Guidance on Infection Control in North Wales -Schools and Pre-School Settings

July 2014 – Review Date July 2015

If a school/pre-school in North Wales requires advice on exclusion periods / communicable diseases they are advised to do the
following –

1.
In the first instance a school/pre-school should refer to the information below which is relevant to both children and staff.
2.
If further information is required regarding an illness and exclusion period a school/pre-school should contact the Health Protection
Team, Public Health Wales in Mold: 01352 803234. (Any school should inform the school nurse of the outcome).
3.
If a school/pre-school observes a higher rate of absence than is usual, they should inform the Health Protection Team – 01352
803234.
4.
In cases of illness involving school staff, schools should contact their Occupational Health Team.
5.
In cases where there are local/national outbreaks of illness schools/pre-schools will be informed and advised of any actions they
are required to take.
Good Hygiene Practice

For guidance on good hygiene practices in relation to hand hygiene, toilet hygiene, clothing and fabrics, farm visits etc schools should
refer to the 2006 Welsh Government document ‘Teach Germs a Lesson’ and childcare settings should refer to ‘Mind the Germs’ and
the local ‘Infection Control Audit Toolkit’ for settings with nursery age children (0-5).

Rashes and skin
infections
Recommended period to be kept away
from school and pre-school settings
Comments
Athlete’s foot None Athletes foot is not a serious condition. Treatment is recommended
Chickenpox Five days from the onset of rash SEE: Vulnerable Children and Pregnant Staff
Cold sores,
(Herpes simplex)
None
Avoid kissing and contact with the sores. Cold sores are generally
mild and self-limiting.
German measles
(rubella)
Six days from onset of rash
Preventable by immunisation (MMR x 2 doses).
SEE: Pregnant Staff
Hand, foot and
mouth
None
Contact your local Health Protection Team if a large number of children are
affected. Exclusion may be considered in some circumstances
Impetigo
Until lesions are crusted and healed,
or 48 hours after commencing
antibiotic treatment
Antibiotic treatment speeds healing and reduces the infectious
period
Measles Four days from onset of rash
Preventable by vaccination (MMR x 2).
SEE: Vulnerable Children and Pregnant Staff
Molluscum
contagiosum
None A self-limiting condition
Ringworm Exclusion not usually required Treatment is required
Roseola (infantum) None None
Scabies Child can return after first treatment Household and close contacts require treatment
Scarlet fever
Child can return 24 hours after
commencing appropriate antibiotic
treatment
Antibiotic treatment recommended for the affected child
Slapped cheek / fifth
disease. Parvovirus B19
None SEE: Vulnerable Children Pregnant Staff
Shingles
Exclude only if rash is weeping
and cannot be covered
Can cause chickenpox in those who are not immune i.e. have not
had chickenpox. It is spread by very close contact and touch. If
further information is required, contact the Health Protection Team.
SEE: Vulnerable Children and Female Staff – Pregnancy
Warts and Verrucae None
Verrucae should be covered in swimming pools, gymnasiums and
changing rooms

Diarrhoea and
vomiting illness
Recommended period to be kept away
from school and pre-school settings
Comments
Diarrhoea and/or
vomiting
48 hours from last episode of
diarrhoea or vomiting
E. coli O157
VTEC
Typhoid [and
paratyphoid] (enteric
fever)
Shigella
(dysentery)
Should be excluded for 48 hours from
the last episode of Diarrhoea
Further exclusion may be required for
some children until they are no longer
excreting
Further exclusion may be required for young children under five
and those who have difficulty in adhering to hygiene practices
This guidance may also apply to some contacts
who may require microbiological clearance
Please consult your local Health Protection Team for further advice
Cryptosporidiosis
Exclude for 48 hours from the last
episode of diarrhoea
Exclusion from swimming is advisable for two weeks after the
diarrhoea has settled

Respiratory
infections
Recommended period to be kept away
from school and pre-school settings
Comments
‘Flu (influenza) Until recovered SEE: Vulnerable Children
Tuberculosis
Always consult the Health Protection
Team
Requires prolonged close contact for spread
Whooping cough
(pertussis)
Five days from commencing antibiotic
treatment, or 21 days from onset of
illness if no antibiotic treatment
Preventable by vaccination. After treatment, non-infectious
coughing may continue for many weeks. The Health Protection
Team will organise any contact tracing necessary.

Other
infections
Recommended period to be kept
away from school and pre-school
settings
Comments
Conjunctivitis None If an outbreak/cluster occurs, consult the Health Protection Team
Diphtheria
Exclusion is essential. Always
consult the Health Protection Team
Family contacts must be excluded until cleared to return by the Health
Protection Team. Preventable by vaccination. The Health Protection Team
will organise any contact tracing necessary
Glandular fever None
Head lice None Treatment is recommended only in cases where live lice have been seen
Hepatitis A
Exclude until seven days after onset
of jaundice (or seven days after
symptom onset if no jaundice)
In an outbreak of hepatitis A, the Health Protection Team will
advise on control measures
Hepatitis B, C,
HIV/AIDS
None
Hepatitis B and C and HIV are blood borne viruses that are not infectious
through casual contact. For cleaning of body fluid spills. SEE: Teach Germs
a Lesson (Welsh Government, 2006)
Meningococcal
meningitis /
septicaemia
Until recovered
Meningitis C is preventable by vaccination. There is no reason to exclude
siblings or other close contacts of a case. The Health Protection Team will
advise on any action needed
Meningitis due
to other
bacteria
Until recovered
Hib and pneumococcal meningitis are preventable by vaccination. There is
no reason to exclude siblings or other close contacts of a case. The Health
Protection Team can advise on actions needed
Meningitis viral None
Milder illness. There is no reason to exclude siblings and other close
contacts of a case. Contact tracing is not required
MRSA None
Good hygiene, in particular hand washing and environmental cleaning, are
important to minimise any danger of spread. If further information is
required, contact the Health Protection Team
Mumps
Exclude child for five days after
onset of swelling
Preventable by vaccination (MMR x 2 doses)
Threadworms None Treatment is recommended for the child and household contacts
Tonsillitis None
There are many causes, but most cases are due to viruses and do not need
an antibiotic

Vulnerable Children

Some medical conditions make children vulnerable to infections that would rarely be serious in most children, these include those being
treated for leukaemia or other cancers, on high doses of steroids and with conditions that seriously reduce immunity.

Pregnant Staff (including pregnant children)

If a pregnant woman develops a rash or is in direct contact with someone with a potentially infectious rash, this should be investigated
by a doctor. The greatest risk to pregnant women from such infections comes from their own child/children, rather than the workplace.

Immunisations

Immunisation status should always be checked at school/pre-school entry and at the time of any vaccination. Parents should be
encouraged to have their child immunised and any immunisation missed or further catch-up doses organised through the child’s GP.
For the most up-to-date immunisation advice www.immunisation.nhs.uk, or the child’s GP can advise.

2 months old
Diphtheria, tetanus, pertussis (whooping cough), polio
and Haemophilus influenza type b (Hib)
DTaP/IPV/Hib Thigh
Pneumococcal disease PCV Thigh
Rotavirus (cut off is 15 weeks old) Rotavirus By mouth
3 months old
Diphtheria, tetanus, pertussis, polio and Hib DTaP/IPV/Hib Thigh
Meningococcal group C disease (MenC) Men C Thigh
Rotavirus (cut off is 24 weeks old) Rotavirus By mouth
4 months old
Diphtheria, tetanus, pertussis, polio and Hib DTaP/IPV/Hib Thigh
Pneumococcal disease PCV Thigh
12 – 13 months old (within a month
of first birthday)
Hib/MenC Hib/MenC Upper arm/thigh
Pneumococcal disease PCV Upper arm/thigh
Measles Mumps and Rubella (German measles) MMR Upper arm/thigh
2,3 & 4 years old; & year 7 (school) Influenza – before flu season in Sept/Oct Flu nasal spray Nostrils
3 years & 4 months or soon after
Diphtheria, tetanus, pertussis, polio DTaP/IPV Upper arm
Measles Mumps and Rubella MMR Upper arm
Girls aged 12 to 13
Years old
Cervical cancer caused by human papilloma virus types
16 & 18 (& genital warts caused by type 6 & 11)
HPV Upper arm
Around 14 years old
Tetanus, diphtheria, and polio Td/IPV Upper arm
MenC MenC Upper arm

The complete routine immunisation schedule from summer 2014 is available from:
www.gov.uk/government/publications/the-complete-routine-immunisation-schedule;

Immunisation for those at risk -this link is the UK universal immunisation schedule and includes immunisations for those at risk.
Children who present with certain risk factors may require additional immunisations. Some areas have local policies – check with GP.

Pregnant staff -should be offered flu vaccination which can be given at any stage of pregnancy; from 28 weeks of pregnancy
onwards, pregnant women should also be offered whooping cough (Pertussis) vaccination.

Staff Immunisations -All staff should undergo a full occupational health check prior to employment; this includes ensuring they are up
to date with immunisations. All staff aged 16–25 should be advised to check they have had two doses of MMR and one dose of Men C.

Adapted from “Health Protection Agency” April 2010.
For references visit www.hpa.org.uk Information produced with the assistance of the Royal College of Paediatrics and Child Health.

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