severe diarrhea Discourage the practice of reptiles as classroom

pets Strictly monitor reptile visits

handwashing after any contact with reptile or cage barriers between reptiles and students

Stop-spread guidelinesStop-spread guidelines(droplet spread)(droplet spread)

Follow handwashing & cleanliness guidelines Discourage the sharing of food and do not permit the

sharing of water bottles during sports Air out classrooms daily, even in winter Teach children & staff to cough or sneeze toward the

floor or to one side, away from others Keep a supply of disposable towels and tissues in each

classroom Dispose of used towels or tissues in a step-can with a

plastic liner

ParvovirusParvovirus(Fifth Disease)(Fifth Disease)

5th of 6 similar rash-causing illnesses caused by Parvovirus B19

Symptoms 1st stage (2-3d) = cold or flu-like lasting 2-3 d 2nd stage (7d) = maybe asymptomatic 3rd stage (?) = “slapped cheek” rash

Incubation period 4-14 days to 1st stage 2-3 weeks to rash

Parvovirus Parvovirus Control & Prevention MeasuresControl & Prevention Measures

Do not exclude children - not contagious Use routine hygienic practices

careful handwashing proper disposal of tissues frequent cleaning of toys and other shared objects

Pregnant women rare reports of stillbirths & miscarriages tested for immunity no recommendation to exclude

Parvovirus Parvovirus (cont.)(cont.)

Transmitted by respiratory route sneezing, talking, coughing, touching secretions infectious before rash & usually not infectious

when rash appears 50% of people infected by adulthood Diagnosis

symptoms immunity by blood test

PediculosisPediculosis(head lice)(head lice)

Lice tiny insects that live on hair but cannot survive away from

the scalp for more than 48 hours Transmission

they crawl from person to person directly or through shared items

Diagnosis by observation Treatment

removing lice from individuals, surroundings & personal items

Pediculosis Pediculosis Control & PreventionControl & Prevention

Refer students with active head lice to their health care provider

Exclude infested students until treated (check school or town “no nit” policy)

Treat personal items and surroundings in school environment wash, dry, quarantine, vacuum

Discuss notification guidelines Check student heads in affected classrooms

regularly

Salmonella sp.Salmonella sp.

Bacteria that must be swallowed (fecal-oral) Incubation period: 12 - 36 hrs Sx: Diarrhea, cramps, nausea, vomiting,

headache, fever, chills, dehydration Duration: few days - few weeks. May be fatal. Sources: undercooked foods of animal origin

i.e. eggs, milk, beef, poultry. Reptiles, other people with salmonella

Seasonal variation

Reptile SalmonellosisReptile Salmonellosis

All reptiles shed salmonella in their feces Increased popularity of reptiles as pets in

households and classrooms Special risk to infants, children,

immunocompromised, pregnant women and the elderly

Lack of awareness

Two Excedrin HeadachesTwo Excedrin Headaches

Hepatitis A fecal-oral transmission long incubation period symptoms in younger

children infectious before

symptoms immune globulin for

prevention

Meningococcal Illness salivary spread serious,10% fatal hysteria producing antibiotics for prevention

E. coliE. coli O157:H7 O157:H7

First identified as human pathogen in 1982 Incubation period: 48 - 96 hrs Symptoms

diarrhea (bloody), cramps, headache 2-7% develop HUS

Duration: 6 - 8 days Imp. foods: beef, raw milk, apple cider

E. coliE. coli O157:H7 in Massachusetts O157:H7 in Massachusetts

1991 - Southeastern Ma. apple cider implicated 23 cases 4 cases HUS no deaths

1995 - Barnstable County hamburger implicated 9 primary cases 1 primary and 1 secondary HUS

Field Trip SafetyField Trip Safety

Traveling animals shows & exhibits reptiles - salmonella bats, raccoons, skunks - rabies

Field trips farms, zoos, orchards

no raw milk no unpasteurized apple juices & cider strict supervision, limited animal contact handwashing

Tools for TeachingTools for Teaching

Handwashing posters Handwashing brochures Handwashing demonstrations Glo-Germ

Hand Hygeine 101Hand Hygeine 101

Cleaning visibly soiled hands Use either a non-antimicrobial or antimicrobial

soap Wet hands first with water, apply soap to hands

and rub hands together vigorously for at least 15 seconds covering all surfaces of hands & fingers

Rinse hands with water and dry thoroughly with a disposable towel

Use towel to turn off faucet

Hand Hygiene 101Hand Hygiene 101

Cleaning hands not visibly soiled May use alcohol based gel Apply product to palm of one hand and rub

hands together, covering all surfaces of hands and fingers, until hands are dry.

Wear gloves when contact with blood or other potentially infectious materials, mucous membranes, and non-intact skin could occur.

Controlling Spread through Controlling Spread through Isolation and/or QuarantineIsolation and/or Quarantine

Isolation Separation of persons who have a specific

infectious disease, and are infectious, from the general population

Quarantine Separation and restriction of movements of

persons who have been exposed to an infectious agent but are not yet ill

Legal AuthorityLegal Authority

The Massachusetts Department of Public Health in cooperation with local public health authorities, has the legal authority to enforce isolation and quarantine (105 CMR 300.200)

Federal isolation and quarantine orders are issued through executive order of the President.

Cleaning & SanitizingCleaning & Sanitizing

Routine cleaning with detergent and water is most useful for removing germs from surfaces

Additional step of sanitizing kills germs on surfaces

BleachBleach Household bleach with water

Effective, economical, convenient and readily available Weakened by heat and sunlight Make new each day and discard leftover

Choose household bleach 5.25% hypochlorite (regular) 6.00% hypochlorite (ultra)

Recipe for use on surfaces that have been detergent-cleaned and rinsed (CT=2 minutes)

¼ cup bleach + 1 gallon cool water 1 TBS. Bleach + 1 quart cool water

Recipe for submerging of eating utensils detergent-cleaned and rinsed (CT=1 minute)

1 TBS. Bleach + 1 gallon cool water

Using SanitizersUsing Sanitizers Application

Spray bottle Cloths Dipping

Use appropriate concentration Follow directions to ensure sufficient contact time

Air-dry bleach sanitized surfaces Other chemicals may require additional fresh water rinsing

Label spray bottles and containers with name, dilution and date

Keep out of reach of children

Cleaning for PreventionCleaning for Prevention

Clean frequently touched surfaces, toys, and commonly shared items at least daily and when visibly soiled.

Use an Environmental Protection Agency (EPA)-registered household disinfectant labeled for activity against bacteria and viruses, an EPA-registered hospital disinfectant, or EPA-registered chlorine bleach/hypochlorite solution.

Always follow label instructions when using any EPA-registered disinfectant. If EPA-registered chlorine bleach is not available and a generic (i.e., store brand) chlorine bleach is used, mix ¼ cup chlorine bleach with 1 gallon of cool water.

Keep disinfectants out of the reach of children.

Cleaning for PreventionCleaning for Prevention Care providers and children should use soap and water to wash

hands when hands are visibly soiled, or an alcohol-based hand rub when soap and water are not available, and hands are not visibly soiled.

Children should wash hands with soap and water 15-20 seconds (long enough for children to sing the “Happy Birthday” song twice).

Care providers should wash their hands between contacts with infants and children, such as before meals or feedings, after wiping the child’s nose or mouth, after touching objects such as tissues or surfaces soiled with saliva or nose drainage, after diaper changes, and after assisting a child with toileting.

Care providers should wash the hands of infants and toddlers when the hands become soiled.

Cleaning for PreventionCleaning for Prevention Oversee the use of alcohol-based hand rubs by children

and avoid using these on the sensitive skin of infants and toddlers.

Keep alcohol-based hand rubs out of the reach of children to prevent unsupervised use.

Keep sink locations and restrooms stocked with soap, paper towels or working hand dryers.

Keep each child care room and diaper changing area supplied with alcohol-based hand rub when sinks for washing hands are not readily accessible.

Cleaning for PreventionCleaning for Prevention

Advise children and care providers to cover their noses and mouths with a tissue when sneezing or coughing, and to put their used tissue in a waste basket.

Make sure that tissues are available in all nurseries, child care rooms, and common areas such as reading rooms, classrooms, and rooms where meals are provided.

Encourage care providers and children to wash their hands or use an alcohol-based hand rub as soon as possible, if they have sneezed or coughed on their hands.

Five Commandments of Five Commandments of Infectious Disease ControlInfectious Disease Control

Prevent illness from spreading Require immunizations Report some illnesses (city/town or state)

individual illnesses outbreaks

Exclude, cohort or treat some children and/or staff Be prepared

hire health care consultant inform parents about policies

State Health Dept.State Health Dept.

Videos Pamphlets Control materials Human Resources - us!

617-983-6800 (24/7)

MDPH Educational Materials:MDPH Educational Materials:HandwashingHandwashing

Check out all the information on the internet!

MA Department of Public Health’s Web Page Address:

http://www.state.ma.us/dph/Centers for Disease Control & Prevention’s Web Page Address

http://www. cdc.gov/http://www.cdc.gov/germstopper/resources.htm