Medical Information
A-Z common medical conditions
Description
This potentially serious infection is common in infants under 12 months of age. The infection begins like any common cold, but soon develops into a cough, rapid breathing and wheezing to the extent that feeding becomes difficult. Wheezing when breathing out is characteristic of bronchiolitis. This happens when inflammation causes the small airways (called the bronchioles) to become obstructed. Seek medical advice if the child develops these symptoms. The respiratory syncytial virus (RSV) is most often responsible for bronchiolitis, although other viruses may cause outbreaks. The disease is transmitted directly by oral contact or airborne droplets, or indirectly by hands, tissues, eating utensils, toys or other articles freshly soiled by the nose and throat discharges of an infected person.
Incubation Period
4-5 days.
Infectious Period
Shortly before the onset of symptoms and during the active stage of the disease.
Controlling the Spread of Infection
Teach children to cover the mouth when sneezing or coughing and to wash their hands after blowing their noses. Dispose of tissues soiled with nose and throat discharges. Ensure staff wash hands after contact with soiled tissues or contact with nose and throat discharges. Exclude until the child is feeling well.
Treatment
A child with acute bronchiolitis will need medical assessment. A child with mild bronchiolitis may be treated at home. The child may benefit from a warm, humid atmosphere (a humidifier or steam). Increase the child’s fluid intake. Use paracetamol to lower a high temperature and relieve a sore throat. Decongestant medication may help relieve symptoms. Some children with bronchiolitis may need to stay in hospital for a short time to receive specialised medical treatment.
Description
Bronchitis is an inflammation of the mucous membrane of the bronchial tubes. It is caused by viruses (especially influenza virus), bacteria (especially streptococcus pneumoniae, see strep throat, page 51), and several other organisms. Infection is often preceded by a cold. Early symptoms include: fever; a short, painful, dry cough with a rapid wheezing respiration; a feeling of rawness and pain in the throat and behind the breastbone; and a feeling of tightness throughout the chest. After a few days the person begins to cough up mucus and usually the other symptoms lessen. Note that asthma is often misdiagnosed as bronchitis. Therefore, bronchitis should only be diagnosed by a doctor. The disease is transmitted directly by oral contact or airborne droplets, or indirectly by hands, tissues, eating utensils, toys or other articles freshly soiled by the nose and throat discharges of an infected person.
Incubation Period
1-10 days.
Infectious Period
Shortly before the onset of symptoms and during the active stage of the disease.
Controlling the Spread of Infection
Teach children to cover the mouth when sneezing or coughing and to wash their hands after blowing their noses. Dispose of tissues soiled with nose and throat discharges. Ensure staff wash hands after contact with soiled tissues or contact with nose and throat discharges. Exclude until the child is feeling well.
Treatment
In mild cases, bed rest in a warm environment for a few days, with a light diet and nourishing drinks, may be all that is needed. In more serious cases, the doctor may prescribe antibiotics. Cough medicines may help relieve symptoms. From the onset of the attack, warmth to the chest may give relief. This can be in the form of a rubber hot water bottle filled with warm (not hot) water or a medicinal chest rub.
Description
Chickenpox is a viral illness that comes on suddenly. Symptoms include fever, runny nose, cough, fatigue and a general rash. Each sore begins as a small bump which becomes blister-like for 3-4 days, then leaves a scab. Several crops of these blisters will come out over a period of days, so at any one time, the child will have sores in various stages of development. The rash tends to be more noticeable on the trunk of the body than on exposed parts of the body. It may appear inside the mouth, on the scalp and in the upper respiratory tract. Chickenpox is highly contagious. It is spread by coughing and contact with a moist rash. One infection gives long-lasting immunity. People rarely get chickenpox twice. Herpes zoster (shingles) is caused by the same virus. It is an eruption in someone who has previously had chickenpox. Direct contact with the moist shingles rash can cause chickenpox in a child who has not already had it.
Incubation Period
13-17 days.
Infectious Period
From two days before the rash appears (that is, during the coughing, runny nose stage) and until all blisters have formed scales or crusts.
Controlling the Spread of Infection
Exclude infected children from the centre until all blisters have crusted, there are no moist sores, and the child feels well. Dispose of tissues soiled with nose and throat discharges. Varicella zoster immunoglobulin (VZIG) may be given to some contacts who are at very high risk of complications because of other medical problems. This is not recommended for normal healthy children. Follow good personal cleanliness practices. Cover the nose and mouth when coughing or sneezing. Dispose of soiled tissues after wiping a runny nose. Wash hands carefully. Do not share eating utensils, food or drinking cups. If there is an outbreak, disinfect mouthed toys after washing them.
Treatment
There is no specific treatment, but calamine lotion or phenergan may soothe the itch. Use a medicine containing paracetamol to lower the child’s temperature or relieve discomfort. Never give aspirin to children who develop fever after exposure to chickenpox. Aspirin appears to increase the risk of Reye’s syndrome, a rare but serious disorder characterised by sleepiness and vomiting. Reye’s syndrome can lead to coma and death.
Description
Cold sores are caused by herpes simplex viruses-usually type 1 and rarely type 2. The area of infection usually reddens and then fluid-filled blisters develop. The blisters tend to recur on the same part of the person’s body, for example, the lips, gums and mouth (causing a condition called gingivostomatitis), the eyes, or other parts of the body. There may be a single blister or a number of blisters present at one time. These blisters burst, becoming ulcers which eventually heal. New skin then grows over the affected area. Once infected with this virus, the person has it for the rest of their life. Therefore, cold sores may recur. Often, cold sores recur when a person is under stress, exposed to sunlight, unwell or run-down, or undergoing hormonal changes. Sometimes, though, they re-appear for no apparent reason.
Incubation Period
3-10 days.
Infectious Period
Until the infected area has completely dried. The cold sore virus has been found in the saliva for as long as seven weeks after recovery from herpes in the mouth.
Controlling the Spread of Infection
Young children unable to comply with good hygiene practices should be excluded while the lesion is weeping. Lesions should be covered by a dressing where possible. Anyone with a cold sore should avoid contact with babies aged less than 2 months. Follow good handwashing and cleaning procedures. Do not allow kissing on or near the infected area or sharing of food or drink containers. Dispose of used tissues correctly. Wash toys that children put in their mouths daily and store dummies separately. Do not allow children to drink from another child’s bottle.
Treatment
The following ointments can be applied to cold sores to dry and clean them and to help prevent secondary infection. They are all available from chemists. • Betadine paint. This is often used on cold sores. It contains iodine. • Gentian violet. It also contains iodine. • Stoxil. It contains idoxuride, which is used as an anti-viral herpes treatment. • Alcohol, methylated spirits etc. These are cheap but may sting. • Vitamin E (in oil form).
Description
The common cold is caused by many different viruses. Symptoms include a runny, stuffed up nose, sneezing, coughing and a mild sore throat, with little or no fever. Children under 5 years of age may get several colds a year. Colds are spread directly by contact with airborne droplets (coughing and sneezing), or indirectly by contaminated hands, tissues, eating utensils, toys or other articles freshly soiled by the nose and throat discharges of an infected person.
Incubation Period
About 1-3 days.
Infectious Period
From about one day before symptoms begin and during the first five days of illness.
Controlling the Spread of Infection
Do not exclude a child with a common cold. Teach children to cover the mouth when sneezing or coughing and to wash their hands after blowing their noses. Dispose of tissues soiled with nose and throat discharges. Ensure staff wash hands after contact with soiled tissues or contact with nose and throat discharges.
Treatment
No specific treatment. Medicines containing paracetamol and decongestants may help to relieve symptoms in children older than 3 months. Take younger children to the doctor. Do not give aspirin to any child with a fever.
Comments
Watch for new or more severe symptoms. They may indicate other more serious infections.
Description
Conjunctivitis is an irritation or infection of the eye caused by bacteria, viruses, chemicals or allergies. Symptoms include a scratchy feeling in one or both eyes and redness in the whites of the eyes. A discharge may be present, causing the eyelids to stick together in the morning. Sensitivity to light is another common symptom. Diagnosis of the source of infection or irritation can be made by examining a smear of the discharge from the eye under a microscope or by culturing the virus or bacteria. This is often not done and so usually the cause is unknown. Viral and bacterial conjunctivitis can be spread by direct contact with secretions from the eye. This type of infection may also be spread indirectly through towels, washcloths, handkerchiefs and other objects that have been contaminated with eye secretions.
Incubation Period
24-72 hours.
Infectious Period
During the entire course of an active bacterial or viral infection, or in the case of a bacterial infection three days after beginning antibiotic treatment. Conjunctivitis caused by chemicals or allergies is not infectious.
Controlling the Spread of Infection
Exclude while there is discharge from the eye.
Treatment
Medication may be prescribed by a doctor. This is usually antibiotic eye drops.
Description
Croup is any kind of inflammation of the larynx or voice box that occurs in children. It is not a single disorder in itself. The characteristic features of croup are a harsh, barking cough and a noisy, harsh sound when breathing in. This noise is caused by air vibrating as it passes through the narrowed, inflamed larynx. Seek medical advice if the child develops these symptoms. Several viruses may cause croup. These include parainfluenza, respiratory syncytial virus (RSV) and various influenza viruses.
Incubation Period
Difficult to define, but about 2-4 days.
Infectious Period
Shortly before the onset of symptoms and during the active stage of the disease.
Controlling the Spread of Infection
Teach children to cover the mouth when sneezing or coughling and to wash their hands after blowing their noses. Dispose of tissues soiled with nose and throat discharges. Ensure staff wash hands after contact with soiled tissues or contact with nose and throat discharges. Exclude until the child is feeling well.
Treatment
A child with croup will need medical assessment. The doctor may recommend that a child with mild croup be treated at home. The child may benefit from a warm, humid atmosphere (a humidifier or steam). Increase their fluid intake and use paracetamol to lower a temperature and relieve a sore throat. It is likely that a child with severe croup will need to stay in hospital for a short time to receive specialised medical treatment.
Description
Cytomegalovirus is a member of the herpes virus group. Most CMV infections cause either no symptoms or only mild symptoms. The virus is spread by close contact with infectious body secretions (saliva, urine, breastmilk, tears, blood, cervical secretions and semen) which enter through mucous membranes (eyes, mouths and genitals) and cuts in the skin. Infection of infants can also occur before birth, at birth, or early in life. Most women (50-60%) have been infected with CMV in the past and cannot be infected with the virus again. However, women who are infected with CMV for the first time while pregnant may infect the unborn baby. Infection of the unborn baby occasionally leads to eye disease, deafness, developmental delay or death. Therefore, pregnant women who are caring for young children need to be particularly careful.
Incubation Period
Not accurately known. Probably 3-12 weeks.
Infectious Period
For as long as the virus is shed in body secretions (usually a few weeks), but occasionally longer or intermittently thereafter.
Controlling the Spread of Infection
It is common for children under the age of 5 to shed CMV in urine and saliva. It is not necessary to exclude these children from the centre. Women of child bearing age working with young children should always practise good personal cleanliness, especially: • good handwashing after contact with body secretions, and especially after changing nappies or assisting in toilet care • not kissing infants on the mouth (hugging is acceptable).
Treatment
Usually none is required.
Comments
Women planning pregnancy need to inform their doctor that they work with young children. For more information, see section on occupational risks for child care workers on page 38.
Description
Diarrhoea is an increase in the frequency, runniness or volume of the faeces. It may be caused by different organisms, for example viruses (such as rotavirus), bacteria (such as campylobacter, salmonella and shigella), and parasites (such as giardia and cryptosporidium). Diarrhoea is spread when hands, objects and surfaces become contaminated with organisms from faeces. Infected people do not always show symptoms. Campylobacter and salmonella infections can result from drinking contaminated water or unpasteurised (raw) milk or by eating contaminated food, especially undercooked poultry, fish or shellfish. Sometimes, diarrhoea has a non-infectious cause, such as antibiotic treatment. The exact cause of the diarrhoea can only be diagnosed by laboratory tests of faecal specimens. Sometimes multiple specimens must be tested. Other symptoms which may accompany diarrhoea include vomiting and stomach pain. Blood or mucus may be seen in the faeces, especially in bacterial infections. Diarrhoea can cause dehydration and serious illness requiring hospitalisation.
Incubation Period
Viral and bacterial infections, usually 1-3 days. Parasitic infections, 5-15 days.
Infectious Period
People are infectious for as long as the organisms are present in their faeces, whether or not they are ill.
Controlling the Spread of Infection
A person with active diarrhoea is more likely to spread the disease than one who is well but has infectious organisms in their faeces. For this reason, children and staff with infectious diarrhoea should not attend the centre until diarrhoea has stopped. Do not exclude children with organisms in their faeces but no diarrhoea. Staff with organisms in their faeces but no diarrhoea should not be involved in the preparation of food. Review the centre’s infection control practices, including nappy changing, toileting and handwashing procedures. Ensure that food is properly cooked and stored.
Treatment
(This section draws on information provided in the pamphlet, “Gastroenteritis: A guide for Parents and Caregivers” which was endorsed by the NHMRC 1996.) Preventing dehydration in children with gastroenteritis Children with diarrhoea need extra fluid to replace what they lose. However, many fluids have too much sugar and the wrong amount of salt. Giving a sick child the wrong kind of fluid can lead to more dehydration and illness. Safe drinks The best fluids to give contain a mixture of special salts (electrolytes) and sugars. You can buy Gastrolyte from the chemist. Mix the sachet of powder with water, not other kinds of fluids. (1 packet of Gastrolyte in 200 ml water). If children refuse Gastrolyte they may be given diluted soft drinks or fruit juice. Diluted cordial 10m1 + 150ml water. Diluted soft drink (eg lemonade) 50ml + 150m1 water Diluted fruit juices 50ml + 150m1 water Unsafe drinks Do not give undiluted fruit juice, fizzy drinks, cordial or lucozade to children with diarrhoea. They may increase diarrhoea and dehydration. Breastfed children Breastfeeding mothers should continue to breastfeed and offer the breast more often. Offer water (boiled if the baby is under 6 months) between feeds. Bottle/Formulae fed babies Continue normal strength formulae or milk if the child is hungry, and offer Gastrolyte or safe drinks as recommended above. Remember that withholding formulae for more than 24 hours may result in the baby losing weight. Re-introducing food Re-introduce food within 24 hours, even if the diarrhoea has not settled. Suitable foods to start off with include bread, plain biscuits, potatoes, rice, noodles, vegetables, plain meats, fish and eggs. Gradually re¬introduce other foods, such as dairy foods and sweet foods such as jelly, honey and jam.
Comments
Children with diarrhoea, who vomit or who refuse extra fluids should see a doctor. In severe cases hospitalisation may be needed. The parent and doctor will need to know the details of the child’s illness while at the centre. Photocopy the letter on page 32 and fill in the details. If the child wears a nappy or has used a potty and you can, collect a bowel motion. Any clean glass jar can be used to store the faeces. Keep the jar of faeces in a plastic bag in the fridge and ask the parent to take this with them to the doctor. You have a better chance of knowing what germ is causing a problem in your centre if you collect the sample early. Make sure you wash your hands well after collecting the sample.
Description
Ear infections are common in childhood. They may be middle ear infections (otitis media) or outer ear infections (otitis externa). Middle ear infections occur on the inside of the ear drum. Because this is a small area, infection leads to an increase in pressure on the eardrum and pain. A young child will not be able to tell you they have a sore ear. However, they may be pulling or rubbing their ear, have a fever or vomit. The child may be distressed, and crying that stops suddenly may mean that the ear drum has burst. Middle ear infections can be caused by bacteria or viruses and often occur a few days after a child gets a cold. Outer ear infections occur on the outside of the ear drum or ear canal and are often associated with swimming.
Incubation Period
A few days.
Infectious Period
Middle ear infections are complications of colds and are not spread from one child to another. Organisms can only be passed from one child to another if and while there is infectious fluid draining out of the ear.
Controlling the Spread of Infection
A child should not attend the centre while there is any fluid coming out of the ear. Any discharge from an ear should be treated as infectious. Wash hands thoroughly. A child with a middle ear infection may return as soon as they feel well enough. The child will often still need to be given antibiotics after returning to care.
Treatment
Middle ear infection. Antibiotics, taken by mouth. Use paracetamol to relieve pain. Outer ear infection. Antibiotics, given as drops in the ear or placed in the ear canal with wicks.
Comments
As ear infections are hard to detect in young children, suspect an ear infection with all fevers and vomiting. Watch the child for any signs of pulling or rubbing of ears. Rarely, a middle ear infection may spread and the child may develop mastoiditis. The area behind the ear will be red and the ear lobe will stick out and down. A child with these symptoms should see a doctor as soon as possible.
Description
This is a mild viral illness. Symptoms are fever, red cheeks, and an itchy, lace-like rash on the body and limbs. The person may also have a cough, sore throat or runny nose. Parvovirus is transmitted by droplets or by secretions from the nose and throat. Complications are rare. However, pregnant women and people with blood disorders or a depressed immune system should consult their doctor. Parvovirus causes miscarriage or still births in a small percentage of women infected during pregnancy. Malformations do not appear to occur in babies who survive this infection in the mother.
Incubation Period
Approximately 1-2 weeks.
Infectious Period
Not infectious once the rash appears.
Controlling the Spread of Infection
Do not exclude people with parvovirus from the centre. Follow good handwashing practices. Clean and disinfect surfaces contaminated by respiratory secretions.
Treatment
No specific treatment.
Description
Fleas are not choosy about where they live and feed. They infect both animals and humans, causing irritation and inflammation of the skin. Animals and humans often become abnormally sensitive to flea bites. Fleas are also capable of transmitting some tapeworms from dogs, cats, rats and mice to humans, but this is rare.
Incubation Period
Effects of flea bites can be seen immediately. The skin will be irritated and inflamed. Other effects of flea infestation-such as tapeworm infection, hypersensitivity and dermatitis-will not be known till later.
Infectious Period
Until the fleas and flea eggs (including those on animals and in the environment) are destroyed by treatment.
Controlling the Spread of Infection
Treat animals, their bedding and their immediate environment (that is, areas where they usually rest) to destroy adult and immature fleas. Dispose of any debris and vacuum floor coverings thoroughly. Boil animal bedding or treat it with insecticides. Treat animals with insecticidal preparations to kill fleas. Use any insecticide strictly according to the instructions on the label. If applying an insecticidal wash, wear rubber gloves and dilute the wash according to the instructions on the label. Avoid absorption of insecticide through the skin. Treat animals with fleas for tapeworm, as fleas can transmit tapeworm infections. If indoor areas are heavily infested with fleas, you may need to treat them. Further advice on methods of treatment can be obtained from local health authorities.
Description
Giardiasis is an intestinal disease caused by a parasite called Giardia lamblia. The organism is identified by a microscopic examination of a faecal specimen. Symptoms include diarrhoea, foul-smelling faeces, cramping, excessive gas or bloating, fatigue, nausea, and sometimes vomiting or weight loss. Fever and bloody faeces are not usually symptoms of giardia infections. Many infected people and animals have no symptoms. In child care centres, children and adults may be well and not have diarrhoea but still be infected with the parasite. This makes their faeces potentially infectious to other children. A person with active diarrhoea is more likely to spread the disease than one who is well but has infectious organisms in their faeces. Giardiasis spreads when hands, objects or food become contaminated with the faeces of infected people and the parasites are then taken in by mouth. Infection may also result from drinking water contaminated by infected humans or animals.
Incubation Period
5-15 days, commonly 6-9 days.
Infectious Period
For as long as the organism is in the person’s faeces, whether or not the person is ill.
Controlling the Spread of Infection
Exclude a person with infectious diarrhoea from the centre until diarrhoea has ceased. Be sure that good handwashing and cleaning procedures are being followed in the centre and at home.
Treatment
The person will not usually be infectious after being treated for several days. Ask parents to check with their doctor about treatment. It is not usually necessary to test or treat children who have no symptoms. Make sure the child has plenty to drink, see “Safe drinks” on page 60.
Description
A few years ago, before the vaccine was introduced, this germ was the most frequent cause of life¬threatening infection in children under 5 years of age. It can cause meningitis (infection of the brain linings), epiglottitis (swelling of part of the throat, which obstructs breathing), pneumonia, joint infection or cellulitis (infection of the tissue under the skin). Symptoms of meningitis include fever, vomiting, headache, irritability, fitting and neck stiffness. Neck stiffness may be hard to identify. The bacteria live in the throat. They are spread in respiratory secretions by direct person-to-person contact (for example, kissing), and by hands, mouthed toys etc.
Incubation Period
2-4 days.
Infectious Period
Hib is infectious as long as there are organisms present in the nose and throat.
Controlling the Spread of Infection
Check the immunisation records of all children in contact with a child with Hib. Unimmunised children who have had close contact with the child with Hib will need special antibiotics. If needed, the public health authorities may help arrange for other children and staff to be given courses of the antibiotic rifampicin by mouth and/or arrange vaccination. Adults may also be given the antibiotic. They are not at risk of disease but may be carrying the germ in their throat.
Treatment
A child with Hib will be treated in hospital with antibiotics. A special antibiotic (rifampicin) may be given to kill organisms present in the nose and throat. This antibiotic is not the same as those used to treat the child’s infection; it is an extra antibiotic given to prevent spread of the disease.
Comments
Vaccination against Haemophilus influenzae type b is recommended for all children.
Description
This is a viral illness. Symptoms are blisters, often seen in the mouth and on the hands and feet. Less commonly, blisters may be seen in the nappy area. It is not a serious illness and has nothing to do with animal diseases with similar names (foot and mouth disease in livestock, or paw and mouth disease in cats). Children with hand, foot and mouth disease may have a low fever, be listless, feel off-colour and not eat well for a day or two. They may also complain of a sore mouth for a few days before the ulcers or blisters appear. Hand, foot and mouth disease is spread through contact with the fluid in the blisters. This is most likely to occur when the virus becomes airborne during coughing, talking, etc. and through contact with faeces.
Incubation Period
Usually 3-7 days.
Infectious Period
As long as there is fluid in the blisters. The faeces can remain infectious for several weeks.
Controlling the Spread of Infection
Exclude children with hand, foot and mouth disease until all the blisters have dried. However, remember virus is present in the child’s faeces for many weeks. Cover blisters on the hands and feet if possible. Allow blisters to dry naturally. The blisters should not be deliberately pierced because the fluid within the blisters is infectious. Follow good handwashing and cleaning techniques.
Treatment
Usually none is required. Use paracetamol for fever and any discomfort. Do not give aspirin to any child with a fever. The disease itself is not serious. However, if the child complains of severe headache, the fever persists, and the child is not getting well, the parents should consult their doctor immediately.
Description
The head louse starts as a small egg about the size of a grain of salt which the female louse glues to the base of the hair shaft. Most often these eggs (nits) are found in the hair behind the ears, at the back of the neck, or around the crown and under the fringe. The eggs hatch in 7-10 days. They mature into an adult louse, which is a wingless insect 2-3 mm long with a flat body and six legs. The adult louse is capable of laying eggs after 10 days. Lice are very quick moving and very difficult to see in the hair. Headlice generally cause itching behind the ears and at the back of the neck. They are spread by direct contact with the scalp of an infested person, or by contact with personal items (such as combs, brushes, hats, scarves, jackets, sweaters, sheets, pillows and pillowcases, blankets, upholstered furniture etc). Lice are very host-specific. Those which live on animals will not live on humans and vice versa.
Incubation Period
The eggs usually hatch in 7-10 days. Once hatched, the lice are capable of laying eggs in 10 days.
Infectious Period
As long as the eggs or lice are alive. Lice do not survive more than two days away from a human host but their eggs may survive longer.
Controlling the Spread of Infection
Exclude a confirmed or suspected case from the centre. Re-admit the child the day after appropriate treatment has started. Dead eggs may still be present but the child is no longer infested and nits need not be removed. Inspect close contacts regularly for signs of infestation. Headlice move away quickly as the hair is parted. Eggs will be easier to see as they will be firmly attached to the hair. If the eggs are more than about 10-15mm from the scalp they have either hatched or died. A good light and a magnifying lens will help you find and identify lice. Discarded skins and black sandy excrement may be seen on pillows and collars. Educate the children, child care workers and parents about headlice and why personal items (like hats) should not be shared. The local health authority will help with this. Dry clean clothing and bedding or launder them in hot water for a minimum of 20 minutes. This should be done both at the centre and at home. Ironing clothes and drying clothes in a hot clothes dryer are also effective ways of killing lice. Place all items that cannot be washed or dry cleaned in a plastic bag for 3-4 days. Vacuum or gently iron carpet and furniture. Do not spray them with insecticide. Wash and clean combs and brushes with detergent and hot water.
Treatment
Use of pediculicides (insecticides that kill lice) Pregnant women, people with sensitive skin, and the parents of infants less than 12 months old should consult a doctor before applying pediculicides. To prevent unnecessary or repeated exposure to pediculicides, the person applying the chemical should wear protective gloves. Pediculicides are ideally applied twice, with the second application 7-10 days after the first. If the treatment is carried out correctly and still appears to be ineffective, then change the pediculicide to one that has a different insecticide base. Resistant headlice can be eradicated by switching to a different pediculicide. Over the years a large number of different products have been used to treat headlice. Three pediculicides stand out as being most effective. These are maldison, pyrethrins and lindane. The following guidelines give information on each product and how to use it. Maldison (CleenSheen, Ovanit Lotion, Head Lice Lotion, KP24) This is recommended by the NHMRC as the first line of treatment. Maldison blocks the action of an enzyme in the nervous system of headlice. Because of differences between insects and humans in the enzyme on which it acts, maldison is far more toxic to insects than it is to humans. In humans, maldison is rapidly broken down and excreted. Nevertheless, as with any insecticide, it should be used only in accordance with the manufacturer’s recommendations. Care should be taken to avoid contact with the eyes, nose and throat. Never use garden strength maldison. Only use maldison preparations formulated for headlice control. There are several maldison formulations for headlice treatment which have either a kerosene or an alcohol (ethanol) base. It is easier to use an alcohol-based preparation. When the treatment is applied to the hair, the alcohol will evaporate rapidly, leaving only a residue of maldison in the hair. Do not use a hair dryer, as heat may inactivate the residue. Follow the manufacturer’s instructions carefully. Pyrethrins (Lyban, Pyrifoam) Pyrethrins are naturally occurring insecticides derived from chrysanthemum flowers. Pyrethrins act on the louse’s nervous system and as a stomach poison, killing headlice on contact. Despite their low toxicity to humans, some people are allergic to pyrethrins. Pyrethrins can also irritate the eyes, nose and throat. Contact with these parts of the body should be avoided. Pyrethrin shampoo is applied to the hair, left for 10 minutes, then rinsed out. Hair should be dried gently with a towel. Do not use a hair dryer as the heat may inactivate the pediculicide. Lindane (gammabenzene hexachloride) (Quellada) Lindane is an insecticide which paralyses the nervous system of the headlouse. Lindane is more toxic than either pyrethrin or maldison. Therefore it is very important to use it strictly according to the manufacturer’s instructions. It should not be applied to the scalp following a hot bath or shower and it should not be scrubbed into the scalp. Avoid contact with the eyes, nose and throat. Small children, pregnant or breastfeeding women, and people with eczema or broken skin should not use lindane. However, lindane is safe and very effective if care is taken, and it is therefore a very useful pediculicide to have available alongside pyrethrin and maldison. Lindane is available as a lotion containing 1% lindane. This is gently rubbed into the hair, allowed to remain for four minutes, and then thoroughly rinsed out. Lindane can be purchased only from pharmacies, under the brand name Quellada.
Comments
Lice may infest people of any socioeconomic position, age or sex. In fact, they may prefer clean hair. The closeness of children in child care centres increases the potential for spread. Disclaimer Use of trade names in this document is for identification purposes only and does not constitute endorsement.
Description
Hepatitis A is an inflammation of the liver caused by a virus. Recent hepatitis A infection can be diagnosed by doing a blood test called ‘anti-hepatitis A IgM’. Symptoms, when present, may include abdominal discomfort, loss of appetite, nausea, low-grade fever and tiredness, sometimes followed by yellow skin and eyes, dark urine and pale faeces. Older children and adults are much more likely to have symptoms than younger children. In mild cases, these last 1-2 weeks. In severe cases, they may last up to several months. Children under age 3 rarely have symptoms. However, they frequently spread the infection through organisms living in microscopic amounts of faeces on their hands. These contaminate objects or food. The virus is then taken in by mouth. Urine, too, can be responsible for transmission.
Incubation Period
15-50 days, usually 3-5 weeks.
Infectious Period
A person is most infectious in the two weeks before yellowing (jaundice) occurs, and then slightly infectious during the first week of having jaundice.
Controlling the Spread of Infection
Exclude the ill child or employee for one week (seven days) after the onset of jaundice or illness. It is important for the infected person to consult their doctor. The doctor may offer immunoglobulin to all intimate household contacts of the infected person. If given 7-10 days after exposure, immunoglobulin may prevent hepatitis A or lessen the severity of the symptoms. The staff from the local public health unit will advise on the need for immunoglobulin for children and child care staff in the centre. Make sure that good handwashing and cleaning procedures are being followed in the centre and at home. Hepatitis A vaccine is recommended for child care workers, particularly those who care for children who are not toilet trained. Hepatitis A vaccine is not recommended for children because infection in children is mild with little or no illness.
Treatment
There is no treatment for hepatitis A once symptoms develop. The illness will stop as the body fights off the virus. Immunoglobulin, as mentioned above, may prevent or lessen symptoms in contacts if given soon after exposure. Immunoglobulin works by enhancing the body’s immune response.
Description
Hepatitis B is an infection of the liver caused by the hepatitis B virus. The virus is found mainly in the blood of an infected person, and to a lesser extent in some other body fluids (for example, semen). Saliva is not thought to play a big part in transmission. Hepatitis B is more common in adults than in children and is not normally a problem in child care facilities. Frequently, this virus is carried without symptoms. Women who have this disease during pregnancy may transmit it to their newborn babies. Many of these babies become long-term carriers of the virus. The disease usually spreads when infected blood enters the body through a cut or abrasion or through a mucous membrane (such as the lining of the mouth). Symptoms, if present, may include abdominal discomfort, loss of appetite, nausea, fever, tiredness, joint pain, dark urine and yellow skin or eyes (jaundice).
Incubation Period
2-6 months.
Infectious Period
For from about one month before jaundice occurs to about 1-3 months after jaundice occurs. Some people may carry the virus for life.
Controlling the Spread of Infection
Exclusion is not necessary. A child who feels unwell may need to stay away. It is not necessary to exclude a long-term carrier from child care. However, staff need to be aware of potential hazards and precautions. Take precautions when handling blood-contaminated items. More information on this subject is given on pages 18-19. Re-emphasise good handwashing, cleaning and disinfecting practices. Prevent scratching, biting, and violent or aggressive behaviour. Cover any open sores, cuts or abrasions that are weeping or moist. If a potentially infectious event occurs (for example, a bite from a hepatitis B carrier child that breaks the skin or a spread of blood from a carrier child), then contact the local public health unit immediately. Immediate preventive treatment may be given to the child or adult in contact with the carrier child.
Treatment
None. Preventive treatment is usually given only to intimate contacts or to people who have been involved in an incident where infected fluids may have contaminated wounds or cuts. Hepatitis B vaccine is available. It has been used to protect people at high risk of hepatitis B, such as dentists and surgeons.
Description
Hepatitis C is also an infection of the liver, caused by the hepatitis C virus. The virus is found primarily in the blood of an infected person. Transmission of hepatitis C is predominantly through contact with contaminated blood. People at risk include, for example, intravenous drug users sharing contaminated injecting drug equipment, and people with haemophilia or other people who received a blood transfusion before February 1990, when screening tests became available. Saliva is not thought to play a large part in transmission. About 20-50% of people with acute infection progress to long-term liver disease. Symptoms of hepatitis C may include abdominal discomfort, loss of appetite, nausea, fever, tiredness, joint pain, dark urine, and yellow skin or eyes (jaundice). The virus may be carried without symptoms.
Incubation Period
6-8 weeks.
Infectious Period
Indefinitely.
Controlling the Spread of Infection
Exclusion is not necessary. A child who is unwell may need to stay away. Take precautions when handling blood-contaminated items. More information on this subject is given on pages 18-19. Re-emphasise good handwashing, cleaning and disinfecting practices. Prevent scratching, biting, and violent or aggressive behaviour. Cover any open sores, cuts or abrasions that are weeping or moist. If a potentially infectious event occurs (for example, a bite from a hepatitis C carrier child that breaks the skin or a spread of blood from a carrier child), then contact the local public health unit.
Treatment
None.
Description
HIV is a virus carried in blood and body fluids. It damages the immune system of the person infected to the extent that the person becomes susceptible to a variety of common and rare diseases. HIV infection is called AIDS when it becomes fully developed in the body. People with AIDS contract repeated infections with unusual organisms and cancers that do not normally affect people with healthy immune systems. Transmission How HIV is spread • Sexual intercourse (anal or vaginal) with an infected person. • Sharing of infected needles and syringes. • Infected mother to child just before or during birth, or through breastmilk. Between 25% and 50% of children born to infected mothers will themselves become infected due to transmission of HIV before, during, or soon after birth. In a small number of cases, the disease is transmitted to the child through the mother’s breastmilk. • Penetration of the skin by infected blood. • There is no evidence that HIV is spread from child to child in schools or child care centres through normal social contact. • HIV is not transmitted through air or water, the sharing of plates, cups or cutlery, swimming pools or toilets, kissing, coughing, sneezing or spitting. There is no evidence that HIV can be spread by mosquitoes or other biting insects, as the virus dies rapidly outside the human body.
Incubation Period
The disease may not be evident for months or even years after HIV infection. In adults, a glandular fever-like illness occurs a month or so after infection in about 50% of people. HIV infection develops into AIDS within 10 years in at least 40-50% of infected people.
Infectious Period
People become infectious about 2-4 weeks after picking up the HIV virus. A blood test for antibodies to the virus will show whether a person has been in contact with and become infected by the HIV virus. It seems likely that HIV infection may be lifelong, and that people infected with HIV will always be potentially infectious. However, the spread of the infection to others requires special and unusual conditions. To date, there have been no reported cases of infection with the virus through ordinary social contact, through involvement with schools, pre-schools or child care centres, or through ordinary non¬sexual family contact.
Controlling the Spread of Infection
We recommend that children who have been infected with the HIV virus and who are apparently healthy do not need to be excluded from the child care centre, provided normally acceptable levels of cleanliness and supervision are maintained. Children who are unwell should be assessed by their doctor before any decision is made about whether they should stay away from school until better. Children who have moist skin lesions or abrasions should cover those lesions while at school. The covering should be waterproof (so that body fluids cannot leak) and they should be securely attached. If lesions are weeping or discharging and cannot be covered, then as a precaution the children should remain away from school until their lesions have healed or can be covered. Children who have significant behavioural disturbances may need to be excluded from school depending on advice from the child’s doctor in consultation with public health staff, the child’s parents or guardians, and child care or educational staff. Children who have developed impairment of immunity should remain away from school during outbreaks of serious contagious diseases such as measles or chickenpox. Children with HIV are more susceptible to such infections. In schools, pre-schools and child care centres and in ordinary social contact, there is no need to segregate items used regularly by all children, such as eating utensils, plates and cups. Washing them in warm soapy water is all that is required. The usual cleaning techniques are sufficient for toileting and washing facilities. Care should be taken when exposure to blood or body fluids of any type occurs. Refer to the section on dealing with blood and body fluids on pages 18-19. In the unlikely event of having to resuscitate a child infected with HIV, take simple precautions if time and facilities allow. These include the use of mechanical ventilators and disposable or sterilisable mouth¬to-mouth masks, if available. The risk of infection through direct mouth-to-mouth contact is extremely low. Never withhold resuscitation. All centres caring for children should ensure that they have a well¬equipped first aid kit and know how to use it effectively. Personnel policies Child care workers and staff members who are infected with HIV (or who think they might be) do not have to inform their employer that they have HIV. However, they do have a duty to act in a responsible manner towards others. In view of the potential for these people to become ill with AIDS, they should seek medical assistance in monitoring their own health. They should also be particularly aware of the dangers to others of accidental transmission of the disease. They must prevent their blood and body fluids coming into physical contact with others. The symptoms and effects of the disease are such that staff may be unable to continue work or may require intermittent sick leave. As in the case of other illnesses, the employer should ensure that the staff member is acquainted with sick leave entitlements.
Treatment
For patients with clinical AIDS, medical practitioners use specific drugs (for example, antibiotics and anti-viral drugs) to overcome secondary infections associated with the disease. Drugs that interfere with the replication of HIV are available. These drugs do not cure AIDS. An enormous worldwide effort is being made to educate people about AIDS, to reduce the spread of HIV, to search for new anti-viral drugs effective against HIV, and to develop a vaccine. Australian authorities are monitoring these developments closely.
Comments
The information in this section has been drawn from several publications: ‘Paediatric AIDS’ in AIDS Task Force Bulletin 3 / 86 ‘Children and AIDS’ in AIDS Task Force Bulletin 4 / 86 HIVIAIDS and the Workplace: Information for Health Workers and Others at Risk in Worksafe Australia booklet
Description
Influenza is an acute viral disease of the respiratory tract characterised by fever, chills, headache, muscle pain, a head cold and a mild sore throat. The cough is often severe. Usually the person will recover naturally within 2-7 days.
Incubation Period
Usually 1-3 days.
Infectious Period
Probably limited to three days from the onset of symptoms.
Controlling the Spread of Infection
An accurate diagnosis of influenza requires a blood test or throat swab. Generally this test is not considered necessary. Exclude a child or staff member with suspected or confirmed influenza from the centre until they look and feel well. Teach children to cover the mouth when sneezing or coughing and to wash their hands after blowing their noses. Dispose of tissues soiled with nose and throat discharges. Wash hands after contact with soiled tissues and articles and after contact with nose and throat discharges.
Treatment
No specific treatment. Antibiotics should be given for bacterial complications only. Medicines containing paracetamol and decongestants may help to relieve symptoms in children older than 3 months. Take younger children to the doctor. Do not give aspirin to any child with a fever.
Comments
Watch for new or more severe symptoms. They may indicate other, more serious infections. Influenza vaccine is available and may protect staff against influenza. Staff who wish to have the influenza vaccine should consult their own doctor. Influenza vaccine is not given routinely to children unless the child has a chronic, debilitating disease, for example, a chronic cardiac (heart) disorder, a pulmonary (lung) disorder, a renal (kidney) disorder or a metabolic disorder.
Description
Measles is a highly infectious and serious viral illness. It begins with fever, tiredness, a cough, a runny nose and inflamed eyes. These symptoms usually worsen over 3 days. The cough tends to be worse at night. The child may avoid light because the eyes are inflamed. At this stage, there may be small white spots on a red base present in the mouth on the inside of the cheek. Between day 3 and 7, a rash begins at the hair line. In 24-48 hours, this has spread over the entire body. When the rash reaches the legs, the rash on the head and face begins to fade. The rash usually disappears after 6 days. Measles lasts about 10 days. The cough may be the last symptom to disappear. A child with measles usually feels very ill. In a fairly high number of cases, the measles virus causes serious complications, such as pneumonia or inflammation of the brain. That is why there is much concern about the disease. Measles is not a simple childhood disease.
Incubation Period
8-14 days, usually 10 days.
Infectious Period
About 4-5 days before the rash begins until the fourth day after the rash appears.
Controlling the Spread of Infection
Exclude children with measles for at least 4 days after the onset of the rash.
Treatment
None.
Comments
Measles is best prevented through immunisation with the MMR vaccine. Children should be vaccinated twice against these diseases, at 12 months of age and between 10 and 16 years old. The vaccine gives lasting immunity.
Description
Meningitis is an inflammation of the covering of the spinal cord. Meningitis may be caused by bacteria or viruses. Bacterial meningitis is usually a more severe infection than viral meningitis. Two bacteria cause most of the bacterial meningitis in childhood. They are Haemophilus influenzae type b and Neiserria meningitidis (meningococci). Meningitis is diagnosed by lumbar puncture. This involves taking a sample of fluid from the spine. Symptoms may include fever, loss of appetite, vomiting, stiff neck and irritability. Older children may experience irritability, confusion, drowsiness, stupor or coma. Younger children and infants may have a high-pitched cry, a bulging of the soft spot on the top of the head (the anterior fontanelle) and convulsions. Often an infected child has recently had a cold or ear infection. The disease is spread through direct contact with droplets and discharges from the nose and throat. It usually requires several hours of contact with an infected person to become infected with the bacteria. Children can become severely ill with meningitis very quickly.
Incubation Period
Short, usually less than one week.
Infectious Period
As long as bacteria are present in the nose and throat. In the case of viral meningitis, as long as the virus is present in the stools.
Controlling the Spread of Infection
A child with bacterial meningitis is usually hospitalised. The child may return to the centre after being treated with antibiotics and when the doctor feels that the child is well and non-infectious. Make sure good handwashing procedures are being followed.
Treatment
A child with meningitis will probably be hospitalised. If the infection is bacterial, the child will be treated with antibiotics.
Description
This is a rare bacterial infection. It can cause life-threatening illness at any age, but is particularly dangerous for young children. The bacteria live in the throat. They are spread in respiratory secretions by direct person-to-person contact (for example, kissing), and indirectly on hands or on mouthed toys’ or objects. Meningococcal infection may cause meningitis or septicaemia (blood stream infection). Symptoms of meningitis include fever, vomiting, headache, irritability, fitting and neck stiffness (see meningitis, page 109). Symptoms of septicaemia include high fever and rash.
Incubation Period
3-4 days.
Infectious Period
The child is infectious as long as organisms are present in the nose and throat.
Controlling the Spread of Infection
If appropriate, public health authorities will arrange for other children and staff to be given a course of rifampicin by mouth and/or arrange vaccination.
Treatment
A special antibiotic (rifampicin) may be given to kill organisms present in the nose and throat. This antibiotic is not the sarhe as those used to treat the child’s infection; it is an extra antibiotic given to prevent spread of the disease. A child with meningococcal infection will be treated in hospital with antibiotics.
Description
Mumps is caused by a virus. Symptoms, when present, include swelling of one or more of the salivary glands, high fever and headache. About 30% of people with mumps will have only mild symptoms or no symptoms at all. In males, tenderness in the testicles may occur. Females may have some lower abdominal pain. Complications can occur, including inflammation of the spinal cord and brain, hearing loss, sterility (very rare) or death (extremely rare). Spread is by direct contact with droplets from the sneeze or cough of an infected person.
Incubation Period
12-25 days, usually 16-18 days.
Infectious Period
Up to six days before swelling of the glands begins and up to nine days after the onset of swelling.
Controlling the Spread of Infection
Exclude the child from the centre for nine days after onset of swelling.
Treatment
None.
Comments
Children should be immunised against mumps at 12 months of age and again at 10-16 years with the measles-mumps-rubella (MMR) vaccine. The vaccine provides long-term immunity. Illness provides lifelong immunity.
Description
Animals may bite and scratch when defending property, territory or food. They may be feeling pain, fear or rage, or they may just be playing. The mouths and claws of animals contain bacteria that can cause bites and scratches to become infected. The infection is not spread from person to person. Rabies in dogs is not present in Australia and is therefore not a concern. It is possible to get tetanus from an animal bite.
Incubation Period
Some animal bites and scratches may become visibly infected within a day. In other cases, it may take up to 10 days for an infection to become obvious.
Treatment
Animal bites and scratches, particularly puncture wounds, should not be dismissed lightly. They should be cleaned immediately and thoroughly with soap or antiseptic. More extensive bites and scratches, particularly deep puncture wounds, should be examined by a doctor in case further treatment is required. Tetanus immunisation should be kept up to date. Children should receive a course of triple antigen (which includes tetanus) at 2 months, 4 months, 6 months, 18 months and 4-5 years before starting school. A tetanus booster is then needed at 15-19 years of age (ADT) and then every 10 years.
Description
Ringworm is not actually a worm, but a spreading area of fungal dermatitis. Ringworm is passed on by direct skin contact or indirectly by touching contaminated articles, clothing and floors. While ringworm can be caught from animals, humans also have some species of ringworm that do not occur in animals at all. Different types of animals have different types of fungi that cause ringworm. If a specimen from the infected area is cultured in the laboratory, it is often possible to narrow down the source of infection to humans, cats and dogs, cattle, horses, pigs etc. Ringworm can be found in different areas of the body (hair, skin and nails). The condition looks different depending where it is located-on the scalp, the nails, the body or the foot. Ringworm of the skin (other than of the scalp, bearded areas and feet) This appears as a flat, spreading, ring-shaped lesion. The outer edge is usually reddish. It often contains fluid or pus, but may also be dry and scaly or moist and crusted. The centre of the patch may appear to be healing. Ringworm of the foot (commonly known as tinea or athlete’s foot) The characteristics of this common condition are scaling or cracking of the skin, especially between the toes, or blisters containing a thin watery fluid. Ringworm of the nail This condition tends to be a long-term fungal disease. It is difficult to treat. It usually affects one or more nails of the hands or feet. The nail gradually thickens and becomes discoloured and brittle. Cheesy looking material forms beneath the nail, or the nail becomes chalky and disintegrates. Ringworm of the scalp and beard This condition begins as a small pimple. It spreads outward leaving fine scaly patches of temporary baldness. Infected hairs become brittle and break off easily.
Incubation Period
Varies with the site of infection. The incubation period for tinea is unknown.
Infectious Period
As long as the condition persists.
Controlling the Spread of Infection
Exclude children with a fungal infection until the day after appropriate treatment has commenced. Inspect close contacts regularly for signs of infection. Make sure good handwashing and cleaning techniques are being practised. Pets can be washed with anti-fungal washes.
Treatment
The condition first needs to be diagnosed correctly. It is treated by applying anti-fungal medications. These may need to be used for a long time if the nails are infected. Parents should seek medical advice. Ringworm in animals can be treated with anti-fungal preparations and tablets. These can be obtained from veterinarians.
Description
This contagious viral infection is marked by the sudden onset of a high fever which lasts 3-5 days and then falls, at which time a rash appears. The rash may look similar to the measles rash, but appears first on the body. Although it can lead to febrile convulsions, roseola is usually a mild illness.
Incubation Period
Around 10 days.
Infectious Period
As the virus which causes this infection was only discovered recently, many aspects of the illness are uncertain. Saliva, nasal discharge and other respiratory secretions are most infectious from a few days before until several days after the rash appears.
Controlling the Spread of Infection
At present, it is not felt necessary to exclude children with roseola. Follow good handwashing, cleaning and disinfection procedures.
Treatment
None.
Description
Rotavirus is an intestinal infection caused by a virus. The virus can be identified by laboratory testing of faeces. Rotavirus infections occur mostly in winter. Symptoms include vomiting, fever and watery diarrhoea. Onset is usually sudden, and the illness mainly affects infants and young children up to 3 years of age. Rotavirus spreads when hands, objects or food become contaminated with infected faeces. It may possibly be spread by respiratory secretions as well.
Incubation Period
About 48 hours.
Infectious Period
The virus may be excreted in the stool for 1-2 days before the illness and up to eight days after the illness.
Controlling the Spread of Infection
Exclude a person with infectious diarrhoea and vomiting from the centre until vomiting and diarrhoea has ceased. Make sure that good handwashing and cleaning procedures are being followed in the centre and at home. Contact your local health authority if several children in one group are ill. Public health workers may be able to help identify how the infectious agent has spread through the centre and prevent further infection.
Treatment
Take a child with vomiting and diarrhoea to the doctor. Drugs are usually not prescribed. Make sure the child has plenty to drink
Description
Rubella is a mild viral disease. Symptoms include fever and a general body rash. The first sign of this illness may be swollen glands, usually at the back of the skull and behind the ears. This is followed by a rash. The rash usually consists of pink isolated spots. These appear first on the face, then spread rapidly to the trunk, upper arms and upper legs. The rash fades rapidly and is usually gone within 3 days. Rubella is spread through airborne droplets or direct contact with the nose or throat secretions of infected persons. Rubella usually causes only mild illness in children. However, infants born to mothers who had rubella during pregnancy may have severe birth defects. The risk is highest in early pregnancy.
Incubation Period
14-21 days, usually 17 days.
Infectious Period
Up to 7 days before and 4 days after appearance of the rash.
Controlling the Spread of Infection
The affected child should remain away from the centre for at least 4 days after onset of the rash and until fully recovered.
Treatment
Immunisation after exposure will not necessarily prevent infection or illness. Pregnant women should not receive the rubella vaccine.
Comments
Children should be immunised twice against rubella, at 12 months of age and again at between 10 and 16 years of age. The rubella vaccine is part of the MMR (measles-mumps-rubella) immunisation.
Description
Salmonella is an intestinal infection caused by bacteria. The germ can be identified by a faecal culture. Symptoms include diarrhoea, fever, abdominal pain, nausea and vomiting, sometimes with blood or mucus in the faeces. Salmonella spreads when hands, objects or food become contaminated with the faeces of infected people and the bacteria are then taken in by mouth. Infection may also occur as a result of drinking unpasteurised (raw) milk, touching raw poultry and meats and not washing hands afterwards, or contact with infected pets.
Incubation Period
6 hours to 3 days, usually 12-36 hours.
Infectious Period
Throughout the illness, and for a variable period of time after the illness is over.
Controlling the Spread of Infection
Exclude a person with infectious diarrhoea from the centre until the diarrhoea has ceased. Do not exclude a person with organisms in their faeces but no diarrhoea. Make sure that good handwashing and cleaning procedures are being followed in the centre and at home. A person with salmonella in their faeces must not be involved in food preparation. Staff may resume handling food when three separate faeces samples show that no salmonella is present. Contact your local health authority if several children in one group are ill. Public health workers may be able to help identify how the germ has spread through the centre and prevent further infection.
Treatment
Treatment with antibiotics is not usually recommended for salmonella infections. Use of antibiotics sometimes results in the person becoming a carrier. The person then appears well but is infectious to others. Recovery from salmonella infection usually occurs within a few days of the onset of symptoms. Parents should consult a doctor about treatment. Make sure the child has plenty to drink, see “Safe drinks” on page 60.
Description
This is an infectious disease of the skin caused by a mite. Scabies and other mites causing skin disease are diagnosed by examining a skin scraping under a microscope for mites or eggs. Scabies and other mites usually cause intense itching. Scabies is usually found between the fingers, on the front of the wrists, and in the folds of the elbows, wrists, armpits, buttocks and genitalia. Thread-like ‘tunnels’ (about 10 mm long) may be present in the skin, but these are often very difficult to identify. When mites have been transmitted from animals to humans, the mites are commonly found on contact areas, such as the arms, chest and neck. Scabies is usually transmitted by skin to skin contact. Very rarely, it is spread on underclothing or bed clothes that have been freshly contaminated by an infested person. The mites only live for a few days off the human or animal body. Although scabies mites from animals can live on humans, they do not reproduce in the skin. Some forms of skin disease in animals caused by mites (such as mange) can also be spread to humans. If an animal has mange, it is important to have a veterinarian diagnose which mite is causing the mange. Some mange mites on animals can spread to humans (for example, scabies and cheyletiella), while others do not spread to humans (for example, demodex). Sarcoptes (which causes scabies) can infect a wide variety of animals (including cats and dogs), while cheyletiella usually infects rabbits but can also infect cats and dogs.
Incubation Period
Itching begins 2-6 weeks after infestation in people not previously exposed to scabies and within 1-4 days in cases of re-infestation. Itching due to cheyletiella can develop within hours of handling the animal.
Infectious Period
Until the mites and eggs are destroyed by treatment.
Controlling the Spread of Infection
Exclude people with mites from the centre until the day after treatment begins. Inspect close contacts regularly for signs of infestation. Wash contaminated undergarments and other clothing worn by the child with hot water and detergent. Also wash bed linen and any other items the child has used in the past two days. Place all items which cannot be washed or dry cleaned in a plastic bag for four days to kill any mites or eggs. Bed mattresses and upholstered furniture can be vacuumed or gently ironed.
Treatment
Skin disease caused by mites can easily be confused with other skin diseases. Treatment should not begin until a doctor has confirmed the diagnosis following examination of a skin scraping for mites. This is particularly important for babies, pregnant women or people who already have other forms of skin disease. Treatment involves application of insecticidal cream, lotion or solution as prescribed by a doctor. If the mite has spread within the centre, all staff and children will need to be treated at the same time. Animals with skin disease caused by mites (mange) should be treated. A vet should examine a skin scraping to confirm the presence of mites and identify whether the mite can spread to humans. Animals and their bedding should then be treated with insecticidal washes, according to the vet’s instructions.
Comments
Scabies is not an indication of poor cleanliness. A diagnosis of scabies should be considered in staff and children who have a long-standing itchy disorder. By the time it is diagnosed, many people may have been infested. All those who have had close skin-to-skin contact with the child (for example, family and close playmates) should be treated simultaneously. Otherwise treatment is likely to be unsuccessful.
Description
Scarlet fever begins suddenly, sometimes causing a convulsion in very young children. As a rule it begins with a sore throat, high temperature and frequent vomiting. This is followed within 12-36 hours by a rash. This appears first on the neck and chest, then rapidly spreads over the body, finally reaching the legs. The child may have a strawberry coloured, textured tongue. Scarlet fever is caused by a streptococcal infection (see strep throat on page 51).
Incubation Period
Usually 1-3 days.
Infectious Period
Only for about 24 hours after appropriate treatment begins. Untreated people remain infectious as long as they are sick. This is usually 3-7 days.
Controlling the Spread of Infection
Exclude the child from the centre until they have taken antibiotics for at least 24 hours and the symptoms have improved significantly. Routine screening of all children and employees at the centre is not necessary, unless the local health authority determines that there is an ongoing epidemic or unless a streptococcal kidney disease has occurred. Follow good personal cleanliness practices. Cover the nose and mouth when coughing or sneezing. Dispose of tissues used to wipe a runny nose. Always follow this with proper handwashing. Do not share eating utensils, food or drinking cups. Disinfect toys that infants and toddlers put in their mouths.
Treatment
Penicillin or other effective antibiotics as prescribed by a doctor. To prevent potential complications such as rheumatic fever, antibiotics should be continued for 10 days. Calamine lotion may be helpful in relieving discomfort from the rash.
Description
School Sores (Impetigo) is a bacterial skin infection caused by the staph organism, the strep organism, or both. This infection spreads easily to other parts of the infected person’s body. It is transferred to other people by direct contact with sores or contaminated clothes. Dry, cracked skin serves as an area for growth of bacteria. Impetigo appears as a flat, yellow, crusty or moist patch on the skin.
Incubation Period
1-3 days.
Infectious Period
As long as there is discharge from the sores.
Controlling the Spread of Infection
Exclude the child until treatment has commenced. Sores on exposed surfaces should be covered with a watertight dressing. Keep a child with impetigo clean. The infected area should be washed with mild soap and water. The child’s clothes, linen and towels should be changed at least once a day. Emphasise the importance of good handwashing procedures for all personnel and children in the centre.
Treatment
The doctor may recommend the use of antibiotic ointment or antibiotics taken by mouth. Refer the child back to the doctor if the condition does not improve.
Description
Shigella is a severe intestinal infection caused by bacteria. The germ can be identified by a faecal culture. Symptoms include diarrhoea (sometimes containing blood or mucus), fever, vomiting and cramps. Some infected people have no symptoms. Shigella spreads when hands, objects or food become contaminated with the faeces of infected people, and the bacteria are then taken in by mouth. Very small numbers of the bacteria are sufficient to cause an infection. Stringent control measures are needed.
Incubation Period
1-7 days, usually 1-3 days.
Infectious Period
While ill and for a few days afterwards.
Controlling the Spread of Infection
Exclude a person with infectious diarrhoea from the centre. Make sure that good handwashing and cleaning procedures are being followed in the centre and at home. A person with shigella in their faeces must not be involved in food preparation. Staff may resume handling food when three separate faeces samples show that no shigella is present. Contact your local health authority if more than one child in one group is ill. Public health workers may be able to help identify how the germ has spread through the centre and prevent further infection.
Treatment
A child with this infection may become seriously ill. The child may need hospitalisation. Seek medical advice on treatment and fluid replacement. The doctor may prescribe antibiotics.
Description
Sore throats are caused by viruses or bacteria. Children do not commonly complain of a sore throat. However, they may have a fever or be reluctant to eat or drink. Children with a sore throat should see a doctor to assess any need for antibiotics. A strep throat is a bacterial infection which can cause fever, sore throat, and oozing and redness of the tonsils and the upper part of the throat. Viral and bacterial throat infections are spread directly by contact with airborne droplets (coughing and sneezing), or indirectly by contaminated hands, tissues, eating utensils, toys or other articles freshly soiled by the nose and throat discharges of an infected person. Scarlet fever is a combination of strep throat and a skin rash (see page 92).
Incubation Period
Usually 1-3 days.
Infectious Period
As long as organisms are being spread by coughing, sneezing etc. Bacterial sore throats last only for about 24 hours after appropriate treatment begins. People with untreated bacterial infections remain infectious as long as they are sick-usually 3-7 days. Viral tonsillitis and sore throats may last several days.
Controlling the Spread of Infection
Send a child with strep throat symptoms to a doctor for assessment and a throat swab culture. Exclude a child diagnosed as having strep throat until appropriate medical treatment is started. Do not exclude a child without symptoms, even if the child has a positive throat culture. Follow good personal cleanliness practices. Cover the nose and mouth when coughing or sneezing. Dispose of soiled tissues after wiping a runny nose. Wash hands carefully. Do not share eating utensils, food or drinking cups. Disinfect toys that infants and toddlers put in their mouths. We do not recommend routine screening of all children and employees in the centre unless there is evidence of an ongoing epidemic as determined by the local health authority or unless strep kidney disease has occurred.
Treatment
Penicillin or other antibiotics as prescribed by a doctor. To prevent potential complications such as rheumatic fever, antibiotics should be continued for 10 days.
Description
Thrush, also known as monilia or candida albicans, is a fungus that infects the top layers of the skin or mucous membranes. The fungus that causes thrush is part of the normal human flora. Usually it lives harmoniously on and in the body. For various reasons, the fungus can multiply to such a degree in some people that it can cause symptoms that require medical treatment. Often this is when the person is feeling rundown or taking antibiotics. Thrush is common in very young babies and infants. They are susceptible at this time because their immune systems are still immature. Thrush is often found inside the mouth as white spots or flakes that cannot be removed by cleaning the mouth. Another site of infection is the vulva and vagina. Frequently thrush is a secondary infection to nappy rash. Thrush is spread by direct contact with fungi living in the mouth, vagina and faeces and on the skin. A mother can infect her newborn baby during the birth.
Incubation Period
Variable, but 2-5 days in infants.
Infectious Period
As long as the white spots or flakes are present.
Controlling the Spread of Infection
Do not exclude babies and children with thrush. Make sure good handwashing and cleaning procedures are being practised.
Treatment
For moderate to severe infection of the mouth or the vulva/vagina the parent should take the child to a doctor. The doctor may prescribe anti-fungal medications. Wash the affected area with water, apply the prescribed cream, and expose the nappy area to air as much as possible.
Description
Toxoplasmosis is a protozoan infection. It is contracted by eating raw or undercooked meat, or through contact with cat faeces. Apart from transmission from mother to unborn child, person-to-person spread does not occur. Toxoplasmosis in pregnant women can affect the unborn child. It may cause rashes, damage to the child’s nervous system, liver or other organs or, rarely, death. Usually, though, the newborn baby is not affected at all. In Australia, very few cases of affected newborn children have occurred. Toxoplasmosis acquired after birth usually results in either no symptoms or mild illness. When mild illness occurs, common symptoms are enlarged lymph nodes, muscle pain, intermittent fever and generally feeling ill. Toxoplasmosis infection is confirmed by a doctor’s examination and blood tests. No immunisation is available.
Incubation Period
Uncertain, but probably from several days to months. Infectious period Infected meat is not safe until cooked properly. Freezing meat does not necessarily make it safe. Cat faeces containing toxoplasma can become infectious 24 hours after being passed.
Infectious Period
Infected meat is not safe until cooked properly. Freezing meat does not necessarily make it safe. Cat faeces containing toxoplasma can become infectious 24 hours after being passed. Cook meat adequately. Hands, knives and other kitchen utensils should be thoroughly washed after being in contact with raw meat. Dispose of cat faeces and litter daily (as it can become infectious after 24 hours). Wear gloves when handling cat faeces or litter trays. Disinfect litter trays daily by scalding with boiling water. Pregnant women without antibodies to toxoplasma should avoid cleaning litter trays and avoid contact with cats of unknown feeding history. Cover children’s sandpits when not in use and keep stray cats away from the sandpit. Feed cats dry, canned or boiled food. Discouraged them from hunting and scavenging.
Controlling the Spread of Infection
As person-to-person spread does not occur, do not exclude infected children or adults. Cook meat adequately. Hands, knives and other kitchen utensils should be thoroughly washed after being in contact with raw meat. Dispose of cat faeces and litter daily (as it can become infectious after 24 hours). Wear gloves when handling cat faeces or litter trays. Disinfect litter trays daily by scalding with boiling water. Pregnant women without antibodies to toxoplasma should avoid cleaning litter trays and avoid contact with cats of unknown feeding history. Cover children’s sandpits when not in use and keep stray cats away from the sandpit. Feed cats dry, canned or boiled food. Discouraged them from hunting and scavenging.
Treatment
Medication is available for significant infections. In most people, infection passes unnoticed.
Comments
It is important for pregnant women to avoid infection as it may seriously affect the unborn child. (Infections acquired after birth can be treated using medication prescribed by a doctor.) Pregnant women should avoid cleaning litter trays or contact with cats (particularly if the feeding history of the cat is unknown). To avoid contact with cat faeces when gardening, wear gloves and wash hands afterwards. These precautions can be relaxed if the woman is known to be immune to toxoplasmosis infection.’
Description
Tuberculosis is primarily an infection of the lungs but it can affect all parts of the body. It is caused by bacteria. Most infected children have a mild fever that resolves without treatment. Often the presence of infection is first noted when the child develops a positive tuberculin skin test (after a Mantoux test). TB is spread by contact with airborne droplets (coughing, sneezing, singing, talking etc.) from a person who has active TB.
Incubation Period
About 4-12 weeks from infection to positive tuberculin skin test. The risk of active disease is greatest within the first year or two after infection, although the germs may lie inactive for many years.
Infectious Period
Young children rarely transmit TB, even if they have a positive tuberculin skin test. Adults are infectious as long as they have active TB in the lungs and are not under treatment.
Controlling the Spread of Infection
Because children who have inactive TB disease are not usually infectious, they may continue to attend the centre with the approval of the health authority. However, a child or staff member with active TB should be excluded until treatment has been given for 1 month. Re-admit the child on the advice of a public health medical officer. If an active case of TB occurs at a child care centre, the health authority may suggest skin testing of employees, children and volunteers at the centre. Adults employed in child care centres should have a pre-employment health screen which includes a tuberculin skin test (Mantoux test) and a chest X-ray. Adults who have spent some time working overseas and then resume working with children should have a pre-employment TB health check before starting work again.
Treatment
People with TB will be given anti-TB drugs under the care of their doctor or the Chest Clinic.
Description
Warts are caused by a papova virus infection of the skin. Common warts develop on the skin of children and adolescents. They mainly occur on the knuckles, backs of hands and knees. Occasionally, common warts come out in a crop. Plane warts are flat-topped. They are most commonly found on the face and on the back of the hands. Plantar warts occur on the soles of the feet. They are found mostly in older children and adolescents.
Incubation Period
About four months, but ranges from 1-20 months.
Infectious Period
Unknown, but if untreated probably as long as warts can be seen.
Controlling the Spread of Infection
Do not exclude a child with warts. Treat warts if the affected area is exposed (for example, on the hands or legs). After treatment the warts are not contagious. The wart virus may enter via moist skin surfaces, such as abrasions and cuts. Therefore it is important to get children to: • dry hands well after washing them; • cover abrasions and cuts with bandaids or a clean dressing; and • wear shoes to protect the feet. Make sure that good handwashing and cleaning procedures are being practised.
Treatment
Warts will usually go away naturally, but this may take a long time. If treatment is necessary liquid nitrogen may be used. This is applied directly to the wart by a doctor. It freezes the warts, which usually disappear after several treatments. Alternatively, the doctor may choose to scrape warts or cut them out.
Description
Whooping cough is a highly contagious bacterial disease. The illness may begin with cold-like symptoms which progress to a cough, or the child may simply begin coughing. After several days, severe coughing fits may cause the child to vomit after coughing or to lose their breath. Sometimes a high-pitched crowing (the whoop) is heard when inhaling. The coughing can last 1-3 months. Whooping cough is particularly serious in children under 2 years of age and hospitalisation is usually necessary. Whooping cough is transmitted by direct contact with droplets from the nose and throat of an infected person.
Incubation Period
Commonly 7-10 days and not more than 21 days.
Infectious Period
Highly contagious in the early stages. The child is no longer infectious to others five days after starting antibiotic treatment with erythromycin.
Controlling the Spread of Infection
Exclude the child until well and until five days after starting antibiotic treatment. Check the immunisation records for every child who has contact with the child with whooping cough. Look for evidence of vaccination with the DTP vaccine at 2, 4, 6, and 18 months of age. The “P” in the vaccine is for pertussis which is whooping cough. Children who have received CDT at any of these times have not been vaccinated against whooping cough. For each child who has not had 4 doses of this vaccine ask the parents to take their child to the doctor and give parents a letter stating that this child has been in contact with another child with whooping cough. Exclude unimmunised close (child care) contacts until they have had five days of antibiotics. This will be any children who have been in contact with the child with whooping cough and who have not received any doses of the DTP vaccine. If these children do not take antibiotics they must be excluded until 14 days after their last exposure to a case of whooping cough in the centre. Exclude unimmunised household contacts under 7 years of age, such as brothers and sisters, until they have had five days of a 7 day course of antibiotics. If they do not take antibiotics they must be excluded for 14 days after their last exposure to a case of whooping cough in the centre.
Treatment
Antibiotics may be given to shorten the period of contagiousness of a child with whooping cough. However, these do not lessen the severity or duration of the illness. Fully immunised communities offer the best protection against whooping cough. Erythromycin may be given to friends and people in close contact with the disease.
Comments
Protection from whooping cough is best achieved through adequate immunisation with DTP (triple antigen) vaccine starting at age 2 months. Adults and teenagers are susceptible to the illness as well and may carry the bacteria while exhibiting only mild symptoms.
Description
Hydatid disease is caused by a small tapeworm called Echinococcus granulosis. This is passed on to humans from infected dogs. The disease is transmitted when tapeworm eggs in dog faeces are transferred from hands to mouths. This may happen when a person handles dogs or objects soiled with dog faeces, or ingests contaminated food or water. Hydatid disease is not transmitted directly from person to person. Hydatid disease causes cysts to grow in different parts of the body. Any organ may be affected. Sometimes these cysts cause no symptoms at all and are found during routine chest X-rays. However, if the cysts grow in vital organs (such as the liver, lungs, kidneys, spleen or bones) they may cause disease. Hydatid disease is essentially a problem of the rural community, especially the sheep farmer.
Incubation Period
Variable, from months to years, depending upon the number and location of cysts and how rapidly they grow.
Infectious Period
Dogs begin to pass eggs of the parasite approximately seven weeks after becoming infected. Most infections in dogs resolve within 6 months, but some adult tapeworms may survive as long as 2-3 years. Dogs can become infected repeatedly.
Controlling the Spread of Infection
Do not exclude an infected child. Ensure that adults and children wash their hands before eating. Dispose of dog faeces regularly, wearing gloves.
Treatment
This may be drug therapy, or surgery to remove the cysts. Gastrointestinal complaints.
Description
There are many worms that can infest children. Most, however, need to live for a period in water, soil or animals before they become infectious to humans. In Australia, with its temperate, dry climate and adequate town sewerage facilities, very few worms are transmitted. In child care centres, the most common worm is the pinworm (also called Enterobius vermicularis). Symptoms of pinworm infection include itchy bottom, irritability and behavioural changes. Sometimes a thin, adult pinworm, about 1 cm long, is found on freshly passed faeces. Pinworms are spread when the person scratches or touches the anal area (where the pinworm lays its eggs) and then puts their hands to their mouth. Occasionally eggs on infected clothing may be breathed in and then enter the gut (where the adult pinworm lives). Pinworms do not infect dogs and cats so domestic pets are not a source of infection.
Incubation Period
Approximately one month after eggs enter the gut, the female pinworm emerges to deposit her eggs.
Infectious Period
Pinworms can spread as long as worms live in the gut. Infection will continue until the person is treated. Immunity does not occur. Both adults and children are susceptible.
Controlling the Spread of Infection
Encourage parents to seek medical treatment for infected children. The child will be free of pinworm infection within a day if the child receives treatment and clothes and bed linen are washed in hot water. Do not exclude a child with pinworm from the centre. Make sure that good handwashing and cleaning procedures are being followed in the centre and at home.
Treatment
Treatment of pinworm is simple, safe and effective. The family doctor may wish to confirm the infection with a simple laboratory test. In most cases, though, the doctor will prescribe treatment on symptoms alone. A single-dose therapy is given to the child and each family member. This is repeated after two weeks. Treatment of other children at the centre is not necessary.
Description
Infection with roundworms, hookworms and tapeworms (including hydatid tapeworm) is uncommon. However, it is still important to observe good personal cleanliness, as infections with hydatid tapeworm or roundworms can have serious effects.
Incubation Period
Eggs or larvae can begin to be passed in the faeces several weeks after infection, depending on the species of worm involved (six weeks in the case of hydatid tapeworms; see hydatid disease on the following page). Symptoms may not be obvious until months or years after the infection was acquired.
Infectious Period
Transmission is possible throughout the period of infestation. Infection will continue until the person is treated. Immunity does not occur. Both adults and children are susceptible.
Controlling the Spread of Infection
Do not exclude the infected person from the centre. Make sure that good handwashing and cleaning procedures are being followed in the centre and at home. Dispose of animal faeces frequently (using gloves) and prevent children from eating dirt. Ensure that animals are wormed regularly with anti-parasitic preparations specific to the worms present in that area. Where hydatid tapeworm is endemic, worm animals every six weeks. Sheep carcasses and infected offal should be disposed of to prevent hydatid infection of dogs (which then infect humans). Stray and free-roaming farm dogs should be restrained to restrict the spread of hydatid tapeworm. Pregnant bitches should be treated for roundworms. Larvae which are dormant in the bitch’s body from a previous infection may infect the unborn puppies. Bitches should be re-treated 3-4 weeks after having the puppies.
Treatment
Diagnosing worm infections requires laboratory tests. Seek medical advice. Except for pinworms, treatment of worm infections varies according to the type of worm and the person’s symptoms.