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Exclude children if directed to do so in the chart below or if:

  • The child’s health care professional recommends exclusion.
  • The child is unable to participate in activities, as normal.
  • The child needs more care than staff can provide without compromising the health and safety of other children.
  • The child has a fever (taken at armpit or orally).
  • A child older than two months has a temperature of 101 degrees Fahrenheit or higher
  • An infant younger than two months has a temperature of 100.4 degrees Fahrenheit or higher
  • The child has two or more episodes of vomiting within a 12-hour period.

The complete list of reportable diseases and conditions. 


DiseaseOverviewSymptomsPreventionExclusion
Chicken Pox (Varicella Zoster infection)Infection caused by the varicella zoster virus.- Rash (small, red, blistering bumps)
- Fever
- Runny nose
- Cough
- Varicella vaccine
- Proper surface sanitation
- Keep room well ventilated
- Regular and thorough handwashing
- Contact Local Health Department* for outbreaks of three or more cases
- Exclude if chicken pox or a rash suggestive of chicken pox
CMV
(Cytomegalovirus)
Viral infection, common in children.- Mild to no symptoms- Regular and thorough handwashing
- Can be harmful to fetus
- Exclusion not required
- Women of childbearing age are at higher risk as the consequences of a fetus exposed to CMV can be serious
COVID-19 (novel coronavirus infection)COVID-19 is a new disease caused by a novel coronavirus not previously seen in humans.- Fever or chills
- Cough
- Shortness of breath or difficulty breathing
- Fatigue
- Muscle or body aches
- Headache
- New loss of taste or smell
- Sore throat
- Congestion or runny nose
- Nausea or vomiting
- Diarrhea
- Avoid being exposed to anyone who is sick
- Proper surface disinfection
- Regular and thorough handwashing
- Contact Local Health Department immediately
Exclude until
- no fever for at least 72 hours AND
- other symptoms have improved AND
- at least 10 days have passed since symptoms started
Diarrheal illness:
cause unknown
There are many causes of diarrhea in children under age five. Illness may be mild and not require medical attention.- Stool frequency exceeding two or more stools above normal for that child
- Stools containing blood or mucus
- Stools that are not contained in a diaper
- Fecal accidents by a child who is normally toilet trained
- Proper surface disinfection
- Proper food storage and preparation
- Regular and thorough handwashing
Exclude until diarrhea ends
Diarrhea (Campylo- bacteriosis)Infection caused by Campylobacter Bacteria.- Bloody diarrhea
- Fever
- Vomiting
- Abdominal cramping
- Proper surface disinfection
- Proper food storage and preparation
- Regular and thorough handwashing
- Contact Local Health Department*
- Exclude until diarrhea ends
Diarrhea
(Cryptosporidiosis)
Infection caused by Cryptosporidium parasite.- Loose stools (watery or bloody)
- Abdominal pain
- Weight loss
- Proper surface disinfection
- Regular and thorough handwashing
- Contact Local Health Department*
- Exclude until diarrhea ends
- Exclude from water play until two weeks after diarrhea ends
Diarrhea
(Shiga-toxin producing E. Coli)
Infection caused by Shiga-toxin producing E. coli such as E. coli O157:H7.- Loose stools (watery or bloody)
- Abdominal pain
- Fever
- Proper surface disinfection
- Proper food storage and preparation
- Regular and thorough handwashing
- Contact Local Health Department*
Exclude until:
- diarrhea ends
- two consecutive negative stool samples 24 hours apart
- cleared for readmission by local health department
Diarrhea
(Giardiasis)
Infection caused by Giardia lamblia parasite.- Loose stools (watery or bloody)
- Excessive gas
- Abdominal pain
- Decreased appetite
- Weight loss
- Proper surface disinfection
- Regular and thorough handwashing
Exclude until diarrhea ends
Diarrhea
(Norovirus)
Viral infection.- Acute onset of watery diarrhea
- Abdominal pain
- Nausea
- Vomiting
- Proper surface disinfection
- Regular and thorough handwashing
Exclude until 48 hours after diarrhea ends
Diarrhea
(Rotavirus)
Viral infection, most common cause of diarrhea
and vomiting.
- Non-bloody diarrhea
- Nausea and vomiting
- Surface disinfection
- Immunization recommended
- Regular and thorough
handwashing
Exclude until diarrhea ends
Diarrhea
(Salmonellosis)
Infection caused by Salmonella bacteria.- Diarrhea
- Fever
- Abdominal cramps
- Nausea or vomiting
- Dehydration (dry mouth, no tears, no urine in eight hours)
- Proper surface disinfection
- Proper food storage and preparation
- Avoiding contact with reptiles, amphibians, poultry, and other animals
- Regular and thorough handwashing
- Contact Local Health Department* .
- Exclude until diarrhea ends for non-typhoidal serotypes
- For Salmonella Typhi exclude until cleared by local health department
Diarrhea
(Shigellosis)
Infection caused by the Shigella bacteria.- Loose, watery stools with blood or mucus
- Fever
- Headache
- Abdominal pains
- Convulsions
- Proper surface disinfection
- Regular and thorough handwashing
- Contact Local Health Department* .
- Exclude until asymptomatic for 48 hours and one negative stool sample
Fifth Disease (Erythema Infectiosum)Infection caused by Human Parvovirus B19.- Fever, headache
- Muscle and joint aches
- Red, lace like rash on cheeks, torso, arms, and thighs that lasts 1- 3 weeks
- Proper surface sanitation
- Disposal of tissues contaminated with blood or mucus
- Regular and thorough handwashing
- Can be harmful to fetus
Exclusion not required
German Measles
(Rubella)
Uncommon, mild infection caused by Rubella virus.- Red or pink rash on the face and body
- Swollen glands behind ears
- Slight fever
- MMR vaccine required
- Regular and thorough handwashing
- Can be very harmful to fetus
- Contact Local Health Department*
- Exclude for seven days after the beginning of the rash
- Exclude non-immunized children
Hand Foot and Mouth Disease (Coxsackievirus)Infection caused by Coxsackievirus, more common in summer and fall.- Tiny blisters in the mouth, on the fingers, palms or hands, buttocks, and soles of feet
- Common cold like symptoms (sore throat, runny nose, cough,
fever)
- When coughing or sneezing cover mouths and noses with a disposable tissue
- Regular and thorough handwashing especially after handling contaminated tissues or changing diapers
- Ensure proper disinfection
Exclusion not required
Head Lice
(Pediculosis Capitis)
Small insects that draw blood from the scalp and lay tiny eggs (nits) on hair shafts.- Itchy skin on scalp or neck
- Scratching around ears and at the nape of the neck
- White nits glued to hair
- Do not share brushes, hats, blankets, or pillows
- Launder contaminated fabric with hot water and high heat drying
- Regular and thorough
handwashing
Exclude until completion of first treatment
Hepatitis A
(HAV)
Viral infection, causes liver inflammation- Fever, fatigue
- Jaundice (yellowing of skin or eyes)
- Decreased appetite, abdominal pain,
vomiting, diarrhea
- HAV vaccine is recommended
- Ensure proper disinfection
- Regular and thorough handwashing
- Contact Local Health Department*
- Exclude until one week after onset of illness or
jaundice
Hepatitis B
(HBV)
Viral infection, causes liver inflammation.- Flu like symptoms, fatigue, decreased appetite
- Jaundice
- Joint pain
- HBV vaccine required
- Cover open wounds/sores
- Wear gloves when handling blood or blood containing fluids
- Disinfect surfaces contaminated with blood
- Regular and thorough handwashing
- Contact Local Health Department*
- If Local Health Department determines there is a significant risk of transmission, the child may be placed in alternate child care
Hepatitis C
(HCV)
Viral infection, causes liver inflammation.- Nausea, decreased appetite, fatigue
- Jaundice
- Muscle and joint pain
- Cover open wounds or sores
- Disinfect surfaces contaminated with blood
- Regular and thorough handwashing
- Contact Local Health Department*
HIV/AIDSViral infection, progressively destroys the body’s immune system.- Slow or delayed growth
- Enlarged lymph nodes
- Swelling of salivary glands
- Frequent infections
- Wear gloves when handling blood or blood containing fluids
- Disinfect surfaces contaminated with blood
- Regular and thorough handwashing
- Contact Local Health Department*
- If local health department determines there is a significant risk of transmission, the child may be placed in an alternate child care
ImpetigoInfection caused by Streptococcal or Staphylococcal bacteria.- Small, red pimples or fluid filled blisters with crusted, yellow scabs on the skin- Wash infected areas and cover any open sores or wounds
- Proper surface sanitation
- Regular and thorough
handwashing
Exclude until 24 hours after treatment has started
InfluenzaInfection caused by the Influenza virus.- Fever, chills, headache
- Cough and sore throat
- Muscle aches
- Decreased energy
- Flu vaccine is recommended
- When coughing or sneezing cover mouths and noses with a disposable tissue
- Regular and thorough
handwashing
Exclude until 24 hours after fever subsides
MRSA
(Methicillin Resistant Staphylococcus aureus)
Infection caused by Staph bacteria resistant to broad spectrum antibiotic
treatment.
- Small, red, pimple like bumps
- Abscesses (collection of pus under the skin)
- Proper surface sanitation
- Do not share towels, clothing, or bedding
- Keep wounds covered
- Regular and thorough
handwashing
Exclusion not required unless open sores cannot be covered
Measles
(Rubeola)
Infection caused by the measles virus, highly contagious.- Fever, cough, runny nose, red and watery eyes
- Small, red spots in mouth
- Rash spreading from the hairline downward
- MMR vaccine required
- Proper surface sanitation
- Regular and thorough handwashing
- Contact Local Health Department*
- Exclude for at least four days after the beginning of the rash
- Exclude non-immunized children
Meningitis (Haemophilus influenzae type b , Pneumococcus, Meningococcus)Bacterial or viral infection, causes swelling or inflammation of brain and spinal cord tissue.- Fever, headache
- Nausea, loss of appetite
- Stiff neck
- Confusion, drowsiness, irritability
- Hib vaccine required
- Pneumococcal vaccine (PCV13) required if born after 7/1/15 (recommended for all children)
- When coughing or sneezing cover mouths and noses with a disposable tissue
- Regular and thorough
handwashing
- Contact Local Health Department*
- Exclude as soon as infection suspected until cleared by a health care professional
Molluscum ContagiosumSkin infection caused by a virus, similar to warts.- Small, flesh colored bumps on the skin
- Cover lesions when possible with clothing or bandages
- Do not share towels, washcloths, or blankets used by an infected child
- Scratching may cause additional lesions and bacterial infection
- Regular and thorough handwashing, especially
after touching bumps
Exclusion not required
Mononucleosis
(Mono)
Infection caused by the Epstein Barr virus.- Mild to no symptoms in young children
- Rare symptoms are fever, sore throat, fatigue, swollen lymph nodes, enlarged liver/spleen, rash from
ampicillin or penicillin
- Do not share objects contaminated with mucus or saliva
- Regular and thorough handwashing
Exclusion not required unless ordered by a health care professional
Mumps
(Rubulavirus)
Viral infection with swelling of one or more salivary glands.- Swollen glands
- Fever, headache, earache
- MMR vaccine required
- Regular and thorough handwashing
- Contact Local Health Department*
- Exclude for at least five days after the beginning of swelling
- Exclude non-immunized children
Pink Eye
(Conjunctivitis)
Bacterial or viral infection causes inflammation of eye tissue.
Other causes: allergies and blocked tear
ducts in infants.
- Red or pink, swollen, itchy eyes
- Yellow or green discharge and crusting in the eyes
- Regular and thorough handwashing especially before and after touching the eyes, nose, and mouth
- Thorough sanitation of objects touched by hands or faces
Exclusion not required
Pinworms
(Enterobiasis)
Infection caused by small thread like roundworm.- Itching and irritation around the anal or vaginal area- Regular and thorough handwashing, keep nails short
- Proper surface sanitation and disinfection
- Launder bedding often
- Avoid shaking bedding to prevent spreading eggs through the air
- Treat other affected household members
Exclusion not required
PneumoniaBacterial or viral infection, causes inflammation of lungs.- Cough, fever
- Difficulty breathing
- Loss of appetite
- Muscle aches
- Fatigue
- Proper surface sanitation
- When coughing or sneezing cover mouths and noses with a disposable tissue
- Dispose tissues contaminated with mucus
- Regular and thorough
handwashing
Exclusion not required
RSV
(Respiratory Syncytial Virus)
Viral infection caused by Respiratory Syncytial virus, causes common cold, occurs mostly in winter and early spring.- Cold like symptoms
- Respiratory problems (wheezing, difficulty breathing)
- Proper sanitation of hard surfaces and toys
- When coughing or sneezing cover mouths and noses with a disposable tissue
- Dispose tissues contaminated with mucus
- Regular and thorough handwashing
Exclusion not required
RingwormInfection caused by several kinds of fungi, may affect the body, feet, or scalp.- Red, circular patches on the skin
- Cracking and peeling of skin between toes
- Redness, scaling of scalp
- Cover skin lesions
- Do not share objects that come in contact with the head (hats, brushes, bedding, etc.)
- Treat other affected household members
- Regular and thorough
handwashing
Exclude until treatment started
Roseola (Human Herpesvirus 6)Viral infection causing a rash in children 6-24 months old.- High fever
- Red, raised rash
- When coughing or sneezing cover mouths and noses with a disposable tissue
- Regular and thorough handwashing
Exclusion not required
Scabies
(Sarcoptes scabei)
Infestation on the skin by small insects (mites)- Rash, severe itching
- Itchy red bumps or blisters in skin folds
- Itching may take a few days to subside after treatment
- Contain clothing and bedding that cannot be laundered in plastic bags for at least four days
- Launder bedding and clothing in hot water with a hot dry cycle
- Treat other affected household members
- Regular and thorough handwashing
Exclud until treatment started
Scarlet FeverInfections caused by Group A streptococcus bacteria.- Sunburn like rash with tiny bumps that may itch
- Fever, sore throat, swollen glands
- Yellow or white coating on tongue and throat
- Avoid direct contact with potentially infected individuals
- When coughing or sneezing cover mouths and noses with a disposable tissue
- Regular and thorough
handwashing
Exclude until antibiotics administered for at least 12 hours and no fever is present
Strep ThroatInfections caused by Group A Streptococcus bacteria.- Sore throat, fever, headache
- Decreased appetite, stomachache
- Swollen lymph nodes
- Avoid direct contact with potentially infected individuals
- When coughing or sneezing cover mouths and noses with a disposable tissue
- Regular and thorough
handwashing
Exclude until 12 hours after antibiotic treatment has started and no fever is present
TB (Tuberculosis)Infection caused by a bacterium, usually affecting the lungs.- Chronic cough
- Weight loss
- Fever, chills, night sweats
- Positive skin test
- When coughing or sneezing cover mouths and noses with a disposable tissue
- Regular and thorough handwashing
- Contact Local Health Department*
- Exclude until health care professional provides a written statement that the child is not infectious
Whooping Cough
(Pertussis)
Contagious bacterial infection that causes mild to severe coughing.- Cold like symptoms
- Coughing that leads to vomiting, loss of breath, or blue face
- Whooping sound when inhaling after coughing
- DTaP vaccine, for children less than seven years of age
- Tdap vaccine, for persons 10 years and older
- When coughing or sneezing cover mouths and noses with a disposable tissue
- Regular and thorough handwashing
- Contact Local Health Department*
- Exclude until five days after treatment has started
- Exclude untreated cases for 21 days from the date cough began

*Physicians, school administrators, and child care operators (G.S. § 130A-135 through 130A-139) must report cases or suspected cases of reportable diseases to their local health department. The local health department then reports this information to the N.C. Division of Public Health (G.S. § 103A-140). 

References:

  1. North Carolina Administrative Code: Chapter 9, Child Care Rules
    • .0804 Infectious and Contagious Diseases
    • .1720 Medication Requirements
  2. Managing Infectious Diseases in Child Care and Schools, A Quick Reference Guide, 4th Edition, American Academy of Pediatrics
  3. North Carolina Administrative Code: Title 10A Health and Human Services, Chapter 41 Epidemiology Health,
    For more specific information

    • Call your Local Health Department
    • Contact the NC Child Care Health and Safety Resource Center (1-800-367-2229)
    • Visit the CDC website Diseases and Conditions

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