communicable diseases and immunization manual

Communicable Diseases and Immunization ManualReporting and Exclusion Guidelines

Reporting communicable/infectious diseases 2Reporting absenteeism 2Reporting animal bites 2Exclusion guidelines 2Pregnant employees and parents 2Reporting to public health 2Common Childhood Communicable Diseases 3Reportable Diseases 15

Head Lice GuidelinesIntroduction 16Whose job is it anyway? 16Dissemination of information 17What to do if head lice is found? 17Sample letter to parents 18Head lice fact sheet 19

Immunization RequirementsRequired immunization for children attending school 21Hepatitis B Program 21Human Papilloma Virus (HPV) Program 21Required immunization for daycares 22Required immunization for day nursery employees 23Publicly funded immunization schedule 24

Environmental CleaningCleaning 25Sanitizing and disinfection 25Cleaning routines 25Toys and activity centres 26Sleep equipment 26Indoor sandboxes 26Water play tables 26Musical instruments and mouthpieces 27Increased incidents of respiratory illness and gastroenteritis 27Recipe for chlorine bleach solution 28Guidelines for cleaning blood or body fluids 29Needle disposal 30

Your health is in your handsHandwashing with soap and water 31Cleaning with alcohol-based hand rub 31Precautions against the flu 32

Porcupine Health Unit, November 2006 / Revision date: January 2017

Communicable Diseases and Immunization Manual

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Reporting and Exclusion Guidelines

Reporting communicable/infectious diseases

Cases of specific communicable/infectious diseases must be reported to the Health Unit according to the Health Protection and Promotion Act, 1990, c. H.7, s. 28, as amended 2014 as follows:

“The principal of a school, who is of the opinion that a pupil in the school has or may have a communicable disease shall, as soon as possible after forming the opinion, report thereon to the Medical Officer of the Health Unit in which the school is located.”

All diseases listed on the Reportable Diseases 2013 MUST be reported to the health unit. The health unit will require the name of the child(ren), date of birth, address, home telephone number, name of parent/guardian and their telephone number at work if available. In order for the health unit to follow-up appropriately with contacts of communicable/infectious diseases, you may be requested to provide the most recent list for the class of the infected child(ren). This list must include name, date of birth, address, home telephone number, name of parent/guardian and their work telephone number if available. Diagnosis should be made by a physician or nurse practitioner. Any child who is too ill to fully participate in regular activities should stay home from school or daycare.

Reporting absenteeism

In order to be pro-active in preventing the spread of communicable diseases, we ask that you contact the Infectious Disease Nurse at the Porcupine Health Unit if the absenteeism rate in your facility increases by 10% or more due to illness.

Reporting animal bites

All bites from animals must be reported to the inspection department of the Porcupine Health Unit under the Health Protection and Promotion Act, Reg. 557. Children should be warned against handling dead, sick or wild animals including raccoons, skunks, foxes and bats.

Exclusion guidelines

The health unit has established exclusion guidelines for common childhood diseases which can be found in Common Childhood Communicable Diseases (page 3).

Pregnant employees and parents

Pregnant employees or parents who are concerned about the effects of any communicable/infectious disease on the unborn child should contact their healthcare provider.

Reporting to public health

Telephone or fax the health unit office to report communicable/infectious diseases in your school or daycare. Telephone: 705-267-1181 Toll free: 1-800-461-1818 Fax: 705-360-7324



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Common Childhood Communicable Diseases

Chickenpox (Varicella): report to health unit within one business dayIncubation period: 2-3 weeksSigns and symptoms:

Fever and skin rash that comes in crops. Rash begins on chest, back, underarm, neck and face; changes to blisters for 5-6 days then scabs.

How it is spread: Virus spreads very easily through the air or through direct contact with fluid in a chickenpox blister.

Contagious period: Usually 1-2 days before onset of rash and continuing until all lesions are crusted (usually about 5 days).

Exclusion guidelines:Exclude if child has a fever. Child can go to school or day nursery as long as they feel well enough to participate in normal activities. Siblings may attend school or day nursery.

What can be done: Thorough and frequent handwashing by staff and children. Vaccine available. Pregnant women who have been exposed and have NOT had chickenpox should call their health care provider.

Common ColdsIncubation period: varies depending on the virusSigns and symptoms:

Runny nose, sneezing, cough, sore throat, tiredness, headache, loss of appetite.How it is spread:

Direct and indirect contact with respiratory tract secretions of an infected person. Contagious period:

Varies depending on the virus. Exclusion guidelines:

Exclude if child has a fever. Child may go to school or day nursery if he feels well enough to take part in normal activities.

What can be done: Clean and disinfect soiled articles and surfaces.Thorough and frequent handwashing by staff and children.



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Conjunctivitis (Pink-eye)Incubation period for bacterial: 1-3 daysSigns and symptoms:

Red, watery, itching, burning eyes; swollen eyelids. A discharge may cause eyelids to crust over and stick together during the night.

How it is spread: Contact with discharge from the eye or respiratory tract of an infected person.

Contagious period:During the course of active infection. May be highly infectious depending on cause.

Exclusion guidelines:Infected people should be presumed contagious until eye discharge has resolved. Parents should minimize exposure by keeping their child home during this time if the child’s behaviour or environment is such that close contact with others cannot be avoided. If an antibiotic is prescribed by a health care provider the child can return 24 hours after start of treatment.

What can be done: Clean and disinfect soiled articles and surfaces. Thorough and frequent handwashing by staff and children.

Diarrhea: report to health unit if 10% or more of children and/or staff are affectedIncubation period varies: Campylobacter 1-10 days; E. coli 3-8 days; Salmonellosis 6-72 hours; Shigellosis 1-3 days; Giardiasis 3-25 daysSigns and symptoms:

Diarrhea, vomiting, nausea, cramps, fever, loss of appetite and blood and/or mucus in bowel movement.

How it is spread:Ingestion of contaminated food or water; also spread from person to person on contaminated hands or objects.

Contagious period:Varies depending on which bacteria are found in the stool. Usually while symptoms persist. Carriers without symptoms may transmit disease.

Exclusion guidelines:Exclude until stool returns to normal and symptoms are gone for a minimum of 24 hours or as otherwise directed by the Health Unit. Negative stool cultures are not required unless an outbreak occurs. Shigella requires 2 successive negative stool cultures, 24 hours apart and at least 24 hours after cessation of symptoms.

What can be done:Thorough handwashing is extremely important in reducing the spread, especially after toilet use.



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Fifth’s Disease (Parvovirus B19): report to health unit if 10% or more of children and/or staff are affectedIncubation period: 4-20 daysSigns and symptoms:

Starts with cold symptoms, fever and upset stomach. Rash begins on the cheeks, ‘slapped cheek appearance’, followed in 1-4 days by a lace-like rash on the trunk and extremities which fades, but may reoccur for 1-3 weeks on exposure to sunlight or heat.

How it is spread: Virus spreads from person to person through contact with respiratory secretions of an infected person. Can also spread from a pregnant woman to her unborn child.

Contagious period: Greatest before onset of rash and probably not communicable after onset of rash.

Exclusion guidelines:No exclusion is necessary unless child does not feel well.

What can be done: Thorough handwashing is important to prevent the spread of infection. Pregnant women who have been exposed should call their health care provider.Exposure causes concern for women in the first half of pregnancy.

Hand, Foot and Mouth Disease: report to health unit if 10% or more of children and/or staff are affectedIncubation period: 3-5 daysSigns and symptoms:

Fever, loss of appetite, sore throat, malaise, painful sores in mouth, rash with or without blisters on hands, feet and diaper area.

How it is spread: Virus spreads from person to person through direct contact with nose and throat discharges and feces of infected people; or via contaminated hands, objects and surfaces.

Contagious period: Most contagious first week of illness in saliva and stool. The virus can live in stool for 4 weeks after the start of illness.

Exclusion guidelines:No exclusion is necessary unless child does not feel well.




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Hepatitis A: report to health unit immediatelyIncubation period: 28-30 daysSigns and symptoms:

Onset is usually sudden with loss of appetite, nausea, tiredness, fever and stomach ache. Tea coloured urine, light coloured stools and jaundice (yellowing of eyes or skin) may appear. Symptoms are generally absent or much milder in children than in adults.

How it is spread: Virus is excreted in stool of infected persons. Spread person to person; it may also be spread in contaminated food or water.

Contagious period:From 2 weeks before until 1 week after the onset of jaundice. Note: Many have no symptoms, but are capable of passing the virus on to others.

Exclusion guidelines:14 days after the onset of symptoms or 7 days after jaundice whichever is shorter.

What can be done: Clean and disinfect soiled articles and surfaces. Thorough and frequent handwashing by staff and children.Vaccine available.

Hepatitis B: report to health unit within one business dayIncubation period: average 2-3 monthsSigns and symptoms:

Loss of appetite, fatigue, abdominal pain, nausea, vomiting and rash. Jaundice (yellowing of eyes or skin) may be present in adults, but often absent in young children. Symptoms vary from none at all to severe.

How it is spread: Virus is found in blood, semen and vaginal fluids. Can be spread by unprotected sex, blood contact, bites and from mother to baby at birth.

Contagious period: Can be spread through blood many weeks before onset of symptoms and continues to be contagious through acute and chronic periods.

Exclusion guidelines:No exclusion is necessary unless the child exhibits biting behaviour or has open sores that cannot be covered.

What can be done: Clean and disinfect soiled articles and surfaces. Thorough and frequent handwashing by staff and children. Health Unit staff will determine if Hepatitis B vaccine and/or immune globulin is required for close contacts.



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Impetigo: report to health unit if 10% or more of children and/or staff are affectedIncubation period: 1-10 daysSigns and symptoms:

A skin rash that is characterized by clusters of blisters or red bumps. The blisters may ooze or be covered with honey coloured crust. The rash usually appears around the nose, mouth and parts of the skin not covered by clothes.

How it is spread: Spread from person to person by direct contact with open sores of people who carry the bacteria without symptoms. Can also be spread by indirect contact.

Contagious period:From onset of skin rash until 24 hours after treatment with oral or topical antibiotic. Very contagious and should be treated at once.

Exclusion guidelines:Exclude until 24 hours after treatment has been started.

What can be done: Clean and disinfect soiled articles and surfaces. Thorough and frequent handwashing by staff and children.Do not share clothing or linens.

Influenza: report to health unit if 10% or more of children and/or staff are affectedIncubation period: 1-3 daysSigns and symptoms:

Fever, headache, fatigue, muscle soreness, runny nose, and sore throat and cough. Often children may have vomiting and diarrhea.

How it is spread: Virus is spread from person to person through respiratory secretions (coughing or sneezing) or by indirect contact with these secretions (e.g., on objects, doors, phones).

Contagious period: 24 hours before onset of symptoms and infectious 3-7 days afterwards.

Exclusion guidelines:Exclude if child has a fever. Child may go to school or day nursery if he feels well enough to take part in normal activities.

What can be done: Clean and disinfect soiled articles and surfaces. Thorough and frequent handwashing by staff and children.Vaccine available from October to April.



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LiceIncubation period for eggs: 1-2 weeksSigns and symptoms:

Itching of the scalp. Look for:1) crawling lice in the hair;2) eggs (nits) glued to the hair near the scalp;3) scratch marks on the scalp or back of the neck or hair line.

How it is spread: Person to person contact with an infected person or their belongings (e.g., direct hair to hair contact or indirect by sharing hats, head phones, combs etc.)

Contagious period: While lice remain alive on the infected person or his clothing.

Exclusion guidelines:Exclusion guidelines vary with school boards.

What can be done: Check the child’s head regularly once a lice treatment is given. Daily checks after treatment are needed to remove any nits. Refer to your school’s Head Lice Policy. For further information on developing a head lice policy or managing care, see the Head Lice Guidelines in this manual.

Measles (Rubeola): report to health unit immediatelyIncubation period: 7-18 daysSigns and symptoms:

Fever, watery eyes, runny nose and cough prior to a red blotchy rash appearing on the 3rd to 7th day. Rash usually begins on the face, spreads down to the trunk and out the extremities and lasts 4-7 days.

How it is spread: Virus in respiratory secretions. Spread person to person through air. Very infectious. Can stay in the air 2 hours after the person leaves the room.

Contagious period: 4 days before the rash appears to 4 days after the onset of rash.

Exclusion guidelines:Exclude until 4 days after the appearance of the rash.

What can be done: Clean and disinfect soiled articles and surfaces. Thorough and frequent handwashing by staff and children.Health Unit staff will determine which students are at risk for measles and exclude them from school until the risk period is over. Unimmunized children may need measles vaccine or immune globulin.



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Meningitis (bacterial): report to health unit immediatelyIncubation period: 2-10 daysSigns and symptoms:

Symptoms may include all or one or any combination of: fever, stiff neck, headache, vomiting, unusual sleepiness, irritability, lack of appetite; sometimes rash or seizures.

How it is spread: Contact with respiratory tract secretions of an infected person.

Contagious period: Until 24 hours after starting effective antibiotic treatment.

Exclusion guidelines:Exclude until child has been treated and is well enough to participate in normal daily activities.

What can be done:Other children (especially infants) should be watched for signs of illness, especially fever. Parents of children at risk will be notified by the Health Unit. Health Unit staff will advise those at risk of need of antibiotics and/or vaccination.

Meningitis (viral): report to health unit immediatelyIncubation period: variesSigns and symptoms:

May experience some or all of the following: sudden fever, severe headache, nausea, vomiting, stiff neck, eyes sensitive to light, insomnia and/or personality changes.

How it is spread: Varies with each virus.

Contagious period: Varies with each virus.

Exclusion guidelines:Exclude until child is well enough to participate in school activities.

What can be done: Thorough and frequent handwashing by staff and children.

MononucleosisIncubation period: 4-6 weeksSigns and symptoms:

Fever, sore throat, swollen glands, fatigue.How it is spread:

Virus spreads through contact with saliva of an infected person or articles soiled with saliva. Kissing facilitates spread among young adults.

Contagious period: Undetermined - virus excretion can occur for many months after infection.

Exclusion guidelines:No exclusion required.




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Mumps: report to health unit immediatelyIncubation period: average 16-18 daysSigns and symptoms:

Fever, swollen, tender glands on one or both sides of the face. Symptoms are sometimes so mild that disease is not recognized.

How it is spread: Virus is spread by direct and indirect contact with respiratory droplets from the nose and mouth.

Contagious period: From 7 days before swelling appears until 5 days after.

Exclusion guidelines:Exclude until 5 days after onset of swelling.

What can be done:Clean and disinfect soiled articles and surfaces. Thorough and frequent handwashing by staff and children. Health Unit staff will determine which children are at risk for mumps and exclude them from school until infectious period is over.Unimmunized children may need mumps vaccine.

PinwormIncubation Period: 1 to 2 months Signs and symptoms:

Usually children have no symptoms. Some children get very itchy around the anus and vagina, especially at night.

How it is spread: Direct contact with affected area or indirect contact with an infected persons objects (toys, toilet seats or baths, clothes).

Contagious Period: Eggs can live for up to 2 to 3 weeks outside the body, on clothing, bedding or other objects.

Exclusion Guidelines:No exclusion necessary.

What can be done:Thorough and frequent handwashing by staff and children; especially after going to the toilet, changing diapers, and before preparing or eating food.Wash bed linens and clothes. Don’t shake them because this can scatter the eggs.Keep everyone’s fingernails short and avoid nail-biting.The eggs are sensitive to sunlight. Open blinds or curtains in to allow light in.



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RingwormIncubation period: Body 4-10 days; Scalp 10-14 daysSigns and symptoms:

Body: Rash that may have a ring shape and raised edge. Edge of the lesion may be dry, itchy and scaly or moist and crusty. As lesions spread outward, the centre often becomes clear.Scalp: May be difficult to detect in early stages. Begins as a small, scaly patch which spreads leaving scaly patches of temporary baldness.

How it is spread: Direct contact with infected person, animal or contaminated articles.

Contagious period: As long as lesions are present and viable fungus persists on contaminated materials.

Exclusion guidelines:Exclude until after treatment has started.

What can be done: Launder soiled clothes, towels, and bedding in hot water. Clean and disinfect environment surfaces. Thorough and frequent handwashing by staff and children. The infected child is not to participate in activities which would expose others directly to lesions such as swimming, sharing of clothing, linens, combs or brushes.

Rosella (Examthem subitum)Incubation period: 5-15 days, usually about 10 daysSigns and symptoms:

Sudden high fever which lasts 3-5 days. The fever disappears and a rash appears mainly on the child’s face and body. The rash consists of small red spots which last a day or two. Affects children between the ages of 3 months to 4 years of age.

How it is spread: The virus is spread when you come in contact with saliva of an infected person, e.g., coughing and sneezing.

Contagious period: The child is infectious while symptoms are present.

Exclusion guidelines:No exclusion necessary.




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Rubella (German Measles) : report to health unit immediatelyIncubation period: 2-3 weeksSigns and symptoms:

May have mild fever and cold symptoms, widespread rash. Swelling of the lymph glands behind the ears.

How it is spread: Virus spreads through contact with the respiratory tract secretions of an infected person.

Contagious period: From 1 week before to at least 4 days after onset of rash.

Exclusion guidelines:Exclude 7 days after onset of the rash.

What can be done: Clean and disinfect soiled articles and surfaces. Thorough and frequent handwashing by staff and children. Pregnant women who have been exposed should call their health care provider.

Scabies: report to health unit if 10% or more of children and/or staff are affectedIncubation period: 2-6 weeks Signs and symptoms:

Very itchy rash. Usually appears on the fingers, elbows, armpits and abdomen. How it is spread:

Parasites spread by direct contact with infected person or articles immediately contaminated beforehand.

Contagious period: Until mites and eggs are destroyed by treatment. A second treatment one week after the first course is often needed.

Exclusion guidelines:Exclude until treatment has started.

What can be done: Launder soiled clothes and bedding in hot water and in hot dryer.



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Scarlet FeverIncubation period: 1-3 days Signs and symptoms:

May include fever, sore throat, swollen glands and headache, plus a very fine raised rash. Appears most often on the neck, chest, in folds of armpit, elbow, groin and inner thigh. A swollen, red tongue may appear. Later there may be peeling of skin on fingertips and toes.

How it is spread: Contact with respiratory tract secretions of an infected person.

Contagious period: If untreated can infect others for up to 10-21 days. If treated with antibiotics, will not be infectious after 24 hours.

Exclusion guidelines:Exclude until 24 hours after treatment has started and child is without fever for 24 hours.


Strep Throat (Streptococcal Sore Throat) Incubation period: Strep Throat 2-5 days Signs and symptoms:

Fever, sore throat, swollen glands and headache. If left untreated, may become Scarlet Fever. How it is spread:

Contact with respiratory tract secretions of an infected person. Contagious period:

If untreated can infect others for up to 10-21 days.If treated with antibiotics, will not be infectious after 24 hours.

Exclusion guidelines:Exclude until 24 hours after treatment has started and child is without fever for 24 hours.




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Whooping Cough (Pertussis): report to health unit immediatelyIncubation period: usually 7-10 days, can range from 5-21 daysSigns and symptoms:

Initial signs are coughing and sneezing followed 1-2 weeks later by breathing characterized by a series of short convulsive-like coughs and high pitched gasps of air called a whoop. Coughs are sometimes followed by vomiting. Symptoms can last 6-12 weeks.

How it is spread: Bacteria in respiratory secretions. Spread from person to person through the air. Very infectious.

Contagious period: Very infectious in the early stages. Little risk 3 weeks after onset of cough even if it persists. If treated with erythromycin, no longer contagious after 5 days of therapy. Note: Pertussis is among the most contagious of diseases.

Exclusion guidelines:Exclude until 5 days after treatment with erythromycin has started and child is feeling well, otherwise 3 weeks from date of onset.

What can be done: Clean and disinfect soiled articles and surfaces. Thorough and frequent handwashing by staff and children. Health Unit staff will determine which students are at risk for pertussis and exclude them from school until the infectious period is over.Contacts may require a booster vaccine and/or antibiotics.


Reportable DiseasesREPORTABLE DISEASES The following specified Reportable Disease, (Ontario Regulation 559/91 and amendments under the Health

Protection and Promotion Act, 1990) are to be reported to the Local Medical Officer of Health.

Acquired Immunodeficiency Syndrome (AIDS) ►Hantavirus Pulmonary Syndrome Pneumococcal Disease, invasiveAcute Flaccid Paralysis ►Hemorrhagic fevers, including: ►Poliomyelitis, acuteAmebiasis ►1. Ebola virus disease Psittacosis/Ornithosis►Anthrax ►2. Marburg virus disease ►Q Fever►Botulism ►3. Other viral causes ►Rabies►Brucellosis ►Hepatitis A ►Respiratory infection, institutional outbreaksCampylobacter enteritis Hepatitis B RubellaChancroid Hepatitis C Rubella, congenital syndromeChickenpox (Varicella) Influenza SalmonellosisChlamydia trachomatis infections ►Lassa Fever ►Severe Acute Respiratory Syndrome (SARS)Cholera ►Legionellosis ►Shigellosis►Cryptosporidiosis Leprosy ►Smallpox►Cyclosporiasis ►Listeriosis Syphilis►Diphtheria Lyme Disease Tetanus►Encephalitis, including: Malaria Transmissible Spongiform Encephalopathy:

1. Primary, viral (including WNV) ►Measles 1.Creutzfeldt-Jakob Disease, all types2. Post-infectious ►Meningitis, acute Trichinosis3. Vaccine-related ► 1. bacterial Tuberculosis4. Subacute sclerosing panencephalitis 2. viral ►Tularemia5. Unspecified 3. other Typhoid Fever

►Food poisoning, all causes ►Meningococcal disease, invasive ►Verotoxin-producing E. coli infection indicator►Gastroenteritis, institutional outbreaks Mumps conditions including Hemolytic Uremic Syndrome(HUS)►Giardiasis Ophthalmia Neonatorum ►West Nile virus Illnesses:Gonorrhea ►Paralytic Shellfish Poisoning 1.West Nile virus Fever►Group A Streptococcal Disease, invasive (iGAS) Paratyphoid fever 2.West Nile virus Neurological ManifestationsGroup B Streptococcal Disease, neonatal Pertussis (Whooping Cough) ►Yellow Fever►Haemophilus influenza b disease, invasive ►Plague Yersiniosis

Note: Disease marked ►and all respiratory infection outbreaks in institutions should be reported immediately by telephone, to the Medical Officer of Health. Other diseases are to be reported the next working day.

To report a disease or for more information, please contact the Porcupine Health Unit at:(705) 267-1181, toll-free 1-800-461-1818 or by confidential fax at (705) 360-7324www.porcupinehu.on.ca

Ontario Regulation 559/91 under the Health Protection and Promotion Act amended on December 2013.


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Head Lice Guidelines

Introduction

Under Ontario Regulation 558/91 of the Health Protection and Promotion Act, Pediculosis (head lice) is not on the list of communicable diseases. As such, the boards of health consider head lice to be a nuisance and not a health hazard.The level of service provided by the Porcupine Health Unit relating to the management of head lice in the schools is derived from the Health Promotion and Protection Act mandate. The changes in the service delivery have prompted the school boards to work cooperatively with the Medical Officer of Health to initiate measures to provide a basic level of service throughout the Porcupine Health Unit area. The intent of the information contained here is to:• provide an equitable level of service to all schools, • provide a systematic process for dealing with and controlling outbreaks of head lice in the

school and community, • educate parents, teachers, students and other school board staff about head lice.In order for a head lice control program to be effective, it is necessary that all major groups work together:• Health unit• Trustees, Principals, Teachers, Students, Secretaries, Custodians• Local community (Parents and Health Professionals)The major responsibility for safeguarding the health, safety, and well-being of the child lies with the parent or legal guardian. If a child is infested with head lice, it is the parents’ responsibility to immediately provide treatment for disinfestation and to take all precautions in the home to prevent the transmission of head lice to other family members.

Whose job is it anyway?

Head lice control works best when everyone helps. Parents, teachers, students, and health units all have a part to play in controlling the ongoing problem.Parents1. Examine children’s heads weekly for signs of infestation.2. Notify the school of suspected cases.3. Carry out treatment for elimination of lice and inform school that treatment has been

completed.



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School and Teacher1. Distribute head lice information to families of students at the beginning of the school year

or as needed.2. Distribute information in classes where head lice is suspected.3. Advise parent/guardian by letter (or form) when their child is identified as having head lice.

Advise parent/guardian on school’s policy about exclusion and when to return to school.4. Report suspected cases to principal.Porcupine Health Unit1. Assist in providing educational material and consultation to staff, students and parents on

request.2. Provide education presentations to students, staff and parents on request.3. Provide training in head lice control to school personnel, volunteers and parents on request.

Dissemination of information

Prior to or during the first week of school in September, the Principal should provide to all staff:• information related to head lice detection and how to report to the health unit,• protocol of school procedures for dealing with a student suspected of having head lice.Early in the school year, preferably before the end of the month of September, the Principal should send a letter to all parents which includes:• information about head lice,• parents’ responsibility in managing head lice and the need to cooperate with the school.Consideration should be given to sending reminders to parents regarding head lice control (e.g., a brief paragraph in the school newsletter) or discussions at regularly scheduled parent meetings (e.g., parent/teacher nights, school open house).The Porcupine Health Unit can provide information sessions to parents and/or teachers regarding facts, myths, detection and treatment of head lice.

What to do if head lice is found?

When a pupil is identified as having head lice:1. The principal should contact the parent or legal guardian to pick up their child and provide

the parent with the necessary treatment information for the management of head lice.2. If the parent/guardian cannot be contacted, the child may be removed from the classroom

at the discretion of the Principal, until the end of the school day.3. The Principal should ensure that a letter is sent home with all the students in the affected

child’s classroom to advise parents that head lice was identified in the classroom.



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Sample letter to parents

Dear Parents:This letter is to inform you about the common problem of head lice. Head lice can affect anyone, but most often it affects younger school-age children.Head lice are parasites. They are considered by health officials to be a nuisance because they are difficult to eliminate. They are not a health hazard and are not connected in any way with long hair, dirt, neglect, or not being clean. Head lice can spread quickly from head to head when a group of children have close contact (e.g., school, camp, day-care). They can be spread by sharing hats, brushes, combs, bedding, etc.Prevention of head lice is everyone’s responsibility. Cooperation and prompt action on the part of parents, school staff, and the health unit will help to reduce the inconvenience to children.We encourage parents to look at their children’s hair on a regular basis. When checking for nits (eggs), the hair should be dry. A convenient time for a visual check may be just before washing your child’s hair.If you find any head lice or nits (eggs), obtain and use a medicated head lice shampoo or medicated cream rinse from your pharmacist, and contact the school to inform them that your child has been treated. The school needs to be informed so that other parents and school officials can be advised to check the heads of others. Finding and treating head lice early will stop your child from getting a severe case and stop the spread of head lice to other children.Further information and reference about head lice can be obtained from the school or local office of the Porcupine Health Unit:

Thank you for your cooperation.Sincerely,

Principal


Head lice fact sheet

Bureau de santé Porcupine Health Unit January 2017

HEAD LICE

Head lice spreads easily, especially when people are in close contact and sharing personal items. One of the first signs of head lice is an itchy scalp.

Here is some information to help you deal with head lice.

What are head lice?

Head lice are tiny wingless insects (about the size of a sesame seed) that vary in colour but are often grey to light brown. Lice lay eggs that are called nits. Nits stick to the hair shaft, within a ¼ inch from the scalp, and take about one week to hatch into adult lice. How do people get head lice?

Head lice are spread through direct contact among people, for example heads touching, or indirectly, such as through sharing hats, combs, clothes, scarves, barrettes, helmets, etc. Lice cannot jump or fly but they can crawl very quickly.

Where do you find lice on a person's head?

Lice are commonly found around the ears, forehead, and nape of the neck. Having head lice does not mean that someone is dirty or unclean. Head lice do not have a preference for clean or dirty hair. Head lice feed of blood from a person's scalp and the warmth of their head.

Can you get sick from head lice?

No, head lice do not cause disease.

What are the symptoms of head lice?

A person may be infested with head lice and not experience symptoms. The most common signs of head lice are:

• tickling and the sensation of movement, • itching, and • sores on the scalp because of scratching.

Bureau de santé Porcupine Health Unit January 2017

What should I do if I think my child has head lice?

Search your child's head for head lice in a brightly lit space.

Part the hair in small sections from side to side beginning at the base of the hair around the ears and across the back of the neck moving upwards until the whole head has been examined.

Recheck your child's head after one to two weeks.

What should I do if my child has head lice?

1. Treat your child's hair with an over-the-counter pesticide to kill lice so that they cannot continue to lay eggs. Talk with a pharmacist to decide which shampoo to use. Always follow the instructions on the label. Treatment should be repeated in 7-10 days to kill any lice that hatched since the last treatment. Do not use the same medication more than two to three times if the treatment is unsuccessful. Home remedies should be avoided.

2. Remove nits using a nit comb or by pinching them between your fingers and sliding them off of the hair shaft. After each treatment continue to check your child's head daily for new nits.

3. Wash clothing, bedding, and towels that were recently used using your laundry machine's hottest setting. Laundry should be dried on high heat for at least 20 minutes. Place items that cannot be washed, such as stuffed animals and pillows, in a tightly sealed plastic bag for two weeks.

4. Vacuum rugs, carpets, upholstered furniture, mattresses, vehicle interiors, and car seats. Do not use pesticide sprays as they are not safe for people or pets.

5. Soak all family combs and brushes for at least 10 minutes in hot water.

How can I prevent head lice?

• Regularly check your child's hair for lice. • Teach children to avoid head to head contact with other children, to not share hats, helmets, combs,

headphones, or scarves with others, and to not lie on beds, couches, pillows, carpets, or stuffed animals that have recently been in contact with an infected person.

• Notify your child's school if your child has head lice. The school has an important role in implementing preventative measures in the classroom.


21

Immunization Requirements

Required immunization for children attending school

Every student must have a complete immunization record on file with the Porcupine Health Unit in order to attend school. The Porcupine Health Unit is required by the Immunization of School Pupil’s Act RR.O 1990 Reg. 645 to ensure that a child attending school in the Porcupine Health Unit area is fully immunized.To fulfill this requirement, the Porcupine Health Unit:• maintains immunization records on every student attending school in the Porcupine Health

Unit area;• reviews student records annually to ensure that each student’s vaccinations are up-to-date; • sends out letters asking for any missing information or reminding parents to update

mandatory immunization as required; • issues suspension notice from the school until the required immunization is received.

(Exceptions to this are permitted only if the parents have submitted either a medical or a statement of conscience or religious belief affidavit that prohibits vaccination.)

In addition to the above services, we offer other school-based immunization programs such as:

Hepatitis B Program

Hepatitis B vaccine is offered to all Grade 7 students. The schedule for the series consists of two doses. The first dose will be given between October and December. The second dose follows four to six month after the first dose.

Human Papilloma Virus (HPV) Program

HPV vaccine is offered to all Grade 7 students. The schedule for the series consists of two doses. The first dose is given between October and December. The second dose follows six months after the first dose.



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Required immunization for daycares

As per the Child Care and Early Years Act: Ontario Regulation 137/15, Day Nursery operators must ensure that all children have complete immunization appropriate to their age prior to admission to the day nursery. Consult the most current Publicly Funded Immunization Schedules for Ontario for up to date information on required vaccines.A record of immunization must be kept as part of each child’s record and be available to the Health Unit upon request.There may be medical or philosophical reasons for not immunizing children. In these cases, parents must complete exemption forms which are located on our website at www.porcupinehu.on.ca. The forms need to be submitted to the PHU and a copy kept with the child’s health records.Although the public health nurse will monitor immunization status, it is your responsibility as the Day Nursery operator to ensure that immunization records are accurate at the time of entry, are kept up-to-date and that you advise the nurse of newly enrolled children in the daycare.



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Required immunization for day nursery employees

When hiring, make sure that prospective staff members meet immunization requirements and you have all relevant health information on file. Update staff health records on a regular basis. Ensure that your staff members have up-to-date immunization as follows:• Combined Measles, Mumps, Rubella Vaccine (MMR)

Adults born prior to 1970 can be assumed to have acquired natural immunity to measles. Adults born in 1970 or later should have a documented dose of MMR vaccine. If he/she does not have a written record of having this vaccine, they should receive a dose of MMR. A second dose of MMR is not necessary for adults working in a daycare.

• Tetanus, Diphtheria (Td) booster or Tetanus, Diphtheria and Pertussis (Tdap) Booster After adequate immunization in childhood, a Td booster is required every 10 years for adults. If an adult 19-64 years of age was not immunized in adolescence with whooping cough (pertussis), the next Td booster should be replaced by the whooping cough booster (tetanus, diphtheria and pertussis). This whooping cough booster vaccine is good for life. It provides protection to adults, while preventing the spread of this highly contagious illness to children and infants.

• Polio Booster Polio boosters are not required for most adults in Canada. Exceptions are:

◦ adults who have never been vaccinated against polio; ◦ incompletely immunized adults should receive the remaining doses; and ◦ adults at increased risk (i.e., individual traveling to a county where polio is endemic).

• Influenza Vaccine The influenza vaccine is strongly recommended for all residents of Ontario. One of the groups at high risk includes children 6 months to 2 years of age. Even if your staff is healthy, since they work or care for children at high risk for severe influenza complication, they should get immunized. It protects everyone.

Keep a record of immunization in each staff member’s personnel file. Remember everyone should keep a record of his/her immunization.Update staff immunization records as necessary.Require employees and volunteers to stay off work when they are ill.


Publicly funded immunization schedule

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Publ

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at v

acci

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n Diphtheria, Tetanus, Pertussis, Polio and Haemophilus influenzae type B

Rotavirus

Pneumococcal Conjugate -C

Meningococcal Conjugate C

Measles, Mumps and Rubella

Varicella

Measles, Mumps, Rubella and Varicella

Hepatitis B

Meningococcal Conjugate A, C, Y, W-135

Human Papilloma Virus

Diphtheria, Tetanus and Pertussis

Diphtheria, Tetanus, Pertussis, and Polio

Influenza

2 m

onth

s

◊ □

◊

4 m

onth

s ◊

□ ◊

6 m

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s ◊

12 m

onth

s

◊

◊ ◊

15 m

onth

s

◊

18 m

onth

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4-6

year

s

◊

◊

Gra

de 7

◊ ◊

◊

14-1

6 ye

ars

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Ever

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ar

◊


25

Environmental Cleaning

Cleaning

Cleaning is the physical removal of dirt and organic materials from inanimate objects and/or surfaces. Cleaning is accomplished by using detergent, water, and applying friction to the contaminated area. The friction created by the physical rubbing of the contaminated area will remove some of the germs (e.g., bacteria, viruses, parasites, moulds) however it does not kill those organisms that remain on the surface.Cleaning is an important first step in removing disease causing organisms from the environment. Surfaces not cleaned may allow dirt and organic matter to blanket germs and reduce the effectiveness of chemical disinfectants.

Sanitizing and disinfection

Sanitizers or disinfectants are, in most cases, a chemical product used after the inanimate object or surface has been cleaned. Both can reduce the amount of microorganisms to acceptable limits. The difference being that a sanitizer will reduce the number of microorganisms, whereas a disinfectant will kill or inactivate all microorganisms with the exception of bacterial spores. Note: Sanitizing can also be achieved by using water at a high temperature (e.g., mechanical dishwashers with a sanitizer cycle of at least 82°C/180°F or higher).Commercial chemical sanitizers and disinfectants must be used in strict accordance with the manufacturer’s directions. Some important points to remember are:• the nature of the contaminated item and/or surface;• the disinfectant must have a have a Drug Identification Number (DIN) from Health Canada;• directions for proper dilution and application;• contact time required (i.e., time to achieve disinfection), generally 10 minutes;• statement as to rinse requirements (e.g., for food contact surfaces); and• possible health risks such as skin or respiratory irritation and allergies.To ensure sufficient chemical strength, solutions are to be prepared fresh daily (unless otherwise specified on the label).

Source: MOHLTC Guide to Developing a Workplace Health Plan for an Influenza Pandemic

Cleaning routines

Cleaning and sanitizing surfaces in a school environment will help prevent the spread of infections. Special attention must be given to the routine cleaning of high touch surfaces such as:• door handles (especially in washrooms),• hand rails,• computer key boards and mouse devices,• table tops and counters,• washrooms.



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Toys and activity centres

• Frequently touched toys in areas with toddlers and infants must be cleaned daily.• Frequently touched toys in areas with non-diapered children must be cleaned weekly or as

required.• If a toy becomes contaminated by body secretions, it must be removed from circulation and

placed in a labelled bin (out of the reach of children) until cleaned and disinfected.• Toys that can withstand high temperatures may be cleaned and sanitized using a mechanical

dishwasher (sanitizing cycle must be at least 82°C/180°F or higher).

Sleep equipment

• Must be used by only a single child.• Label mats to ensure it is used only by the assigned child.• Must be cleaned and disinfected before assigned to another child.• Sleeping mats and blankets should be stored in a manner that will prevent contact with one

another.

Indoor sandboxes

• Sand used indoors must come from an approved source and should be pre-washed (available from most hardware stores).

• Must be cleaned and sanitized regularly and the sand must be replaced on a regular basis.• Must be covered when not in use.• Exclude children or staff members with a cold, cough or skin infection from play.• Children and staff members wash their hands before and after play.

Water play tables

Water tables are at high risk for the potential spread of communicable diseases. Extra care must be taken when using water play tables.• Fill the water container immediately before use.• Water must be drained and the water container disinfected after each use.• Clean and disinfect toys after each use.• Do not use sponge toys.• Exclude children or staff members with a cold, cough or skin infection from water table play.• Exclude infants, toddlers, and diapered children from group water play. These children can

play individually or in individual containers.• Children and staff must wash hands before and after play.• During an outbreak of illness STOP use of water play tables.



27

Musical instruments and mouthpieces

Musical instruments and mouthpieces, particularly those used by more than one student, should be cleaned and disinfected to prevent the spread of infectious diseases.Steps for disinfecting mouthpieces/musical instruments:• Soak in warm water for twenty minutes.• Wash with soap and water.• Rinse thoroughly with water.• Immerse in a disinfectant solution. When using the disinfectant, follow the manufacturer’s

instructions on dilution levels and immersion times to ensure effectiveness.• Rinse thoroughly with water and let dry.• In schools where dishwashers are available, mouthpieces that are able to withstand heat can

be placed in a mechanical dishwasher for cleaning and sanitizing. The mechanical dishwasher sanitizing cycle must reach a minimum of 82°C/180°F to be effective.

Additional guidelines for musical instruments:• Do not allow students with visible sores, or respiratory infections to use mouthpieces or

instruments. • Clean brass instruments with a cleaning snake and warm water before passing to other

students.• Wipe dry woodwind instruments after every use.• Disinfect mouthpieces after use by a student who has had a communicable disease and throw

out all used reeds.• Reeds must labelled and used by only one person.

Increased incidents of respiratory illness and gastroenteritis

(Episodes of vomiting and diarrhea)In incidents where there is an increase of respiratory illnesses and gastroenteritis, the following control measures should be put into place:• Effective and frequent handwashing by all individuals:

◦ following toilet use; ◦ before and after preparing and/or eating food; and ◦ after handling contaminated articles.

• Ensure adequate supplies of liquid soap and paper towels are in all sanitary facilities and at all handwashing basins.

• Check all disinfectants to ensure proper concentration and usage.• Properly dispose of all infective/contaminated articles. Flush or discard vomitus or stool in the

toilet and make sure that the surrounding area is cleaned and disinfected.• Adhere to a rigid cleaning schedule (i.e., washrooms, work surfaces, touch surfaces such as

door knobs, fountain taps, and toys).• Symptomatic students and staff should remain at home until 48 hours after the last episode

of diarrhea and/or vomiting or until respiratory symptoms have cleared.



28

Recipe for chlorine bleach solution

Low level disinfection:Surfaces within the school environment generally require a low level of disinfection.

Concentration: 200 parts per millionContact time: surface must remain wet for 1 minute

High level disinfection:Use in areas contaminated with blood/body fluid spills to prevent transmission of diseases.

Concentration: 5000 parts per millionContact time: surface to remain wet for 10 minutes

Easy to use online Chlorine Dilution Calculatorhttp://www.publichealthontario.ca/en/ServicesAndTools/Tools/Pages/Dilution-Calculator.aspx Enter the:• Volume of solution required• Desired concentration of sodium hypochlorite• Concentration of bleach solution being used (found on the label of the bleach product)• Press ‘enter’The tool will automatically calculate the amount of bleach solution that should be diluted with water to get the desired concentration.

Source: Ontario Agency for Health Protection and Promotion



29

Guidelines for cleaning blood or body fluids

Treat all blood and body fluids as potentially hazardous. Blood borne pathogens (disease causing germs) may be present in any child or staff, therefore routine practices need to be used at all times when dealing with blood or body fluids.Procedure for cleaning blood and body fluid spills• Assemble materials required for dealing with the spill.• Inspect the area around the spill thoroughly for splatters or splashes. • Restrict the activity around the spill until the area has been cleaned and disinfected and is

completely dry.• Put on gloves; if there is a possibility of splashing, wear a gown and facial protection.• Confine and contain the spill; wipe up any blood or body fluid spills immediately using either

disposable towels or a product designed for this purpose. Dispose of materials by placing them into a regular waste receptacle.

• Disinfect the entire spill area with a high level disinfectant and allow it to stand for the amount of time recommended by the manufacturer.

• Wipe up the area again using disposable towels and discard into regular waste.• Care must be taken to avoid splashing or generating aerosols during the clean-up.• Remove gloves and perform hand hygiene.Procedure for cleaning blood and body fluid spills on carpet• Assemble materials required for dealing with the spill.• Restrict the activity around the spill until the area has been cleaned and disinfected and is

completely dry. • Put on gloves; if there is a possibility of splashing, wear a gown and facial protection. • Mop up as much of the spill as possible using disposable towels.• Disinfect the entire spill area with a high level disinfectant and allow it to sand for the amount

of time recommended by the manufacturer. • Safely dispose of the cleanup materials and gloves by placing them in the waste receptacle. • Remove gloves and perform hand hygiene. • Arrange for the carpet to be cleaned with an industrial carpet cleaner as soon as possible.

Source: Best practices for Environmental Cleaning for prevention and control of infection (PIDAC), May 2012



30

Needle disposal

Used needles can contain very small amounts of blood, which in turn, may carry viruses that cause serious diseases such as HIV, Hepatitis B and Hepatitis C. Since we do not always know whose blood contains these viruses, the safest approach is to treat all blood as though it contains viruses. Children should be warned NEVER to touch needles.Safe needle disposal:• Only adults should handle and dispose of needles.• Take a container made of strong plastic or metal to the needle site (e.g., empty Javex bottles

or used coffee tins).• Place container on a flat surface.• If possible, use tweezers, pliers or wear gloves to pick up the needle.• Pick up needle, pointing the tip away from your body.• Do not hold the container in your hand when putting a needle into it.• Drop the needle in the container and tighten the lid securely.• Throw out the container with general garbage pick-up.



31

Your health is in your hands

Washing your hands is the single most important way to prevent illness.Your hands play a major role in the spread of germs that cause illness. Hand hygiene is considered the most important and effective infection prevention and control measure to prevent the spread of infection. Effective hand hygiene kills or removes bacteria on the skin and maintains good hand health. There are two methods of killing/removing germs on hands:

Handwashing with soap and water

Wash hands for at least 15 seconds.

Cleaning with alcohol-based hand rub

Wash hands for at least 15 seconds.

Source: Images from Ministry of Health and Long-Term Care



32

Your health is in your hands

Precautions against the flu

Clean your hands. Washing your hands well and often is one of the best ways to prevent viruses. Lather up for 15 seconds with soap and water or use an alcohol-based sanitizer.

Cough and sneeze into your sleeve. Hands spread germs; keep them clean.

Keep commonly touched surfaces clean. All frequently touched surfaces and items should be kept clean using a household disinfectant.

Stay home if you’re sick. Don’t spread your germs. If your symptoms get worse, call your health care provider.

Get immunized. Talk to your health care provider.


communicable diseases and immunization manual

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