LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS OFFICE OF PUBLIC HEALTH

COMMUNICABLE DISEASE CHART

DISEASE AIDS (acquired immunodeficiency syndrome) CHICKENPOX (varicella) EARLY SIGNS AND SYMPTOMS Initially - a self -limited mononucleosis-like illness; later depends on opportunistic infection - swollen lymph nodes, anorexia, chronic diarrhea, weight loss, fever, fatigue. Usually begins with a sudden onset of mild fever, followed several days later by the occurrence of small raised pimples which shortly become filled with clear fluid. Scabs form later. INCUBATION PERIOD Variable, 2 months to 10 years or longer. MODE OF TRANSMISSION Blood and body fluids, sexual transmission. PERIOD OF COMMUNICABILITY Begins early after onset of HIV infection and extends throughout life. SCHOOL ATTENDANCE Blood & body fluid precautions. Child should be regularly evaluated by physician and child care provider for appropriate placement and/or possible exclusion. Isolation at home is required for 6 days after the appearance of the rash or until sores are healed, or only a few remain, which are well covered by scabs. Other children in the family may attend school, but are to be closely observed and excluded immediately after the first sign of the disease. Exclusion not required. Reservoir of infection are mostly asymptomatic shedders of virus. Excluding known cases would not make a difference. PREVENTIVE MEASURES Use of standard precautions in school setting. Education of children and school personnel on AIDS. Avoid high risk behavior. Develop policies for handling blood spills/injuries. Avoid exposure to cases. Strict hand washing and use of standard precautions. Immunization is available. REPORT Yes 2-3 weeks; commonly 13-17 days. Airborne, droplet, direct contact and Lasts for an interval of at least 7 days from the earliest evidence of a disease. indirect (fomites) transmission. Yes

CMV (cytomegalovirus herpesvirus group) INFECTION

Asymptomatic infections are the most common, particularly in children. Severe symptoms in infancy; if acquired later in life fever, sore throat, glandular swelling.

COMMON COLD (upper respirato- Symptoms of rhinitis, coryza, sneezing, lacrimation, irritated ry infections caused by a variety of nasopharynx. May be complicated by laryngitis, pharyngitis viruses- rhinoviruses, adenoviruses). and otitis. DIARRHEAL DISEASES (caused Varies according to causative agent, symptoms may include nausea, vomiting, diarrhea, stomach cramps, headache, blood by Salmonella, Shigella, E.coli and/or mucus in stool, fever. O157:H7, Campylobacter, Cryptosporidium, Rotaviruses)

The incubation period for CMV infections Contact and droplet transmission. transmitted in households is unknown. Infection usually manifests 3 to 12 weeks after blood transfusions and between 1 and 4 months after tissue transplantation. Droplet transmission and contact 1-3 days (usually 48 hours). with contaminated hands, tissues etc. Varies according to causative agent: Salmonella 6-72 hrs. usually 12-26 hrs. Shigella 12-96 hrs, usually 1-3 days, range 110 days; E-coli 0157:H7 12 - 60 hrs. Cryptosporidiosis unknown, range 1-12 days; Rotavirus 24-72 hrs. usually 48 hours. The incubation period from ingestion of an egg until an adult gravid female migrates to the perianal region is 1 to 2 months or longer. Fecal-oral transmission.

Virus is shed in urine and saliva for many months.

Strict hand washing and use of standard precautions.

Report outbreaks

1 day before symptom onset to 5 days after.

Exclusion not required unless severe symptoms occur.

Strict hand washing and use of standard precautions.

No

Duration of clinical symptoms or until causative agent is no longer present in stool.

Exclude until diarrhea has resolved or is controlled (contained in diaper or in toilet) or until cleared by medical provider.

Food hygiene. Strict hand washing and use of standard precautions.

Report outbreaks of rotovirus

ENTEROBIASIS (pinworm)

Frequently asymptomatic. The most typical - perianal pruritus, especially at night, which may lead to excoriations and bacterial superinfection. Occasionally, invasion of the female genital tract with vulvovaginitis. Also - anorexia, irritability, and abdominal pain. Viral disease (parvovirus B19). Reddish eruption, no fever, characterized by an intense facial rash with a slapped cheek appearance. Reddening of the skin fades and recurs; exaggerated by exposure to sunlight. Outbreaks are frequent. Risk for pregnant women. Consult their medical provider.

A person remains infectious as long as female nematodes Exclude until treated. Direct contact, indirect contact (fomites) by fecal-oral transmission. are discharging eggs on perianal skin. Eggs remain infective in an indoor environment usually for 2 to 3 weeks. Droplet transmission. Children with EI may attend child care or school, because they People with EI are most infectious before onset of the rash. They are unlikely to be infectious after onset of the are no longer contagious. rash.

Hand washing. Prevention of fecal-oral transmission.

No

ERYTHEMA INFECTIOSUM (Fifth disease)

Usually between 4 and 14 days (but can be as long as 21 days). Rash and joint symptoms occur 2 to 3 weeks after infection.

Standard precautions are indicated including hand hygiene and proper disposal of used facial tissues.

No

GIARDIASIS (Giardia lamblia)

Asymptomatic infection is common. Diarrhea, abdominal Usually is 5-25 days (1 to 4 weeks) , median cramps, bloating, frequent loose and pale greasy stools, fatigue, 7-10 days. weight loss. 3 to 6 days.

Fecal-oral transmission.

As long as the infected person excretes cysts.

Exclude until diarrhea has resolved and/or cleared by the medical provider. Do not exclude unless the student is drooling uncontrollably.

Hand hygiene and prevention of fecal-oral transmission.

Yes

HAND-FOOT-AND-MOUTH Enanthem consisting of ulcers located on the buccal mucosa, DISEASE (Strains of Entero- viruses tongue or gums. After 2 days of enanthem an exanthem - Coxsackievirus disease) develops (vesicular rash over the hands and/or the feet). HEPATITIS A Many infected persons, especially children, are asymptomatic or have mild symptoms without jaundice. Onset is usually abrupt with fever, nausea, abdominal discomfort and anorexia followed within a few days by jaundice, dark tea colored urine and pale clay colored stools. Anorexia, abdominal discomfort, nausea, vomiting, muscle aches, rash, jaundice. Includes inapparent cases.

Contact transmission.

Several weeks after the infection starts; respiratory shedding of the virus is limited to a week or less.

Hand hygiene and proper disposal of used facial tissues.

No

15-50 days (usually 25-30 days).

Contact transmission and fecal-oral 2 weeks before symptom onset and 1 week after transmission. jaundice occurs.

Exclude cases for first 2 weeks of illness but no longer than 7 days after onset of jaundice, or as decided by the physician.

Immune globulin (IG) for household contacts. Not indicated for contacts in a usual school situation. In day care centers when hepatitis A infection is identified in an employee or child - IG for previously unimmunized employees in contact with the index case and for unimmunized children in the same room as the index case. Good sanitation and personal hygiene with strict handwashing. Standard precautions by school personnel when attending injuries and/or blood spills. Education of staff and parents. Immunization of contacts. Universal immunization of all infants. Required for all day care children. Standard precautions by school personnel when attending injuries and/or blood spills. Education of staff and parents.

Yes

HEPATITIS B

6 weeks 6 months (Usually 45-180 days, average 60-90 days).

Commonly found on the hands and face, but sometimes widely Variable and indefinite; usually 4-10 days IMPETIGO CONTAGIOSA scattered over the body. There are small fluid-filled pimples at after bacteria attach to the skin. (Caused by Staphylococci or Streptococci infections) *For other staphy- first, followed by the formation of loose scales and/or crusts. lococci skin infections see below. INFECTIOUS MONONUCLEOSIS (Epstein-Barr Virus Infection) INFLUENZA (influenza virus type A, B, C) Manifests typically as fever, exudative pharyngitis, lymphadenopathy, hepatosplenomegaly and atypical lymphocytosis. Generally is characterized by sudden onset of fever, often with chills or rigors, headache, malaise, diffuse myalgia and a nonproductive cough. Subsequently, the respiratory tract signs of sore throat, nasal congestion, rhinitis and cough become more prominent. Conjunctival injection, abdominal pain, nausea and vomiting can occur. Often confused with other respiratory infections (i.e. common cold). Is estimated to be 30 to 50 days.

Contact with blood and body fluids. Blood can be infective many weeks before the onset and Sexual transmission. through the acute clinical phase of the illness. In case of chronic carriage, persons with chronic Hepatitis B surface antigen are infective lifelong. Contact transmission. The disease is The person is infective while sores remain unhealed or spread by direct contact with cases untreated. or through fomites contaminated by discharges from the sores. Contact transmission.

No contraindication against regular school attendance. Exclude during acute illness and children who bite or can not contain secretions. Exclude for 48 hours after start of effective therapy, since covering of lesions may be difficult.

Yes

No

Usually 1-3 (rarely 5) days.

Droplet and contact transmission.

The period of communicability is indeterminate. Exclusion to prevent transmission is not practical. Intermittent excretion is lifelong.Virus is excreted for many months after infection and can occur intermittently throughout life. Probably limited to 1 day before the onset of illness and Exclusion to prevent transmission is impractical. Quarantine 3-5 days after the onset in adults, up to 7 days in young does not affect the course of outbreak and is not recommended. School closings may be decided by school administration for children. academic reasons.

No specific measures recommended.

No

Immunization is available. Universal precautions, respiratory hygiene and personal hygiene should be maintained.

Report outbreaks and pediatrics deaths

MEASLES (Rubeola)

Dry hacking cough, red watery eyes which are usually About 10 days, varying from 7-18 days from sensitive to light, runny nose and fever. Fever usually precedes exposure to onset of fever, usually 14 days the rash by a few days. Erythematous maculopapular rash until rash appears. appears at hairline spreading downward over body. Pathognomonic enanthemas (Koplik spots) appear prior to rash in prodrome period. Patient is usually quite ill. The clinical symptoms and neurologic complications are similar to other forms of purulent bacterial meningitis. Symptoms may include headache, lethargy, vomiting, irritability, fever, nuchal rigidity, cranial nerve signs, seizures and coma. Fever, usually high, drowsiness and/or impaired consciousness, irritable, fussy, agitated, severe headache, vomiting, stiff neck, pain on moving neck. Fever, vomiting, lethargy, headache, stiff neck.

Airborne transmission.

From beginning of illness until 4 days after rash appears, Isolate at home for at least 4 days following the appearance of the rash. Other children in family may attend the school, but highly communicable. must be under observation. All unimmunized children should be immediately immunized.

Immunization is available.

Yes

MENINGITIS, BACTERIAL (other than N. meningitidis and H. influenzae)

MENINGITIS, HAEMOPHILUS influenzae type b MENINGITIS, NEISSERIA meningitidis.

Droplet transmission. Unknown, probably short, less than 4 days. Children aged <2 years are at increased risk for pneumococcal infection. Persons who have certain underlying medical conditions also are at increased risk for developing pneumococcal infection or experiencing severe disease and complications. Droplet transmission or direct Varies from 2-10 days, commonly 3-4 days. contact.

Until after 24 hours of antibiotic treatment.

Exclude during acute illness and until treated. Antimicrobial chemoprophylaxis is not recommended for contacts of children with invasive pneumococcal disease, regardless of their immunization status.

Immunization is available (two pneumococcal vaccines are available for use in children). Standard precautions are recommended. No prophylaxis.

Yes

As long as organisms are present, which may be for a prolonged period of time even without nasal discharge. Noncommunicable within 24-48 hours after the starting of effective antibiotic therapy.

Exclude during acute illness and until starting effective treatment for carriage of the organism.

Immunization is available. Close contacts and day care center contacts should be treated prophylactically and observed for symptoms for 5 days. Prompt treatment if symptoms develop is extremely important. School contacts are not at higher risk of developing the disease. Immunization is available. Household contacts should be given prophylactic treatment and observed for 5 days. School contacts are not at high risk and do not need prophylaxis.

Yes

MENINGITIS, VIRAL (Aseptic)

Fever, sore throat, headache, nausea and vomiting, stiff neck. In meningococcemia cases onset often is abrupt with fever, chills, malaise, prostration and a rash that initially may be macular, maculopapular or petechial. In fulminant cases (Waterhouse-Friderichsen syndrome), purpura, disseminated intravascular coagulation, shock, coma and death can ensue within several hours despite appropriate therapy. The illness is characterized by sudden onset of fever with signs and symptoms of meningeal involvement, with changes in Cerebrospinal fluid (CSF) including increased protein, increased lymphocytes count, normal sugar and absence of bacteria. Begins with a slight fever and nausea. Then painful swelling appears about the angle of the jaw and in front of the ear. Irritation and itching of the scalp (many children are asymptomatic). Lice are light grey insects which lay eggs (nits) on the hair, especially at the nape and about the ears.

Varies from 2-10 days, commonly 3-4 days.

Droplet transmission.

As long as meningococcal agent remains in the nose and Cases should be excluded until well and until starting antibiotic treatment for carriage of the organism. throat. It usually disappears within 24 hours after the starting of effective antibiotic therapy. About 5% of the population are healthy carriers.

Yes

The incubation period for influenza is 1-4 days, with an average of two days for enteroviral meningitis. It is different for other viral meningitis.

Fecal-oral route (enterovirus).

For enterovirus viral meningitis: Shedding of the virus in When the child is cleared to return by a health professional. feces can continue for several weeks, but shedding from When the child is able to participate and staff determine that the respiratory tract usually lasts a week or less. they can care for the child without compromisiing their ability to care for the health and safety of the other children in the grooup. The period of maximum communicability is from 1 to 2 Exclude for 9 days from onset of parotid gland swelling. Other days before to 5 days after the onset of parotid swelling. children in the family may attend school under close observation by the school personnel. Until effective treatment is completed. Any child with lice must be satisfactorily treated with an effective insecticide before returning to school. Exclusion is not necessary after initial treatment, even though nits may be present.

Use good hand-washing techniques and routine infection control measures.

Yes

MUMPS (Epidemic Parotitis)

Usually from 16 to 18 days, but cases may occur from 12 to 25 days after exposure.

Droplet transmission.

Immunization is available.

Yes

PEDICULOSIS (Head Lice)

Approximately 7-10 days after eggs hatch. Direct and indirect (fomites) Eggs hatch in a week. New lice start laying contact. eggs about two weeks later. Nits hatch in 1014 days, adults live 3-4 weeks. The incubation period from the laying of eggs to the hatching of the first nymph is 6 to 10 days. Mature adult lice capable of reproducing do not appear until 2 to 3 weeks. 7-10 days, and rarely exceeding 14 days. Droplet transmission.

Examine and treat all infested children in class. Retreat if indicated in 8-10 days to kill newly hatched lice. Store hats and coats separately and eliminate sharing of combs and brushes. School fumigation is unnecessary. Notify families to check for symptoms in household contacts.

No

PERTUSSIS (Whooping Cough)

Initially, symptoms are similar to those of a cold with sneezing and coughing. From 1 to 2 weeks later the cough becomes more severe with the characteristic Whoop.

During the cold period and the first 3 weeks of the whoop or 5-7 days after start of antibacterial therapy.

Exclude patient from the presence of young children and infants, especially unimmunized infants until the patient has received antibiotics for at least 5 days. Other immunized children in the family may attend school under close observation. Exclude immediately at the first sign of illness. Inadequately immunized household contacts less than 7 years old should be excluded for 14 days after last exposure or until the cases and contacts have received antibiotics for 5 days. Anyone having ringworm should be placed under treatment by a physician. Return to school is dependent upon being under adequate treatment. No child should be readmitted to the classroom unless he/she has a note from a physician stating he/ she is under medical care. All infected areas should be covered if student does not have good hygienic habits.

Immunization in early infancy, usually given in combination with diphtheria and tetanus immunization as DTaP vaccine. Booster doses are given at intervals as recommended by the physician or health department. In addition to standard precautions, droplet precautions are recommended for 5 days after initiation of effective therapy or until 3 weeks after the onset of paroxysms if appropriate antimicrobial therapy is not given. Prophylaxis of contacts.

Yes

RINGWORM (Tinea capitis)

A fungal infection that may affect the body, feet and scalp. On 10-14 days. the scalp - circular scaly patches with raised edges and short broken off hairs. Discrete areas of hair loss studded by stubs of broken hairs. On the feet (Athletes Foot, Ringworm of the Feet) - occurs as fine vesiculopustular or scaly lesions between toes, particularly in the third and fourth interdigital spaces. May occur anywhere on the body as well. Pruritus (Itching) is common. Begins with a rash. The fever and rash in rubella usually have a 16-18 days with a range of 14-23 days. simultaneous onset. Small nodular swellings behind the ears often occur, aiding in diagnosis. Usually lasts 3 days. Today it is rare in the US because of routine immunization. Appears as small, scattered, red spots which are most frequently found in the web of the fingers and areas of the thighs and arms where the skin is thin. Itching is most severe at night. Staph, including MRSA, can also cause serious infections such as severe skin infections , surgical wound infections, bloodstream infections and pneumonia. The symptoms could include high fever, swelling, heat and pain around a wound, headache, fatigue and other symptoms. In persons without previous exposure usually is 4 to 6 weeks. People who previously were infested develop symptoms 1 to 4 days after repeated exposure to the mites. Undetermined since disease occurs often in persons who have been colonized for months.

As long as present on the person or on contaminated Contact. It is spread by contaminated clothing (caps, etc.) or by con- clothing. tact with dogs and cats. More common in children 5-12 years of age.

Proper treatment of cases to prevent spread to others. Use standard precautions.

No

RUBELLA (German Measles)

Droplet transmission.

7 days before and at least 4 days (up to 14) after onset of Exclude children from school for 7 days after onset of rash. rash; highly communicable. Exposure of susceptible pregnant women to infected children should be avoided. Until the mites and eggs are destroyed (usually after 1 or Exclude infected children from school until the day after 2 days of proper treatment with scabicides). treatment.

Routine immunization is available. Women of childbearing age with no previous history of disease should be immunized. In addition to standard precautions, for postnatal rubella, droplet precautions are recommended for 7 days after the onset of the rash. Good personal hygiene. Launder bedding and clothing (hot water and hot drying cycle) worn next to skin at least 4 days before start of treatment. Items that cannot be laundered should be kept in plastic bags for at least 4 days. Notify families to check for symptoms in household contacts. Prophylactic treatment of those who have had skin-to-skin contact with infected persons.
Practicing good hygiene (e.g., keeping your hands clean by washing with soap and

Yes

SCABIES (Sarcoptes scabei)

Contact (skin-to-skin contact with infected persons).

No

STAPHYLOCOCCAL SKIN INFECTIONS (Including MRSA)

Staph, including MRSA, are spread A person remains infectious from their skin infection site Do not exclude if wound/skin infection is covered, draining pus by direct skin-to-skin contact, such as long as they have a discharge. Most sources of stais contained and proper treatment administered. as shaking hands, wrestling, or other phylococci/MRSA are colonized individuals. direct contact with the skin of another person. Staph are also spread by contact with items that have been touched by people with staph, for example, towels shared after bathing and drying off, or shared athletic equipment in the gym or on the field. Droplet and direct and indirect contact (fomites). From the first signs of illness until 24-48 hours after start The patient should remain out of school until 24 hours after starting antibiotic therapy. of effective antibiotic therapy. About 10-21 days if uncomplicated and untreated. Transmission of infection, including school outbreaks of pharyngitis, almost always follows contact with respiratory tract secretions. May also be associated with crowding. The close contact facilitates transmission.

water or using an alcohol-based hand sanitizer and showering immediately after participating in exercise) Covering skin trauma such as abrasions or cuts with a clean dry bandage until healed Avoiding sharing personal items (e.g., towels, razors) that come into contact with your bare skin; using a barrier (e.g., clothing or a towel) between your skin and shared equipment such as weight-training benches Maintaining a clean environment by establishing cleaning procedures for frequently touched surfaces and surfaces that come into direct contact with people's skin. Antibiotic treatment of cases and asymptomatic contacts at high risk, i.e., those with history of rheumatic fever. Use of standard precautions. Close contact with the case should be avoided, if possible.

Report outbreaks

STREPTOCOCCAL INFECTION Sore throat, swollen glands, headache, fever and generalized 1-3 days. reddish rash. In some cases, sore throat may be the only sign. (Including Scarlet Fever and Scarlet fever and step throat are the same disease except for the Streptococcal Sore Throat) rash with scarlet fever.

Yes

Revised 04/11

For more information or to report a disease, call 504-568-8313 or 1-800-256-2748 (24 hours a day, 7 days a week) http://www.dhh.louisiana.gov/offices/publications.asp?ID=249&Detail=1032