HomeMy WebLinkAboutcommunicable-disease-case-and-outbreak-toolkit-for-schools-and-chidcarePage 1 of 41
Division of Communicable Disease Control and Prevention
Communicable Disease Case and Outbreak Toolkit for Schools and
Childcare
Guidance for Schools and Childcare Sites to Report and
Manage Communicable Disease Cases and Outbreaks
Table of Contents
•Communicable Disease and Outbreak Reporting Basics ............. 2
•Gastrointestinal Illnesses and Outbreaks .................................... 5
•Respiratory Illnesses and Outbreaks ........................................... 15
•Appendices ..................................................................................... 19
Kimi Watkins-Tartt
Kavita K. Trivedi, MD
San Leandro, CA 94577
(510) 267-3250
Division of Communicable Disease Control and Prevention
Page 2 of 41
This toolkit provides guidance for reporting and responding to specific communicable diseases
commonly encountered in childcare and school settings.
What is reportable?
This guidance does not replace or revise applicable laws or other requirements that
apply to school or licensed childcare settings, including but not limited to their
authority to exclude individuals on the basis of health and safety. See the California
Health and Safety Code (e.g., § 120230), Education Code (e.g., § 48213, § 49451),
California Code of Regulations (e.g., Titles 17 and 22), and child care center licensing
requirements such as daily inspection for illness.
Title 17 Section 2508 requires schools and childcare sites to report the following to
local public health:
1.Individual cases of Title 17 diseases (e.g., measles, pertussis).
2.Outbreaks, as defined in Table 1 below.
3.Unusual disease occurrences.
To report to Alameda County Public Health, call the Acute Communicable
Disease (ACD) Section at 510-267-3250.
How do I respond to individual cases of communicable diseases?
Answer these questions referring to APPENDIX A:
1.Is this disease reportable?
2.Do I need to post/send out an exposure notice?
3.Does the individual need to be excluded?
4.When can the individual return, if excluded?
Refer to APPENDIX A - Common Childhood Diseases for Alameda County Public
Health’s recommendations for individual cases of specific communicable diseases.
For symptoms without a diagnosis, consider consulting CDPH’s Guidance for
Responding to Symptoms of Illness in Childcare or School.
For additional information, please see Shope, T. and Hashikawa, A.N. (2023).
Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide
(6th ed.). American Academy of Pediatrics.
Division of Communicable Disease Control and Prevention
Pa ge 3 of 41
Responding to Outbreaks
Childcare centers licensed by California Department of Social Services
(CDSS): Per Title 22, licensees should report all outbreaks or suspected outbreaks
involving two or more children of any communicable disease, including those not
listed in Title 17, Section 2500, such as head lice.
K-12 schools and other non-licensed settings: In general, an outbreak is defined as
more cases of an illness than expected for a particular group at a particular time.
See Table 1 below for details.
Table 1. Outbreak Reporting Thresholds for Alameda County Public Health
Department (does NOT apply to CDSS-licensed facilities)
Gastrointestinal Illness Viral Respiratory Illness Reportable Title 17 Disease
3 or more cases of vomiting
and/or diarrhea (3 or more
episodes of loose stools
within a 24-hour period or an
occurrence of loose stools
that is above normal for the
person) in a student or staff
member, with symptom
onset occurring within 72
hours and within the same
group (such as a single
classroom, sports team, or
after-school group).
Please follow the guidance
in the Respiratory Guidance
and Outbreak section below
and contact us if you need
additional assistance
1 or more cases (includes
pertussis and tuberculosis)
Division of Communicable Disease Control and Prevention
Pa ge 4 of 41
Figure 1: Outbreaks Among Schools and Childcare 2018- July 2024, Alameda County
Division of Communicable Disease Control and Prevention
Am I required to report the outbreak?
For most illnesses, report any suspected outbreak. Schools and facilities not licensed
by CDSS do not need to report the following outbreaks, but you can still call Alameda
County Public Health for guidance:
•Lice
•Scabies
•Bed bugs
•Hand, foot, and mouth disease
•Pink eye
•Viral respiratory illnesses
How do I report the Outbreak?
To report to Alameda County Public Health, call the Acute Communicable Disease (ACD)
Section at 510-267-3250.
Basics of Gastrointestinal Illness
Gastrointestinal (GI) viruses spread quickly and easily through small particles of
poop and vomit, potentially contaminating nearby food, surfaces, and objects. Be
sure to:
•Thoroughly clean and disinfect soiled and high-touch areas.
•Promote proper handwashing with soap and water. Hand-sanitizers may not be
effective against all GI illnesses.
•Wash fruits and vegetables before eating. Cook meat thoroughly. Do not handle
food or care for others when you are sick.
Generally, people with GI illness are most contagious while symptomatic and in the
first few days of feeling better.
•The specifics on symptom type, onset, duration, and guidelines for return will vary
depending on the illness. Refer to the CDPH symptom guidance for considerations
on returning to school with unspecified GI illnesses. For specific known diseases,
see APPENDIX A - Common Childhood Diseases.
Norovirus is the most common cause of GI outbreaks in school/childcare settings*,
but GI outbreaks can still be caused by other viruses, bacteria, or parasites (see
APPENDIX B – Norovirus Information for Schools and Childcare).
•Frequently, the exact pathogen causing a GI outbreak will not be known. In such
instances, schools should apply Norovirus outbreak control measures, which
involves a bleaching/disinfecting response comprehensive enough to eliminate any
GI microbe. See Managing Gastrointestinal Illnesses and Outbreaks below. Please
see CDPH Norovirus Toolkit for School and Childcare Center Outbreaks for additional
detailed guidance.
*Claire P. Mattison, Laura E. Calderwood, Zachary A. Marsh, Mary E. Wikswo, Neha Balachandran, Anita K.
Kambhampati, Michelle E. Gleason, Hannah Lawinger, Sara A. Mirza; Childcare and School Acute
Gastroenteritis Outbreaks: 2009–2020. Pediatrics November 2022; 150 (5): e2021056002.
10.1542/peds.2021-056002
Pa ge 5 of 41
Division of Communicable Disease Control and Prevention
Page 6 of 41
Managing Gastrointestinal Illnesses and Outbreaks:
How do I manage a GI Outbreak?
Follow the steps outlined below to manage the outbreak:
•ISOLATE and TRACK symptomatic individuals.
•CLEAN1 and DISINFECT2 soiled and high touch areas.
•REPORT to Alameda County Public Health at 510-267-3250.
•EDUCATE on hand hygiene, cleaning, and disinfection.
•MONITOR absences and illnesses to identify additional cases.
•For sites with nutrition/food services, follow steps under FOOD SAFETY.
1.ISOLATE
Immediately remove students/staff from any area where vomiting or
diarrhea incidents have occurred until the area has been cleaned and
disinfected with a bleach solution or approved disinfectant for Norovirus
(see APPENDIX C - Clean- up and Disinfection for Norovirus & APPENDIX D -
Help Prevent the Spread of Norovirus, and Cleaning and Disinfection section
below).
Send home anyone with diarrhea or vomiting, including staff. Contact
parents or guardians to pick up their children as soon as possible.
•Instruct students and staff to stay home from school if they become
sick with vomiting or diarrhea at home. Notify all sick people that
they can return to school 48 hours after vomiting and diarrhea have
stopped.
Keep all sick people away from others while they wait to be picked up.Avoid common areas like hallways, cafeterias, and lunch areas.
•Start a line list of anyone with diarrhea or vomiting. Note their
symptoms, name, grade, classroom number, and date of symptom
onset (See APPENDIX E – VGI Line List Template).
•Consider excluding affected classrooms from group activities (e.g.,
clubs, dances, sports, assemblies) until Alameda County Public
Health notifies administration that the outbreak is over.
1 Cleaning removes most germs, dirt, and impurities from surfaces. Clean with water, soap, and scrubbing.
2 Disinfecting kills most germs on surfaces and objects. Disinfecting is done with stronger bleach solutions or chemicals.
Clean surfaces before you disinfect them.
Division of Communicable Disease Control and Prevention
Pa ge 7 of 41
2.CLEAN AND DISINFECT
Clean
Cleaning staff should wear a mask, disposable gloves, gowns, and eye
protection when cleaning up vomit or fecal material. When finished,
remove protective gear before leaving area and wash hands immediately
with soap and water.
Remove vomit or diarrhea right away.
•Soak liquids with disposable absorbent materials, such as cloth,
baking soda, paper towels, sawdust, or kitty litter. Do not vacuum
material. Steam cleaning may be preferable for carpets.
•Using gloves, pick up material with paper towels and discard in plastictrash bag.
Clean up soiled and high touch areas immediately.
•Wash areas with soapy water.
•Rinse areas with plain water.
•Wipe areas dry with paper towels.
•Discard all waste into a plastic trash bag or biohazard bag.
Immediately close and dispose of bag. Don’t stop here! Move onto
disinfection after surface is cleaned.
Discard soiled objects that are too difficult to clean and disinfect, like
puzzle pieces, crayons, or chalk.
Implement at least twice daily general cleaning and disinfection of common
areas and high-touch surfaces such as classrooms, bathrooms, cafeteria,
door handles, handrails, light switches, desks, chairs, tablets, keyboards,
play structures and sports equipment.
•See APPENDIX D – Help Prevent the Spread of Norovirus.
Clean and disinfect inside of all transport vans or buses daily using a bleachsolution.
•See APPENDIX D – Help Prevent the Spread of Norovirus.
•If the bus is soiled with vomit or feces, See APPENDIX C – Clean-up
and Disinfection for Norovirus.
Disinfect
Note: Disinfection should only be done by trained staff using PPE and following
standard precautions and OSHA guidelines.
After cleaning up vomit and diarrhea (see above), apply a freshly
prepared bleach solution to contaminated surfaces as well as surfaces
within a 10-to-25-foot radius of the vomit or diarrhea incident.
•Use a bleach solution with a concentration of 1000-5000 ppm.
•1000 ppm bleach solution is approximately 1/3 cup regular bleach
(or 1/4 cup of concentrated bleach) to 1 gallon water.
•3500 ppm bleach solution is approximately 1 cup regular bleach (or
3/4 cup concentrated bleach) to 1 gallon water.
•5000 ppm bleach solution is approximately 1 and 2/3 cups regular
bleach (or 1 and 1/4 cup of concentrated bleach) to 1 gallon of
water.
Division of Communicable Disease Control and Prevention
Page 8 of 41
•See APPENDIX C - Clean-Up and Disinfection for Norovirus in
English and Spanish for directions to make a 1000 and 5000ppm bleach solution.
Allow surfaces to remain wet for at least 5 minutes.
Rinse food contact surfaces with clean water after disinfecting with bleach solution.
Make sure rooms are well-ventilated.
Bleach is the most effective disinfectant against Norovirus. If unable to use bleach, use a disinfectant from EPA List G, but be aware that these disinfectants may not be as effective as bleach. Never mix bleach with any other cleaning products.
Whenever possible use cleaning materials that can be thrown away after each use. If not possible, change bleach solution, mop head, or any other cleaning materials after each clean up and launder them with hot water
before using again.
Aim to disinfect high touch surfaces and objects at least twice daily until
the outbreak is over.
In daycare settings with young children, be sure to clean and disinfect any
item that has been in a child’s mouth before it is used by other children. Be
sure that staff wash hands with soap and water after touching items that
have been in children’s mouths.
For additional cleaning and disinfection guidance for specific surfaces and
items, see Table 2 below.
Table 2: Cleaning and Disinfection Instructions for Specific Surfaces and Items.
High-Touch Surfaces
E.g., Door handles, handrails,
light switches, toilets, faucets,
tables, counters, chairs, walls,
toys, phones, playground
equipment, activity centers,
and shared items.
•Carefully remove any vomit and diarrhea,and clean contaminated objects andsurfaces with soap and hot water. Then,
disinfect with the bleach solution.
•Supply classrooms with disinfectant spray
or wipes listed on EPA List G for use by
teachers and staff to frequently disinfecthigh-touch surfaces in the classroom, suchas desks, doorknobs, chairs, tablets, andother non-porous classroom item/surfacesthat are frequently touched.
•Always keep cleaning supplies in an area
where they cannot be accessed bystudents.
Non-Porous (Hard) Surfaces
E.g., Toilets, sinks, furniture,
walls, floors and other hard
•Carefully remove vomit and diarrhea, and
clean contaminated objects and surfaces with
Division of Communicable Disease Control and Prevention
Pa ge 9 of 41
surfaces. bleach solution.
Porous Surfaces
E.g., Carpets, upholstery,
and other porous surfaces.
•For contaminated surfaces that cannot be
disinfected with bleach, such as carpets
and some furnishings, after removing the
vomit or feces and cleaning with soap and
hot water, steam-clean at a temperature
of 158° F for five minutes or 212°F for one
minute.
•To minimize aerosolization of virus
particles, do not vacuum.
•Consider removing area rugs, and otherporous items (plush toys) that are non- essential from affected classrooms for theduration of an outbreak.
Food/Mouth Contact Items
Objects that may come in
contact with food or the
mouths of people (such as
toys or dishes).
•Carefully remove vomit and diarrhea. Then,
disinfect with the bleach solution. Rinse
thoroughly with clean water afterwards.
•Alternatively, dishes, utensils, and cups canbe cleaned with a dishwasher (using hotwater and dishwasher detergent)immediately after use.
Cloth and Plush Items
E.g., clothing, linens, textiles
and plush items, including
stuffed animals, bedding,
curtains, and mattress
covers.
•Carefully remove vomit and diarrhea.
•Wash items in a pre-wash cycle, followed by a
regular wash cycle with detergent.
•Dry items at a temperature greater than 170º
F.
•Do not mix contaminated and uncontaminated
items in one load; it is better to discard soiled
materials than to risk exposure during cleaning.
•If there are no on-site laundry facilities, double
wrap soiled items in plastic bags, and take
them to an off-site facility to be washed and
dried.
•If soiled items are sent home, be sure to
provide guidance on proper washing and drying
procedures to parents or guardians.
Diaper Changing
Stations and Potty
Chairs
•Wash and sanitize handwashing sinks,
faucets, counters, toilet seats, handles,
and bowls, soap dispensers, and bathroom
doorknobs at least twice a day.
•Use the English and Spanish cleaning anddisinfection instructions for bathroom
Division of Communicable Disease Control and Prevention
Pa ge 10 of 41
surfaces that are soiled with vomit or
feces (See APPENDIX C – Clean-up and
Disinfection for Norovirus).
•Utilize disposable covers on any diaper
changing surfaces.
•Clean and disinfect changing areas after every diaper change.
•Do not change diapers on any surfaces that
are used for food preparation/service or
student activities/play.
•Staff should wear gloves while changing
diapers and must wash hands immediately
following diaper changing or after assisting
anyone with toileting.
Objects Not Easily Cleaned
Soiled items that are difficult
to clean, like puzzle pieces,
chalk, crayons and clay
•Discard.
3.REPORT
Report gastrointestinal illness outbreaks to Alameda County Public Health.
•To report, call 510-267-3250
Prepare to answer the following questions for Alameda County Public Health:
•When did this outbreak start?
•What symptoms do ill individuals have?
•How many students have been ill in total?
•How many staff have been ill in total?
•Are the ill individuals from a specific grade/classroom/activity?o If yes: Approximately how many staff and students/children are in that group?
o If no: Are cases of ill individuals dispersed across the entire school or childcare site?
If yes: Approximately how many students/children and
staff do you have at your site?
•Were any events, field trips, or activities held during the week prior to the first illness, especially if food was served?
•Have any ill students or staff been absent for more than a couple of
days?
•Are there any positive test results for any ill student?
•Are any students or staff known to have visited the emergency room, been hospitalized or died?
•Any custodial protocols for cleaning areas with vomit and diarrhea?
•If vomiting or diarrheal incidents have happened in school, when, and
Division of Communicable Disease Control and Prevention
Pa ge 11 of 41
where?
•If there is a kitchen on site:
o Have any kitchen staff been ill?o Is there a record of the breakfast, lunch, and snack menus for the past two weeks?
Notify and consult your school administration as well as the regional
licensing office about this outbreak, if licensed by CDSS.
Complete a daily line list to document new illnesses and send to Alameda
County Public Health daily (excluding weekends and holidays) by fax at 510-
273-3744 or by encrypted email to AcuteCD@acgov.org. See APPENDIX E –
VGI Line List Template.
Potential next steps after reporting
•If the school identifies a specific diagnosis reported by
parents/guardians of attendees or staff, please share information with
Alameda County Public Health to help inform recommendations for
outbreak control.
•Staff from Alameda County Public Health and/or Alameda County
Department of Environmental Health may conduct a site visit and provide
additional site- specific recommendations, as needed. If a site visit is
warranted, you will be contacted to arrange a date and time. For site
visits, we request the presence of the following school representatives:
school principal or administrator, head of
maintenance/operations/janitorial, school nurse, dietary/food service
director, and kitchen supervisor
4.EDUCATE
Review outbreak response and prevention measures with staff. Ensure
guidance is implemented by assigning specific response and prevention
measures to appropriate staff.
Post and distribute the Vomiting/Diarrhea exposure notice (See Viral
Gastroenteritis—Vomiting/Diarrhea Exposure Notice link in APPENDIX A) and
CDC Norovirus Fact Sheet (APPENDIX F – Norovirus Illness: Key Facts) to staff
and families of students in affected classrooms.
Instruct students, staff, and volunteers with diarrhea and/or vomiting not to
return to school until at least 48 hours AFTER vomiting and diarrhea have
stopped.
Educate all children, students, staff, and volunteers on appropriate hand
hygiene using soap and water. Hand sanitizer gel is not effective against
Norovirus, the most common cause of viral gastroenteritis.
•Proper handwashing means covering all parts of the hands, including
fingernails, with soap; rubbing lathered hands together vigorously for at
least 20 seconds (singing the birthday song or the ABCs song may help);
thoroughly rinsing hands with water; and drying hands with a clean towel
or air dry them.
Division of Communicable Disease Control and Prevention
Pa ge 12 of 41
Schedule handwashing breaks for students and staff to encourage
frequent handwashing.
Have staff supervise the handwashing of younger students and children.
During outbreaks, consider periodically broadcasting public announcements
to remind children, students, staff, and volunteers to practice frequent
handwashing, especially before lunch and snack times.
Ensure that soap and paper towels are well stocked near handwashing sinks
and that any trash can with body fluids is quickly covered and then removed by
trained staff/maintenance.
•See APPENDIX G - CDC Handwashing Promotion Library.
5.MONITOR
On a daily basis, use existing data sources (such as attendance data, call
out logs) to track additional illnesses.
•Consider including a message on the attendance office Voicemail asking
the caller to give specifics on symptom type and onset date when
reporting an illness.
•ACPHD can provide a survey link that can be used to gather information
about student illnesses and symptoms. Contact ACPHD at 510-267-3250 if
you would like to utilize this survey.
Log case information into the line list (See APPENDIX E – VGI Line List Template)
Provide Alameda County Public Health with daily case updates
(excluding weekends and holidays).
•If there are any new cases, send Alameda County Public Health the
updated line list.
•If no new cases, email Alameda County Public Health stating “We have
no new cases on DD/MM/YY.”
•Line lists and other information containing protected health information
(PHI) may be sent to Public Health via fax at 510-273-3744 or by encrypted
email to AcuteCD@acgov.org.
Continue active surveillance until Alameda County Public Health notifies
administration that the outbreak is over (generally 4-6 days without new
cases, but this varies depending on whether a specific disease is identified as
the cause of the outbreak).
6.FOOD SAFETY
Staff
Exclude ill food service staff (i.e., cafeteria staff or anyone who handles food)
from work until at least 48 hours after symptom resolution.
Division of Communicable Disease Control and Prevention
Pa ge 13 of 41
•If a food worker is diagnosed with certain Title 17 diseases (e.g.,
Salmonella spp., Shigella spp.), Alameda County Public Health may
restrict this individual from returning to work until stool specimens are
negative. In these instances, clearance to return to work can only be
issued by Alameda County Public Health according to statute.
Immediately notify Alameda County Public Health at (510) 267-3250 if any food
services staff become ill with vomiting or diarrhea (either at home or
at work).
Require food service staff to wear disposable gloves and masks when handling,
serving, or preparing food.
Ensure that all food service staff have access to a dedicated bathroom facility that is
not shared with students or other non-food service staff.
•Ensure handwashing station is located either within or adjacent to bathrooms.
•Handwashing stations should have warm water, handwashing cleanser, and
sanitary single-use towels, or a heated-air hand drying device.
Ensure that all food service staff wash their hands thoroughly before
handling food and immediately after using the restroom.
Distribute educational materials to food service staff. (See APPENDIX H -
Norovirus: Facts for Food Workers)
Food Preparation/Handling
Throw away all potentially contaminated food.
Use a bleach solution to disinfect all food preparation and services areas as
well as dining tables, chairs, self-serve food areas, drink/ice dispensers and
vending machines at least twice daily and before and after meals/snack. Allow
surface to remain wet for at least 5 minutes, then rinse using clean water.
•See APPENDIX D - Help Prevent the Spread of Norovirus.
Immediately clean and disinfect any food preparation or service
area contaminated with vomit or feces.
•See APPENDIX C – Clean-up and Disinfection for Norovirus.
Use safe food-handling techniques, such as washing fruits and vegetables
and cooking meat thoroughly.
Discontinue any student activities/crafts involving food preparation until
Alameda County Public Health notifies administration that the outbreak is
over.
Food Service/Consumption/Clean-up
Use dedicated food service areas and stop all self-service food and drinks
(including ice storage bins). Instead, have kitchen staff or other adults serve
food and drinks while wearing disposable gloves.
Staff who change diapers should not be involved in food preparation or
food service
Division of Communicable Disease Control and Prevention
Pa ge 14 of 41
Prohibit the use of shared food utensils and cups.
Consider using single-use dining materials and utilize pre-packaged
snacks during time of outbreak.
Ensure that clean water, soap, and paper towels are available in dining areas
and other areas where eating may occur.
Run dishes, utensils, and cups through a dishwasher (using hot water
and dishwasher detergent) immediately after use
Division of Communicable Disease Control and Prevention
Pa ge 15 of 41
Basic of Respiratory Illness
There is substantial overlap between the common cold and more serious
illnesses such as COVID-19 and influenza.
Influenza, COVID-19, and the common cold spread similarly. They are transmitted by
small particles that come from your nose and mouth when you sneeze, cough, sing,
or talk, which raises the possibility of infecting those nearby.
Generally, people with some respiratory illnesses (such as the common cold
and COVID-19) can be infectious for hours to days before they show
symptoms.
Once symptoms begin, infectiousness can last for multiple days. The specifics on
symptom type, onset, duration, and guidelines for return will vary depending on the
illness. Refer to the CDPH symptom guidance for considerations on returning to
school with unspecified respiratory illnesses. For specific known diseases, see
APPENDIX A- Common Childhood Diseases.
Most common respiratory viruses are treated with rest and hydration
Managing Respiratory Illnesses and Outbreaks:
How do I manage a respiratory outbreak?
•ISOLATE and TRACK symptomatic individuals per state and local guidance
•CLEAN1 and DISINFECT2 soiled and high touch areas.
•REPORT to Alameda County Public Health at 510-267-3250
per “Responding to Outbreaks” Section above or as needed
•EDUCATE your student, staff, and parent community on respiratory
and hand hygiene.
•MONITOR absences and illnesses to identify additional cases.
1.ISOLATE
Send home AND recommend COVID-19 testing to anyone with fever. For
anyone with a cough, sore throat, or other acute respiratory illness
symptoms, recommend COVID-19 testing and decide whether to send home
based on CDPH symptom guidance or your facility’s protocol.
Notify individuals that they can return to school/childcare once they are
fever- free for 24 hours without medication and symptoms are mild or
improving. See CDC’s Respiratory Virus Guidance for actions to take for 5
days after return that help to prevent the spread of illness.
1 Cleaning removes most germs, dirt, and impurities from surfaces. Clean with water, soap, and scrubbing. 2 Disinfecting kills most germs on surfaces and objects. Disinfecting is done with stronger bleach solutions or chemicals. Clean
surfaces before you disinfect them.
Division of Communicable Disease Control and Prevention
Page 16 of 41
2.REPORT
Reporting guidelines can be found in “Responding to Outbreaks”Section above.
Outbreaks of viral respiratory illness in K-12 settings can be reported toAlameda County Public Health as needed (see Table 1 above), but this is
not required. K-12 schools can track cases using the included template
in APPENDIX I - Respiratory - ILI Line List for Schools, if helpful.
Childcare facilities can track outbreak information using the included
template or similar (See APPENDIX I - Respiratory - ILI Line List for Schools)
and should report to regional licensing office as required.
Potential next steps after reporting:
•Alameda County Public Health may ask you for a line list to track
respiratory illness cases (See APPENDIX I - Respiratory - ILI Line List for
Schools) and may ask about specific symptoms, diagnoses reported, etc.
3.CLEAN and DISINFECT
Immediately clean visibly soiled and high touch areas, like doorknobs and desks.
Follow your school’s standard procedures for routine cleaning and disinfecting.Typically, this means daily cleaning or disinfecting surfaces and objects that are
touched often.
4.EDUCATE
Review outbreak response and prevention measures with staff.
Exposure Notices and Return
If the cause of the outbreak is known, visit exposure notice links in APPENDIX
A – Common Childhood Disease to post and distribute the appropriate
exposure notice. If an exposure notice is not available for a specific disease,
contact Alameda County Public Health to determine whether an exposure
notice should be sent
Advise exposed individuals and/or their guardians to watch for signs and
symptoms of respiratory disease, especially fever, and to notify a
designated school staff if these develop. The staff person may be the
attendance clerk, health technician/clerk, classroom teacher, school nurse,
or school administrator.
Individuals can return once they are fever-free for 24 hours without
medication and symptoms are mild or improving per CDC Respiratory Virus
Guidance
Division of Communicable Disease Control and Prevention
Page 17 of 41
Respiratory and Hand Hygiene
Educate children, students, staff and volunteers to cough and sneeze into their
arm or elbow or into a tissue.
Educate all students and staff on appropriate hand hygiene. Schedule breaks
for students and staff to encourage frequent handwashing or use of an
alcohol-based hand sanitizer.
•Proper handwashing means covering all parts of the hands, including
fingernails, with soap; rubbing lathered hands together vigorously for at
least 20 seconds (singing the birthday song or the ABCs song may help);
thoroughly rinsing hands with water; and drying hands with a paper towel.
Encourage staff to supervise the handwashing of younger students and
children.
During outbreaks, consider periodically broadcasting public
announcements to remind children, students, staff, and volunteers to practice
frequent handwashing, especially before lunch and snack times.
•See APPENDIX G- CDC Handwashing Promotion Library.
Prevention
Masking
Recommend masking to anyone with confirmed COVID-19 or other
respiratory illness, per CDC Respiratory Virus Guidance
Vaccinations
Encourage students, staff, and volunteers to stay up-to-date on influenza,
COVID- 19 and other recommended immunizations.
Ventilation and Filtration
Optimize or upgrade your HVAC mechanical ventilation system.
Open doors and windows for natural ventilation.
Add portable air cleaning devices to classrooms.
Review CDPH ventilation guidance.
5.MONITOR
On a daily basis, use existing data sources (e.g., attendance data, call out
logs) to track additional illnesses.
•Consider including a message on the attendance office voicemail asking
the caller to give specifics on symptom type and onset date when
reporting an illness.
•ACPHD can provide a survey link that can be used to gather information
about student illnesses and symptoms. Contact ACPHD at 510-267-3250 if
you would like to utilize this survey.
If requested by Alameda County Public Health:
•Log case information into SPOT.
Division of Communicable Disease Control and Prevention
Page 18 of 41
This guidance is for specific diseases. For children with symptoms of illness but no specific
diagnosis, refer to CDPH Considerations when a Child has Symptoms of Illness in Child Care or
School. As a general rule, children should stay home from school if they do not feel well enough
to participate or if they are sick enough that staff members determine they cannot care for
the child without compromising their ability to care for the health and safety of the other
APPENDICES APPENDIX A - Common Childhood Diseases
Linked to additional information. Is this disease reportable to Public
needed? childcare or school while symptomatic?
return?
Bed Bugs No No No N/A
Campylobacter Yes Yes, if outbreak Yes 24 hrs. after diarrhea3
suspected, resolves contact ACPHD for exposurenotice. Chickenpox No, unless individual is hospitalized, died, or part of an outbreak.
Alameda County Public Health Department (ACPHD) website.
Consult with ACPHD if there are concerns for exposure to pregnant or immunocompro-
nonimmune siblings of cases should also be excluded from Day 8 after sibling’s rash onset through Day 21 after sibling’s rash scabbed over.
blisters have scabs and there are no new blisters.
For non-immune siblings of cases: after 21 days have passed since the sibling's rash scabbed over.
(C. diff) resolves
3 Diarrhea is when within a 24-hour period 3 or more episodes of loose stools or an occurrence of loose stools that is above normal for the person.
highlighted in green
Division of Communicable Disease Control and Prevention
Disease/Condition Reporting Notification Exclusion and Return Linked to additional Is this Exposure notice Exclude from When can individualinformation. disease needed?childcare or return?reportable to school while
Public Health? symptomatic?
COVID-19 No Yes, available on ACPHD website.
water exposure occurred on site, contact ACPHD to determine if exposure notice is needed.
If ≤5 years old or a food handler, 48 hrs. after diarrhea resolves. For all others, 24 hrs. after diarrhea resolve.
Stay out of public swimming pools until 2 weeks after 3
O157:H7/Shigatoxin producing E. coli suspected, contact ACPHD for exposure notice.
ACPHD guidance for clearance.
If not restricted, 24 hrs. after diarrhea
≤5
3 Diarrhea is defined as 3 or more episodes of loose stools or an occurrence of loose stools that is above normal for the person within a 24-hour period.
4 Certain staff (food, healthcare, or childcare staff) and some children (5 years of age and under OR over 5 and need toileting assistance) may be restricted
from work/school/group care by the Alameda County Public Health Department. This means they can go back only when their stool is tested by the Alameda
County Public Health Laboratory confirming no bacteria or toxins are found.
Pa ge 19 of 41
Division of Communicable Disease Control and Prevention
Pa ge 20 of 41
Disease/Condition Reporting Notification Exclusion and Return
Linked to additional information. Is this disease reportable to Public
needed? childcare or school while symptomatic?
return?
Hand, Foot, and Mouth Disease No Yes, available on ACPHD website.
Yes, if symptoms of After fever-free for 24 hrs. without the use of fever-reducing medication and uncontrolled drooling with mouth sores has resolved; children should not return with difficulty or pain while eating
ACPHD website.
Yes, notify parent or caregiver of suspected lice infestation at end of day and encourage proper treatment.
treatment.
Alternatively, schools may choose not to exclude child, regardless of whether they receive treatment, as outlined in CDPH
7
3 Diarrhea is when within a 24-hour period 3 or more episodes of loose stools or an occurrence of loose stools that is above normal for the person.
Division of Communicable Disease Control and Prevention
Page 21 of 41
Disease/Condition Reporting Notification Exclusion and Return
Linked to additional information. Is this disease reportable to Public
needed? childcare or school while symptomatic?
return?
HiB (Haemophilus influenzae Type b) - Invasive invasive disease and child is <5 or at any age if diagnosed with meningitis
ACPHD for exposure notice. antibiotics and fever- free for 24 hours without use of fever- reducing medication and symptoms are improving
ACPHD website. day (keep blisters/lesions covered).
appropriate treatment; keep blisters/lesions
individual less than 18 years of age has
ACPHD website. guidelines for Preventing Spread of Respiratory Viruses
ACPHD for ACPHD
Meningitis ACPHD for ACPHD
(Mono) ACPHD website. meets other sign/symptom- based exclusion
criteria are resolved
resistant Staphylococcus draining sores or boils covered with a
Division of Communicable Disease Control and Prevention
Pa ge 22 of 41
Disease/Condition Reporting Notification Exclusion and Return
Linked to additional information. Is this disease reportable to Public
needed? childcare or school while symptomatic?
return?
clean, dry bandage until healed.
Mumps Yes Yes, contact ACPHD for ACPHD
outbreak suspected
suspected send notice available on ACPHD website.
and no outbreak, 24 hrs. after vomiting
and diarrhea resolve.
If a food handler or
an outbreak, 48 hrs. after vomiting and
Disease) ACPHD website. meets other sign/symptom- based exclusion criteria
criteria are resolved
Cough) ACPHD for exposure notice.
After 5 days of appropriate antibiotic treatment
(Conjunctivitis) ACPHD website.
Virus (RSV) individual less than 5 years of age has
ACPHD website. meets other sign/symptom- based
guidelines for Preventing Spread of Respiratory Viruses
Division of Communicable Disease Control and Prevention
Page 23 of 41
Disease/Condition Reporting Notification Exclusion and Return
Linked to additional information. Is this disease reportable to Public
needed? childcare or school while symptomatic?
return?
exclusion criteria
ACPHD website. day treatment started.
Athletes with ringworm of the body (tinea corporis) cannot participate in contact sports until 72 hours after treatment initiation unless affected area
disease) ACPHD website. meet other sign/symptom- based exclusion
guidelines for Preventing Spread of Respiratory Viruses When You‘re Sick
outbreak
suspected
suspected send notice available on ACPHD website.
and no outbreak, 24
hrs. after vomiting
and diarrhea resolve.
If a food handler or
an outbreak, 48 hrs. after vomiting and diarrhea resolve.
Division of Communicable Disease Control and Prevention
Disease/Condition Reporting Notification Exclusion and Return
Linked to additional information. Is this disease reportable to Public
needed? childcare or school while symptomatic?
return?
Rubella Yes Yes, contact ACPHD for ACPHD
suspected, contact ACPHD for exposure notice.
ACPHD guidance for clearance.
If not restricted, 24 hrs. after diarrhea
ACPHD website. appropriate treatment
ACPHD website. rash cannot be covered covered or, if unable to be covered, when all blisters have
suspected, contact ACPHD for exposure notice.
ACPHD guidance for clearance.
If not restricted, 24 hrs. after diarrhea
Fever ACPHD website.
Yes 24 hrs. after starting antibiotics and fever- free for 24 hours without use of fever- reducing medication and symptoms are
4 Certain staff (food, healthcare, or childcare staff) and some children (5 years of age and under OR over 5 and need toileting assistance) may be restricted
from work/school/group care by the Public Health Department. This means they can go back only when their stool is tested by the Public Health Department
Laboratory confirming no bacteria or toxins are found.
Page 24 of 41
Division of Communicable Disease Control and Prevention
Page 25 of 41
Disease/Condition Reporting Notification Exclusion and Return
Linked to additional information. Is this disease reportable to Public
needed? childcare or school while symptomatic?
return?
Typhoid/Paratyphoid Fever suspected, contact ACPHD for exposure notice.
ACPHD guidance for clearance.
If not restricted, 24 hrs. after fever and diarrhea resolve and on appropriate
(cause unknown) outbreak suspected outbreak. Available on ACPHD website.
Yes, if meets sign/symptom- based exclusion criteria
and there is not an outbreak, 24 hrs. after vomiting and diarrhea3 resolve.
If a food handler or part of an outbreak, 48 hours after vomiting and
3 Diarrhea is defined as 3 or more episodes of loose stools or an occurrence of loose stools that is above normal for the person within a 24-hour period. 4 Certain staff (food, healthcare, or childcare staff) and some children (5 years of age and under OR over 5 and need toileting assistance) may be restricted from work/
school/group care by the Public Health Department. This means they can go back only when their stool is tested by the Public Health Department Laboratory confirming no bacteria or toxins are found.
Division of Communicable Disease Control and Prevention
Page 26 of 41
APPENDIX B – Norovirus Information for Schools and Childcare
Division of Communicable Disease Control and Prevention
Pa ge 27 of 41
APPENDIX C – Clean-up and Disinfection for Norovirus (English)
Division of Communicable Disease Control and Prevention
Pa ge 28 of 41
APPENDIX C – Clean-up and Disinfection for Norovirus (Spanish)
Division of Communicable Disease Control and Prevention
Pa ge 29 of 41
APPENDIX D – Help Prevent the Spread of Norovirus (English)
Division of Communicable Disease Control and Prevention
Pa ge 30 of 41
APPENDIX D – Help Prevent the Spread of Norovirus (Spanish)
Alameda County Public Health Department
Name of School: Today’s Date:
Communicable Disease Control and Prevention
Acute Communicable Disease Section
1100 San Leandro Blvd, 3rd Floor
San Leandro, CA 94577
Phone: (510) 267-3250 Fax: (510) 273-3744
Identification Illness Description Risk
Factors
Laboratory
Test Illness Outcome
Name
St
a
f
f
/ Te
a
c
h
e
r
/ Pu
p
i
l
(S
/
T
/
P
)
Cl
a
s
s
Ag
e
Se
x
On
s
e
t
da
t
e
of
sy
m
p
t
o
m
s
Da
t
e
of
la
s
t
sy
m
p
t
o
m
s
Di
a
r
r
h
e
a
x2
w/
I
24
hr
(Y
/
N
)
Bl
o
o
d
y
di
a
r
r
h
e
a
(Y
/
N
)
Vo
m
i
t
i
n
g
(Y
/
N
)
Na
u
s
e
a
(Y
/
N
)
Ab
d
o
m
i
n
a
l
cr
a
m
p
s
(Y
/
N
)
Fe
v
e
r
> 10
0
.
4
(Y
/
N
)
He
a
d
a
c
h
e
(Y
/
N
)
Ot
h
e
r
Pr
e
g
n
a
n
t
(Y
/
N
)
Im
m
u
n
e
Co
m
p
r
o
m
i
s
e
(Y
/
N
)
Sp
e
c
i
m
e
n
te
s
t
e
d
(Y
/
N
)
Sp
e
c
i
m
e
n
t
y
p
e
(s
t
o
o
l
,
vo
m
i
t
u
s
)
Po
s
i
t
i
v
e
No
r
o
v
i
r
u
s
(Y
/
N
)
Ho
s
p
i
t
a
l
i
z
e
d
/ De
a
t
h
(H
/
D
)
Comment
(antiemetic,
abx, etc.)
VGI Line List for Schools
No New Illnesses Today
Page 31 of 41
Division of Communicable Disease Control and Prevention
APPENDIX F – CDC Norovirus Illness – Key Facts (English)
Page 32 of 41
Division of Communicable Disease Control and Prevention
APPENDIX F – CDC Norovirus Illness – Key Facts (English) Cont.
Page 33 of 41
Division of Communicable Disease Control and Prevention
Page 34 of 41
APPENDIX F – CDC Norovirus Illness – Key Facts (Spanish)
Division of Communicable Disease Control and Prevention
Page 35 of 41
APPENDIX F – CDC Norovirus Illness – Key Facts (Spanish) Cont.
Division of Communicable Disease Control and Prevention
Page 36 of 41
APPENDIX G - CDC Handwashing Promotion Library
Follow this link for posters, graphics and other resources to promote hand hygiene:
Health Promotion Materials | Handwashing | CDC
Division of Communicable Disease Control and Prevention
Page 37 of 41
APPENDIX H – Norovirus: Facts for Food Workers (English)
Division of Communicable Disease Control and Prevention
Page 38 of 41
APPENDIX H – Norovirus: Facts for Food Workers (English) Cont.
Division of Communicable Disease Control and Prevention
Page 39 of 41
APPENDIX H – Norovirus: Facts for Food Workers (Spanish)
Division of Communicable Disease Control and Prevention
Page 40 of 41
APPENDIX H – Norovirus: Facts for Food Workers (Spanish) Cont.
Alameda County Public Health Department
Name of School: Today’s Date:
Communicable Disease Control and Prevention
Acute Communicable Disease Section
1100 San Leandro Blvd, 3rd Floor
San Leandro, CA 94577
Phone: (510) 267-3250 Fax: (510) 273-3744
Identification Risk Laboratory Test Illness Outcome
Name
/
Te
a
c
h
e
r
/
Pu
p
i
l
(S
/
T
/
P
)
Ag
e
Se
x
Da
t
e
of
Sy
m
p
t
o
m
s
>=
1
0
0
.
4
˚
F
/
(Y
/
N
)
(Y
/
N
)
th
r
o
a
t
(Y
/
N
)
(Y
/
N
)
no
s
e
(Y
/
N
)
(Y
/
N
)
(s
p
e
c
i
f
y
)
(Y
/
N
)
Co
m
p
r
o
m
i
s
e
(Y
/
N
)
In
f
l
u
e
n
z
a
Te
s
t
(Y
/
N
)
?
CO
V
I
D
-19
Te
s
t
ot
h
e
r
te
s
t
(Y
/
N
)
?
If
/
De
a
t
h
(H
/
D
)
Comment
(antiviral treat-,
ment, etc.)
Respiratory - ILI Line List for Schools
No New Illnesses Today
Page 41 of 41