Communicable Diseases and Exclusion from Child Care
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.
| Disease | Overview | Symptoms | Prevention | Exclusion |
|---|---|---|---|---|
| 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* within 24 hours - 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 | - Vaccination - Avoid being exposed to anyone who is sick - Wearing a well-fitting mask - Regular and thorough handwashing | - Contact Local Health Department* - For current guidance: Child Care Strong NC Public Health Toolkit |
| 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 (Clostridium difficile, C diff) | Infection caused by spore- and toxin-forming bacteria. | - Diarrhea - Abdominal pain - Fever | - Proper surface disinfection - Regular and thorough handwashing (hand sanitizers are not effective against spores) | - 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: - Two consecutive negative stool cultures collected 24 hours apart and not sooner than 48 hours after completion of antibiotics - 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 OR - Cleared by local health department for Salmonella Typhi (Typhoid fever) |
| 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 AND one negative stool culture collected not sooner than 48 hours after completion of antibiotic - Cleared for readmission by local health department |
| 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/AIDS | Viral 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 |
| Impetigo | Infection 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 |
| Influenza | Infection 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 Contagiosum | Skin 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 |
| Pneumonia | Bacterial 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 |
| Ringworm | Infection 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 at the end of the day and 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 | Exclude until treatment started |
| Scarlet Fever | Infections 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 Throat | Infections 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 |
* § 130A-136. School principals and child care operators to report.
A principal of a school and an operator of a child care facility, as defined in G.S. 110-86(3), who has reason to suspect that a person within the school or child care facility has a communicable disease or communicable condition, must contact the local health department in the county or district in which the school or facility is located.
References:
- Chapter 9, Child Care Rules:
- .0804 Infectious and Contagious Diseases
- .1720 Medication Requirements
- Managing Infectious Diseases in Child Care and Schools, A Quick Reference Guide, 4th Edition, American Academy of Pediatrics
- North Carolina Administrative Code: Title 10A Health and Human Services, Chapter 41 Epidemiology Health.
- For more specific information:
- Call a local Child Care Health Consultant
- Call your Local Health Department
- Visit the CDC website Diseases and Conditions