Communicable Illness


  1. Streptococcal Sore Throat / Scarlet Fever    4. Head Lice         7. Chicken Pox
  2. Mono                                                          5. Hepatitis A        8. Fifths Disease
  3. Impetigo                                                      6. Hepatitis B        9. Conjunctivitis (Pinkeye)

Streptococcal Sore Throat/Scarlet Fever

Streptococcal sore throat ( strep throat ) and scarlet fever ( a strep throat with a rash ) are common infections in young children. these illnesses are usually not serious; however, complications such as rheumatic fever ( which can damage heart valves ) or kidney disease may rarely develop if children do not receive proper antibiotic treatment.

Cause: Streptococcus bacteria ( Group A beta-hemolytic strep )

Symptoms: Sudden onset of fever, sore throat and swollen glands. Nausea and vomiting may occur with severe cases. With scarlet fever, a very fine raised rash  ( feels like sandpaper) is present. The rash blanches with pressure. The rash appears most often on the neck, chest, in folds of armpit, elbow, groin, and in the inner thigh. Later on, there may be peeling of the skin on the fingertips and toes.

Spread: When an infected person coughs or sneezes contaminated droplets into air and another person inhales them. A person can also get infected from touching these secretions and then touching his/her mouth or nose.

Incubation: It usually takes two to five days from the time a person is exposed until symptoms develop.

Contagious Period: Until 24 hours after treatment begins.

Exclusion: Until 48 hours after antibiotic treatment  begins and until child is without fever for 24 hours. Student should bring verification of treatment.


  1. Wash hands thoroughly with soap and warm water after contact with secretions from the nose, and mouth.

  2. If your child develops a sore throat and other symptoms listed above, keep him/her home and call your healthcare provider.

  3. Diagnoses: Confirmed by identification of strep throat, by throat culture.

  4. Treatment: If the culture is positive, a shot or antibiotics taken by mouth are prescribed. Antibiotics should be taken for the prescribed amount of time. This treatment will help to prevent more serious illness such as rheumatic fever.

For more information, you, or your healthcare provider may call your local health department, Orange County Health Care Agency: 1-800-564-8448.

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Mononucleosis ( Infectious )

Infectious mononucleosis ( mono) is an acute syndrome that commonly occurs in young people from 10-29 years. It is spread by oral-pharyngeal route via saliva.

Cause: The disease is caused by the Epstein-Barr virus and can occur in both sporadic and epidemic forms.

Symptoms: Generally mild in children and difficult to recognize. Fever, sore throat, swollen glands ( especially behind the neck ), headache, and tiredness. Sometimes there is a rash. Young adults may have jaundice ( yellowing of the skin or eyes) and enlarged spleen. Infectious mononucleosis usually lasts from one week to several weeks.

Spread: Person-to-person, through saliva. Spread can occur by kissing or sharing items contaminated with saliva ( e.g. drinking cups, bottles, or toys).

Incubation: It takes about 4-6 weeks from the time a person is exposed until symptoms develop.

Contagious Period: The period of communicability is unknown but may be as long as 1 year. Some adults are carriers of the virus.

Exclusion: Until acute symptoms have disappeared. Discuss with physician/parents any restriction on activities and any recommendations regarding rest or reduced school day. Upon a students readmission to school, discuss with student and staff necessity for proper disposal of articles soiled with nose and throat discharges and good hand washing. Pharyngeal excretion may persist for as long as a year following infection. Student needs additional rest and regulation of activities according to tolerance.


  1. Wash hands thoroughly with soap and warm water after any contact with saliva or items contaminated with saliva.

  2. Clean and disinfect mouthed toys at least daily and when soiled.

  3. Diagnosis: See your healthcare provider. Blood tests are available, but may be difficult to interpret in children less than 4 years of age.

  4. Treatment: Discuss supportive therapy with your healthcare provider.

For more information, you or your healthcare provider may call your local health department, Orange County Health Care Agency: 1-800-564-8448.

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Impetigo is a  highly contagious skin disease characterized by pustular eruptions, often occurring on the nose, arms, legs, or around the mouth. It is seen primarily in infants and young children. Complications such as heart or kidney disease may develop if children do not receive proper treatment.

Cause: Streptococcus and Staphylococcus bacteria.

Spread: By direct contact.

Incubation: 2 to 5 days from the time a person is exposed until symptoms develop.

Contagious Period: Until lesions are dry.

Exclusion: Student may not return to school until lesion is dry.


  1. Wash hands carefully with soap and running water after contact with sores.

  2. Isolation of area; cover area with clean dressing

  3. Clean toys and items the child uses.

  4. Diagnosis/Treatment- if you suspect impetigo, contact your physician for diagnoses and treatment. Impetigo often can be treated with topical antibiotics( applied directly to the skin ) when only a few lesions are present. When there are more than a few sores, your physician may prescribe oral or injectable antibiotics.

For more information, you or your healthcare provider may call your local health department, Orange County Health Care Agency: 1-800-564-8448.

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Head Lice

Head lice infestations are a common problem for children in childcare settings and schools. Anyone can get head lice.

Head Lice are very small, tan-colored insects ( less than 1/8" long ) which live on human heads. The nits are tiny ( about the size of the eye of a needle) and grey or white in color.

Cause: Pediculus humanus captitis, a louse.

Symptoms: 1.Itching of the scalp and/or back of neck. 2.Presence of louse. 3.Presence of nits (eggs) on hair shaft: a: observe on hair shaft close to the; difficult to remove with fingernails; b: nits resemble dandruff, but dandruff can be easily removed from hair shaft and lice nits cannot; c: louse nits are small, grayish white, tear-shaped, and hatch in 1 week. 4. reddened areas around the scalp, behind ears and neck.

Spread: Lice are spread by direct head-to-head contact and by sharing personal items such as combs, brushes, barrettes, hats, scarves, jackets, blankets, sheets, pillowcases. Lice do not jump or fly; they crawl and can fall off the head. Head lice do not live longer than 48 hours off the head. They only lay their eggs while on the head. Nits which are more than 1/2" from the scalp are dead or empty and will not hatch. The nits do not hatch if they fall off the head. Lice do not spread to or from pets.

Incubation: It takes  7-10 days from when the eggs are laid until they hatch.

Contagious Period: Until treated with a lice-treatment period.

Exclusion: Until hair has been properly treated an all nits have been removed. Recheck the child as he/she returns to school, and evaluate the student in 7-10 days to determine if he/she has become reinfected with nits.

Treatment: For head lice is (1) insecticidal shampoo, e.g., Kwell, Proiderm Lotion, Rid, Pyrinate-200, etc. Follow manufacture's instructions on package.
(2) Reshampoo in 7-11 days to kill any lice that have hatched during the week.
(3) Comb out all nits with a fine-tooth comb after shampooing. (4) Soak or boil combs and brushes in hot water ( 140 F(60C) or higher ) for 10 minutes to kill nits and lice. (5) Machine launder and dry headgear, articles of clothing, and bed linen at hot temperature. Dry cleaning or sealing in plastic bag for 10 days is also effective.(6) Buy lice control spray to use on objects that cannot be laundered or dry cleaned. (7) Vacuum beds and rooms infected person has used.

For more information, you or your health care provider may call your local health department, Orange County Health Care Agency: 1-800-564-8448.

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Hepatitis A

Formerly called infectious hepatitis is an inflammation of the liver that occurs sporadically or in epidemics . It is transmitted by the fecal-oral route.

Cause: Hepatitis A virus ( HAV)

Symptoms: Onset is usually sudden, fever, loss of appetite, tiredness, nausea.
                   dark colored urine, light-colored stools and jaundice( yellowing of
                   eyes and skin) may appear a few days later. Jaundice occurs more
                   often among adults than children. Symptoms vary greatly, form severe
                    to none at all.

Spread: Hepatitis A is transmitted by close personal contact, or by contaminated
              water or food. Spread can occur when a person does not wash his/her
              hands after using the toilet or changing diapers and later prepares food.

Incubation: Is 15-50 days (average 28-30 days).

Contagious Period: The greatest infectivity occurs during the 2-week period
                                 before the onset of jaundice. The disease is generally non-
                                 infectious after 1 week of jaundice.

Reportable: Provider: This disease is reportable to the County Health Department
                                      Parents/guardians: Inform your childcare provider if
                                      your child has this illness.

Exclusion: Exclude student from school. Student may return a minimum of 1
                  week following onset of jaundice.

Prevention/Control: Hand washing is the most important measure for prevention
                                  control. When working with infants, hands should be
                                  thoroughly washed after every diaper change. The public
                                  should be educated regarding sanitary disposal of feces,
                                  and careful hand washing. Eliminate known sources of
                                  contamination, such as impure water, foods, or milk.
                                  Finally use the dishwasher or hot water and detergents for
                                  eating utensils.

If immune globulin (IG) is given to persons exposed to hepatitis A, it should be
given within 14 days of exposure. When immune globulin is indicated for childcare
staff and attendees, the health department will make appropriate recommendations.

Hepatitis A vaccine: Hepatitis A vaccine is available for any person age 2 years
                                   and older. Although hepatitis A vaccine is not routinely
                                   recommended for the childcare and staff attendees, if an
                                   outbreak occurs in the childcare setting or community, the
                                   health department may make specific recommendations
                                   for vaccine administration.

Diagnoses: A blood test ( Hepatitis A IgM antibody test ) is done to determine
                    whether there is recent or current infection.

Treatment: No specific medication is given to persons with hepatitis A.

For more information, you or your healthcare provider may call your local health department, Orange County Health Care Agency: 1-800-564-8448.

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Hepatitis B

Hepatitis B is an infection that causes inflammation of the liver and is primarily transmitted via blood, saliva, and/or semen. Older terms for hepatitis B are serum hepatitis, protransfusion hepatitis, and long-incubation hepatitis.

Cause: Hepatitis B virus.

Symptoms: Loss of appetite, tiredness, abdominal pain, nausea, vomiting, dark
                   (tea or cola colored) urine, light colored stools, and sometimes rash
                   or joint pain. Jaundice ( yellowing of eyes or skin ) may be present in
                   adults but it is uncommon in young children. Symptoms vary greatly
                   from none at all to severe illness. Adults have symptoms more often
                   than children do.

Spread: Hepatitis B can be transmitted primarily  through blood, semen, and/or
              saliva. It can be directly introduced by infected blood products such as
              needle sticks or blood transfusions. Hepatitis B is indirectly introduced by
              infected fluids, or secretions from skin cuts, abrasions, and burn. The
              virus can survive on contaminated equipment/articles as long as 7 days,
              e.g., ear-piercing and tattooing equipment, shared drug paraphernalia,
              toys, and any article visibly contaminated. Hepatitis B can be absorbed
              through mucosal surfaces via splashing of infected fluids or secretions
              into mouth or eye; sexual contact, kissing, utensils, cigarettes, etc.;
              toothbrushes, thermometers. The virus is perinatally transmitted if the
              mother is acutely or chronically infected.

Incubation: The incubation period is 45 to 160 days (average 60 to 90 days).

Contagious Period: The virus has been shown to be in the blood many weeks
                                 before the onset of symptoms. The blood remains infectious
                                 through the acute clinical course.

Exclusion: Exclude student from school. Student may return to school when
                   acute clinical symptoms are gone.

Reportable: This disease is reportable to the County Health Department.
                     Parents/guardians may inform the childcare provider when their
                     child has this illness.

Prevention/Control: (1) screening blood donors; (2) sterilizing or disinfecting
                                  syringes, needles, and other contaminated equipment or
                                  articles; (3) discouraging the sharing of utensils, cups,
                                  toothbrushes, razors, and other personal items; (4) using
                                  individual containers for students' toothbrushes and other
                                  personal items; (5) good hand washing after toileting and
                                  before eating; (6) properly disposing of  sanitary napkins;
                                  (7) using dishwasher or hot water and detergent for eating

Treatment is symptomatic . Immunity follows infection and there is no crossover to type A hepatitis. Immune globulin prophylaxis (Ig or HBIg) recommendations are (1) for maximum effectiveness, give globulin promptly following exposure. (2) Administer following needle stick or mucosal exposure to infected blood. (3)Sexual contact of those with an acute HBV infection. (4) infants born to HBsAg-positive mothers and to staff and patients of institutions that care for the developmentally disabled if it is shown that hepatitis cannot be controlled by using environmental measures.

Hepatitis B Vaccine:  All infants should receive hepatitis B vaccine as part of
                                    their routine immunization schedule. This would include
                                    3 doses of hepatitis B vaccine during the first 18 months
                                    of life.

Diagnosis: Hepatitis B can be diagnosed through blood tests.

Treatment: Discuss supportive therapy with your healthcare provider. Persons
                    exposed to blood or bloody fluids from an infected person should
                    contact their healthcare provider or the local or state health
                    department immediately regarding the need for hepatitis B immune
                    globulin and vaccine.

For more information, you or your healthcare provider may call your local health department, Orange County Health Care Agency: 1-800-564-8448.

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Chicken Pox

Chicken pox is a highly contagious disease marked by an eruption on the skin and mucous membranes. One attack usually confers immunity. Epidemics are most frequent in winter and spring.

Cause: The cause of chicken pox is the varicella zoster virus.

Symptoms: 1. ( initial stage) slight fever 2. malaise 3. loss of appetite
                   4. headache. Rash: 1. first appears on back and chest, spreading
                   to face and extremities, but sparse in distal limbs 2. continues to
                   make it's appearance for average of 2-3 days. 3. Itchy; begins as
                   flat red macule that rapidly progresses to lesions resembling insect
                   bites. These lesions develop into blisters with an amber fluid.
                   5. Blisterlike eruptions are in crops; after eruptions rupture, crusts
                   form. 6. All stages present in varying degrees at one time.

Spread: Chicken pox is transmitted primarily by secretions from the respiratory
              tract of infected persons. To a lesser degree, discharge from skin lesions
             ( the scabs are not infectious).

Incubation: The incubation period is 14 to 21 days.

Contagious Period:  The period of communicability is from 1 day prior to the
                                  rash to 5 or 6 days after the onset of the rash.


Exclusion: Immediately exclude student for the school. Student may return to
                  school when all vesicles ( blisters ) have crusted.

Prevention/Control: 1.  If high-risk students are exposed, varicella zoster
                                       immune  globulin ( VZIG ) given within 72 hours
                                      may favorably alter the course of disease.  2. When
                                      a pregnant woman or a person with a weak immune
                                      system who has not had the chicken pox is exposed,
                                      he or she should contact a physician immediately for
                                      possible treatment. If you suspect that your child has
                                      chicken pox, you may wish to contact a healthcare
                                      provider. Please do not go to the health care
                                      provider's office without calling first. They will
                                      want to keep your child from others to prevent
                                      further spread.

                                     DO NOT GIVE ASPIRIN TO ANY CHILD OR
                                     ADOLESCENT UNDER THE 18 YEARS OF AGE.
There is a risk of developing Reye's syndrome (a serious
                                     condition which can cause death) when children or
                                     adolescents take aspirin for viral illnesses such as chicken
                                     pox or influenza.

                                    3.Wash hands thoroughly with soap and warm running
                                       water after contact with secretions from the nose or
                                       mouth or blister fluid.4. All children should be routinely
                                      vaccinated at 12 to 18 months of age with one dose of
                                      varicella vaccine. Unvaccinated children 12 months to 12
                                      years of age, who do not have a reliable history of
                                      chicken pox, should receive one dose of varicella vaccine.
                                      Susceptible persons 13 years of age and older should
                                      receive two doses of vaccine,4 to 8 weeks apart.
                                      5. Administration of varicella vaccine is not recommended
                                      to prevent disease in somone who has not had chicken
                                      pox and has recently been exposed to chicken pox virus.
                                      6. Treatment: Discuss supportive therapy with your health
                                      care provider.

For more information, you or your healthcare provider may call your local health department, Orange County Health Care Agency: 1-800-564-8448.

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Fifth disease ( also know as erythema infectiousum ) is a mild, nonfebril erythematous eruption that usually occurs in children 2 to 12 years old. There are two characteristic stages.

Cause: It is presumed that the origin is viral.

Symptoms: Initial stage: 1. Rash initially appears on face 2. Face has "slapped
                   cheek" appearance 3. Face rash fades within 4 days Second stage:
1. Begins after onset of facial rash 2. Erythematous maculopapules
                   appear on extensor surface of proximal extremities.3. Lesions spread,
                   involving entire extremities 4. When lesions begin to fade, they
                    produce lacelike appearance 5. Rash may last days or weeks 6. Rash
                   may reappear months later in response to external stimuli, e.g., sun-
                   light, temperature extremes, exercise, trauma.

Spread: The disease is most likely transmitted by direct contact with infected

Incubation: Is 7 to 14 days

Contagious Period: The period of communicability is unknown ( most
                                 occurrences subside in1 to 2 months).

Exclusion: Exclude student from school until rash subsides.

Prevention/Control: Treatment is not indicated; disease is self-limited.

For more information, you or your healthcare provider may call your local health department, Orange County Health Care Agency: 1-800-564-8448.

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Commonly called pinkeye, conjunctivitis is an inflammation of the conjunctiva, the mucous membrane that lines the eyelids and extends over the sclera.

Symptoms: Bacterial: 1. Sclera red or pink and lining of eyelid inflamed in one or
                    both eyes 2. Photophobia 3. Moderate tearing 4. Minimal or no
                    itching 5. Blurred vision that clears with blinking 6. Purulent discharge
                    7. Dried discharge on eyelids upon awakening 8. Swollen eyelids
                    Viral: 1. Minimal itching 2. Onset sudden 3. Initially only one eye
                    involved 4. Photophobia 5. Sclera red or pink and lining of eyelid
                    inflamed in both eyes 6. Profuse tearing 7. Preauricular node
:1. Conjunctiva red. 2. Mucosa swollen; profuse tearing ( first watery, later can
                    become purulent) 3. Intense itching, burning, rubbing  4. Nasal mucosa swollen and pale.
                    5. Both eyes involved.

Spread: Bacterial and viral conjunctivitis is transmitted by contact with the discharge from the
              conjunctiva or upper respiratory tract of infected persons or by contaminated fingers, clothing
             or other articles.

Incubation:  The incubation period is usually 24 to 72 hours for bacterial conjunctivitis, generally 5 to 12
                     days for viral conjunctivitis.

Contagious Period: The period of communicability for bacterial conjunctivitis is any time during the
                                 course of active infection; for viral conjunctivitis it is usually the later part of the
                                 incubation period up to 14 days following onset.

Exclusion:  (1)For both bacterial and viral conjunctivitis, exclude student from school.(2) Student with
                     either bacterial or viral conjunctivitis may return when eyes are clear. (3) Student with
                     allergic conjunctivitis does not have to be excluded from school.

Prevention/Control: 1. Refer student to physician for treatment. 2. Isolate student from others.  3. Good
                                  handwashing technique. 4. Cool compresses. 5. Treatment is ophtalmic solution or
                                  ointment as prescribed.

For more information, you or your healthcare provider may call your local health department, Orange County Health Care Agency: 1-800-564-8448.

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