Communicable Diseases at the Department of Public Health

1. Communicable Diseases at the Department of Public Health

2. Settings for Spread • Household • Day Care Center • School • Workplace

3. Facts • 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.

4. Day Care CentersConducive 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

5. Day Care Centers (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

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

7. Infections in Day Care

8. Disease Transmission • Direct Contact • Respiratory or Droplet • Bloodborne • Fecal-Oral • Zoonotic

9. Stop-spread guidelines(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

10. Stop-Spread Guidelines(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

11. Stop-spread guidelines(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

12. Parvovirus(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

13. Parvovirus Control & 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

14. Parvovirus (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

15. Pediculosis(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

16. Pediculosis Control & 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

17. 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

18. Reptile 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

19. 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 Two Excedrin Headaches

20. E. coli 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

21. E. coli 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

22. Field 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

23. Tools for Teaching • Handwashing posters • Handwashing brochures • Handwashing demonstrations • Glo-Germ

24. Hand 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

25. Hand 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.

27. Controlling Spread through Isolation 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

28. Legal 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.

29. Cleaning & Sanitizing • Routine cleaning with detergent and water is most useful for removing germs from surfaces • Additional step of sanitizing kills germs on surfaces

30. Bleach • 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

31. Using 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

32. Cleaning 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.

33. Cleaning 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.

34. Cleaning 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.

35. Cleaning 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.

36. Five Commandments of Infectious 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

37. State Health Dept. • Videos • Pamphlets • Control materials • Human Resources - us! • 617-983-6800 (24/7)

38. MDPH Educational Materials: Handwashing

39. Check out all the information on the internet! MA Department of Public Health’sWeb 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