Communicable Diseases and Schools What you need to know

1. Communicable Diseases and SchoolsWhat you need to know Presented by the Branch-Hillsdale-St. Joseph Community Health Agency

2. Exposure- Disease Detection Timeline • Exposure • Onset of Symptoms Some electronic surveillance • Seek Medical Care (maybe yes, maybe no) Some electronic surveillance • Diagnosis • Reported to Health Department Surveillance (electronic) • Reported to State Surveillance (electronic)

3. Topics for Presentation • MRSA • Norovirus • Flu & other communicable diseases • Head lice. • School Closing issues • Cleaning • Diabetes • MI-Child • 211

4. What to do about MRSA?

5. What is MRSA? (Methicillin Resistant Staphylococcus aureus) • “Super Bug” • Sometimes called a “staph” infection • Commonly causes skin infections • Resistant to penicillin & other antibiotics

6. What does MRSA look like? • Spider bite • Turf burn • Impetigo • Boil • Abscess Source: LA County Health Department Source: Mark Grubb, MD Source: CDC Source: CDC Source: CDC

7. How do you get MRSA? How does it spread? • Skin to Skin Contact • Touching skin infections • Touching drainage from skin infections • Surface to Skin Contact • Touching unclean sports equipment, keyboards, phones, desktops, doorknobs. • Sharing personal hygiene items (skin ointments, razors, bar soap, towels)

8. Who is at High Risk for MRSA? • People who • Live in crowded conditions • Lack resources to stay clean • Share sports equipment • Share personal hygiene items • Overuse antibiotics or take them incorrectly • Have abraded or injured skin • Have severe immune system problems - Cancer, Leukemia, HIV • ** However – Anyone can get MRSA

9. How is MRSA Treated? • By a healthcare provider who may: • Drain the infection and/or • Prescribe an antibiotic and/or • Reduce the amount of MRSA on the patient’s skin

10. Stop the Spread of MRSA! Hand washing is the most important way to prevent MRSA • Wash your hands often with warm soapy water, use friction and scrub for 20 seconds (sing your abc’s) • Use 60% alcohol-based hand sanitizer when soap and water are not available • Require students to report potential skin infections to the school nurse/office • Cover open wounds with clean, dry bandages that adhere to skin on all 4 sides • Don’t touch other people’s skin lesions

11. Clean & Disinfect to get Rid of MRSA on Surfaces • Cleaning gets rid of the dirt you can see • Soap & water is a good cleaning solution • Disinfecting gets rid of most of the germs • Follow manufactures guidelines for disinfectants • Establish routine cleaning schedules • MRSA can stay on environmental surfaces for weeks! • Clean & Disinfect frequently all environmental surfaces that may come in direct contact with skin

12. Should schools close because of an MRSA infection? • The decision to close a school for any communicable disease should be made by school officials in consultation with local and/or state public health officials. However, in most cases, it is not necessary to close schools because of an MRSA infection in a student. It is important to note that MRSA transmission can be prevented by simple measures such as hand hygiene and covering infections. • In general it is not necessary to close schools to "disinfect" them when MRSA infections occur. MRSA skin infections are transmitted primarily by skin-to-skin contact and contact with surfaces that have come into contact with someone else's infection. • Cleaning and disinfection should be performed on surfaces that are likely to contact uncovered or poorly covered infections. • Cleaning surfaces with detergent-based cleaners or registered disinfectants is effective at removing MRSA from the environment. • Environmental cleaners and disinfectants should not be used to treat infections.

13. Should students with MRSA skin infections be excluded from attending school or playing sports? • Unless directed by a physician, students with MRSA infections should not be excluded from attending school. • Exclusion from school should be reserved for those with wound drainage ("pus") that cannot be covered and contained with a clean, dry bandage and for those who cannot maintain good personal hygiene. • Students with active infections should be excluded from activities where skin-to-skin contact is likely to occur (e.g., sports) until their infections are healed.

14. Practical Advice for Teachers/School Personnel • If you observe children with open draining wounds or infections, refer the child to the school nurse. • Enforce hand hygiene with soap and water before eating and after using the bathroom. • Students with skin infections may need to be referred to a licensed health care provider for diagnosis and treatment. School health personnel should notify parents/guardians when possible skin infections are detected. • Use standard precautions (e.g., hand hygiene before and after contact, wearing gloves) when caring for non-intact skin or potential infections. • Use barriers such as gowns, masks and eye protection if splashing of body fluids is anticipated

15. Norovirus

16. What is a Norovirus? • Noroviruses are a group of viruses that cause the “stomach flu,” or Gastroenteritis in people. The term norovirus is the official name for this group of viruses. • Approximately 23 million cases each year in U.S. • Potentially 500-750 annually in SJ County • Leading cause of outbreaks of gastroenteritis

17. Symptoms • Nausea, vomiting, diarrhea, abdominal cramps • Sometimes low-grade fever, chills, headache, myalgia, fatigue • Often begins suddenly, and the infected person may feel very sick

18. Incubation, Duration, Communicability • Incubation period: 12 - 48 hours (median in outbreaks is 33 - 36 hours) • Duration of illness: 24 - 60 hours • Period of communicability: onset through 72 hours after recovery

19. Transmission • Found in the stool and vomit of infected people • Can be transmitted several ways: • Eating food or drinking liquids that are contaminated with norovirus • Direct person-to-person spread – highly contagious • Airborne and fomite (think money) transmission in droplets contaminating surfaces or entering the mouth and being swallowed

20. How serious is it? • Usually not serious, although people may feel very sick and vomit many times a day • Most get better within 1 or 2 days, and they have no long-term health effects related to their illness • Can be serious for the very young, the elderly, and persons with weakened immune systems due to dehydration

21. St. Joseph County GI ActivityOctober, 2002 through December, 2008Branch-Hillsdale-St. Joseph Community Health Agency Communicable Disease Reports

22. Treatment • Drink plenty of fluids to prevent dehydration • No antiviral medication • No vaccine to prevent infection • Cannot be treated with antibiotics because antibiotics work to fight bacteria and not viruses

23. Prevention - Hand Washing • After using restrooms and before eating • Be sure ALL hand wash sinks have warm water, soap, and paper towels

24. Other Prevention Measures • Isolation of symptomatic individuals, and proper cleaning and disinfection are critical in stopping this virus. • Any vomiting episode should be treated as a potential norovirus and schools should react pro-actively to institute norovirus guidelines immediately; not throughout a school necessarily, but in the classroom or section of the school where the incident has happened.  

25. Cleaning and Disinfectingfor Norovirus

26. Cleaning • Put on personal protective equipment • Remove visible debris with absorbent material and place in plastic bag, then follow with disinfection. • For clean-up of carpet or upholstered furniture, remove visible debris with absorbent material and place in plastic bag, then steam clean at 158oF for 5 minutes or 212oF for 1 minute • Launder soiled clothing/linens separately and dry in a hot dryer.

27. Disinfection • Bleach works best and is low cost • Bleach concentrations and mixing instructions: • For stainless steel, food/mouth contact items, toys use 1 T in 1 gal of water • For non-porous surfaces, tile surfaces, counter-tops, sinks, toilets use 1/3 cup in 1 gal of water • For porous surfaces, wooden floors use 1 cup in 1 gal of water • Contact time is 10-20 minutes, then rinse with clean water • Use a fresh bottle of bleach

28. Cleaning & Disinfection in Schools, Healthcare Facilities, Restaurants • Additional guidance is available for cleaning and disinfection of these facilities in the document “Guidelines for Environmental Cleaning and Disinfection of Norovirus”. • This is available at www.bhsj.org/eh/Food/eh_food.htm

29. What triggers concern in a school, daycare center, or similar setting? • If you are concerned, contact your local public health nurse or environmental health sanitarian. • Sanitarians are already familiar with your school as they inspect your kitchen and are also familiar with the cleaning standards for communicable disease control. Call before you have a problem if you are at all concerned. • A larger than expected number of children or individuals out sick with gastrointestinal illness in a particular classroom, wing, or building. • What if you don’t act……

30. The Flu

31. The Flu • The flu is a contagious respiratory illness caused by influenza viruses. It can cause mild to severe illness, and at times can lead to death. The best way to prevent this illness is by getting a flu vaccination each fall. • Every year in the United States, on average: • 5% to 20% of the population gets the flu; • more than 200,000 people are hospitalized from • flu complications, and; • about 36,000 people die from flu. • 50 million Americans get the flu • Flu season last from about November through March, often into April – and peaks in February and March

32. What are the symptoms of the flu? • Dry cough • Fever • Aches • Headache • Sore throat • Fatigue • Transmitted by – person to person cough, sneeze – inhale virus • Symptoms usually last 2-7 days

33. Is it contagious? How is it spread? • Adults may be contagious from 1 day before feeling sick to up to 7 days after getting sick. • Children can be contagious for longer than 7 days. • Flu is spread when a person who has the flu coughs, sneezes, or speaks and spreads virus into the air, and other people inhale the virus. • The viruses can also be spread when a person touches a surface with flu viruses on it (for example, a door handle) and then touches his or her nose or mouth. – Think Hand Washing!!!!!!!

34. The Flu in St. Joseph County Influenza October, 2002 through December, 2008

35. Lice! • Note: No matter what you do, after hearing this next piece of information, for the next 2 hours you will itch! Adult Lice – compared to a dime Adult lice are about 1/8 inch long.

36. A little lice lingo • Nits, Nymphs and adults - Nits are lice eggs. They are yellow or white, smaller than a grain of rice and difficult to see. They are often confused with dandruff. • Nymphs are baby lice, reddish brown in color and grow to adult lice in about 7 days. • Adult lice are about the size of a small grain of rice. Adult lice live about 30 days.

37. What, Who, How(So many questions, so little time) • What is it? An insect found mostly on the head. Head lice are extremely common, as 6-12 million people get head lice every year. • Who is at risk?? Kids aged 3-10 and their families are at the greatest risk. • How is it spread? Lice do not hop or jump or fly. They crawl. They spread from person to person contact during such activities as: • * Slumber parties, sports activities and playground activities. • * Sharing of sports uniforms, coats, scarves, hats or hair accessories. • * Sharing infested brushes, combs or towels. • * Laying on an infested pillow, stuffed animal, bedding or carpet.

38. SymptomsHow do I find those critters? Are there symptoms? 1. A tickling feeling on the scalp. 2. Itching, caused by an allergic reaction to the bites. 3. Sores on the head from excessive scratching. These sores can sometimes become infected Where should I look? Close to the scalp behind the ears and at the neckline in the back of the head. A thorough examination of all of your child’s head is important as these are not the only places lice may be hiding.

39. Thoughts on removal • * Remove clothing before treating (clothing may be infested) • * Work under bright light (sunlight, bright indoor lamp) • * Several treatment options are listed on the back of this sheet. • * Do NOT use crème rinse or conditioning shampoo before treatment • * Put on clean clothes after treatment • * Comb dead and remaining lice out of hair after treatment. • * Re-treat as necessary, especially for long or thick hair. • * Check treated person for 2 to 3 weeks until you are sure all nits and lice are gone.

40. Treatment Options Treatment with Lice Shampoo • Wash hair with household shampoo. • Completely wet hair with lice shampoo. • Add warm water, leave product on head for recommended time - usually 10 minutes. • Rinse thoroughly with warm water while removing any dead lice and nits. • Re-treatment may be necessary in seven to 10 days as this kills hatching eggs.

41. Option #2A great home remedy • 1. (This treatment takes about 12 hours). This method has been the most successful. • * Rub olive oil all over the child’s head. Work it right down into the scalp. • * Cover hair with a plastic shower cap (use extreme caution with small children under 3) • * leave cap on for 12 hours. • * Shampoo several times with a mild shampoo. • * This method may be repeated a second time for very thick or long hair.

42. Do Not Treat Classrooms • Lice live their entire life cycle on the human body. • Lice die within 24 hours after falling off the host. • Treatment of classrooms with insecticidal sprays is unnecessary and may be hazardous.

43. Diabetes

44. What is diabetes? Diabetes is a disease in which the body cannot properly use food for energy. The hormone insulin, which is made in the pancreas, helps the body to get energy from food. In people with diabetes, either the pancreas doesn’t make insulin or the body cannot use insulin properly.

45. How Insulin Works Sugar is the basic fuel for the cells in the body, and insulin takes the sugar from the blood into the cells. Without insulin, glucose, the body’s main energy source, builds up in the blood. Diabetes can lead to serious problems and complications, such as heart disease, blindness, kidney failure, lower limb amputations and premature death.

46. Diabetes Prevalence In 2007, 17.9 million children and adults have been diagnosed with diabetes and there are another 5.7 million who are undiagnosed-for a total of 23.6 million Americans with diabetes. 3,500 in SJ County

47. Type 1 Diabetes Used to be called insulin-dependent or juvenile-onset. The exact cause is unknown but it appears to be an auto-immune disease that develops when the body’s immune system destroys pancreatic beta cells-the only cells in the body that make the hormone insulin which regulates blood glucose. People with type 1 diabetes must take insulin every day by injection or pump.

48. Type 2 Diabetes In type 2 diabetes either the pancreas does not produce enough insulin or the cells ignore the insulin. If the cells are not getting insulin or “resisting” the insulin, then sugars will build up in the blood. Most common form of diabetes Can be prevented with lifestyle changes May need pills or insulin to control blood sugar

49. Pre-Diabetes??? • Before people develop type 2 diabetes, they almost always have "pre-diabetes" -- blood glucose levels that are higher than normal but not yet high enough to be diagnosed as diabetes. There are 57 million people in the United States who have pre-diabetes. Recent research has shown that some long-term damage to the body, especially the heart and circulatory system, may already be occurring during pre-diabetes. • Research has also shown that if you take action to manage your blood glucose when you have pre-diabetes, you can delay or prevent type 2 diabetes from ever developing. • There are two different tests your doctor can use to determine whether you have pre-diabetes • Can be prevented with proper diet and exercise.

50. Diabetes Management in School • Diabetes Medical Management Plan • Monitoring Blood Glucose • Diabetic Emergencies • Meal Plan/ Exercise • Special Occasions (cake, cookies, parties, Halloween)