Transcript Infectious Disease in Out of Home Child Care, Part III

Infectious Disease in Out
of Home Child Care
Part III: Illnesses transmitted skin-to-skin,
by body fluids and by insects
Jonathan B. Kotch, MD, MPH, Director
National Training Institute for Child Care Health Consultants
The University of North Carolina at Chapel Hill
Objectives for Part III
At the end of this training learners will
be able to:
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Describe the causes and consequences of the
infectious diseases in child care transmitted skinto-skin, by body fluids and by insects, and
Identify modes of transmission and prevention
of infectious diseases transmitted skin-to-skin,
by body fluids and by insects.
Skin-to-Skin Infections
(Churchill and Pickering, 1997)
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Viruses
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Herpes simplex
Varicella-zoster
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Molluscum contagiosum
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HPV (warts)
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Bacteria
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Group A strep
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Staphylococcus aureus
Parasites
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Pediculosis (lice)
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Sarcoptes scabiei
(scabies)
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Tinea capitus (scalp
ringworm)
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Tinea corporis (body
ringworm)
New Issue - MRSA
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Methicillin-resistant Staph aureus
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Child care cases rare
More common in health care settings
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Hospitals
Nursing homes
Associated with contact sports, and sharing
clothes and towels in locker rooms
Also associated with compromised skin
integrity (cuts, abrasions, boils)
Blood, Urine, Saliva
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Saliva
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Cytomegalovirus (CMV)
Epstein-Barr virus (EBV)
Herpes simplex virus
Blood
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Hepatitis B (HBV)
Human Immunodeficiency Virus (HIV)
Cytomegalovirus (CMV)
Epstein-Barr virus (EBV)
Prevention
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Immunization
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HBV
Varicella-zoster
Standard precautions
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Bloodborne pathogens (OSHA)
Indications for Exclusion1
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Mouth sores with drooling
Rash with fever or behavior change
Impetigo
Draining boils or skin lesions not contained by a dressing
(i.e., lesions on hands or face)
Purulent conjunctivitis (pink eye)
Scabies
Shingles (usually affects caregivers, not children) if the
lesions cannot be contained under a bandage that is
under clothes (i.e., lesions on hands or face)
1Courtesy
of Steve Shuman
Head Lice2
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Unlike exclusion for other conditions, children
with head lice don’t have to be sent home
until the end of the day.
Parents of affected children shall be notified
and informed that their child must be treated
properly before returning to the child care
facility the next day.
2Courtesy
of Steve Shuman
Arthropod borne
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Tickborne
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Lyme disease
Rocky Mountain spotted fever
Ehrlichiosis
Mosquitoborne
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West Nile Virus (WNV)
Other arboviruses such as Eastern Equine
encephalitis
Risks
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WNV: 4,269 cases reported in 2006 (CDC)
Lyme disease: 23,305 cases reported in 2005 (CDC)
2007 West Nile Virus Activity in the U.S.
(Reported to CDC as of December 11, 2007)
All About WNV
(CDC, 2003)
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Relatively few children
have been reported
with severe West Nile
Virus disease.
By contrast, most of the
deaths due to WNV are
among people over 50
years old. Half of those
deaths were among
people over 77 years
old.
Fight the Bite© logo used with permission.
N,N-diethyl-3methylbenzamide (DEET)
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Repellent with DEET is safe when used
according to directions, according to the EPA
and the AAP.
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No serious illness has been linked to the use of DEET
in children
However, no definitive studies exist in the scientific
literature about what concentration of DEET is safe
for children.
Products with different strengths of DEET are
available. The AAP recommends that
concentrations up to 30% may be used for
children (but do not use DEET in children
younger than 2 months of age).
New recommendations from
the CDC (2005)
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Picaridin (KBR 2023), along with DEET,
is considered to have demonstrated “a
higher degree of efficacy”
Oil of lemon eucalyptus is comparable
to low concentrations of DEET (but not
recommended for children under 3)
Take it Outside
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Sunscreen – use liberally
Insect repellent - use sparingly
Other precautions
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Proper clothing (ideally long sleeves and long
pants)
Separate playground from wooded areas
Tick-checks
Eliminate standing water
Keep outdoor sand boxes and sand tables covered
Acknowledgement
Supported by Grant #U93-MC00003 from the
Maternal and Child Health Bureau of the
Health Resources and Services
Administration, U.S. Department of Health
and Human Services.
END OF PART III