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Information ⬇

Editors

MarjoRenko
VillePeltola

Excluding a Child with an Infection from Day Care

Essentials

  • A distinction must be made between absence required because of the child's disease and because of the risk of infecting others.
    • This guideline does not consider how many days a child should remain absent from day care to recover from the disease. A sick child should always be allowed a sufficient period of convalescence after a disease.
  • Antimicrobial treatment as such does not require exclusion.
  • The first clinically observed case of infection (index case) is rarely the first case of infection: at the time the index case is diagnosed there may be many infected asymptomatic children in the day care group.
  • Contagiousness is highest at the beginning of the disease. Therefore, to reduce the infection pressure both children and staff should preferably stay home immediately symptoms of infection appear. Many diseases are highly contagious even before symptoms appear, which makes exclusion less effective.
  • For exclusion of children with infections from day care see table T1.
  • See also relevant local policies and recommendations.

General remarks

  • Even if exclusion is not necessary, children should be given sufficient time to recover from any infection before returning to early childhood education and care.
  • Care in a child day care centre increases the incidence of infections in small children about threefold, particularly during the first six months.
  • Vaccination is a fundamental means of preventing infectious diseases in children.
  • Infections among children in day care centres can be reduced by having a sufficient number of staff in relation to the number of children and by good hand hygiene.

Transmission of diseases

  • Most infections are transmitted by direct contact or by large droplets in the air up to a distance of about one metre.
  • The most contagious microbes are also transmitted in infective numbers with smaller droplets travelling longer distances. In such cases, we speak of aerosol or airborne transmission.
  • Microbes are most often transmitted through the mucosa or through damaged skin, usually not through intact skin.
  • Microbes transmitted with large droplets or saliva to surfaces, such as toys, may remain infective for several hours, some for as long as several days.
  • Microbes excreted in large numbers in faeces (such as enteroviruses, diarrhoea viruses, and, to some extent, all respiratory viruses) are also transmitted through the faecal-oral route in association with changing nappies, for example. Good hand hygiene reduces particularly such infections.

Basic principles for various disease groups

Respiratory infections

  • There are often many infected people with no symptoms; exclusion is usually not required. Whooping cough and respiratory infections caused by group A streptococci form exceptions (TableT1).
  • In conjunctivitis, the causative viruses and bacteria are usually the same as in respiratory tract infections. Exclusion is therefore not required. The need to be absent will depend on the severity of symptoms.
  • In otitis media, exclusion is of no use.

Intestinal infections

  • Children with diarrhoea or vomiting should be treated at home until they have been asymptomatic for 2 days. The time should be counted from the end of actual diarrhoea; faeces need not be normally solid. There is no need to exclude asymptomatic children with pathogens (bacteria or viruses) found in their stools, with the exception of Shigella, Salmonella typhi or paratyphi and EHEC.
  • Salmonella typhi or paratyphi
    • If Salmonella typhi or paratyphi is found in the stools of a child in day care, they cannot return to day care until they are symptom-free and have delivered 3 negative stool samples at one-week intervals, the first sample being taken not earlier than one week after finishing the antimicrobial medication. The personnel and the community health nurse of the day-care centre should be informed about the situation.
    • An asymptomatic child of nappy-wearing age who has a sibling under school age with S. typhi or S. paratyphi should be excluded from the day-care centre until 3 negative stool samples have been obtained.
    • School-age children can attend school normally as far as their condition allows. They must not participate in home economics classes or distribution of school meals until negative stool samples have shown that they are not infected. Good hand and toilet hygiene should be emphasized.
  • For other types of Salmonella, no samples or exclusion are needed, and the child can return to day care after 2 days without symptoms. The personnel and the community health nurse of the day-care centre should be informed about the situation. School-age children can attend school normally as far as their condition allows. Good hand and toilet hygiene should be emphasized.
  • Enterohaemorrhagic E. coli (EHEC) requires exclusion until 3 negative stool samples have been obtained at intervals of 24 to 48 hours. Asymptomatic nappy-wearing siblings of children infected with EHEC should be kept away from day care until one negative stool sample has been obtained after the index case has been shown to be negative.
  • Shigella infection is a dangerous communicable disease. It is very easily transmitted and should always be treated with antimicrobials because the transmission chain must be broken. The child should be excluded from day care until 3 negative samples have been obtained.

Diseases transmitted through blood (HIV, hepatitis B and C)

  • As HIV, hepatitis B and hepatitis C are not transmitted in normal interaction, exclusion is usually unnecessary.
  • In day care
    • Dummies and toothbrushes should not be shared
    • Use disposable gloves when handling body fluids
    • Take care when cleaning up body fluids containing blood
    • Use a separate bag for body fluids containing blood
  • As it is up to the parents to decide whether to disclose that their child has a hepatitis or HIV infection, any child in day care may be positive for diseases transmitted through blood. The above instructions must therefore be applied to all children.
  • Transmission by biting has not been observed.
  • If a day care group is known to include a carrier of hepatitis B, vaccination of the whole group may be considered.

Excluding children with an infection from day care or school

InfectionMode of transmissionIncubation periodRecommended period of exclusion to prevent infections
COVID-19Droplet, possibly aerosol2-4 daysExclusion will be of no use.
EnterovirusesDroplet or faecal-oral3-6 daysFor the duration of symptoms; faecal excretion of the virus may continue for several weeks but exclusion will be of no use.
Hepatitis AFaecal-oral15-50 days1 week from the onset of symptoms
Herpes simplexContact2 days to 2 weeksPrimary infection: for the duration of symptoms; recurrent infection: no exclusion
Whooping coughDroplet5-21 days5 days from the beginning of macrolide treatment. If symptoms have continued for more than 21 days at the time of diagnosis, no exclusion is needed.
Influenza A and BDroplet, possibly aerosol1-4 daysExclusion will be of no use.
Human pinwormContact1-2 monthsExclusion will be of no use.
MeningococcusDroplet1-10 daysExclusion for a minimum of 24 h from the beginning of treatment.
For close contacts, a single prophylactic dose to limit spread:
  • Ciprofloxacin, for children < 20 kg, 250 mg p.o., for people ≥ 20 kg, 500 mg p.o.
  • Alternatively, azithromycin 10 mg/kg p.o. or a single dose of ceftriaxone, 125 mg i.m.
MononucleosisContact, particularly with saliva30-50 daysExclusion will be of no use.
MRSA or ESBL carriersContactExclusion will be of no use.
MycoplasmaDroplet1-4 weeksExclusion will be of no use.
ImpetigoContact7-10 days24 and 48 h from the beginning of oral and topical antimicrobials, respectively
Molluscum and other wartsContact2-7 weeksExclusion will be of no use.
Parainfluenza virusesDroplet, spreads in large droplets3-16 daysExclusion will be of no use.
Erythema infectiosumDroplet4-20 daysExclusion will be of no use.
Head liceDirect contact6-9 daysUntil the first treatment has been given
RS virus (RSV, respiratory syncytial virus)Droplet, spreads in large droplets. Also direct contact.4-6 daysExclusion will be of no use.
RhinovirusesDroplet, possibly aerosol1-2 daysExclusion will be of no use.
MumpsDroplet12-25 days5 days from the beginning of symptoms
Streptococcus A and/or scarlet feverContact, droplet2-5 days24 h from beginning of treatment
CytomegalovirusContact through blood, urine or salivaAbout 1 monthNo exclusion
ScabiesContact2-3 weeksUntil treated
TuberculosisRespiratory tuberculosis is transmitted by droplet and aerosol.
Latent tuberculosis is not infectious.		2-10 weeks, sometimes several yearsA child with respiratory tuberculosis should be excluded for a minimum of 2 weeks from the beginning of effective medication. Exposure tests and treatment of latent tuberculosis, as necessary, should be arranged for exposed children in specialized care.
MeaslesDroplet and aerosol9-14 daysAt least 4 days from eruption of the rash
Exanthema subitumDroplet, particularly contact with saliva5-15 daysExclusion will be of no use.
ChickenpoxDroplet and direct contact10-21 daysUnvaccinated child: until the crusts have dried, usually 5-6 days after eruption of the rash.
Vaccinated child: until new skin lesions no longer appear.
RubellaDroplet and direct contact14-21 days7 days after eruption of the rash
Shingles (herpes zoster)ContactCovering the skin lesion usually suffices to prevent transmission.

References

Related Keywords ⬆

ATC Code:

J01FA10

J01FA01

J01FA02

J01FA06

J01FA09

J01FA10

J01FA15

J04AB02

J01MA02

Primary/Secondary Keywords