This document provides guidelines for preventing the spread of communicable diseases in Virginia schools. It defines key terms and describes diseases that spread through direct contact, the intestinal tract, and respiratory tract. Guidelines include strict handwashing, environmental cleaning, monitoring illness numbers, and excluding sick students and staff according to symptoms.

12. Reservoir ( of infectious agents) : Any person, animal, arthropod, plant, soil, or substance (or combination of these) in which an infectious agent normally lives and multiplies, on which it depends primarily for survival, and where it reproduces itself in such manner that it can be transmitted to a susceptible host.

16. Subsections The following subsections contain prevention guidelines for control of infectious diseases in the school setting and a description of selected infectious diseases. - Prevention Guidelines for Diseases Spread Through Direct Skin Contact - Prevention Guidelines for Diseases Spread Through the Intestinal Tract - Prevention Guidelines for Diseases Spread Through the Respiratory Tract - Prevention Guidelines for Sports-Related Infectious Diseases

21. Impetigo

22. Scabies

28. Prevention Guidelines for Diseases Spread Through the (Intestinal Tract) Overview Communicable infectious diseases that are usually spread through the intestinal tract-including those commonly known as (campylobacteria, giardia, hepatitis A, hepatitis E, pinworms, rotavirus, salmonella, and shigella)- can be spread from person to person by direct or indirect transfer of the disease-causing organism (infectious agent). Organisms that cause such diseases include bacteria, viruses, and parasites.

30. Direct transmission of the organisms, for most of the diseases, can occur by hand-to-mouth transfer of the organism from the stool of an infected person (i.e., fecal-oral route), especially in institutions and day care centers. Indirect transmission of the organisms can occur, though usually to a lesser extent for some of the diseases, through contaminated inanimate materials or objects (e.g., ingestion of organism in food, unpasteurized milk, water). For some of the diseases, it is possible to transfer the organisms through other modes (e.g., contact with an infected pet, possibly fecal-respiratory route). Some organisms, such as Campylobacter and Salmonella bacteria, must be ingested in large quantities to cause illness.

34. Return Guidelines: Excluded students and staff may come back to school after treatment and when severe diarrhea is gone. During outbreaks, negative stool cultures may be required before excluded students and staff may come back to school. Prevention Guidelines for Disease Spread Through the (Intestinal Tract): - Strictly enforce proper handwashing after using the bathroom, diapering, and before preparing or eating food. Handwashing is the best way to prevent spread of infectious diseases caused by organisms that are transmitted by the fecal-oral route. -

36. Prevention Guidelines for Diseases Spread Through the (Respiratory Tract) Overview Communicable infectious diseases that are usually spread through the respiratory tract-including those commonly known as (Chicken pox, common cold, flu, measles, bacterial meningitis, tuberculosis, and whooping cough) can be spread from person to person by direct, or airborne transfer of the disease-causing organism (infectious agent). Organisms that cause such diseases include bacterial and viruses. When a person infected with such a disease coughs, sneezes, blows their nose, sings, or talks

38. (usually limited to about 1 yard) they can produce infected droplets (large infected particles that settle out of the air) or infected airborne particles (microbial aerosols that do not settle out of the air for a long time). Direct transmission of the organisms can occur by direct contact with the mucous membranes of the infected person (e.g. touching or kissing) or direct projection (spray) of the droplets onto the eye, nose, or mouth. Indirect transmission of the organisms can occur, for most of the diseases, by hands and articles (e.g., handkerchiefs, toys, pencils, books, desks)

39. freshly soiled by droplets, discharges from nose and throat, or secretions from lesions of an infected person-the organisms are transmitted by contaminated hands carrying organisms to the mucous membranes of the eye or nose. Furthermore, transmission of the organisms can occur by inhalation of airborne particles. Diseases spread through the respiratory tract can be mild (e.g., viral colds) or life-threatening (e.g., bacterial meningitis). People who are infected with such disease and do not wash their hands after touching their eyes, nose, or mouth increase the likelihood of spreading the disease by contaminating

40. articles with discharges from their respiratory tract. The organisms can easily be transferred to other through those contaminated articles. In addition, people who are infected with respiratory disease and do not cover their mouths and nose when coughing or sneezing can increase the likelihood of airborne spread, which can predominate among crowded populations in enclosed spaces (e.g., school buses).

45. Note: Aspirin (or products containing salicylate) should never be administered to children for fever control of any viral illness, but particularly if influenza or chickenpox is suspected. There is an association with Reye’s syndrome (vomiting, liver problems, and/or coma) and the use of aspirin in the treatment of these types of illnesses.

46. Prevention Guidelines for (Sports-Related Infectious Diseases) Overview The spread of communicable infectious diseases among students in the school setting is a problem shared by all educational institutions. Contact in the classroom, cafeteria, or school yard can facilitate the spread of infectious diseases. In addition to the exposures that students face in these common situations, student athletes may contract

47. or spread infectious diseases while participating in sporting activities. Teachers, coaches, and athletic staff, schooleam physicians, school nurses, and others responsible for the health and safety of athletes need to be aware of the infectious disease spread that can occur during training, competition, or even during physical education class activities. Risk of Exposure There may be risk of exposure for the individual athlete, the team, and spectators. Transmission of infectious diseases in sports settings usually occurs via direct contact, the fecal-oral route, common-source exposure, or airborne

48. and/or droplet spread. In some cases, disease transmission is unavoidable due to infectiousness before symptoms become apparent. In other cases the spread of disease occurs as a result of many people congregating together or sharing water bottles or other eating/drinking utensils. The following chart list some infectious diseases that have occurred due to sports-related activities.

49. Tournaments involving gymnastics, basketball, wrestling, other indoor sports. Airborne or droplet Measles Team sports Saliva exchange Meningococcal illnesses Swimming Common-source Pseudomonas aeruginosa Team sports Common-source or fecal-oral Enteroviruses (coxsackievirus, echoviruses) Wrestling, rugby, basketball, football Direct contact Herpes simplex virus Staphylococcus aureus Group A streptococci, fungi Sports Involved Mode of Transmission Disease Sports-Related Infectious Diseases

50. School Exclusion Guidelines Prevention Guidelines: Some concern has been raised about the possibility of sports-related transmission of blood-borne pathogens. Team physicians, trainers, school nurse, physical education teachers, and others involved with the health of the student athlete should not only be able to recognize and manage acute problems but should also institute policies for the prevention of disease transmission. These policies should include, but not be limited to, the following, which are taken from Goodman, et. Al. (1994). 92

54. Thank You Dr.Gamal Ahmed [email_address]