Staying Healthy in Child Care - National Health and Medical ...
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<strong>Stay<strong>in</strong>g</strong> <strong><strong>Health</strong>y</strong><br />
<strong>in</strong> <strong>Child</strong> <strong>Care</strong><br />
Prevent<strong>in</strong>g <strong>in</strong>fectious diseases <strong>in</strong> child care<br />
4 th edition (draft)<br />
(12 August 2005)<br />
Draft for Public Consultation
Contents<br />
Part 1<br />
How <strong>in</strong>fections are spread……………………………………………………..... 2<br />
Watch<strong>in</strong>g for <strong>and</strong> record<strong>in</strong>g <strong>in</strong>fections <strong>in</strong> children……………………………... 5<br />
A child with a fever…………………………………………………………….. 6<br />
Adm<strong>in</strong>istration of medication…………………………………………………... 9<br />
Medication permission form………………………………………………….... 11<br />
Exclusion of sick children <strong>and</strong> staff…………………………………………….. 12<br />
Recommended m<strong>in</strong>imum exclusion periods……………………………………. 13<br />
H<strong>and</strong> wash<strong>in</strong>g…………………………………………………………………… 18<br />
Nappy chang<strong>in</strong>g <strong>and</strong> toilet<strong>in</strong>g…………………………………………………... 21<br />
Clean<strong>in</strong>g the centre…………………………………………………………….... 24<br />
Deal<strong>in</strong>g with spills of blood, faeces, vomit, ur<strong>in</strong>e <strong>and</strong> nasal discharge………… 28<br />
S<strong>and</strong>pits…………………………………………………………………………. 30<br />
Animals…………………………………………………………………………. 31<br />
Immunisation…………………………………………………………………… 32<br />
Australian St<strong>and</strong>ard Vacc<strong>in</strong>ation Schedule……………………………………... 37<br />
Comparison of effects of vacc<strong>in</strong>es <strong>and</strong> diseases………………………………... 39<br />
Parent Advice Sheet…………………………………………………………….. 41<br />
Food safety……………………………………………………………………… 44<br />
Occupational health for child care workers…………………………………...... 47<br />
Part 2 Respiratory compla<strong>in</strong>ts<br />
Asthma………………………………………………………………………….. 51<br />
Bronchiolitis…………………………………………………………………….. 53<br />
Bronchitis……………………………………………………………………….. 55<br />
Common cold…………………………………………………………………… 57<br />
Croup……………………………………………………………………………. 59<br />
Ear <strong>in</strong>fections…………………………………………………………………… 61<br />
Influenza………………………………………………………………………… 63<br />
Pneumococcal disease…………………………………………………………... 65<br />
Runny noses (with green or yellow discharge)…………………………………. 67<br />
Sore throats <strong>and</strong> streptococcal sore throat (strep throat)………………………... 68<br />
Tuberculosis…………………………………………………………………….. 70<br />
Whoop<strong>in</strong>g cough………………………………………………………………... 72<br />
Part 3 Gastro<strong>in</strong>test<strong>in</strong>al compla<strong>in</strong>ts<br />
Campylobacter………………………………………………………………….. 74<br />
Cryptosporidiosis……………………………………………………………….. 76<br />
Diarrhoea <strong>and</strong> vomit<strong>in</strong>g………………………………………………………… 78<br />
Giardiasis……………………………………………………………………….. 81<br />
Norovirus……………………………………………………………………….. 83<br />
Rotavirus………………………………………………………………………... 85<br />
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Salmonella………………………………………………………………………. 87<br />
Shigellosis………………………………………………………………………. 89<br />
Worms<br />
Hydatid disease…………………………………………………………. 90<br />
P<strong>in</strong>worm………………………………………………………………… 91<br />
Roundworm, hookworm <strong>and</strong> tapeworm………………………………… 93<br />
Part 4 Sk<strong>in</strong> compla<strong>in</strong>ts<br />
General notes on rashes…………………………………………...…………….. 94<br />
Chickenpox……………………………………………………………………... 95<br />
Cold sores………………………………………………………………………. 97<br />
Parvovirus B19 (Erythema <strong>in</strong>fectiosum, slapped cheek syndrome, fifth disease) 99<br />
H<strong>and</strong>, foot <strong>and</strong> mouth disease………………………………………………….. 100<br />
Head lice………………………………………………………………………... 101<br />
Measles…………………………………………………………………………. 105<br />
Molluscum contagiosum………………………………………………………... 107<br />
Fungal <strong>in</strong>fections of the scalp, sk<strong>in</strong> or nails (r<strong>in</strong>gworm, t<strong>in</strong>ea, athlete’s foot)…. 108<br />
Roseola………………………………………………………………………….. 110<br />
Rubella………………………………………………………………………….. 111<br />
Scabies <strong>and</strong> other mites caus<strong>in</strong>g sk<strong>in</strong> disease…………………………………... 113<br />
Scarlet fever…………………………………………………………………….. 115<br />
School sores…………………………………………………………………….. 116<br />
Thrush…………………………………………………………………………... 117<br />
Warts…………………………………………………………………...……….. 118<br />
Part 5 Other compla<strong>in</strong>ts<br />
Conjunctivitis…………………………………………………………………… 120<br />
Cytomegalovirus (CMV)……………………………………………………….. 122<br />
Gl<strong>and</strong>ular fever…………………………………………………………………. 124<br />
Haemophilus <strong>in</strong>fluenzae type B (Hib)………………………………………….. 125<br />
Hepatitis A……………………………………………………………………… 127<br />
Hepatitis B………………………………………………………………………. 129<br />
Hepatitis C………………………………………………………………………. 131<br />
HIV……………………………………………………………………………… 133<br />
Men<strong>in</strong>gococcal <strong>in</strong>fection………………………………………………………... 135<br />
Mumps………………………………………………………………………….. 137<br />
Toxoplasmosis………………………………………………………………….. 138<br />
Viral men<strong>in</strong>gitis…………………………….…………………………………… 139<br />
Glossary of terms……………….……………………………………….. 140<br />
Useful Websites…………………………………………………………... 143<br />
References.............................................................................. 145<br />
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Prevent<strong>in</strong>g Illness<br />
Infections are common <strong>in</strong> children <strong>and</strong> often lead to illness. At home, children are<br />
reasonably well protected from <strong>in</strong>fectious diseases because they don’t come <strong>in</strong> contact<br />
with many people. The adults they meet are generally immune to many childhood<br />
illnesses because they had them as children. Because of this immunity, adults cannot<br />
transmit those <strong>in</strong>fections to children. When children spend time <strong>in</strong> child care or other<br />
facilities <strong>and</strong> are exposed to a large number of children for some time, <strong>in</strong>fectious diseases<br />
spread.<br />
It is not possible to prevent the spread of all <strong>in</strong>fections <strong>and</strong> illnesses with<strong>in</strong> centres.<br />
However, a lot of illnesses from <strong>in</strong>fectious disease can be prevented.<br />
You can reduce illness. There is good evidence that the <strong>in</strong>fection control methods that are<br />
recommended <strong>in</strong> this section reduce illness <strong>in</strong> children <strong>in</strong> care. The methods <strong>in</strong>itially<br />
seem to be time consum<strong>in</strong>g, but they quickly become part of acceptable daily rout<strong>in</strong>e.<br />
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How <strong>in</strong>fections spread<br />
There are four steps to the spread of <strong>in</strong>fections<br />
1. The person with the <strong>in</strong>fection spreads the germ <strong>in</strong>to their environment.<br />
2. The germ must survive <strong>in</strong> the appropriate environment e.g. air, food, water, on<br />
objects <strong>and</strong> surfaces.<br />
3. The germ is then passed to another person.<br />
4. The next person becomes <strong>in</strong>fected.<br />
1. The person who has the <strong>in</strong>fection<br />
This child or adult may or may not show any signs of illness. They may be <strong>in</strong>fectious<br />
before they become unwell, dur<strong>in</strong>g their illness, after they have recovered, or without any<br />
signs of illness at all.<br />
For example, <strong>in</strong> cases of diarrhoea due to Giardia, children <strong>and</strong> staff who no longer have<br />
diarrhoea may still have <strong>in</strong>fectious Giardia <strong>in</strong> their bowel motions. For this reason, the<br />
<strong>in</strong>fection control process must always be followed by all people <strong>in</strong> the child care centre.<br />
2. The germ must survive <strong>in</strong> the environment<br />
Infectious illnesses may be due to viruses, bacteria, protozoa or fungi. All of these<br />
organisms are too small to see with the naked eye. These germs can survive on h<strong>and</strong>s <strong>and</strong><br />
objects, for example toys, door h<strong>and</strong>les <strong>and</strong> bench tops. The length of time a germ may<br />
survive on a surface depends on the germ itself, the type of surface it has contam<strong>in</strong>ated<br />
<strong>and</strong> how often the surface is cleaned. Wash<strong>in</strong>g with detergent <strong>and</strong> water is a very<br />
effective way of remov<strong>in</strong>g germs.<br />
3. The germ is then passed to another person<br />
Germs can be transmitted <strong>in</strong> a number of ways, <strong>in</strong>clud<strong>in</strong>g through the air by droplets;<br />
through contact with faeces <strong>and</strong> then contact with mouths; through direct contact with<br />
sk<strong>in</strong>; <strong>and</strong> through contact with other body secretions (such as ur<strong>in</strong>e, saliva, discharges or<br />
blood).<br />
Airborne droplets from nose <strong>and</strong> throat<br />
Some <strong>in</strong>fections are spread when an <strong>in</strong>fected person sneezes or coughs out t<strong>in</strong>y airborne<br />
droplets. The droplets <strong>in</strong> the air may be breathed <strong>in</strong> directly by another person, or<br />
<strong>in</strong>directly enter another person through contact with surfaces <strong>and</strong> h<strong>and</strong>s with the droplets<br />
on them 1 .<br />
Examples…<br />
• Chickenpox • Mumps<br />
• Common cold • Streptococcal sore throat<br />
• Diphtheria • Heamophilus <strong>in</strong>fluenzae type b (Hib)<br />
• Influenza • Measles<br />
• Whoop<strong>in</strong>g cough (Pertussis) • Tuberculosis<br />
• Pneumococcal disease • Rubella<br />
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• Men<strong>in</strong>gitis (bacterial) <strong>in</strong>clud<strong>in</strong>g men<strong>in</strong>gococcal <strong>in</strong>fection<br />
• Parvovirus <strong>in</strong>fection (human parvovirus <strong>in</strong>fection, parvovirus B19 <strong>in</strong>fection,<br />
slapped cheek, slapped face, erythema <strong>in</strong>fectiosum, fifth disease)<br />
Faecal-oral<br />
Some <strong>in</strong>fections are spread when microscopic amounts of faeces from an <strong>in</strong>fected person<br />
are taken <strong>in</strong> by another person by mouth. An <strong>in</strong>fected person doesn’t necessarily have<br />
symptoms of their illness. The faeces may be passed directly from soiled h<strong>and</strong>s to mouth<br />
or <strong>in</strong>directly by way of objects, surfaces, food or water soiled with faeces.<br />
Examples…<br />
• Campylobacter <strong>in</strong>fection • Rotavirus <strong>in</strong>fection<br />
• Cryptosporidiosis • Salmonella <strong>in</strong>fection<br />
• Giardiasis • Thrush<br />
• H<strong>and</strong>, foot <strong>and</strong> mouth disease • Shigella <strong>in</strong>fection<br />
• Hepatitis A • Viral gastroenteritis<br />
• Worms<br />
Sk<strong>in</strong> or mucous membrane (l<strong>in</strong><strong>in</strong>g of nose <strong>and</strong> mouth) contact<br />
Some <strong>in</strong>fections are spread directly when secretions come <strong>in</strong>to contact with mucous<br />
membrane or broken sk<strong>in</strong>. Infections are spread <strong>in</strong>directly when mucous membranes or<br />
broken sk<strong>in</strong> come <strong>in</strong> contact with contam<strong>in</strong>ated objects.<br />
Examples…<br />
• Chicken pox • Cold sores (herpes simplex)<br />
• Conjunctivitis • H<strong>and</strong>, foot <strong>and</strong> mouth disease<br />
• Molluscum contagiosum • R<strong>in</strong>gworm<br />
• School sores (Impetigo) • Staphylococcus aureus<br />
• Thrush • Warts (common, flat <strong>and</strong> plantar)<br />
Saliva<br />
Some <strong>in</strong>fections are spread by direct contact with saliva (such as kiss<strong>in</strong>g) or <strong>in</strong>direct<br />
contact with contam<strong>in</strong>ated objects (children suck<strong>in</strong>g <strong>and</strong> shar<strong>in</strong>g toys).<br />
Examples…<br />
• Gl<strong>and</strong>ular fever (Mononucleosis) • Cytomegalovirus <strong>in</strong>fection (CMV)<br />
Ur<strong>in</strong>e<br />
Some <strong>in</strong>fections are spread when ur<strong>in</strong>e is transferred from soiled h<strong>and</strong>s or objects to the<br />
mouth.<br />
Example…<br />
• Cytomegalovirus (CMV)<br />
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Blood<br />
Some <strong>in</strong>fections are spread when blood from an <strong>in</strong>fected person comes <strong>in</strong>to direct contact<br />
through broken or abraded sk<strong>in</strong> or with the mucous membranes of another person. The<br />
transmission of these <strong>in</strong>fections is extremely unlikely <strong>in</strong> the child care sett<strong>in</strong>g.<br />
Examples…<br />
• Hepatitis B • Hepatitis C<br />
• Human Immunodeficiency Virus (HIV)<br />
4. The next person becomes <strong>in</strong>fected<br />
When the germ has reached the next person it must f<strong>in</strong>d a way to enter the body. It can<br />
enter through the mouth, <strong>in</strong>test<strong>in</strong>al tract, nose, lungs, mucosa of eyes, genitals or through<br />
a sore or broken <strong>and</strong> abraded sk<strong>in</strong>. Whether a person develops illness after this germ has<br />
entered the body depends on both the germ <strong>and</strong> the person’s immunity. We can prevent<br />
illness at this stage by prevent<strong>in</strong>g entry to the body (for example, by mak<strong>in</strong>g sure all toys<br />
that children put <strong>in</strong> their mouths are clean, wash<strong>in</strong>g children’s h<strong>and</strong>s, cover<strong>in</strong>g wounds)<br />
<strong>and</strong> by immunisation.<br />
How easily are diseases spread <strong>in</strong> a child care centre<br />
Some viruses such as measles <strong>and</strong> norovirus are very <strong>in</strong>fectious <strong>and</strong> will very easily<br />
<strong>in</strong>fect non-immune people. Measles virus can rema<strong>in</strong> airborne for up to 2 hours after a<br />
person has left a room so that further people are exposed. Norovirus is a very common<br />
cause of diarrhoea <strong>and</strong> can <strong>in</strong>fect 50% or more of people <strong>in</strong> a group.<br />
At the other end of the extreme, hepatitis B, hepatitis C <strong>and</strong> HIV are very difficult to<br />
spread <strong>in</strong> a child care sett<strong>in</strong>g.<br />
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Watch<strong>in</strong>g for <strong>and</strong> record<strong>in</strong>g <strong>in</strong>fections <strong>in</strong> children<br />
Check<strong>in</strong>g for symptoms of illness<br />
Because you care for the children <strong>in</strong> your group every day, you are probably used to the<br />
way each of them looks <strong>and</strong> behaves when they are healthy. This will help you to notice<br />
quickly when one of them is sick.<br />
Symptoms<br />
Be aware of symptoms of illness throughout the day. These are some of the th<strong>in</strong>gs to look<br />
for:<br />
• severe, persistent or prolonged cough<strong>in</strong>g (child goes red or blue <strong>in</strong> the face, <strong>and</strong><br />
makes a high-pitched croupy or whoop<strong>in</strong>g sound after cough<strong>in</strong>g)<br />
• breath<strong>in</strong>g trouble (particularly <strong>in</strong> babies under 6 months old)<br />
• yellowish sk<strong>in</strong> or eyes<br />
• conjunctivitis (tears, eyelid l<strong>in</strong><strong>in</strong>g is red, irritated eyes, followed by swell<strong>in</strong>g <strong>and</strong><br />
discharge of pus from eyes)<br />
• unusual spots or rashes<br />
• patch of <strong>in</strong>fected sk<strong>in</strong> (crusty sk<strong>in</strong> or discharg<strong>in</strong>g yellow area of sk<strong>in</strong>)<br />
• feverish appearance<br />
• unusual behaviour (child is cranky or less active than usual, cries more than usual,<br />
seems uncomfortable or just seems unwell)<br />
• frequent scratch<strong>in</strong>g of the scalp or sk<strong>in</strong><br />
• grey or very pale faeces<br />
• unusually dark, tea-coloured ur<strong>in</strong>e<br />
• sore throat or difficulty <strong>in</strong> swallow<strong>in</strong>g<br />
• headache, stiff neck<br />
• vomit<strong>in</strong>g<br />
• loss of appetite<br />
• diarrhoea (an <strong>in</strong>crease <strong>in</strong> the frequency, runn<strong>in</strong>ess or volume of the faeces)<br />
• mucus discharge from the nose (thick, green or bloody)<br />
What to do if a child seems unwell<br />
• Tell the director <strong>and</strong> the parents<br />
• Separate the child from the other children<br />
• Take the child’s temperature if you th<strong>in</strong>k they may have a fever<br />
• Rem<strong>in</strong>d a child who is cough<strong>in</strong>g or sneez<strong>in</strong>g to cough <strong>in</strong>to their elbow. This<br />
reduces the risk of the child then contam<strong>in</strong>at<strong>in</strong>g other children <strong>and</strong> their<br />
surround<strong>in</strong>gs. If the child covers their mouth with their h<strong>and</strong>s, ask the child to<br />
wash their h<strong>and</strong>s afterwards<br />
• If you wipe a child’s nose, dispose of the tissue <strong>in</strong> a plastic-l<strong>in</strong>ed rubbish b<strong>in</strong>, <strong>and</strong><br />
then wash your h<strong>and</strong>s<br />
• If you touch a child who might be sick, avoid touch<strong>in</strong>g other children until after<br />
you have washed your h<strong>and</strong>s<br />
• Keep moist sk<strong>in</strong> conditions <strong>and</strong> abrasions covered<br />
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• Encourage parents to tell you when anyone <strong>in</strong> the family is ill. If someone <strong>in</strong> the<br />
family is sick, watch for signs of illness <strong>in</strong> the child<br />
A child with a fever<br />
All children will occasionally have an elevated temperature (fever) 2 . Hav<strong>in</strong>g a fever is<br />
one of the commonest reasons for children to see a doctor <strong>and</strong> it is one of the symptoms<br />
that cause most worries for parents. The def<strong>in</strong>ition of a fever is an oral (mouth)<br />
temperature greater than 37.5°C or an axillary (armpit) temperature greater than 37°C.<br />
Normal body temperature may vary quite considerably accord<strong>in</strong>g to the age of the child<br />
<strong>and</strong> the time of day. To take a child’s temperature, it is safest to place the thermometer<br />
under the child’s arm, with the thermometer <strong>in</strong> direct contact with the sk<strong>in</strong> for at least<br />
three m<strong>in</strong>utes.<br />
Br<strong>in</strong>g<strong>in</strong>g a temperature down<br />
Paracetamol is often given to ‘br<strong>in</strong>g a fever down’. There is no doubt that fever can make<br />
a child (or an adult) feel miserable, quite apart from the symptoms of the condition<br />
caus<strong>in</strong>g the fever. Many people worry as soon as a child gets a fever, <strong>and</strong> th<strong>in</strong>k they must<br />
immediately try to br<strong>in</strong>g it down. This is usually unnecessary as fever <strong>in</strong> itself is not<br />
harmful. Fever is a sign that suggests there is an <strong>in</strong>fection, <strong>and</strong> is a sign that the body is<br />
fight<strong>in</strong>g the <strong>in</strong>fection 3 . Fever is one of the mechanisms the body uses to get rid of germs.<br />
There is some evidence that giv<strong>in</strong>g medications to reduce the fever can <strong>in</strong> fact slow the<br />
body’s immune response to <strong>in</strong>fection. In most <strong>in</strong>stances we should not be worry<strong>in</strong>g about<br />
treat<strong>in</strong>g the fever itself – we should be focus<strong>in</strong>g our attention of the way the child looks,<br />
behaves, the level of alertness <strong>and</strong> whether there are any other symptoms such as<br />
vomit<strong>in</strong>g or cough. Many paediatricians would argue that we are giv<strong>in</strong>g young children<br />
too much paracetamol.<br />
Paracetamol is safe when given <strong>in</strong> recommended doses, but an overdose can cause liver<br />
failure. It is very important to read the label carefully as paracetamol for children comes<br />
<strong>in</strong> different strengths <strong>and</strong> formulations. It is essential that the dosage is appropriate for the<br />
weight of the child. Follow the <strong>in</strong>structions on the bottle or box.<br />
Ibubrofen is another over-the-counter medication that is sometimes used as an alternative<br />
to paracetamol. This is also relatively safe, although it is to be avoided <strong>in</strong> the vomit<strong>in</strong>g<br />
child or when the child has asthma.<br />
Aspir<strong>in</strong> should never be given to children because of its side effects. It can cause stomach<br />
upset, gastric bleed<strong>in</strong>g <strong>and</strong> is associated with a rare but potentially fatal condition called<br />
Reye Syndrome.<br />
If a child has a fever, ensure the child dr<strong>in</strong>ks plenty of fluids <strong>and</strong> they are not<br />
overdressed. Avoid cold-water spong<strong>in</strong>g or cold baths that make the child shiver. If<br />
spong<strong>in</strong>g/bath<strong>in</strong>g will make the child feel more comfortable, use lukewarm water.<br />
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Keep<strong>in</strong>g records<br />
The director should keep a record of any illness at the centre. Remember to record illness<br />
<strong>in</strong> both staff <strong>and</strong> children. It is important to record which part of the centre the child or<br />
adult was <strong>in</strong> for most of the day. A sample record is shown on page 7.<br />
Keep<strong>in</strong>g records can be a factor <strong>in</strong> prevent<strong>in</strong>g the spread of <strong>in</strong>fection. Records show you<br />
when your approach to <strong>in</strong>fection control is work<strong>in</strong>g. They are <strong>in</strong>valuable <strong>in</strong> help<strong>in</strong>g you<br />
<strong>and</strong> public health workers identify the cause of any outbreak <strong>and</strong> how to control it.<br />
Report<strong>in</strong>g to the parent <strong>and</strong> doctor<br />
It may be useful for the parents <strong>and</strong> the child’s doctor to have written <strong>in</strong>formation on the<br />
child’s illness. A sample report form is given on page 8. A photocopy of this form should<br />
be kept <strong>in</strong> the child’s file.<br />
Sample record of illness <strong>in</strong> the centre<br />
Name Age Symptoms Room or Date Time of<br />
Group<br />
onset<br />
John Smith 2 Rash on head <strong>and</strong> neck Toddlers 16/1/94 2 p.m.<br />
Amy<br />
Johnson<br />
6<br />
months<br />
Fever, runny nose Babies 17/1/94 1.30 p.m.<br />
Jason Brown 4 Weep<strong>in</strong>g eye Pre-school 17/1/94 4 p.m.<br />
June Jones Staff Weep<strong>in</strong>g eye Pre-school 17/1/94 5 p.m.<br />
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Comments<br />
Remember<br />
Symptoms Record what you see as best you can.<br />
When Record when you first noticed the illness. You may wish to <strong>in</strong>clude further<br />
<strong>in</strong>formation, for example, the action taken (exclusion for four days, review of nappy<br />
chang<strong>in</strong>g practices etc.) <strong>and</strong> the doctor’s diagnosis.
Sample report form for parent/doctor<br />
Make copies of this letter for easy use<br />
<strong>Child</strong> <strong>Care</strong> Centre: ________________________________________________________<br />
Address: ________________________________________________________________<br />
Contact person: __________________________________________________________<br />
Phone: _________________________________________________________________<br />
Dear Parent/Doctor,<br />
Re: (child’s name) ________________________________Date of birth: ____/____/____<br />
<strong>Child</strong> has: (comments, <strong>in</strong>clud<strong>in</strong>g time observed, number of times, severity)<br />
Vomit<strong>in</strong>g<br />
Diarrhoea<br />
Rash (description of rash <strong>and</strong> where rash started)<br />
Other<br />
There has/has not been recent similar illness <strong>in</strong> other children <strong>in</strong> the centre.<br />
The diagnosis <strong>in</strong> the other children was:<br />
The child’s temperature was ____° C taken under the child’s arm at ___________(time).<br />
The child has eaten_______________________________________________________<br />
The child has drunk ______________________________________________________<br />
The child last passed ur<strong>in</strong>e at ____________ (time).<br />
Parent contacted by_____________________________________ at __________ (time).<br />
Signed:<br />
_________________________________________________________________<br />
Date: ___________ Time_________<br />
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Adm<strong>in</strong>istration of medication<br />
Adm<strong>in</strong>ister<strong>in</strong>g medication to children at the request of their parents is a task that requires<br />
attention to detail, meticulous record keep<strong>in</strong>g, team work <strong>and</strong> common sense. It is a<br />
responsibility that must be taken seriously, due to the potential health risks, <strong>and</strong> litigation<br />
issues that may arise as a result of <strong>in</strong>correct adm<strong>in</strong>istration.<br />
In the <strong>in</strong>terest of children’s safety <strong>and</strong> well-be<strong>in</strong>g, the centre should only adm<strong>in</strong>ister<br />
medication if the medication is <strong>in</strong> its orig<strong>in</strong>al conta<strong>in</strong>er with the pharmacy label attached<br />
list<strong>in</strong>g the child as the prescribed person <strong>and</strong> the dosage to be given. This applies to all<br />
medications; regardless of whether they are non-prescribed (such as teeth<strong>in</strong>g gels, nappy<br />
creams, cough medic<strong>in</strong>es etc) or prescribed (antibiotics etc).<br />
An example of a Medication Permission Form is provided on page 11.<br />
Responsibilities of child care providers/staff<br />
• Dur<strong>in</strong>g orientation clearly expla<strong>in</strong> to parents the centre’s policy for adm<strong>in</strong>ister<strong>in</strong>g<br />
medication, <strong>in</strong>clud<strong>in</strong>g paracetamol. It is important that parents underst<strong>and</strong> both<br />
the centre’s expectations <strong>and</strong> the parents’ responsibilities prior to the child<br />
becom<strong>in</strong>g ill.<br />
• Expla<strong>in</strong> to all parents the centre is unable to adm<strong>in</strong>ister medication unless it is <strong>in</strong><br />
its orig<strong>in</strong>al conta<strong>in</strong>er with the pharmaceutical label attached list<strong>in</strong>g the child as the<br />
prescribed person <strong>and</strong> the dosage to be given.<br />
• Ensure parents fully complete the daily medication record form.<br />
• Ensure parents deliver medication to a staff member, so that it can be stored<br />
securely (out of children’s access) <strong>and</strong> at the recommended temperature (eg <strong>in</strong> the<br />
fridge, cupboard etc). It is vital that medication is not left <strong>in</strong> the children’s bags<br />
where children may ga<strong>in</strong> access.<br />
• Ensure medication is adm<strong>in</strong>istered promptly at the prescribed <strong>in</strong>tervals.<br />
• Check before adm<strong>in</strong>ister<strong>in</strong>g. All medication must be checked by two staff<br />
members before be<strong>in</strong>g adm<strong>in</strong>istered to children <strong>in</strong> care.<br />
• Two signatures required. The medication record form is to be signed by the<br />
person adm<strong>in</strong>ister<strong>in</strong>g the medication <strong>and</strong> the person who has cross checked that<br />
the correct medication <strong>and</strong> dose has been given to the correct person at the right<br />
time.<br />
• Advise parents that the centre is unable to adm<strong>in</strong>ister a medication at a different<br />
dosage or frequency other than that recommended on the medication label, unless<br />
alternative written advice is received from a medical practitioner.<br />
• Advise parents that the centre will not adm<strong>in</strong>ister medication that is labelled for<br />
another person or that is past the recommended ‘use by’ date.<br />
• Use of nebulisers is permitted provid<strong>in</strong>g parents demonstrate their use to staff to<br />
ensure correct adm<strong>in</strong>istration.<br />
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Responsibilities of parents<br />
• Complete/review a medication permission form at least weekly when the child<br />
attends <strong>and</strong> medication is required. These forms should <strong>in</strong>clude details such as the<br />
name of the child, the name of the medication, dosage, storage requirements, how<br />
it is to be adm<strong>in</strong>istered (eg ear drops, oral medic<strong>in</strong>e, nebuliser etc) <strong>and</strong> how often<br />
it is to be adm<strong>in</strong>istered.<br />
• H<strong>and</strong> the medication <strong>and</strong> the medication record form to the child carer upon<br />
arrival at the centre. Parents must not leave medication <strong>in</strong> the child’s bag.<br />
• Collect medication on departure from the centre.<br />
• Confirm the child was given the required medication by speak<strong>in</strong>g with the group<br />
leader on collection of the child.<br />
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Medication Permission Form<br />
In the <strong>in</strong>terest of children’s safety <strong>and</strong> well-be<strong>in</strong>g, the Centre shall only adm<strong>in</strong>ister<br />
medication if it is <strong>in</strong> its orig<strong>in</strong>al conta<strong>in</strong>er with the pharmaceutical label attached list<strong>in</strong>g<br />
the child as the prescribed person, strength of drug <strong>and</strong> the frequency it is to be given.<br />
This applies to all medications, regardless of whether they are non-prescribed (such as<br />
teeth<strong>in</strong>g gels, nappy creams, cough medic<strong>in</strong>es, etc) or prescribed (antibiotics etc).<br />
<strong>Child</strong>’s full name:<br />
<strong>Medical</strong> Practitioner/Chemist etc:<br />
Medication:<br />
Name of medication<br />
Date prescribed<br />
Reason for medication<br />
Storage requirements<br />
Time <strong>and</strong> date of last dose given<br />
I request that the above medication be given <strong>in</strong> accordance with the <strong>in</strong>struction below:<br />
(Please complete table <strong>and</strong> list any further <strong>in</strong>structions here).<br />
Further <strong>in</strong>structions:<br />
Parent’s full name<br />
Signature<br />
Date Dosage Time to<br />
be given<br />
Time medication<br />
actually given<br />
Signature of staff<br />
adm<strong>in</strong>ister<strong>in</strong>g<br />
medication<br />
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Signature of staff<br />
cross check<strong>in</strong>g<br />
medication<br />
Comments
Exclusion of sick children <strong>and</strong> staff<br />
Exclud<strong>in</strong>g sick children <strong>and</strong> staff is probably the most important way of limit<strong>in</strong>g the<br />
spread of <strong>in</strong>fection <strong>in</strong> the child care centre. The spread of certa<strong>in</strong> <strong>in</strong>fectious diseases can<br />
be reduced by exclud<strong>in</strong>g a person who is known to be <strong>in</strong>fectious, from contact with others<br />
who are at risk of catch<strong>in</strong>g the <strong>in</strong>fection.<br />
Parents may f<strong>in</strong>d an exclusion rul<strong>in</strong>g difficult <strong>and</strong> some parents may place great pressure<br />
on the director to vary from the centre’s exclusion rules. Often these parents are under<br />
great pressure themselves to fulfil work, study or other family commitments. This may<br />
lead to stress <strong>and</strong> conflict between parents <strong>and</strong> centre staff.<br />
The best way to avoid conflict is to have a written policy that clearly states the centre’s<br />
exclusion criteria. This policy should state the m<strong>in</strong>imum periods recommended by the<br />
<strong>National</strong> <strong>Health</strong> <strong>and</strong> <strong>Medical</strong> Research Council (NHMRC). This policy should also state<br />
any additional conditions or exclusion periods your centre may have. Give the policy to<br />
all parents <strong>and</strong> staff when they first jo<strong>in</strong> the centre.<br />
Directors should not be <strong>in</strong>fluenced by letters from doctors which allow the child back <strong>in</strong>to<br />
care, unless the child’s condition fulfils the criteria for return to care. Sometimes doctors<br />
make different diagnoses for children <strong>in</strong> the same centre with illnesses that appear<br />
similar. Your local public health authority should be able to help you with these situations<br />
or when you are <strong>in</strong> doubt about exclusion.<br />
Whenever you exclude a child take the opportunity to review your <strong>in</strong>fection control<br />
techniques with all child carers. In particular, check h<strong>and</strong> wash<strong>in</strong>g is be<strong>in</strong>g done as<br />
recommended <strong>in</strong> this book.<br />
Involvement of parents<br />
Provide parents with a copy of the centre’s policies on immunisation, medication,<br />
<strong>in</strong>fection control (hygiene) <strong>and</strong> exclusion when the child is enrolled. Encourage parents<br />
to return <strong>and</strong> discuss these policies with you. The exclusion policy is the policy most<br />
likely to cause concern. Make sure that parents underst<strong>and</strong> why the centre has an<br />
exclusion policy.<br />
Most parents will appreciate your attempts to prevent illness <strong>in</strong> their children. In<br />
particular, it is important that parents support the centre’s policies on cleanl<strong>in</strong>ess. Ask<br />
parents to encourage their children to wash their h<strong>and</strong>s on arrival at the centre <strong>and</strong> when<br />
leav<strong>in</strong>g.<br />
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The need for exclusion depends upon:<br />
• The ease with which the <strong>in</strong>fection can be spread<br />
• The ability of the <strong>in</strong>fected person to follow hygiene precautions<br />
• The severity of the disease 4<br />
The exclusion procedure<br />
• Identify when symptoms or a diagnosis fit a condition with an exclusion period<br />
• Refer to the table on page 13 for the recommended m<strong>in</strong>imum periods of exclusion<br />
• Advise the parents or staff member when they may return to the centre<br />
Recommended exclusion periods are based on the time that a person with a specific<br />
disease or condition is likely to be <strong>in</strong>fectious.<br />
Recommended ‘Not excluded’ means there is not a significant risk of transmitt<strong>in</strong>g<br />
<strong>in</strong>fection to others.<br />
The follow<strong>in</strong>g are recommended m<strong>in</strong>imum periods of exclusion based on risk of <strong>in</strong>fection<br />
but a child or staff member may need to stay at home longer than the exclusion period to<br />
recover from an illness.<br />
Recommended m<strong>in</strong>imum exclusion periods for<br />
<strong>in</strong>fectious conditions for school, pre-schools <strong>and</strong> child<br />
care centres<br />
<strong>Child</strong>ren who are physically unwell should stay home from school,<br />
pre-school <strong>and</strong> child care centres.<br />
Def<strong>in</strong>ition of ‘Contacts’ will vary accord<strong>in</strong>g to disease. Please refer to specific Fact Sheet<br />
for def<strong>in</strong>ition of ‘Contacts’. (Fact sheets are listed <strong>in</strong> the contents pages of the manual).<br />
Different exclusion periods will apply to people whose work <strong>in</strong>volves food h<strong>and</strong>l<strong>in</strong>g: if<br />
they have vomit<strong>in</strong>g <strong>and</strong>/or diarrhoea they should not return to work until they have been<br />
symptom-free for 48 hours <strong>and</strong> do not have loose bowel actions 5 . For some conditions<br />
such as Campylobacter <strong>and</strong> Giardia, even though the organism may still found <strong>in</strong> the<br />
bowel actions, children may be able to return to the child care centre 24 hours after the<br />
diarrhoea has ceased. This is because the number of organisms will be less <strong>and</strong> it will be<br />
possible for good hygiene to be effectively ma<strong>in</strong>ta<strong>in</strong>ed.<br />
Condition Exclusion of Case Exclusion of Contacts<br />
Amoebiasis<br />
Exclude until there has not Not excluded<br />
(Entamoeba histolytica) been a loose bowel motion<br />
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for 24 hours<br />
Campylobacter Exclude until there has not<br />
been a loose bowel motion<br />
for 24 hours<br />
C<strong>and</strong>idiasis See ‘Thrush’<br />
Chickenpox (Varicella) Exclude until all blisters have<br />
dried. This is usually at least<br />
5 days after the rash first<br />
appeared <strong>in</strong> unimmunised<br />
children <strong>and</strong> less <strong>in</strong><br />
immunised children. 6<br />
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Not excluded<br />
Any child with an immune<br />
deficiency (for example,<br />
leukaemia) or receiv<strong>in</strong>g<br />
chemotherapy should be<br />
excluded for their own<br />
protection. Otherwise, not<br />
excluded.<br />
CMV<br />
(Cytomegalovirus <strong>in</strong>fection)<br />
Exclusion is NOT necessary Not excluded<br />
Cryptosporidium <strong>in</strong>fection Exclude until there has not<br />
been a loose bowel motion<br />
for 24 hours<br />
Not excluded<br />
Diarrhoea<br />
Exclude until there has not Not excluded<br />
(No organism identified) been a loose bowel motion<br />
for 24 hours<br />
Diphtheria Exclude until medical Exclude contacts who live <strong>in</strong><br />
certificate of recovery is the same house until cleared<br />
received follow<strong>in</strong>g at least 2 to return by an appropriate<br />
negative throat swabs, the<br />
first swab not less than 24<br />
hours after f<strong>in</strong>ish<strong>in</strong>g a course<br />
of antibiotics followed by<br />
another swab 48 hours later.<br />
health authority.<br />
German measles See ‘Rubella’<br />
Giardiasis Exclude until there has not<br />
been a loose bowel motion<br />
for 24 hours<br />
Not excluded<br />
Gl<strong>and</strong>ular fever<br />
(Mononucleosis, EBV<br />
<strong>in</strong>fection)<br />
Exclusion is NOT necessary Not excluded<br />
H<strong>and</strong>, foot <strong>and</strong> mouth disease Exclude until all blisters have<br />
dried.<br />
Not excluded<br />
Haemophilus <strong>in</strong>fluenzae type Exclude until the person has<br />
b (Hib)<br />
received appropriate<br />
antibiotic treatment for at<br />
least 4 days. 7<br />
Not excluded<br />
Head lice (Pediculosis) Exclude until effective<br />
treatment has commenced<br />
Not excluded<br />
Hepatitis A Exclude until a medical<br />
certificate of recovery is<br />
received, but not before<br />
seven days after the onset of<br />
jaundice.<br />
Not excluded<br />
Hepatitis B Exclusion is NOT necessary Not excluded<br />
Hepatitis C Exclusion is NOT necessary Not excluded
Herpes simplex (cold sores,<br />
fever blisters)<br />
Human Immunodeficiency<br />
Virus (HIV/AIDS)<br />
Exclusion is not necessary if<br />
the person is<br />
developmentally capable of<br />
ma<strong>in</strong>ta<strong>in</strong><strong>in</strong>g hygiene<br />
practices to m<strong>in</strong>imise the risk<br />
of transmission. If the person<br />
is unable to comply with<br />
these practices they should<br />
be excluded until the sores<br />
are dry. Sores should be<br />
covered by a dress<strong>in</strong>g where<br />
possible.<br />
Exclusion is NOT necessary.<br />
If the person is severely<br />
immunocompromised, they<br />
will be vulnerable to other<br />
people’s illnesses.<br />
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Not excluded<br />
Not excluded<br />
Hydatid disease Exclusion is NOT necessary Not excluded<br />
Impetigo See ‘School Sores’<br />
Influenza <strong>and</strong> <strong>in</strong>fluenza-like<br />
illnesses<br />
Exclude until well Not excluded<br />
Legionnaires’ disease Exclusion is NOT necessary Not excluded<br />
Leprosy Exclude until approval to<br />
return has been given by an<br />
appropriate health authority<br />
Not excluded<br />
Measles Exclude for 4 days after the Immunised <strong>and</strong> immune<br />
onset of the rash<br />
contacts are not excluded.<br />
Non-immunised contacts of a<br />
case are to be excluded from<br />
child care until 14 days after<br />
the first day of appearance of<br />
rash <strong>in</strong> the last case, unless<br />
immunised with<strong>in</strong> 72 hours<br />
of first contact dur<strong>in</strong>g the<br />
<strong>in</strong>fectious period with the<br />
first case.<br />
All immunocompromised<br />
children should be excluded<br />
until 14 days after the first<br />
day of appearance of rash <strong>in</strong><br />
the last case. 8<br />
Men<strong>in</strong>gitis (bacterial) Exclude until well <strong>and</strong> has<br />
received appropriate<br />
antibiotics<br />
Not excluded<br />
Men<strong>in</strong>gitis (viral) Exclude until well Not excluded<br />
Men<strong>in</strong>gococcal <strong>in</strong>fection Exclude until appropriate<br />
antibiotic treatment has been<br />
completed<br />
Not excluded<br />
Molluscum contagiosum Exclusion is NOT necessary Not excluded<br />
Mumps Exclude for n<strong>in</strong>e days or until Not excluded
Norovirus<br />
swell<strong>in</strong>g goes down<br />
(whichever is sooner)<br />
Exclude until there has not<br />
been a loose bowel motion<br />
for 48 hours<br />
Parvovirus <strong>in</strong>fection (fifth<br />
disease, erythema<br />
<strong>in</strong>fectiosum, slapped cheek<br />
syndrome)<br />
Exclusion is NOT necessary Not excluded<br />
Pertussis See ‘Whoop<strong>in</strong>g Cough’<br />
Respiratory Syncytial virus Exclusion is NOT necessary Not excluded<br />
R<strong>in</strong>gworm/t<strong>in</strong>ea Exclude until the day after<br />
appropriate antifungal<br />
treatment has commenced<br />
Not excluded<br />
Roseola Exclusion is NOT necessary Not excluded<br />
Ross River virus Exclusion is NOT necessary Not excluded<br />
Rotavirus <strong>in</strong>fection Exclude until there has not<br />
been a loose bowel motion or<br />
vomit<strong>in</strong>g for 24 hours<br />
Not excluded<br />
Rubella (German measles) Exclude until fully recovered<br />
or for at least four days after<br />
the onset of the rash<br />
Not excluded<br />
Salmonella <strong>in</strong>fection Exclude until there has not<br />
been a loose bowel motion<br />
for 24 hours<br />
Not excluded<br />
Scabies Exclude until the day after<br />
appropriate treatment has<br />
commenced<br />
Not excluded<br />
Scarlet fever See ‘Streptococcal sore<br />
throat’<br />
School sores (impetigo) Exclude until appropriate<br />
antibiotic treatment has<br />
commenced. Any sores on<br />
exposed sk<strong>in</strong> should be<br />
covered with a watertight<br />
dress<strong>in</strong>g.<br />
Not excluded<br />
Shigella <strong>in</strong>fection Exclude until there has not<br />
been a loose bowel motion<br />
for 24 hours<br />
Not excluded<br />
Streptococcal sore throat Exclude until the person has Not excluded<br />
(<strong>in</strong>clud<strong>in</strong>g scarlet fever) received antibiotic treatment<br />
for at least 24 hours <strong>and</strong> feels<br />
well<br />
Thrush (c<strong>and</strong>idiasis) Exclusion is NOT necessary Not excluded<br />
Toxoplasmosis Exclusion is NOT necessary Not excluded<br />
Tuberculosis (TB) Exclude until medical<br />
certificate is produced from<br />
appropriate health authority<br />
Not excluded<br />
Typhoid, Paratyphoid Exclude until medical Not excluded unless<br />
certificate is produced from considered necessary by<br />
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appropriate health authority public health authorities<br />
Varicella See ‘Chickenpox’<br />
Viral gastroenteritis (viral Exclude until there has not Not excluded<br />
diarrhoea)<br />
been a loose bowel motion<br />
for 24 hours<br />
Warts Exclusion is NOT necessary Not excluded<br />
Whoop<strong>in</strong>g cough (pertussis) Exclude until five days after<br />
start<strong>in</strong>g appropriate antibiotic<br />
treatment or for 21 days from<br />
the onset of cough<strong>in</strong>g 9<br />
Contacts that live <strong>in</strong> the same<br />
house as the case <strong>and</strong> have<br />
received less than three doses<br />
of pertussis vacc<strong>in</strong>e are to be<br />
excluded from the centre<br />
until they have had 5 days of<br />
an appropriate course of<br />
antibiotics. If antibiotics have<br />
not been taken, these contacts<br />
must be excluded for 14 days<br />
after their last exposure to the<br />
case while the person was<br />
<strong>in</strong>fectious.<br />
Worms Exclude if diarrhoea present Not excluded<br />
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H<strong>and</strong> wash<strong>in</strong>g<br />
Infections can be spread by a person who shows no signs of illness. H<strong>and</strong> wash<strong>in</strong>g is the<br />
most effective way of controll<strong>in</strong>g <strong>in</strong>fection.<br />
The best way to prevent the transmission of disease is to wash your h<strong>and</strong>s thoroughly.<br />
Educat<strong>in</strong>g staff to wash their h<strong>and</strong>s effectively decreases the amount of disease <strong>in</strong> <strong>in</strong>fants<br />
<strong>and</strong> toddlers. H<strong>and</strong> wash<strong>in</strong>g is effective because it loosens, dilutes <strong>and</strong> flushes off germs<br />
<strong>and</strong> contam<strong>in</strong>ated matter. Use the follow<strong>in</strong>g method to make sure your h<strong>and</strong>s <strong>and</strong> the<br />
children’s h<strong>and</strong>s are as germ-free as possible.<br />
How to wash h<strong>and</strong>s<br />
The process of thoroughly wash<strong>in</strong>g <strong>and</strong> r<strong>in</strong>s<strong>in</strong>g your h<strong>and</strong>s should take 10 – 15 seconds.<br />
This can be achieved by slowly count<strong>in</strong>g to 10 when you wash <strong>and</strong> then slowly count<strong>in</strong>g<br />
to 10 when you r<strong>in</strong>se. This is about as long as it takes to s<strong>in</strong>g ‘Happy Birthday’ twice.<br />
• Use liquid soap <strong>and</strong> runn<strong>in</strong>g water.<br />
• Rub your h<strong>and</strong>s vigorously as you wash them.<br />
• Wash your h<strong>and</strong>s all over. Pay particular attention to wash the palms <strong>and</strong> backs of<br />
h<strong>and</strong>s, <strong>in</strong> between f<strong>in</strong>gers, under f<strong>in</strong>ger nails <strong>and</strong> around wrists.<br />
• R<strong>in</strong>se your h<strong>and</strong>s thoroughly to remove all suds <strong>and</strong> germs. Thorough r<strong>in</strong>s<strong>in</strong>g will<br />
help prevent dermatitis from suds.<br />
• Turn off the tap us<strong>in</strong>g paper towel.<br />
• Pat dry your h<strong>and</strong>s with a new paper towel.<br />
Tra<strong>in</strong> the children under your care to wash their h<strong>and</strong>s <strong>in</strong> this way. Encourage the<br />
children not to touch the tap after they have washed <strong>and</strong> dried their h<strong>and</strong>s. The tap will<br />
have lots of germs on it. You will need to supervise <strong>and</strong> observe them so that they<br />
develop h<strong>and</strong> wash<strong>in</strong>g as a good habit.<br />
Babies need to have their h<strong>and</strong>s washed as well<br />
Babies need their h<strong>and</strong>s washed as often <strong>and</strong> as thoroughly as older children.<br />
If the baby is able to st<strong>and</strong> at an appropriate size h<strong>and</strong> bas<strong>in</strong>, you need to wash their h<strong>and</strong>s<br />
just as you would for yourself. If the baby is unable to st<strong>and</strong> at a h<strong>and</strong> bas<strong>in</strong>, wash their<br />
h<strong>and</strong>s with either premoistened towelettes or wet disposable cloths, mak<strong>in</strong>g sure the<br />
baby’s h<strong>and</strong>s have been air dried or r<strong>in</strong>sed to remove any soap.<br />
Soaps, towels <strong>and</strong> lotion<br />
Liquid soap dispensers <strong>and</strong> disposable paper towels are the preferred option for h<strong>and</strong><br />
wash<strong>in</strong>g. Liquid soap is advocated rather than solid bar soap because it is less likely to<br />
become contam<strong>in</strong>ated <strong>and</strong> is more likely to be used. 10 If reusable conta<strong>in</strong>ers are used for<br />
liquid soap, they must be cleaned <strong>and</strong> dried before refill<strong>in</strong>g with fresh soap. Antibacterial<br />
h<strong>and</strong> washes should not be used rout<strong>in</strong>ely <strong>in</strong> child care centres as they are unnecessary<br />
<strong>and</strong> may encourage the development of resistant bacteria 11 .<br />
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Effective h<strong>and</strong> dry<strong>in</strong>g is just as important as thorough h<strong>and</strong> wash<strong>in</strong>g because wet<br />
surfaces transfer germs more effectively than dry ones 12 . Disposable paper towel is the<br />
preferred option. Cloth towels should not be used as they allow re-contam<strong>in</strong>ation of the<br />
h<strong>and</strong>s. Warm air dryers are also not recommended as they take longer to dry h<strong>and</strong>s than<br />
with paper towel, can only serve one person at a time <strong>and</strong> often people do not spend long<br />
enough us<strong>in</strong>g the dryer.<br />
<strong>Child</strong>ren with eczema have a type of sk<strong>in</strong> that is dry, itchy <strong>and</strong> sensitive. Their sk<strong>in</strong> is<br />
easily <strong>in</strong>flamed, gets itchy <strong>and</strong> is made worse by rubb<strong>in</strong>g <strong>and</strong> scratch<strong>in</strong>g. Reduc<strong>in</strong>g the<br />
dryness <strong>and</strong> irritation of the sk<strong>in</strong> is very important. These children may f<strong>in</strong>d that frequent<br />
use of soap <strong>and</strong> water may irritate their sk<strong>in</strong>. They can use sorbolene cream <strong>in</strong>stead of<br />
soap. They can put the cream on <strong>and</strong> then gently rub off under runn<strong>in</strong>g water. They<br />
should pat their h<strong>and</strong>s dry rather than rub <strong>and</strong> apply more sorbolene cream if needed.<br />
H<strong>and</strong> wash<strong>in</strong>g takes time<br />
In the steps for good h<strong>and</strong> wash<strong>in</strong>g you need to slowly count to ten while soap<strong>in</strong>g <strong>and</strong><br />
rubb<strong>in</strong>g your h<strong>and</strong>s <strong>and</strong> then slowly count to ten while r<strong>in</strong>s<strong>in</strong>g your h<strong>and</strong>s. This may<br />
seem like a long time. It is a challenge to allow enough time <strong>in</strong> your daily program for<br />
children to wash their h<strong>and</strong>s well. But it can be done.<br />
When to wash your own h<strong>and</strong>s<br />
• When you arrive at the centre. This reduces the <strong>in</strong>troduction of germs.<br />
• Before h<strong>and</strong>l<strong>in</strong>g food<br />
• Before eat<strong>in</strong>g<br />
• After chang<strong>in</strong>g a nappy<br />
• After go<strong>in</strong>g to the toilet<br />
• After clean<strong>in</strong>g up faeces or vomit<br />
• After wip<strong>in</strong>g a nose, either a child’s or your own<br />
• Before giv<strong>in</strong>g medication<br />
• After h<strong>and</strong>l<strong>in</strong>g garbage<br />
• After com<strong>in</strong>g <strong>in</strong> from outside play<br />
• Before go<strong>in</strong>g home. This prevents tak<strong>in</strong>g germs home.<br />
When to wash the children’s h<strong>and</strong>s<br />
• When they arrive at the centre. This reduces the <strong>in</strong>troduction of germs. Parents<br />
can help with this.<br />
• Before <strong>and</strong> after eat<strong>in</strong>g <strong>and</strong> h<strong>and</strong>l<strong>in</strong>g food<br />
• After hav<strong>in</strong>g their nappy changed. Their h<strong>and</strong>s will become contam<strong>in</strong>ated while<br />
they are on the change mat.<br />
• After go<strong>in</strong>g to the toilet<br />
• After com<strong>in</strong>g <strong>in</strong> from outside play<br />
• After touch<strong>in</strong>g nose secretions<br />
• Before jo<strong>in</strong><strong>in</strong>g the mixed age group (if applicable)<br />
• Before go<strong>in</strong>g home. This prevents tak<strong>in</strong>g germs home. Parents can help with this.<br />
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Cover your cough <strong>and</strong> stop the spread of germs<br />
Some <strong>in</strong>fections such as measles, whoop<strong>in</strong>g cough <strong>and</strong> <strong>in</strong>fluenza, are spread when an<br />
<strong>in</strong>fected person sneezes or coughs out t<strong>in</strong>y airborne droplets. The droplets <strong>in</strong> the air may<br />
be breathed <strong>in</strong> directly by another person, or <strong>in</strong>directly enter another person through<br />
contact with surfaces <strong>and</strong> h<strong>and</strong>s with the droplets on them.<br />
To m<strong>in</strong>imise the risk of spread<strong>in</strong>g these germs, children should be encouraged to either<br />
a) Cover their mouth <strong>and</strong> nose with a tissue when they sneeze or cough, then dispose<br />
of the used tissue appropriately. Wash their h<strong>and</strong>s with soap <strong>and</strong> water, dry<strong>in</strong>g<br />
thoroughly.<br />
or<br />
b) Cough or sneeze <strong>in</strong>to their upper sleeve, or elbow, not <strong>in</strong>to their h<strong>and</strong>s. Then wash<br />
their h<strong>and</strong>s with soap <strong>and</strong> water, <strong>and</strong> dry them thoroughly.<br />
Birthday cakes <strong>and</strong> blow<strong>in</strong>g out c<strong>and</strong>les<br />
When it is a child’s birthday, many children like to br<strong>in</strong>g a cake to share with their<br />
friends. To prevent contam<strong>in</strong>ation from airborne droplets when the child blows out the<br />
c<strong>and</strong>les, cover the cake with transparent plastic film or greaseproof paper. The c<strong>and</strong>les<br />
can be <strong>in</strong>serted through the cover<strong>in</strong>g <strong>and</strong> disposed of after the c<strong>and</strong>les have been blown<br />
out <strong>and</strong> have cooled.<br />
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Nappy chang<strong>in</strong>g <strong>and</strong> toilet<strong>in</strong>g<br />
Have an area specifically set aside for chang<strong>in</strong>g nappies. Do not share the same nappy<br />
change mat with children from another room.<br />
Check to make sure that all the supplies you need are ready.<br />
Get a walk<strong>in</strong>g child to walk to the change area.<br />
Use only your h<strong>and</strong>s to carry a crawl<strong>in</strong>g child. Hold the child away from your body when<br />
you pick up the child.<br />
The use of disposable nappies should be encouraged <strong>in</strong> child care centres. This will<br />
reduce the risk of <strong>in</strong>fections as disposable nappies do not ‘leak’ like cloth nappies <strong>and</strong><br />
are able to be disposed of immediately.<br />
Use the follow<strong>in</strong>g method to stop disease spread<strong>in</strong>g through contact with faeces.<br />
• Place paper on the change table.<br />
• Always wear gloves for a ‘dirty’ nappy (one with faeces on it).<br />
• Remove the child’s nappy <strong>and</strong> any clothes with ur<strong>in</strong>e <strong>and</strong>/or faeces on them.<br />
• Clean the child’s bottom.<br />
• Remove the paper <strong>and</strong> put it <strong>in</strong> a ‘h<strong>and</strong>s-free’ lidded b<strong>in</strong>.<br />
• Remove your gloves now, before you touch the child’s clean clothes. Remove<br />
gloves by peel<strong>in</strong>g them back from your wrists, turn<strong>in</strong>g them <strong>in</strong>side out as you go.<br />
Do not let your sk<strong>in</strong> touch the outer contam<strong>in</strong>ated surface of the glove. Put the<br />
gloves <strong>in</strong> the b<strong>in</strong>.<br />
• Dress the child. Wash the child’s h<strong>and</strong>s. Now you can hold the child close to you.<br />
• Take the child away from the change table.<br />
• Clean the change table, pay<strong>in</strong>g particular attention to the mat, at the completion of<br />
each nappy change.<br />
• Wash your h<strong>and</strong>s.<br />
Cloth nappies<br />
If a parent provides cloth nappies for their child’s use, ensure the parent also provides<br />
‘plastic pants’ to help prevent faeces, <strong>and</strong> therefore germs, from leak<strong>in</strong>g. Wear<strong>in</strong>g<br />
cloth<strong>in</strong>g over plastic pants also reduces the number of germs from the bowel be<strong>in</strong>g<br />
transferred to surfaces <strong>in</strong> the centre. It is a good idea for the nappy <strong>and</strong> the plastic pants to<br />
be covered with cloth<strong>in</strong>g at all times. Parents need to be aware that cloth nappies with<br />
ur<strong>in</strong>e <strong>and</strong>/or faeces will not be r<strong>in</strong>sed or washed at the centre. They are to be placed <strong>in</strong>to a<br />
plastic bag <strong>and</strong> laundered at home.<br />
Paper on the change table<br />
Every time a child has their nappy changed, germs are put on the change table. By<br />
plac<strong>in</strong>g a piece of paper on the change table many of the germs from the child are kept on<br />
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the paper <strong>and</strong> do not reach the table at all. The paper is removed <strong>in</strong> the middle of the<br />
nappy change, before the child’s clean clothes are put on, the paper <strong>and</strong> the germs are<br />
then put <strong>in</strong> the b<strong>in</strong>. Any paper can be used for this; paper towel is easy to use but can be<br />
expensive, greaseproof paper is another alternative. A popular barrier is large sheets of<br />
computer paper.<br />
Gloves<br />
Gloves should be worn when chang<strong>in</strong>g dirty nappies because there are always billions of<br />
germs <strong>in</strong> faeces. Wear<strong>in</strong>g gloves for wet nappies is not essential because germs are not<br />
usually found <strong>in</strong> ur<strong>in</strong>e, but you may choose to use them. However, you should wear<br />
gloves for all nappy changes if your h<strong>and</strong>s have any cuts or cracked sk<strong>in</strong>. It is also wise to<br />
wear gloves for all nappy changes if you are pregnant (refer CMV page 122).<br />
Clean<strong>in</strong>g the child<br />
Damp paper towels, premoistened towelettes or damp cloths (‘bottom cloths’) may be<br />
used to clean the child. However, each towel must be removed immediately after use <strong>and</strong><br />
put <strong>in</strong> the b<strong>in</strong> or put aside for wash<strong>in</strong>g. Wet the towels with water from the tap or poured<br />
from bottles. Don’t use recycled water from a bowl. If you use bottom cloths, wash these<br />
<strong>in</strong> hot water <strong>and</strong> never mix bottom cloths <strong>and</strong> face cloths <strong>in</strong> the same wash.<br />
Clean<strong>in</strong>g the nappy change table<br />
Try to have at least two change surfaces for each day. A v<strong>in</strong>yl sheet over the change mat<br />
can be the morn<strong>in</strong>g surface. Use this method to help keep the nappy change table clean.<br />
• After each change, wash the table (mat) well with detergent <strong>and</strong> warm water. Use<br />
paper towel or a piece of cloth to rub the surface. Put the paper towel <strong>in</strong> the b<strong>in</strong> or<br />
the cloth aside for wash<strong>in</strong>g after each change. There will be many germs on this<br />
cloth; it cannot be used aga<strong>in</strong> until it has been washed. These may be washed with<br />
the bottom cloths.<br />
• If faecal matter spills onto the change table (mat) clean with detergent <strong>and</strong> warm<br />
water, then leave to dry.<br />
• Thoroughly clean the surface with detergent at the end of a nappy chang<strong>in</strong>g<br />
session <strong>and</strong> at the end of the day. Wipe the area with detergent <strong>and</strong> warm water<br />
<strong>and</strong> leave to dry.<br />
• Remove the morn<strong>in</strong>g change mat or v<strong>in</strong>yl sheet <strong>and</strong> leave to dry, preferably<br />
outside <strong>in</strong> the sun. Use the fresh mat for the afternoon.<br />
• Wash your h<strong>and</strong>s.<br />
Mattresses <strong>and</strong> covers used on the nappy change table need to be smooth <strong>and</strong> <strong>in</strong> good<br />
condition because germs can survive <strong>in</strong> cracks, holes, creases, pleats, folds or seams.<br />
Toilet-tra<strong>in</strong><strong>in</strong>g<br />
• Ask parents to supply a clean change of cloth<strong>in</strong>g.<br />
• Place soiled clothes <strong>in</strong> a plastic bag for parents to take home at the end of the day.<br />
Soiled clothes will not be r<strong>in</strong>sed or washed at the centre. (Expla<strong>in</strong> to parents that<br />
wash<strong>in</strong>g soiled clothes at the centre can spread germs.)<br />
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• Help the child use the toilet.<br />
• Help the child wash their h<strong>and</strong>s. Ask older children if they washed their h<strong>and</strong>s<br />
count<strong>in</strong>g to ten <strong>and</strong> ten aga<strong>in</strong> when they r<strong>in</strong>sed. Expla<strong>in</strong> to the child that wash<strong>in</strong>g<br />
their h<strong>and</strong>s <strong>and</strong> dry<strong>in</strong>g them properly will stop germs that might make them sick.<br />
• Us<strong>in</strong>g a potty chair <strong>in</strong>creases the risk of spread<strong>in</strong>g disease. If the child can use a<br />
toilet this is preferable. If the child must use a potty, empty the contents <strong>in</strong>to the<br />
toilet <strong>and</strong> wash the chair. Do not wash it <strong>in</strong> a s<strong>in</strong>k used for wash<strong>in</strong>g h<strong>and</strong>s.<br />
• Wash your own h<strong>and</strong>s.<br />
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Clean<strong>in</strong>g the centre<br />
Wash<strong>in</strong>g germs away<br />
Wash<strong>in</strong>g germs down the dra<strong>in</strong> is better than try<strong>in</strong>g to kill germs with dis<strong>in</strong>fectant.<br />
Detergents <strong>and</strong> soaps help to loosen the germs so that they can be washed away.<br />
Use colour-coded sponges <strong>in</strong> each area (for example blue <strong>in</strong> the bathroom, yellow <strong>in</strong> the<br />
kitchen) <strong>and</strong> keep them separate. Wear utility gloves when clean<strong>in</strong>g <strong>and</strong> hang them<br />
outside to dry when f<strong>in</strong>ished. Wash your h<strong>and</strong>s after remov<strong>in</strong>g the gloves.<br />
Dis<strong>in</strong>fectants<br />
Dis<strong>in</strong>fectants are usually unnecessary unless a surface cannot be adequately cleaned with<br />
detergent. Most germs do not survive for long on clean surfaces when exposed to air <strong>and</strong><br />
light. Even <strong>in</strong> hospitals, dis<strong>in</strong>fectants are be<strong>in</strong>g used less <strong>and</strong> less.<br />
There is no ideal dis<strong>in</strong>fectant.<br />
Dis<strong>in</strong>fectants cannot kill germs if the surface is not clean. It is more important to make<br />
sure that all surfaces have been cleaned with detergent <strong>and</strong> warm water than to use a<br />
dis<strong>in</strong>fectant.<br />
To kill germs, any dis<strong>in</strong>fectant needs:<br />
• enough time to kill the germs. This is at least 10 m<strong>in</strong>utes.<br />
• to be used <strong>in</strong> the right concentration<br />
• a clean surface to be able to get to the germ.<br />
• to be able to act aga<strong>in</strong>st those particular germs.<br />
Even when all of these conditions are met a dis<strong>in</strong>fectant will not kill all the germs<br />
present. For example <strong>in</strong> one teaspoon of faeces there may be 1,000,000,000,000 particles<br />
of a virus. After 10 m<strong>in</strong>utes a dis<strong>in</strong>fectant may kill 99.99% of these germs. This sounds<br />
like many germs are killed, but because there are so many germs present the dis<strong>in</strong>fectant<br />
may leave around 1,000,000,000 germs still alive. Less than 100 of these virus particles<br />
can be enough to make enough to make another child sick.<br />
Detergents<br />
Effective clean<strong>in</strong>g with detergent <strong>and</strong> warm water, followed by r<strong>in</strong>s<strong>in</strong>g <strong>and</strong> dry<strong>in</strong>g<br />
removes the bulk of germs from surfaces; germs are unable to multiply on clean, dry<br />
surfaces 13 . Ensure that clean<strong>in</strong>g equipment is cleaned <strong>and</strong> stored so it can dry between<br />
uses, well ma<strong>in</strong>ta<strong>in</strong>ed, <strong>and</strong> designed to reduce dust dur<strong>in</strong>g use. Appropriate equipment<br />
<strong>in</strong>cludes mops with detachable heads (to allow for launder<strong>in</strong>g <strong>in</strong> wash<strong>in</strong>g mach<strong>in</strong>e us<strong>in</strong>g<br />
hot water), laundered or disposable cloths <strong>and</strong> vacuum cleaners fitted with appropriate<br />
filters 14 .<br />
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Bathrooms. Wash taps h<strong>and</strong>les, toilet seats, toilet<br />
h<strong>and</strong>les <strong>and</strong> door knobs. Check the bathroom dur<strong>in</strong>g<br />
the day <strong>and</strong> clean if obviously soiled.<br />
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Wash daily<br />
plus when visibly<br />
soiled<br />
√<br />
Wash weekly<br />
plus when visibly<br />
soiled<br />
Toys <strong>and</strong> objects put <strong>in</strong> the mouth. √<br />
Surfaces the children have frequent contact with, for<br />
example, bench tops, taps, cots <strong>and</strong> tables.<br />
√<br />
Mattress covers <strong>and</strong> l<strong>in</strong>en, if each child does not<br />
use the same mattress cover every day.<br />
√<br />
Door knobs. √<br />
Floors. √<br />
Low shelves. √<br />
Other surfaces often touched by children. √<br />
Special areas for clean<strong>in</strong>g<br />
Nappy change area<br />
Clean the nappy change area (table or mat) thoroughly after each nappy change with<br />
detergent <strong>and</strong> warm water.<br />
If faecal matter spills onto the change table or mat, clean with detergent <strong>and</strong> warm water,<br />
<strong>and</strong> leave to dry. At the end of the morn<strong>in</strong>g <strong>and</strong> at the end of the day, remove the mat;<br />
wash with warm water <strong>and</strong> detergent <strong>and</strong> leave to dry, preferably <strong>in</strong> the sun.<br />
Cloth<strong>in</strong>g<br />
Staff cloth<strong>in</strong>g, or over-cloth<strong>in</strong>g, should be washed daily <strong>in</strong> hot water. It is a good idea for<br />
staff to wear overclothes, such as aprons, gowns or coats. These can be removed <strong>and</strong><br />
washed at the end of the day. This helps to protect the child care worker’s own family<br />
when she/he returns home. Overclothes must be worn over cloth<strong>in</strong>g that cannot be<br />
washed every day, for example jumpers.<br />
The children’s dress-up clothes should be also be washed regularly. We recommend<br />
wash<strong>in</strong>g them once a week <strong>in</strong> hot water <strong>and</strong> detergent.<br />
L<strong>in</strong>en<br />
Wash l<strong>in</strong>en <strong>in</strong> hot water. Do not carry used l<strong>in</strong>en aga<strong>in</strong>st your own cloth<strong>in</strong>g or coverall.<br />
Instead, take it to the laundry <strong>in</strong> a basket or plastic bag. Treat soiled l<strong>in</strong>en as you would a<br />
dirty nappy. If washed at the centre, soiled l<strong>in</strong>en should be:<br />
• soaked to remove the bulk of the contam<strong>in</strong>ation<br />
• washed separately <strong>in</strong> hot water<br />
• dried <strong>in</strong> the sun or on a hot cycle <strong>in</strong> the clothes dryer
Wear gloves when h<strong>and</strong>l<strong>in</strong>g soiled l<strong>in</strong>en.<br />
Dummies<br />
Dummies must never be shared by children. When not <strong>in</strong> use, dummies should be stored<br />
<strong>in</strong> <strong>in</strong>dividual plastic conta<strong>in</strong>ers. Each conta<strong>in</strong>er should have the child’s name on it. Do not<br />
store dummies where they may come <strong>in</strong> contact with another dummy or toy. Store<br />
dummies out of children’s reach.<br />
Toothbrushes<br />
Toothbrushes must never be shared by children. Toothbrushes should be labelled with the<br />
child’s name. Store them out of the reach of children. Do not let them drip on one<br />
another. The bristles should be exposed to the air <strong>and</strong> allowed to dry. Do not store<br />
toothbrushes <strong>in</strong> <strong>in</strong>dividual conta<strong>in</strong>ers because this stops them from dry<strong>in</strong>g.<br />
Bacteria grow on wet toothbrushes.<br />
Cots<br />
If a child soils a crib or cot:<br />
• Put on gloves.<br />
• Clean the child.<br />
• Remove your gloves.<br />
• Dress the child.<br />
• Wash the child’s h<strong>and</strong>s.<br />
• Put on gloves.<br />
• Clean the cot.<br />
• Place soiled l<strong>in</strong>en <strong>in</strong> a l<strong>in</strong>ed, lidded laundry b<strong>in</strong>.<br />
• Remove bulk of soil<strong>in</strong>g/spill with absorbent paper towels.<br />
• Remove any visible soil<strong>in</strong>g by clean<strong>in</strong>g thoroughly with detergent <strong>and</strong> water.<br />
• Remove gloves.<br />
• Wash your h<strong>and</strong>s.<br />
• Provide clean l<strong>in</strong>en.<br />
Toys<br />
Wash<strong>in</strong>g toys effectively is very important to reduce spread of disease. Toys, especially<br />
those <strong>in</strong> rooms with younger children, need to be washed after every day. Warm water<br />
<strong>and</strong> detergent help to loosen the germs so that they can be washed away. Use the centre’s<br />
dishwasher if you can.<br />
Remove toys for wash<strong>in</strong>g dur<strong>in</strong>g the day. Start a ‘Toys to Wash’ box <strong>and</strong> place toys <strong>in</strong> it<br />
dur<strong>in</strong>g the day if you see a child sneeze on a toy, or if the toy has been discarded after<br />
play by a child who is unwell.<br />
In the nappy change area have a box of clean <strong>and</strong> a box of ‘to-be-washed’ toys. Give a<br />
child a clean toy if they need one while be<strong>in</strong>g changed <strong>and</strong> after the nappy change place it<br />
immediately <strong>in</strong> the ‘Toys to Wash’ box.<br />
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• Buy only washable toys. Get rid of non-washable toys. Individual non-washable<br />
toys may be assigned to a child <strong>and</strong> kept <strong>in</strong> the child’s cot for the use of that child<br />
only.<br />
• Wash toys daily <strong>in</strong> hot water <strong>and</strong> detergent, r<strong>in</strong>se them well <strong>and</strong> dry them. Many<br />
toys can be cleaned <strong>in</strong> the dishwasher.<br />
• All toys, <strong>in</strong>clud<strong>in</strong>g cloth toys <strong>and</strong> books, can be dried by sunlight.<br />
• It is useful to separate toys <strong>in</strong>to baskets. The toys <strong>in</strong> each basket can then be<br />
rotated between wash<strong>in</strong>g one day <strong>and</strong> <strong>in</strong> use the next.<br />
• Books should be <strong>in</strong>spected for visible dirt <strong>and</strong> soil<strong>in</strong>g. Books can be cleaned by<br />
wip<strong>in</strong>g them with a moist cloth with detergent on it, <strong>and</strong> then dry<strong>in</strong>g them. Leave<br />
damp or wet books out of circulation until dry.<br />
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Deal<strong>in</strong>g with spills of blood, faeces, vomit, ur<strong>in</strong>e <strong>and</strong><br />
nasal discharge<br />
Prevention is better than cure.<br />
Accidental spills <strong>and</strong> secretions of body fluids are a fact of life with<strong>in</strong> a child care centre.<br />
Manag<strong>in</strong>g these spills <strong>in</strong>cludes:<br />
• Avoid<strong>in</strong>g direct contact with blood or other fluids.<br />
• When clean<strong>in</strong>g or treat<strong>in</strong>g a child’s face which has blood on it, ensure you are not<br />
at eye level with the child. If you are at eye level <strong>and</strong> the child is upset, there is a<br />
chance, through their cry<strong>in</strong>g or cough<strong>in</strong>g for their blood to enter your eyes or<br />
mouth.<br />
• Wear gloves if possible.<br />
• Cover any cuts <strong>and</strong> abrasions on your h<strong>and</strong>s with a waterproof dress<strong>in</strong>g. <strong><strong>Health</strong>y</strong><br />
sk<strong>in</strong> is an effective barrier aga<strong>in</strong>st you becom<strong>in</strong>g <strong>in</strong>fected from spilled blood <strong>and</strong><br />
other body fluids.<br />
• Supervise children at all times; ensur<strong>in</strong>g safety <strong>and</strong> safe play is a priority at all<br />
times. When a child is <strong>in</strong>jured, there are several th<strong>in</strong>gs you will need to do. These<br />
<strong>in</strong>clude look<strong>in</strong>g after the child, send<strong>in</strong>g for the first aid officer, check<strong>in</strong>g that noone<br />
else has come <strong>in</strong> contact with the <strong>in</strong>jured child’s blood, <strong>and</strong> clean<strong>in</strong>g up the<br />
blood.<br />
• Regularly toilet children.<br />
• Use disposable nappies rather than cloth.<br />
• Exclude children with diarrhoea <strong>and</strong>/or vomit<strong>in</strong>g.<br />
The child<br />
• When attend<strong>in</strong>g an <strong>in</strong>jured child who is bleed<strong>in</strong>g, take care to avoid contact with<br />
the blood.<br />
• Comfort the child <strong>and</strong> move them to safety.<br />
• Apply pressure to the bleed<strong>in</strong>g area. Use gloves if available. (If gloves are not<br />
available, take the first opportunity to get someone wear<strong>in</strong>g gloves to take over<br />
from you. Then wash your h<strong>and</strong>s.)<br />
• Elevate the bleed<strong>in</strong>g area, unless you suspect a broken bone or fracture.<br />
• Send for the first aid officer.<br />
• When the wound is covered <strong>and</strong> no longer bleed<strong>in</strong>g, remove gloves. Put them <strong>in</strong> a<br />
plastic bag <strong>and</strong> place the bag <strong>in</strong> the rubbish b<strong>in</strong>.<br />
• Wash your h<strong>and</strong>s thoroughly with soap <strong>and</strong> water.<br />
The first aid officer<br />
• Wear gloves if there is time.<br />
• Dress the child’s wound with a b<strong>and</strong>age or suitable substitute <strong>and</strong> seek medical<br />
assistance.<br />
• Remove gloves. Put them <strong>in</strong> a plastic bag <strong>and</strong> place the bag <strong>in</strong> the rubbish b<strong>in</strong>.<br />
• Wash h<strong>and</strong>s thoroughly with soap <strong>and</strong> warm water.<br />
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Blood<br />
Because of the risk of <strong>in</strong>fection, it is important for everyone to avoid contact with an<br />
<strong>in</strong>jured child’s blood. But if it does spill onto another adult or child, take the follow<strong>in</strong>g<br />
precautions.<br />
• Wash the area of contact thoroughly with soap <strong>and</strong> warm water.<br />
• If contact has been with an open wound, broken sk<strong>in</strong>, mucous membrane (mouths,<br />
eyes, genitals) or a penetrat<strong>in</strong>g <strong>in</strong>jury:<br />
− if the blood contacted your mouth or your eyes r<strong>in</strong>se the area very well with<br />
water.<br />
− if the blood contacted a wound or broken sk<strong>in</strong>, wash the area thoroughly with<br />
soap <strong>and</strong> water.<br />
− seek medical advice.<br />
Deal<strong>in</strong>g with blood spills<br />
• Wear gloves.<br />
• Place paper towel over the spill. <strong>Care</strong>fully remove the paper towel <strong>and</strong> contents.<br />
Place the paper towel <strong>in</strong> a plastic bag, seal the bag <strong>and</strong> put it <strong>in</strong> the rubbish b<strong>in</strong>.<br />
• Clean the surface with warm water <strong>and</strong> detergent, <strong>and</strong> allow to dry.<br />
• Wash h<strong>and</strong>s thoroughly with soap <strong>and</strong> warm water.<br />
Deal<strong>in</strong>g with faeces, vomit <strong>and</strong> ur<strong>in</strong>e<br />
• Wear gloves.<br />
• Place paper towel over the spill. <strong>Care</strong>fully remove the paper towel <strong>and</strong> contents.<br />
Place the paper towel <strong>in</strong> a plastic bag, seal the bag <strong>and</strong> put it <strong>in</strong> the rubbish b<strong>in</strong>.<br />
• Clean the surface with warm water <strong>and</strong> detergent, <strong>and</strong> allow to dry.<br />
• Wash h<strong>and</strong>s thoroughly with soap <strong>and</strong> warm water.<br />
Deal<strong>in</strong>g with nasal discharge<br />
Wash<strong>in</strong>g your h<strong>and</strong>s every time after you wipe a child’s nose will reduce the spread of<br />
colds. If you cannot wash your h<strong>and</strong>s after every nose wipe, use gloves <strong>and</strong> clean tissues<br />
which must be disposed of safely <strong>and</strong> appropriately 15 .<br />
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S<strong>and</strong>pits<br />
S<strong>and</strong>pits can be great fun. They are also a potential source of <strong>in</strong>fection. They need to be<br />
well ma<strong>in</strong>ta<strong>in</strong>ed <strong>and</strong> kept clean.<br />
S<strong>and</strong>pits must be closely covered when the child care centre is unattended to prevent<br />
contam<strong>in</strong>ation from animal faeces or <strong>in</strong>appropriately discarded sharp or dangerous<br />
objects such as broken glass.<br />
The s<strong>and</strong> should be of a depth that can be easily raked over before each use, to help<br />
screen for foreign objects.<br />
S<strong>and</strong> that is contam<strong>in</strong>ated by animal or human faeces, blood or other body fluids should<br />
be removed. Use a shovel <strong>and</strong> dispose of the s<strong>and</strong> <strong>in</strong> a plastic bag. The rema<strong>in</strong><strong>in</strong>g s<strong>and</strong><br />
should be raked over at <strong>in</strong>tervals dur<strong>in</strong>g the day <strong>and</strong> left exposed to the sun. Where<br />
extensive contam<strong>in</strong>ation has occurred, all s<strong>and</strong> should be replaced.<br />
<strong>Child</strong>ren must wash their h<strong>and</strong>s with soap <strong>and</strong> water after play<strong>in</strong>g <strong>in</strong> the s<strong>and</strong>pit.<br />
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Animals<br />
Animals can be a great source of joy <strong>and</strong> stimulation for children.<br />
The mouths <strong>and</strong> claws of all animals carry bacteria which can cause <strong>in</strong>fections <strong>in</strong> flesh<br />
around the bite, <strong>and</strong> eventually, if untreated, may spread <strong>in</strong>to the bloodstream.<br />
Some simple preventative measures will m<strong>in</strong>imise risk to health from contact with<br />
animals.<br />
• Ensure that animals are de-fleaed, de-wormed <strong>and</strong> immunised as appropriate.<br />
• Animals that are ill should be treated promptly by a vet. An animal that is irritable<br />
because of pa<strong>in</strong> or illness is more likely to bite or scratch.<br />
• Supervise children when they have contact with animals. <strong>Child</strong>ren should be<br />
discouraged from play<strong>in</strong>g with animals while animals are eat<strong>in</strong>g. Don’t let<br />
children put their faces close to animals.<br />
• Do not allow animals to contam<strong>in</strong>ate s<strong>and</strong>pits, soil, pot plants <strong>and</strong> vegetable<br />
gardens.<br />
• Always wear gloves when h<strong>and</strong>l<strong>in</strong>g animal faeces, empty<strong>in</strong>g litter trays <strong>and</strong><br />
clean<strong>in</strong>g cages.<br />
• Dispose of animal faeces <strong>and</strong> litter daily. Place faeces <strong>and</strong> litter <strong>in</strong> a plastic bag<br />
<strong>and</strong> put it out with the garbage.<br />
• Pregnant women <strong>in</strong> particular should avoid contact with cat faeces.<br />
• If you have a bird cage, wet the floor of the cage before clean<strong>in</strong>g it to avoid<br />
<strong>in</strong>halation of powdered, dry bird faeces.<br />
• Avoid br<strong>in</strong>g<strong>in</strong>g <strong>in</strong> or keep<strong>in</strong>g ferrets, turtles, iguanas, lizards or other reptiles,<br />
psittac<strong>in</strong>e birds (birds of the parrot family) or any wild or dangerous animals.<br />
• Make sure that children wash their h<strong>and</strong>s after touch<strong>in</strong>g animals.<br />
Bat bites<br />
Australian bats harbour a Lyssavirus which is very similar to the rabies virus. Only<br />
people who are immunised with rabies vacc<strong>in</strong>e should approach or h<strong>and</strong>le bats. If you are<br />
scratched or bitten by a bat, immediately clean the wound with soap <strong>and</strong> runn<strong>in</strong>g water<br />
for 5 m<strong>in</strong>utes <strong>and</strong> contact your doctor or a public health unit.<br />
Fish <strong>and</strong> other mar<strong>in</strong>e organisms<br />
Scratches from fish <strong>and</strong> other mar<strong>in</strong>e organisms such as coral can cause unusual<br />
<strong>in</strong>fections. If an <strong>in</strong>jury caused by a fish, or a wound contam<strong>in</strong>ated by sea, pond, or<br />
aquarium water, becomes <strong>in</strong>fected, it is important to see your doctor <strong>and</strong> expla<strong>in</strong> how the<br />
<strong>in</strong>jury occurred.<br />
Fleas<br />
Fleas <strong>in</strong>fect both animals <strong>and</strong> humans caus<strong>in</strong>g irritation <strong>and</strong> <strong>in</strong>flammation of the sk<strong>in</strong>.<br />
Treat animals, their bedd<strong>in</strong>g <strong>and</strong> their immediate environment (that is, where they usually<br />
rest) to destroy adult <strong>and</strong> immature fleas.<br />
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Immunisation<br />
<strong>Child</strong>hood vacc<strong>in</strong>ation<br />
The cheapest <strong>and</strong> most reliable method of prevent<strong>in</strong>g certa<strong>in</strong> <strong>in</strong>fections is immunisation.<br />
Immunisation protects the person who has been immunised, children who are too young<br />
to be vacc<strong>in</strong>ated, <strong>and</strong> other people who have been vacc<strong>in</strong>ated but did not respond to the<br />
vacc<strong>in</strong>e.<br />
The pr<strong>in</strong>ciple of immunisation (or vacc<strong>in</strong>ation) is simple: it gives the body a memory of<br />
<strong>in</strong>fection without the risk of natural <strong>in</strong>fection.<br />
Ask all parents to provide a copy of their child’s vacc<strong>in</strong>ation records. If the child is not<br />
vacc<strong>in</strong>ated, tell the parents that their child will be excluded from care dur<strong>in</strong>g outbreaks<br />
of some <strong>in</strong>fectious diseases (such as measles <strong>and</strong> whoop<strong>in</strong>g cough), even if their child is<br />
well.<br />
If the child is vacc<strong>in</strong>ated, make sure that the child has received all the vacc<strong>in</strong>ations<br />
recommended for their age group.<br />
Ways that you can encourage parents to vacc<strong>in</strong>ate their children <strong>in</strong>clude:<br />
• put up wall charts <strong>in</strong> rooms for under 2 year olds.<br />
• send home first birthday MMR (measles–mumps–rubella) rem<strong>in</strong>der cards.<br />
• send home fourth birthday rem<strong>in</strong>der cards for MMR, DTPa <strong>and</strong> Polio.<br />
• each month review which children are beh<strong>in</strong>d <strong>in</strong> their vacc<strong>in</strong>ations, update the<br />
child’s records kept <strong>in</strong> the centre <strong>and</strong> send home a rem<strong>in</strong>der card.<br />
• put a computerised message at the bottom of receipts.<br />
• when enroll<strong>in</strong>g children, make a note <strong>in</strong> the director’s diary of when updates will<br />
be needed.<br />
The immunisations <strong>and</strong> the diseases they prevent<br />
DTPa immunisation<br />
Immunisation with DTPa vacc<strong>in</strong>e is the best way to prevent diphtheria, tetanus <strong>and</strong><br />
pertussis. DTPa vacc<strong>in</strong>e is three vacc<strong>in</strong>es comb<strong>in</strong>ed <strong>in</strong>to one <strong>in</strong>jection which is safe <strong>and</strong><br />
effective, <strong>and</strong> several <strong>in</strong>jections are needed to provide good protection. DTPa is similar to<br />
the previous DTP vacc<strong>in</strong>e (DTPw) but conta<strong>in</strong>s only small parts of the pertussis bacteria<br />
<strong>in</strong>stead of whole bacteria. The possible general side effects of DTPa are much less<br />
frequent than seen with the previous DTPw. Other side effects, such as convulsions or<br />
collapse rarely occur.<br />
Diphtheria<br />
Diphtheria is caused by bacteria which are found <strong>in</strong> the mouth, throat <strong>and</strong> nose of an<br />
<strong>in</strong>fected person. Diphtheria can cause a membrane to grow around the <strong>in</strong>side of the<br />
throat, which can lead to difficulty <strong>in</strong> swallow<strong>in</strong>g, breathlessness <strong>and</strong> suffocation. A<br />
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powerful poison (tox<strong>in</strong>) is produced by the diphtheria bacteria <strong>and</strong> may cause serious<br />
complications.<br />
Tetanus<br />
Tetanus is an often-fatal disease caused by a tox<strong>in</strong> made by bacteria present <strong>in</strong> soil <strong>and</strong><br />
manure. You don’t catch tetanus from other people. Rather, the bacteria enter the body<br />
through a wound, which may be as small <strong>and</strong> <strong>in</strong>significant as a p<strong>in</strong>prick. Tetanus attacks<br />
the nervous system, caus<strong>in</strong>g severe muscle spasms, first felt <strong>in</strong> the neck <strong>and</strong> jaw muscles<br />
(lockjaw).<br />
Pertussis (whoop<strong>in</strong>g cough)<br />
Pertussis, or whoop<strong>in</strong>g cough, is a highly contagious disease caused by bacteria <strong>and</strong> is<br />
spread by cough<strong>in</strong>g or sneez<strong>in</strong>g. Whoop<strong>in</strong>g cough affects the air passages <strong>and</strong> can cause<br />
difficulty <strong>in</strong> breath<strong>in</strong>g. Severe cough<strong>in</strong>g spasms occur <strong>and</strong> between these spasms, the<br />
child gasps for breath caus<strong>in</strong>g the characteristic ‘whoop’ sound. Not all children get the<br />
‘whoop’. Vomit<strong>in</strong>g often follows a cough<strong>in</strong>g spasm.<br />
Polio immunisation<br />
Oral polio vacc<strong>in</strong>e (OPV or Sab<strong>in</strong>) is given as drops by mouth. Several doses are needed<br />
to provide good protection. The vacc<strong>in</strong>e conta<strong>in</strong>s small amounts of three types of live<br />
polio viruses, which have been altered so they do not cause the disease, <strong>and</strong> a very small<br />
amount of an antibiotic (neomyc<strong>in</strong>). A child should not be given OPV if he or she has, or<br />
lives with someone who has, a disease such as leukaemia or HIV/AIDS or is on<br />
medication that causes lowered immunity. A few people will have mild symptoms such<br />
as headache, muscle pa<strong>in</strong>s <strong>and</strong> mild diarrhoea after receiv<strong>in</strong>g OPV. OPV is be<strong>in</strong>g phased<br />
out <strong>in</strong> Australia <strong>and</strong> will be replaced by <strong>in</strong>activated polio vacc<strong>in</strong>e.<br />
Inactivated polio vacc<strong>in</strong>e (IPV) <strong>and</strong> IPV-conta<strong>in</strong><strong>in</strong>g comb<strong>in</strong>ation vacc<strong>in</strong>es are now<br />
available <strong>in</strong> Australia. These vacc<strong>in</strong>es conta<strong>in</strong> small amounts of three types of polio<br />
viruses, which have been <strong>in</strong>activated. A course of 3 <strong>in</strong>jections with a booster dose at 4<br />
years produces long-last<strong>in</strong>g protection to these poliovirus types.<br />
Polio<br />
Follow<strong>in</strong>g the <strong>in</strong>troduction of polio vacc<strong>in</strong>es there has been a dramatic decrease <strong>in</strong> polio<br />
<strong>in</strong>fection. S<strong>in</strong>ce 1995, no cases of polio have been reported <strong>in</strong> Australia 16 . Australian<br />
children still need to be immunised aga<strong>in</strong>st polio, even though cases do not occur here.<br />
There is an ongo<strong>in</strong>g risk of polio be<strong>in</strong>g imported from other countries <strong>and</strong> re-established<br />
here if our children <strong>and</strong> adults are not immunised. Polio may cause mild symptoms or<br />
very severe illness <strong>in</strong>clud<strong>in</strong>g permanent crippl<strong>in</strong>g.<br />
Measles-mumps-rubella (MMR) immunisation<br />
<strong>Child</strong>ren should be immunised aga<strong>in</strong>st measles, mumps <strong>and</strong> rubella at 12 months of age<br />
<strong>and</strong> at 4 years of age. The vacc<strong>in</strong>e can also be given to older children <strong>and</strong> adults, <strong>and</strong> is<br />
very effective. The comb<strong>in</strong>ation measles-mumps-rubella (MMR) vacc<strong>in</strong>e protects<br />
children <strong>and</strong> adults aga<strong>in</strong>st all three diseases. The MMR vacc<strong>in</strong>e conta<strong>in</strong>s small amounts<br />
of reduced strength live measles, mumps <strong>and</strong> rubella viruses, <strong>and</strong> a small amount of an<br />
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antibiotic (neomyc<strong>in</strong>). Reactions to MMR immunisation are much less frequent than the<br />
complications of natural measles. The most common reaction is feel<strong>in</strong>g unwell <strong>and</strong><br />
hav<strong>in</strong>g a low grade fever, possibly with a rash, occurr<strong>in</strong>g 5 to 12 days after immunisation.<br />
<strong>Child</strong>ren who develop the rash dur<strong>in</strong>g this time are not <strong>in</strong>fectious to others. Occasionally<br />
children will develop mild swell<strong>in</strong>g of the facial gl<strong>and</strong>s about three weeks after the<br />
immunisation because of the mumps component of the vacc<strong>in</strong>e. More serious reactions to<br />
the vacc<strong>in</strong>e are rare. Although MMR vacc<strong>in</strong>es are not recommended dur<strong>in</strong>g pregnancy,<br />
there is no risk to pregnant women from contact with recently vacc<strong>in</strong>ated <strong>in</strong>dividuals as<br />
the vacc<strong>in</strong>e virus is not transferred from person to person.<br />
Measles<br />
Measles is a serious, highly contagious viral illness of fever, rash, runny nose, cough <strong>and</strong><br />
conjunctivitis. Complications follow<strong>in</strong>g measles can be very dangerous, <strong>and</strong> pneumonia<br />
occurs <strong>in</strong> 4% of cases. For every 10 children who contract measles encephalitis, one will<br />
die <strong>and</strong> up to four will have permanent bra<strong>in</strong> damage. Measles has caused more deaths <strong>in</strong><br />
Australia <strong>in</strong> the past 15 years than diphtheria, pertussis <strong>and</strong> rubella comb<strong>in</strong>ed.<br />
Mumps<br />
Mumps is a viral disease, which causes fever, headache <strong>and</strong> <strong>in</strong>flammation of the salivary<br />
gl<strong>and</strong>s. Occasionally it causes an <strong>in</strong>fection of the membranes cover<strong>in</strong>g the bra<strong>in</strong><br />
(men<strong>in</strong>gitis) but permanent effects are rare. In as many as five per 1,000 patients it can<br />
cause <strong>in</strong>flammation of the bra<strong>in</strong> (encephalitis). Mumps can also cause permanent<br />
deafness.<br />
Rubella<br />
Rubella, which used to be called German measles, is usually a mild disease of childhood<br />
but it can also affect teenagers <strong>and</strong> adults. The usual symptoms of rubella are a slight<br />
fever, swollen gl<strong>and</strong>s, jo<strong>in</strong>t pa<strong>in</strong> <strong>and</strong> a rash which appears on the face <strong>and</strong> neck <strong>and</strong> lasts<br />
for two or three days. Recovery from rubella is almost always speedy <strong>and</strong> complete. The<br />
most dangerous form is congenital rubella, where <strong>in</strong>fection dur<strong>in</strong>g the first 20 weeks of<br />
pregnancy can result <strong>in</strong> devastat<strong>in</strong>g abnormalities <strong>in</strong> the newborn baby. The best way to<br />
protect expectant mothers <strong>and</strong> their babies from rubella is to make sure that all women<br />
have been immunised before they become pregnant, <strong>and</strong> to immunise all children to stop<br />
the spread of <strong>in</strong>fection.<br />
Hib immunisation<br />
Several doses of Hib vacc<strong>in</strong>e are required to protect a child aga<strong>in</strong>st Hib. The first dose is<br />
normally given at two months of age. However, children up to the age of five years who<br />
were not immunised as babies can be given Hib vacc<strong>in</strong>e. Hib vacc<strong>in</strong>es are very safe. Mild<br />
swell<strong>in</strong>g, redness <strong>and</strong> pa<strong>in</strong> at the <strong>in</strong>jection site have been reported <strong>in</strong> up to 5% of children<br />
who receive a Hib vacc<strong>in</strong>e. The swell<strong>in</strong>g <strong>and</strong> redness usually appear with<strong>in</strong> 3 to 4 hours<br />
after the <strong>in</strong>jection <strong>and</strong> resolve completely with<strong>in</strong> 24 hours 17 . Fever <strong>and</strong> irritability are<br />
uncommon.<br />
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Haemophilus <strong>in</strong>fluenzae type b (Hib)<br />
Hib was the most frequent cause of life threaten<strong>in</strong>g <strong>in</strong>fection <strong>in</strong> children under five years<br />
of age before the <strong>in</strong>troduction of Hib vacc<strong>in</strong>es. Despite its name, it is not related <strong>in</strong> any<br />
way to <strong>in</strong>fluenza (‘the flu’). It may cause <strong>in</strong>fection of the membranes cover<strong>in</strong>g the bra<strong>in</strong><br />
(men<strong>in</strong>gitis), swell<strong>in</strong>g <strong>in</strong> the throat (epiglottitis) which can block breath<strong>in</strong>g, pneumonia,<br />
jo<strong>in</strong>t <strong>in</strong>fection or <strong>in</strong>fection of the tissue under the sk<strong>in</strong>, usually on the face (cellulitis).<br />
Pneumococcal immunisation<br />
Rout<strong>in</strong>e pneumococcal immunisation is given at 2, 4 <strong>and</strong> 6 months of age. It is<br />
recommended that the pneumococcal vacc<strong>in</strong>e be given at the same time as other<br />
scheduled vacc<strong>in</strong>es. Some children may need another dose or two depend<strong>in</strong>g upon where<br />
<strong>in</strong> Australia they live, <strong>and</strong> if they have any risk factors which identify them as be<strong>in</strong>g at<br />
greater risk of pneumococcal disease.<br />
Pneumococcal disease<br />
Pneumococcal disease is caused by bacteria <strong>and</strong> can lead to severe bra<strong>in</strong> <strong>in</strong>fection<br />
(men<strong>in</strong>gitis), blood <strong>in</strong>fection (bacteraemia), pneumonia, <strong>and</strong> middle ear <strong>in</strong>fections (otitis<br />
media). The bacteria are spread <strong>in</strong> droplets shed from the mouth or nose through kiss<strong>in</strong>g<br />
or contact with articles that have been contam<strong>in</strong>ated with the <strong>in</strong>fected droplets.<br />
Pneumococcal bacteria are commonly carried <strong>in</strong> the back of the throat <strong>and</strong> nose of<br />
healthy children <strong>and</strong> adults. Pneumococcal disease is most common <strong>in</strong> children under the<br />
age of 2 years 18 .<br />
Chickenpox immunisation (Varicella)<br />
A s<strong>in</strong>gle dose of the live vacc<strong>in</strong>e is available to all children when they turn 18 months of<br />
age (from 1 st November 2005). One dose of the chicken pox vacc<strong>in</strong>e protects up to 90%<br />
of vacc<strong>in</strong>ated children. If a vacc<strong>in</strong>ated child becomes <strong>in</strong>fected despite vacc<strong>in</strong>ation, the<br />
<strong>in</strong>fection is usually very mild.<br />
Chickenpox<br />
Chickenpox is a highly contagious disease caused by the varicella-zoster virus.<br />
Chickenpox starts with cold-like symptoms such as a runny nose, mild fever, cough <strong>and</strong><br />
fatigue followed by a rash. The rash usually starts on the trunk of the body <strong>and</strong> spreads<br />
over the whole body. The rash starts as small red spots which rapidly turn <strong>in</strong>to blisters.<br />
Chickenpox is spread through coughs <strong>and</strong> sneezes <strong>and</strong> through direct contact with the<br />
fluid <strong>in</strong> the blisters of the rash.<br />
In healthy children, chickenpox is usually a mild disease which lasts about 5-10 days.<br />
The chickenpox rash can be very itchy <strong>and</strong> scratch<strong>in</strong>g can lead to bacterial <strong>in</strong>fections of<br />
the spots. <strong>Child</strong>ren with other medical conditions are at risk of develop<strong>in</strong>g other lifethreaten<strong>in</strong>g<br />
complications such as pneumonia or <strong>in</strong>flammation of the bra<strong>in</strong> (encephalitis).<br />
If a woman develops chickenpox dur<strong>in</strong>g pregnancy, there is a small risk (less than 2%) of<br />
damage to the unborn baby. Adults tend to have more severe symptoms of the<br />
chickenpox disease than children <strong>and</strong> are much more likely to develop complications.<br />
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Men<strong>in</strong>gococcal C immunisation<br />
A s<strong>in</strong>gle dose vacc<strong>in</strong>e is available to all children when they turn 12 months of age. The<br />
vacc<strong>in</strong>e provides over 90% protection 19 aga<strong>in</strong>st men<strong>in</strong>gococcal C disease. This vacc<strong>in</strong>e<br />
can be given at the same time as the other vacc<strong>in</strong>es that are due at 12 months of age. The<br />
vacc<strong>in</strong>e is very safe <strong>and</strong> does not conta<strong>in</strong> live bacteria so cannot cause men<strong>in</strong>gitis <strong>in</strong> the<br />
child. There are other stra<strong>in</strong>s of men<strong>in</strong>gococcal <strong>in</strong>fection (eg type B) that are not covered<br />
by this vacc<strong>in</strong>e.<br />
Men<strong>in</strong>gococcal C disease<br />
Men<strong>in</strong>gococcal disease is an uncommon life-threaten<strong>in</strong>g <strong>in</strong>fection caused by bacteria that<br />
live at the back of the throat or <strong>in</strong> the nose <strong>in</strong> about 10% of people at any one time.<br />
Although most people who carry these bacteria rema<strong>in</strong> well, they can spread the<br />
men<strong>in</strong>gococcal bacteria to others. The onset of men<strong>in</strong>gococcal disease is very quick <strong>and</strong><br />
can rapidly cause bra<strong>in</strong> <strong>in</strong>fection (men<strong>in</strong>gitis) or blood poison<strong>in</strong>g (septicaemia) or a<br />
comb<strong>in</strong>ation of both. In Australia, 15% of people who develop men<strong>in</strong>gococcal disease<br />
die. The highest rate of men<strong>in</strong>gococcal disease occurs <strong>in</strong> children under 5 years of age 20 .<br />
Hepatitis B immunisation<br />
Hepatitis B immunisation is recommended for all babies <strong>and</strong> teenagers. All babies <strong>in</strong><br />
Australia are given one dose of hepatitis B vacc<strong>in</strong>e at birth to provide early protection<br />
aga<strong>in</strong>st the disease. A further three doses of hepatitis B vacc<strong>in</strong>e are required to provide<br />
optimal protection. These are 2 months, 4 months of age <strong>and</strong> either 6 or 12 months of age<br />
depend<strong>in</strong>g on where <strong>in</strong> Australia the child lives. Most side effects of hepatitis B vacc<strong>in</strong>e<br />
are m<strong>in</strong>or <strong>and</strong> disappear quickly. Soreness at the <strong>in</strong>jection site may occur, as may low<br />
grade fever, nausea, feel<strong>in</strong>g unwell <strong>and</strong> jo<strong>in</strong>t pa<strong>in</strong>. More serious side effects are extremely<br />
rare.<br />
Hepatitis B<br />
Hepatitis B virus affects the liver <strong>and</strong> can cause fever, nausea, tiredness, dark ur<strong>in</strong>e <strong>and</strong><br />
yellow sk<strong>in</strong> (jaundice). About 5% of people <strong>in</strong>fected as adults, <strong>and</strong> most of those <strong>in</strong>fected<br />
as children, become carriers of the <strong>in</strong>fection <strong>and</strong> can cont<strong>in</strong>ue to spread it to other people.<br />
These carriers are also at <strong>in</strong>creased risk of develop<strong>in</strong>g liver disease <strong>and</strong> cancer later <strong>in</strong><br />
life.<br />
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The Australian St<strong>and</strong>ard Vacc<strong>in</strong>ation Schedule 20<br />
AGE VACCINE<br />
Birth Hepatitis B 1<br />
2 months Hepatitis B 2,3 DTPa Hib 1,2<br />
4 months Hepatitis B 2,3 DTPa Hib 1,2<br />
IPV 7vPCV<br />
IPV 7vPCV<br />
6 months Hepatitis B 2 DTPa Hib 1 IPV 7vPCV<br />
12 months Hepatitis B 3 Hib 1,2<br />
MMR MenCCV<br />
18 months VZV 1 23vPPV<br />
2 years<br />
4 years DTPa IPV MMR<br />
10 — 13<br />
years<br />
15 — 17<br />
years<br />
50 years<br />
<strong>and</strong> over<br />
65 years<br />
<strong>and</strong> over<br />
Schedule key<br />
Hepatitis B 4 VZV 1<br />
dTpa<br />
dT 23vPPV 2<br />
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23vPPV<br />
Influenza<br />
(annual) 2<br />
Influenza<br />
(annual)<br />
Hepatitis B 1 Monovalent hepatitis B vacc<strong>in</strong>e.<br />
Hepatitis B 2<br />
Hepatitis B vacc<strong>in</strong>e given as either monovalent vacc<strong>in</strong>e or <strong>in</strong> comb<strong>in</strong>ation with<br />
DTPa, 3 doses at 2, 4 <strong>and</strong> 6 months, <strong>in</strong> addition to the birth dose for a total of 4<br />
doses.<br />
Hepatitis B 3 Hepatitis B vacc<strong>in</strong>e <strong>in</strong> comb<strong>in</strong>ation with Hib (PRP-OMP), 3 doses at 2, 4 <strong>and</strong> 12<br />
months, <strong>in</strong> addition to the birth dose for a total of 4 doses.<br />
Hepatitis B 4 Hepatitis B vacc<strong>in</strong>e for 10 to 13 year olds who have not received a primary<br />
course.<br />
Hib 1 PRP-T, HbOC (non-Indigenous children).<br />
Hib 2 PRP-OMP (all children).<br />
23vPPV 1<br />
Pneumococcal polysaccharide vacc<strong>in</strong>e (Aborig<strong>in</strong>al <strong>and</strong> Torres Strait Isl<strong>and</strong>er<br />
children only); this dose can be given between 18 months <strong>and</strong> 2 years of age<br />
(refer to State/Territory Public <strong>Health</strong> Units for recommended age for<br />
adm<strong>in</strong>istration).<br />
23vPPV 2 &<br />
Influenza 2 <strong>National</strong> Indigenous Pneumococcal <strong>and</strong> Influenza Immunisation Program.<br />
VZV 1<br />
Vacc<strong>in</strong>ation only for children with a negative history of varicella disease or<br />
vacc<strong>in</strong>ation.
Vacc<strong>in</strong>e Key<br />
Hepatitis B Hepatitis B vacc<strong>in</strong>e<br />
DTPa Diphtheria-tetanus-acellular pertussis <strong>in</strong>fant/child formulation<br />
dTpa<br />
Hib<br />
Adult/adolescent formulation<br />
diphtheria-tetanus-acellular pertussis vacc<strong>in</strong>e<br />
Haemophilus <strong>in</strong>fluenzae type b (Hib) vacc<strong>in</strong>e PRP-OMP, PRP-T, HbOC (as<br />
monovalent or <strong>in</strong> comb<strong>in</strong>ation)<br />
IPV Inactivated poliomyelitis vacc<strong>in</strong>e (<strong>in</strong> comb<strong>in</strong>ation)<br />
MMR Measles-mumps-rubella vacc<strong>in</strong>e<br />
VZV Varicella-zoster vacc<strong>in</strong>e<br />
7vPCV 7-valent pneumococcal conjugate vacc<strong>in</strong>e<br />
23vPPV 23-valent pneumococcal polysaccharide vacc<strong>in</strong>e<br />
MenCCV Men<strong>in</strong>gococcal C conjugate vacc<strong>in</strong>e<br />
Influenza Influenza vacc<strong>in</strong>e<br />
dT Adult diphtheria-tetanus vacc<strong>in</strong>e.<br />
Visit the Australian Government Department of <strong>Health</strong> <strong>and</strong> Age<strong>in</strong>g website for updated<br />
vacc<strong>in</strong>ation schedules. http://www1.health.gov.au/immh<strong>and</strong>book/pdf/h<strong>and</strong>book.pdf<br />
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Comparison of effects of vacc<strong>in</strong>es <strong>and</strong> diseases<br />
Disease Effects of disease Side effects of vacc<strong>in</strong>ation<br />
Diphtheria - contagious<br />
bacteria spread by<br />
droplets; causes severe<br />
throat <strong>and</strong> breath<strong>in</strong>g<br />
difficulties.<br />
Hepatitis B - virus<br />
spread ma<strong>in</strong>ly by blood,<br />
sexual contact or from<br />
mother to newborn<br />
baby, causes acute<br />
hepatitis or chronic<br />
carriage.<br />
Hib - contagious<br />
bacteria spread by<br />
droplets; causes<br />
men<strong>in</strong>gitis, epiglottitis<br />
(respiratory<br />
obstruction),<br />
septicaemia,<br />
osteomyelitis.<br />
Influenza - contagious<br />
virus spread by<br />
droplets; causes fever,<br />
muscle <strong>and</strong> jo<strong>in</strong>t pa<strong>in</strong>s,<br />
pneumonia.<br />
Measles - highly<br />
<strong>in</strong>fectious virus spread<br />
by droplets; causes<br />
fever, cough, rash.<br />
Men<strong>in</strong>gococcal<br />
<strong>in</strong>fections - bacteria<br />
spread by respiratory<br />
droplets. Cause sepsis<br />
(<strong>in</strong>fection of the blood<br />
stream) <strong>and</strong> men<strong>in</strong>gitis<br />
(<strong>in</strong>fection of the tissues<br />
surround<strong>in</strong>g the bra<strong>in</strong>).<br />
About 1 <strong>in</strong> 15 patients dies. The<br />
bacteria release a tox<strong>in</strong>, which can<br />
produce nerve paralysis <strong>and</strong> heart<br />
failure.<br />
About 1 <strong>in</strong> 4 chronic carriers will<br />
develop cirrhosis or liver cancer.<br />
About 1 <strong>in</strong> 20 men<strong>in</strong>gitis patients dies<br />
<strong>and</strong> about 1 <strong>in</strong> 4 survivors has<br />
permanent bra<strong>in</strong> or nerve damage.<br />
About 1 <strong>in</strong> 100 epiglottitis patients<br />
die.<br />
Causes <strong>in</strong>creased hospitalisation <strong>in</strong><br />
the elderly. High-risk groups <strong>in</strong>clude<br />
the elderly, diabetics, <strong>and</strong> alcoholics.<br />
1 <strong>in</strong> 25 children with measles<br />
develops pneumonia <strong>and</strong> 1 <strong>in</strong> 2000<br />
develops encephalitis (bra<strong>in</strong><br />
<strong>in</strong>flammation). For every 10 children<br />
who develop measles encephalitis, 1<br />
dies <strong>and</strong> 4 have permanent bra<strong>in</strong><br />
damage. About 1 <strong>in</strong> 100 000 develops<br />
SSPE (bra<strong>in</strong> degeneration) which is<br />
always fatal.<br />
About 1 <strong>in</strong> 10 patients dies.<br />
Of those that survive, 1 <strong>in</strong> 30 has<br />
severe sk<strong>in</strong> scarr<strong>in</strong>g or loss of limbs,<br />
<strong>and</strong> 1 <strong>in</strong> 30 has severe bra<strong>in</strong> damage.<br />
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Draft for Public Consultation<br />
DTPa vacc<strong>in</strong>e- about 1 <strong>in</strong> 10 has<br />
local <strong>in</strong>flammation or fever.<br />
Serious adverse events are very<br />
rare, <strong>and</strong> much less common<br />
than with DTPw.<br />
About 1 <strong>in</strong> 15 to 1 <strong>in</strong> 100 will<br />
have pa<strong>in</strong> <strong>and</strong> fever.<br />
Anaphylaxis occurs <strong>in</strong> about 1 <strong>in</strong><br />
600 000.<br />
About 1 <strong>in</strong> 20 has discomfort or<br />
local <strong>in</strong>flammation. About 1 <strong>in</strong><br />
50 has fever.<br />
About 1 <strong>in</strong> 10 has local<br />
reactions. Guilla<strong>in</strong>-Barré<br />
syndrome occurs <strong>in</strong> about 1 <strong>in</strong> 1<br />
million.<br />
About 1 <strong>in</strong> 10 has discomfort,<br />
local <strong>in</strong>flammation or fever.<br />
About 1 <strong>in</strong> 100 develops a rash<br />
which is non-<strong>in</strong>fectious. 1 <strong>in</strong> 1<br />
million recipients may develop<br />
encephalitis (<strong>in</strong>flammation of<br />
the bra<strong>in</strong>).<br />
Polysaccharide vacc<strong>in</strong>e: Local<br />
reactions common. Mild fever,<br />
headache, malaise <strong>in</strong> 1 <strong>in</strong> 30.<br />
Conjugate vacc<strong>in</strong>e: About 1 <strong>in</strong><br />
10 has local <strong>in</strong>flammation, fever,<br />
irritability, anorexia or<br />
headaches.
Mumps - contagious<br />
virus spread by saliva;<br />
causes swollen neck<br />
<strong>and</strong> salivary gl<strong>and</strong>s,<br />
fever.<br />
Pertussis - contagious<br />
bacteria spread by<br />
droplets; causes<br />
whoop<strong>in</strong>g cough <strong>and</strong><br />
vomit<strong>in</strong>g, last<strong>in</strong>g up to<br />
3 months.<br />
Pneumococcal<br />
<strong>in</strong>fections - bacteria<br />
spread by droplets;<br />
cause fever,<br />
pneumonia,<br />
septicaemia,<br />
men<strong>in</strong>gitis.<br />
Polio - contagious virus<br />
spread by faeces <strong>and</strong><br />
saliva; causes fever,<br />
headache, vomit<strong>in</strong>g <strong>and</strong><br />
may progress to<br />
paralysis.<br />
Rubella - contagious<br />
virus spread by<br />
droplets; causes fever,<br />
rash, swollen gl<strong>and</strong>s,<br />
but causes severe<br />
malformations <strong>in</strong> babies<br />
of <strong>in</strong>fected pregnant<br />
women.<br />
Tetanus - caused by<br />
tox<strong>in</strong> of bacteria <strong>in</strong> soil;<br />
causes pa<strong>in</strong>ful muscle<br />
spasms, convulsions,<br />
lockjaw.<br />
Varicella (chickenpox)<br />
- caused by highly<br />
contagious virus;<br />
causes low-grade fever<br />
<strong>and</strong> vesicular rash.<br />
Reactivation of the<br />
virus later <strong>in</strong> life causes<br />
1 <strong>in</strong> 200 children develops<br />
encephalitis. 1 <strong>in</strong> 5 males past<br />
puberty develop <strong>in</strong>flammation of the<br />
testes. Occasionally mumps causes<br />
<strong>in</strong>fertility or deafness.<br />
About 1 <strong>in</strong> 200 whoop<strong>in</strong>g cough<br />
patients under the age of 6 months<br />
dies from pneumonia or bra<strong>in</strong><br />
damage<br />
About 1 <strong>in</strong> 10 men<strong>in</strong>gitis patients dies<br />
While many <strong>in</strong>fections cause no<br />
symptoms, about 1 <strong>in</strong> 20 hospitalised<br />
patients dies <strong>and</strong> 1 <strong>in</strong> 2 patients who<br />
survive is permanently paralysed.<br />
About 5 <strong>in</strong> 10 patients develop a rash<br />
<strong>and</strong> pa<strong>in</strong>ful swollen gl<strong>and</strong>s; 5 <strong>in</strong> 10<br />
adolescents <strong>and</strong> adults have pa<strong>in</strong>ful<br />
jo<strong>in</strong>ts; 1 <strong>in</strong> 3000 develops<br />
thrombocytopenia (bruis<strong>in</strong>g or<br />
bleed<strong>in</strong>g); 1 <strong>in</strong> 6000 develops<br />
<strong>in</strong>flammation of the bra<strong>in</strong>; 9 <strong>in</strong> 10<br />
babies <strong>in</strong>fected dur<strong>in</strong>g the first 10<br />
weeks after conception will have a<br />
major congenital abnormality (such<br />
as deafness, bl<strong>in</strong>dness or heart<br />
defects).<br />
About 1 <strong>in</strong> 10 patients dies. The risk<br />
is greatest for the very young or old.<br />
1 <strong>in</strong> 5000 patients develop<br />
encephalitis (bra<strong>in</strong> <strong>in</strong>flammation).<br />
About 3 <strong>in</strong> 100 000 patients die.<br />
Infection dur<strong>in</strong>g pregnancy can result<br />
<strong>in</strong> congenital malformations <strong>in</strong> the<br />
baby. Onset of <strong>in</strong>fection <strong>in</strong> the<br />
mother from 5 days before to 2 days<br />
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1 <strong>in</strong> 100 vacc<strong>in</strong>e recipients may<br />
develop swell<strong>in</strong>g of the salivary<br />
gl<strong>and</strong>s. 1 <strong>in</strong> 3 million recipients<br />
develop mild encephalitis.<br />
As for DTPa vacc<strong>in</strong>e (see<br />
diphtheria).<br />
Polysaccharide vacc<strong>in</strong>e: Less<br />
than 1 <strong>in</strong> 20 has pa<strong>in</strong> or local<br />
reaction.<br />
Conjugate vacc<strong>in</strong>e: About 1 <strong>in</strong><br />
10 has local reaction or fever.<br />
OPV: Less than 1 <strong>in</strong> 100<br />
recipients develops diarrhoea,<br />
headache <strong>and</strong>/or muscle pa<strong>in</strong>s. 1<br />
<strong>in</strong> 2.5 million recipients or close<br />
contacts develops paralysis.<br />
IPV: Local redness (1 <strong>in</strong> 3), pa<strong>in</strong><br />
(1 <strong>in</strong> 7) <strong>and</strong> swell<strong>in</strong>g (1 <strong>in</strong> 10)<br />
common. Up to 1 <strong>in</strong> 10 has<br />
fever, cry<strong>in</strong>g, <strong>and</strong> decreased<br />
appetite.<br />
About 1 <strong>in</strong> 10 has discomfort,<br />
local <strong>in</strong>flammation, or fever.<br />
About 1 <strong>in</strong> 20 has swollen<br />
gl<strong>and</strong>s, stiff neck, or jo<strong>in</strong>t pa<strong>in</strong>s.<br />
About 1 <strong>in</strong> 100 has a rash, which<br />
is non-<strong>in</strong>fectious.<br />
Thrombocytopenia (bruis<strong>in</strong>g or<br />
bleed<strong>in</strong>g) occurs after a first<br />
dose of MMR at a rate of about<br />
1 <strong>in</strong> 30 500.<br />
As for DTPa vacc<strong>in</strong>e (see<br />
diphtheria).<br />
About 1 <strong>in</strong> 5 has a local reaction<br />
or fever. A mild varicella-like<br />
rash may develop <strong>in</strong> 3-5 per<br />
hundred recipients.
herpes zoster<br />
(sh<strong>in</strong>gles).<br />
after delivery results <strong>in</strong> severe<br />
<strong>in</strong>fection <strong>in</strong> the newborn baby <strong>in</strong> up<br />
to one-third of cases.<br />
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Parent Advice Sheet<br />
Commonly observed adverse events follow<strong>in</strong>g immunisation<br />
<strong>and</strong> what to do about them<br />
All the common adverse events follow<strong>in</strong>g immunisation are usually mild <strong>and</strong> transient<br />
<strong>and</strong> treatment is not usually required. If the adverse event follow<strong>in</strong>g immunisation is<br />
severe or persistent, or if you are worried about yourself or your child’s condition, see<br />
your doctor or immunisation cl<strong>in</strong>ic nurse as soon as possible or go to a hospital.<br />
Commonly observed adverse events (conditions) follow<strong>in</strong>g specific<br />
vacc<strong>in</strong>es used <strong>in</strong> the Australian St<strong>and</strong>ard Vacc<strong>in</strong>ation Schedule<br />
(ASVS)<br />
VZV MMR MenCCV<br />
• Localised pa<strong>in</strong>,<br />
redness & swell<strong>in</strong>g at<br />
<strong>in</strong>jection site<br />
• Occasionally,<br />
<strong>in</strong>jection site nodule –<br />
may last many weeks<br />
(no treatment needed)<br />
• Low grade<br />
temperature (fever)<br />
Seen 5-26 days after<br />
vacc<strong>in</strong>ation:<br />
• Pustular rash (2-5<br />
lesions) usually at<br />
<strong>in</strong>jection site which<br />
occasional covers<br />
other parts of the<br />
body<br />
DTPa-conta<strong>in</strong><strong>in</strong>g vacc<strong>in</strong>es &<br />
dTpa<br />
• Irritable, cry<strong>in</strong>g,<br />
unsettled <strong>and</strong> generally<br />
unhappy<br />
• Drows<strong>in</strong>ess or<br />
tiredness<br />
• Localised pa<strong>in</strong>,<br />
redness & swell<strong>in</strong>g at<br />
<strong>in</strong>jection site<br />
• Occasionally,<br />
<strong>in</strong>jection site nodule –<br />
• Occasionally <strong>in</strong>jection<br />
site nodule – may last<br />
many weeks (no treatment<br />
needed)<br />
Seen 7 to 10 days after<br />
vacc<strong>in</strong>ation:<br />
• Low grade temperature<br />
(fever) last<strong>in</strong>g 2-3 days,<br />
fa<strong>in</strong>t red rash (not<br />
<strong>in</strong>fectious), head cold<br />
<strong>and</strong>/or runny nose, cough<br />
<strong>and</strong>/or puffy eyes<br />
• Drows<strong>in</strong>ess or tiredness<br />
• Swell<strong>in</strong>g of salivary<br />
gl<strong>and</strong>s<br />
Influenza<br />
• Drows<strong>in</strong>ess or tiredness<br />
• Muscle aches<br />
• Localised pa<strong>in</strong>, redness<br />
& swell<strong>in</strong>g at <strong>in</strong>jection site<br />
• Occasionally <strong>in</strong>jection<br />
site nodule – may last<br />
many weeks (no treatment<br />
needed)<br />
• Low grade temperature<br />
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Draft for Public Consultation<br />
• Irritable, cry<strong>in</strong>g,<br />
unsettled <strong>and</strong><br />
generally unhappy<br />
• Loss of appetite<br />
• Headache (usually<br />
observed <strong>in</strong><br />
adolescent/adults)<br />
• Localised pa<strong>in</strong>,<br />
redness & swell<strong>in</strong>g at<br />
<strong>in</strong>jection site<br />
• Occasionally,<br />
<strong>in</strong>jection site nodule<br />
– may last many<br />
weeks (no treatment<br />
needed)<br />
• Low grade<br />
temperature (fever)<br />
IPV & IPV-conta<strong>in</strong><strong>in</strong>g<br />
vacc<strong>in</strong>es<br />
• Muscle aches<br />
• Localised pa<strong>in</strong>,<br />
redness & swell<strong>in</strong>g at<br />
<strong>in</strong>jection site<br />
• Occasionally<br />
<strong>in</strong>jection site nodule<br />
– may last many<br />
weeks (no treatment<br />
needed)<br />
• Low grade
may last many weeks<br />
(no treatment needed)<br />
• Low grade<br />
temperature (fever)<br />
(fever) temperature (fever)<br />
HepB Hib 23vPPV<br />
• Localised pa<strong>in</strong>,<br />
redness & swell<strong>in</strong>g at<br />
<strong>in</strong>jection site<br />
• Occasionally,<br />
<strong>in</strong>jection site nodule –<br />
may last many weeks<br />
(no treatment needed)<br />
• Low grade<br />
temperature (fever)<br />
• Localised pa<strong>in</strong>, redness<br />
& swell<strong>in</strong>g at <strong>in</strong>jection site<br />
• Occasionally, <strong>in</strong>jection<br />
site nodule – may last<br />
many weeks (no treatment<br />
needed)<br />
• Low grade temperature<br />
(fever)<br />
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• Localised pa<strong>in</strong>,<br />
redness & swell<strong>in</strong>g at<br />
<strong>in</strong>jection site<br />
• Occasionally,<br />
<strong>in</strong>jection site nodule<br />
– may last many<br />
weeks (no treatment<br />
needed)<br />
• Low grade<br />
temperature (fever)<br />
7vPCV OPV dT (ADT)<br />
• Localised pa<strong>in</strong>,<br />
redness & swell<strong>in</strong>g at<br />
<strong>in</strong>jection site<br />
• Occasionally,<br />
<strong>in</strong>jection site nodule –<br />
may last many weeks<br />
(no treatment needed)<br />
Key to table:<br />
• Occasionally, diarrhoea<br />
(no treatment usually<br />
needed but parent or carer<br />
must wash h<strong>and</strong>s carefully<br />
after chang<strong>in</strong>g nappies)<br />
DTPa Diphtheria-tetanus-pertussis (acellular) <strong>in</strong>fant/child formulation<br />
• Localised pa<strong>in</strong>,<br />
redness & swell<strong>in</strong>g at<br />
<strong>in</strong>jection site<br />
• Occasionally,<br />
<strong>in</strong>jection site nodule<br />
– may last many<br />
weeks (no treatment<br />
needed)<br />
• Low grade<br />
temperature (fever)<br />
dTpa Adult/adolescent formulation diphtheria-tetanus-pertussis (acellular) vacc<strong>in</strong>e<br />
dT or<br />
ADT<br />
Adult diphtheria-tetanus vacc<strong>in</strong>e<br />
hepB hepatitis B vacc<strong>in</strong>e<br />
Hib<br />
Haemophilus <strong>in</strong>fluenzae type b (Hib) vacc<strong>in</strong>e PRP-OMP, PRP-T, HbOC (as<br />
monovalent or <strong>in</strong> comb<strong>in</strong>ation)<br />
Influenza Influenza vacc<strong>in</strong>e<br />
IPV<br />
Inactivated poliomyelitis vacc<strong>in</strong>e (usually <strong>in</strong> comb<strong>in</strong>ation with other vacc<strong>in</strong>e <strong>and</strong><br />
given as <strong>in</strong>jection)<br />
7vPCV 7-valent pneumococcal conjugate vacc<strong>in</strong>e
23vPPV 23-valent pneumococcal polysaccharide vacc<strong>in</strong>e<br />
MenCCV Men<strong>in</strong>gococcal C conjugate vacc<strong>in</strong>e<br />
MMR measles-mumps-rubella vacc<strong>in</strong>e<br />
OPV oral poliomyelitis vacc<strong>in</strong>e<br />
VZV<br />
varicella-zoster vacc<strong>in</strong>e (both Varivax Refrigerated <strong>and</strong> Varilrix, unless stated<br />
otherwise)<br />
NA not applicable<br />
What to do to manage <strong>in</strong>jection site discomfort<br />
Many vacc<strong>in</strong>e <strong>in</strong>jections may result <strong>in</strong> soreness, redness, itch<strong>in</strong>g, swell<strong>in</strong>g or burn<strong>in</strong>g at<br />
the <strong>in</strong>jection site for 1 to 2 days. Paracetamol might be needed to ease the discomfort.<br />
Sometimes a small, hard lump may persist for some weeks or months. This should not be<br />
of concern <strong>and</strong> requires no treatment.<br />
Manag<strong>in</strong>g fever after immunisation<br />
Give extra fluids to dr<strong>in</strong>k. Do not overdress the baby if hot. Although the rout<strong>in</strong>e use of<br />
paracetamol at the time of vacc<strong>in</strong>ation is no longer necessary, it may be needed if, for<br />
example, an <strong>in</strong>fant or child has a high fever follow<strong>in</strong>g vacc<strong>in</strong>ation. The dose of<br />
paracetamol is 15 mg/kg of paracetamol liquid, up to a maximum daily dose of 90<br />
mg/kg/day.<br />
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Food safety<br />
Gett<strong>in</strong>g ready for meals <strong>and</strong> snacks<br />
• Before meals, clean tables that are to be used for the meal.<br />
• Wash your h<strong>and</strong>s before prepar<strong>in</strong>g or serv<strong>in</strong>g food. If you are <strong>in</strong>terrupted to care<br />
for another child while prepar<strong>in</strong>g food or spoon-feed<strong>in</strong>g an <strong>in</strong>fant, be sure to wash<br />
your h<strong>and</strong>s aga<strong>in</strong> before you cont<strong>in</strong>ue.<br />
• Check that all the children’s h<strong>and</strong>s are washed before they eat or dr<strong>in</strong>k.<br />
• Teach children to turn away from food when they cough or sneeze, <strong>and</strong> then to<br />
wash their h<strong>and</strong>s.<br />
• Make sure children do not share food, plates or utensils. Do not allow children to<br />
choose their food from a common bowl because they may touch food that other<br />
children will eat. Rem<strong>in</strong>d them that shar<strong>in</strong>g dur<strong>in</strong>g meals can spread germs that<br />
might make them or other children sick.<br />
• Use a separate spoon for each baby you feed.<br />
Prepar<strong>in</strong>g food<br />
Food is an excellent place for bacteria to grow. Germs that do not grow <strong>in</strong> food can still<br />
be passed from one person to another <strong>in</strong> food. Bacteria that are common on our sk<strong>in</strong> <strong>and</strong><br />
<strong>in</strong> the environment can cause food poison<strong>in</strong>g if allowed to grow to large numbers <strong>in</strong> food.<br />
<strong>Child</strong> care centres where staff members change nappies <strong>and</strong> prepare or serve food on a<br />
daily basis have over three times as much diarrhoea as centres where staff do not do both<br />
these jobs. For this reason, the person who prepares <strong>and</strong> serves food should not be the<br />
person who changes nappies or helps children go to the toilet on that day.<br />
The child care centre should have a h<strong>and</strong> bas<strong>in</strong>, soap <strong>and</strong> disposable towels <strong>in</strong> the kitchen<br />
so that staff who are prepar<strong>in</strong>g food can easily wash their h<strong>and</strong>s. Staff should wear clean<br />
overalls when work<strong>in</strong>g <strong>in</strong> the kitchen. The kitchen should be fly <strong>and</strong> verm<strong>in</strong> proof.<br />
If you are <strong>in</strong>volved <strong>in</strong> h<strong>and</strong>l<strong>in</strong>g, prepar<strong>in</strong>g or serv<strong>in</strong>g food, remember these basic po<strong>in</strong>ts.<br />
• Wash your h<strong>and</strong>s before h<strong>and</strong>l<strong>in</strong>g food.<br />
• To prevent cross-contam<strong>in</strong>ation between raw <strong>and</strong> cooked foods:<br />
− keep raw <strong>and</strong> cooked foods separate (even <strong>in</strong> the fridge),<br />
− do not keep uncooked food above cooked food <strong>in</strong> the fridge, <strong>and</strong><br />
− use separate utensils (<strong>in</strong>clud<strong>in</strong>g cutt<strong>in</strong>g boards, knives, etc) for raw <strong>and</strong><br />
cooked food.<br />
• Keep food hot (over 60° Celsius) or keep food cold (5° Celsius or less 21 );<br />
otherwise don’t keep it at all. While the legal requirement for reheat<strong>in</strong>g food is<br />
60°Celsius, it is recommended that food should be reheated to 70°C for 2 m<strong>in</strong>utes.<br />
Heat<strong>in</strong>g to this temperature will destroy germs that may have grown <strong>in</strong> the food<br />
after it was cooked. The reheat<strong>in</strong>g to 70°Celsius is recommended as the centre<br />
does not know if the food has been cooked, stored <strong>and</strong> transported to the centre<br />
correctly. 22 Ensure the food is allowed to cool before it is given to the child to eat.<br />
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• Keep a non-mercury thermometer <strong>in</strong> your fridge so that you can check that the<br />
temperature is below 5° Celsius.<br />
• Throw out left-overs. Tell parents what their child left, but do not return the leftover<br />
food.<br />
• Heat food once only.<br />
• Heat milk for bottles once only.<br />
• Check that food has cooled before giv<strong>in</strong>g it to the child. Remove a small piece of<br />
food with a spoon to another plate <strong>and</strong> test the temperature of the food with your<br />
h<strong>and</strong>. Throw this piece of food away <strong>and</strong> wash the spoon.<br />
Breast milk<br />
Breast milk is best for babies. It has immunological properties that help prevent illness <strong>in</strong><br />
babies. Mothers of babies up to 12 months should be encouraged to provide expressed<br />
breast milk or to visit the centre to feed their babies. Support <strong>and</strong> encourage mothers who<br />
wish to supply breast milk for their babies. Encourag<strong>in</strong>g words from a child care worker<br />
go a long way to help<strong>in</strong>g a mother who is try<strong>in</strong>g to work <strong>and</strong> express breast milk.<br />
Breast milk can be stored <strong>in</strong> the refrigerator for 48 hours or <strong>in</strong> a deep freezer for up to six<br />
months, depend<strong>in</strong>g upon the deep freeze. Frozen breast milk must be thawed quickly—<br />
but don’t put it <strong>in</strong> boil<strong>in</strong>g water or it will curdle. Place the conta<strong>in</strong>er under cold runn<strong>in</strong>g<br />
water. Gradually allow the water to get warmer until the milk becomes liquid. Do not<br />
shake the thawed breast milk – roll gently to mix. Test the temperature by dropp<strong>in</strong>g a<br />
little milk onto your wrist.<br />
Ensure breast milk is clearly labelled with the child’s name <strong>and</strong> the time <strong>and</strong> date the<br />
milk was expressed. Throw away any milk that is left over. Do not re-freeze or re-heat<br />
left-over milk. Ask mothers to supply breast milk <strong>in</strong> multiple small quantities to prevent<br />
wastage.<br />
Formula<br />
When prepar<strong>in</strong>g formula, follow the manufacturer’s <strong>in</strong>structions carefully. Throw away<br />
any formula that is left over. Do not freeze or re-heat left-over formula. Ensure the bottles<br />
are clearly labelled with the child’s name <strong>and</strong> date the formula was made up.<br />
Microwave ovens<br />
Do not warm bottles <strong>in</strong> the microwave. Microwave ovens distribute heat unevenly. Also,<br />
water <strong>in</strong> the milk turns to steam <strong>and</strong> collects at the top of the bottle. There is a danger that<br />
the baby could be scalded.<br />
<strong>Child</strong>ren’s cook<strong>in</strong>g classes<br />
<strong>Child</strong>ren love to cook. Cook<strong>in</strong>g is a safe <strong>and</strong> enjoyable activity for children <strong>in</strong> child care<br />
centres provided that a few simple precautions are taken.<br />
• Always be aware of the dangers of heat.<br />
• If they have had vomit<strong>in</strong>g or diarrhoea they should not participate until they have<br />
not had any symptoms for 48 hours.<br />
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• Make sure children wash their h<strong>and</strong>s before start<strong>in</strong>g.<br />
• Tie up any long hair.<br />
• Limit the type of food that children prepare to food that will be cooked<br />
afterwards. Germs <strong>in</strong> the food will be destroyed when the food is cooked.<br />
• Foods suitable for cook<strong>in</strong>g classes <strong>in</strong>clude: cooked biscuits, fresh pasta, soups <strong>and</strong><br />
pizza.<br />
• Foods not suitable for cook<strong>in</strong>g classes <strong>in</strong>clude: fruit salad, refrigerator biscuits<br />
<strong>and</strong> jellies.<br />
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Occupational <strong>Health</strong> <strong>and</strong> Safety for child care workers<br />
Employers have a duty to take reasonable care of their own safety <strong>and</strong> health at work <strong>and</strong><br />
to provide <strong>and</strong> ma<strong>in</strong>ta<strong>in</strong> a work environment where their employees are not exposed to<br />
hazards. Employers must also ensure, as far as practicable, that the health of other people<br />
who are not employees is not harmed by the work.<br />
Employees should take reasonable care for their own safety <strong>and</strong> health at work. They<br />
should also avoid adversely affect<strong>in</strong>g the safety <strong>and</strong> health of children, other staff<br />
members <strong>and</strong> visitors <strong>in</strong> the workplace.<br />
Exclusion of sick children <strong>and</strong> staff<br />
Exclud<strong>in</strong>g sick children <strong>and</strong> staff is probably the most important way of limit<strong>in</strong>g the<br />
spread of <strong>in</strong>fection <strong>in</strong> the child care centre. The spread of certa<strong>in</strong> <strong>in</strong>fectious diseases can<br />
be reduced by exclud<strong>in</strong>g a person who is known to be <strong>in</strong>fectious from contact with others<br />
who are at risk of catch<strong>in</strong>g the <strong>in</strong>fection. Staff, as well as children, need to adhere to the<br />
centre’s exclusion policy for <strong>in</strong>fectious conditions (see pages 13).<br />
Immunisation requirements<br />
<strong>Child</strong> care workers may be exposed to diseases that are preventable by immunisation<br />
<strong>in</strong>clud<strong>in</strong>g hepatitis A, measles, mumps, rubella, varicella <strong>and</strong> pertussis. Workers who<br />
have not previously been <strong>in</strong>fected with or immunised aga<strong>in</strong>st these diseases are at risk of<br />
<strong>in</strong>fection. All of these diseases can cause serious illness <strong>in</strong> adults. Some of these diseases,<br />
such as rubella <strong>and</strong> chickenpox, can cause serious damage to an unborn baby if a woman<br />
is <strong>in</strong>fected dur<strong>in</strong>g her pregnancy.<br />
Employers of child care facilities have an obligation to prevent or m<strong>in</strong>imise the risk to<br />
childcare workers from exposure to diseases that are preventable by vacc<strong>in</strong>ation.<br />
Immunisation of workers is the only effective way to manage the risk <strong>in</strong> childcare<br />
sett<strong>in</strong>gs, as these diseases are usually <strong>in</strong>fectious before the onset of symptoms.<br />
The <strong>National</strong> <strong>Health</strong> <strong>and</strong> <strong>Medical</strong> Research Council (NHMRC) recommends that<br />
childcare workers should be immunised aga<strong>in</strong>st 23 :<br />
• Hepatitis A<br />
• Measles-Mumps-Rubella (MMR) for childcare workers born dur<strong>in</strong>g or s<strong>in</strong>ce 1966<br />
who do not have vacc<strong>in</strong>ation records of two doses of MMR or do not have<br />
antibodies for rubella<br />
• Varicella for childcare workers who have not previously been <strong>in</strong>fected with<br />
chickenpox<br />
• Pertussis. This is especially important for those workers car<strong>in</strong>g for the youngest<br />
children who are not fully vacc<strong>in</strong>ated<br />
• Although the risk is low, staff of child day care centres that care for children with<br />
<strong>in</strong>tellectual disabilities should seek advice about hepatitis B immunisation if the<br />
children are unimmunised. Immunisation of the children should be encouraged.<br />
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Employers of childcare facilities should 24 :<br />
• develop a staff immunisation policy; this would state the immunisation<br />
requirements for childcare workers at the centre<br />
• develop a staff immunisation record; this should document previous <strong>in</strong>fection or<br />
immunisation for the relevant diseases (as listed above)<br />
• require all new <strong>and</strong> current staff to complete the staff immunisation record<br />
• regularly update staff immunisation records as workers become vacc<strong>in</strong>ated<br />
• provide workers with <strong>in</strong>formation about diseases that are preventable by<br />
immunisation; for example through <strong>in</strong>-service tra<strong>in</strong><strong>in</strong>g <strong>and</strong> written material such<br />
as fact sheets<br />
• take all reasonable steps to encourage non-immune workers to be vacc<strong>in</strong>ated<br />
Infectious diseases dur<strong>in</strong>g pregnancy<br />
<strong>Child</strong> care workers who are pregnant need to be aware of how some <strong>in</strong>fections can affect<br />
the unborn child. This is a good time for the centre to make sure that all workers are<br />
follow<strong>in</strong>g good <strong>in</strong>fection control practices.<br />
Rubella (German measles)<br />
Rubella is a vacc<strong>in</strong>e-preventable disease. It is especially important for women of child<br />
bear<strong>in</strong>g age to be protected aga<strong>in</strong>st rubella. If a pregnant woman contracts rubella, her<br />
baby may be born deaf, bl<strong>in</strong>d or with heart <strong>and</strong> lung damage. Because rubella is difficult<br />
to diagnose, a past history of the disease is unreliable as a guide to immunity. A blood<br />
test will show whether or not you have had rubella. If non-immune mothers catch rubella<br />
<strong>in</strong> the first 8-10 weeks of pregnancy, up to 90% of babies will have some rubellaassociated<br />
problems. The risk decreases but cont<strong>in</strong>ues until week 20 of pregnancy 25 .<br />
Cytomegalovirus (CMV)<br />
CMV <strong>in</strong>fection <strong>in</strong> early pregnancy may affect the unborn child. The <strong>in</strong>fant may be<br />
unaffected, deaf or have multiple abnormalities. Whether the baby is affected depends on<br />
many factors. The two ma<strong>in</strong> factors are previous CMV <strong>in</strong>fection <strong>and</strong> the stage of<br />
pregnancy. The risk is very low if the mother has had CMV <strong>in</strong>fection before. The risk of<br />
severe effects may be higher if the mother catches the disease <strong>in</strong> early pregnancy. People<br />
who have contact with young children <strong>and</strong> are exposed to children’s ur<strong>in</strong>e <strong>and</strong> saliva are<br />
at risk of CMV <strong>in</strong>fection. Studies show that workers <strong>in</strong> child day-care centres are at<br />
highest risk, especially when car<strong>in</strong>g for children younger than two years of age 26 . <strong>Child</strong><br />
care workers may wish to have a blood test for CMV immunity before becom<strong>in</strong>g<br />
pregnant. This would allow them to make an <strong>in</strong>formed decision about work practices <strong>and</strong><br />
to discuss these with their doctor.<br />
Toxoplasmosis<br />
<strong>Child</strong> care workers are not at greater risk of contract<strong>in</strong>g toxoplasmosis than other people.<br />
Toxoplasma <strong>in</strong>fection <strong>in</strong> pregnancy may lead to congenital abnormalities. There is no risk<br />
if the mother has had the disease before, but this is often unknown. Toxoplasmosis is<br />
acquired from contact with cat faeces (e.g. <strong>in</strong> soil or s<strong>and</strong>pits) or eat<strong>in</strong>g poorly cooked<br />
meat. If you are consider<strong>in</strong>g pregnancy, then a blood test will tell you if you have already<br />
had toxoplasmosis.<br />
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Erythema <strong>in</strong>fectiosum, also called parvovirus or fifth disease<br />
The symptoms of this disease are slapped cheek rash (red cheeks that look as though<br />
they have been slapped) or arthritis. A pregnant woman who develops these<br />
symptoms should discuss this with her doctor. Parvovirus causes miscarriage or stillbirths<br />
<strong>in</strong> a small percentage of women <strong>in</strong>fected dur<strong>in</strong>g pregnancy. Malformations do<br />
not appear to occur <strong>in</strong> babies who survive this <strong>in</strong>fection <strong>in</strong> the mother.<br />
Varicella (Chickenpox)<br />
Most child care workers will probably have had chickenpox as a child <strong>and</strong> will not get<br />
it aga<strong>in</strong>. Infection with chickenpox <strong>in</strong> the first three months of pregnancy may damage<br />
the unborn child. Pregnant women who are exposed to chickenpox at any stage of the<br />
pregnancy should see their doctor soon after exposure. The doctor will give varicella<br />
zoster immunoglobul<strong>in</strong> (VZIG) if the woman does not have antibodies to varicella.<br />
VZIG is an <strong>in</strong>jection of antibodies aga<strong>in</strong>st chickenpox.<br />
Other hazards <strong>in</strong> the child care <strong>in</strong>dustry<br />
Staff members <strong>in</strong> child care workplaces may be exposed to many other hazards<br />
<strong>in</strong>clud<strong>in</strong>g:<br />
Manual h<strong>and</strong>l<strong>in</strong>g <strong>in</strong>juries<br />
Lift<strong>in</strong>g <strong>and</strong> carry<strong>in</strong>g children <strong>and</strong> the equipment used <strong>in</strong> child care workplaces may<br />
lead to manual h<strong>and</strong>l<strong>in</strong>g <strong>in</strong>juries such as spra<strong>in</strong>s <strong>and</strong> stra<strong>in</strong>s. The activities undertaken<br />
by child care workers should be assessed <strong>and</strong> modified if possible to reduce repetitive<br />
lift<strong>in</strong>g <strong>and</strong> m<strong>in</strong>imise the risk of <strong>in</strong>jury.<br />
Slippery surfaces<br />
Floors <strong>and</strong> the surfaces of pathways, steps <strong>and</strong> ramps <strong>in</strong>side <strong>and</strong> outside child care<br />
workplaces should be slip resistant, especially around wet areas such as bathrooms<br />
<strong>and</strong> toilets. The risk of slips, trips <strong>and</strong> falls can also be reduced by good<br />
housekeep<strong>in</strong>g, keep<strong>in</strong>g walkways clear of toys <strong>and</strong> other loose items <strong>and</strong> by ensur<strong>in</strong>g<br />
that spills are cleaned up promptly.<br />
Electricity<br />
In situations where portable items of electrical equipment, such as vacuum cleaners,<br />
electric frypans, portable stereos <strong>and</strong> CD players are used, electric circuits should be<br />
protected by Residual Current Devices (RCDs) to reduce the risk of electrocution.<br />
Power cords <strong>and</strong> extension leads should be protected from damage by toys <strong>and</strong><br />
equipment, chemicals <strong>and</strong> heat. It is recommended that cords <strong>and</strong> leads are checked<br />
for nicks, cuts <strong>and</strong> other damage on a regular basis <strong>and</strong> to immediately remove a<br />
damaged item until it is properly repaired.<br />
<strong>Child</strong>ren should not be left unsupervised <strong>in</strong> situations where they may cut electric<br />
cords, spill water onto electric equipment or pull cords <strong>and</strong> leads out of power po<strong>in</strong>ts.<br />
Unused power po<strong>in</strong>ts should be covered with blank plugs to ensure that children do<br />
not poke small items <strong>in</strong>to the empty holes.<br />
H<strong>and</strong> care<br />
Some <strong>in</strong>fections are spread when blood from an <strong>in</strong>fected person comes <strong>in</strong>to direct<br />
contact through broken or abraded sk<strong>in</strong>, therefore healthy sk<strong>in</strong> can be a very effective<br />
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arrier to disease <strong>and</strong> <strong>in</strong>fection. Prolonged contact with water softens the sk<strong>in</strong> <strong>and</strong><br />
makes it more susceptible to irritation. Soaps <strong>and</strong> detergents remove oils from the sk<strong>in</strong><br />
caus<strong>in</strong>g dryness <strong>and</strong> possible crack<strong>in</strong>g 27 . Reduc<strong>in</strong>g the dryness <strong>and</strong> irritation of the<br />
sk<strong>in</strong> is very important. Sorbolene cream can be used <strong>in</strong>stead of soap <strong>and</strong> h<strong>and</strong>s patted<br />
dry, rather than rubbed vigorously. Apply more sorbolene cream if needed. Use<br />
barrier cream to protect sk<strong>in</strong> that will be wet for long periods. Do not use barrier<br />
cream on damaged sk<strong>in</strong> 28 . Treat m<strong>in</strong>or cuts <strong>and</strong> abrasions promptly. Wash h<strong>and</strong>s with<br />
a mild soap <strong>and</strong> water <strong>and</strong> make sure that they are thoroughly dry.<br />
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Part 2 Respiratory compla<strong>in</strong>ts<br />
Asthma<br />
Description<br />
One <strong>in</strong> five Australian children has asthma, mak<strong>in</strong>g it the most common chronic<br />
medical condition <strong>in</strong> childhood 29 . Apart from the normal coughs <strong>and</strong> colds of<br />
childhood, it is the condition most likely to be encountered <strong>in</strong> early childhood sett<strong>in</strong>gs.<br />
Not all of these children will have symptoms all of the time. There is a range of<br />
severity of asthma, from those children who have only one or two attacks <strong>in</strong> their<br />
lifetime through to those who need to take medication every day. Most children with<br />
asthma are able to lead essentially normal lives, provided they receive the correct<br />
medical management.<br />
In asthma, the smaller airways <strong>in</strong> the lungs become narrow due to <strong>in</strong>flammation <strong>and</strong><br />
then swell<strong>in</strong>g of their walls; <strong>in</strong> addition there is a lot of mucus production <strong>and</strong><br />
tighten<strong>in</strong>g <strong>and</strong> spasm of the smooth muscle <strong>in</strong> the walls. This results <strong>in</strong> further<br />
narrow<strong>in</strong>g of the airways, which reduces the flow of air <strong>in</strong> <strong>and</strong> out of the lungs, <strong>and</strong> is<br />
also responsible for the wheeze, cough, <strong>and</strong> difficulty <strong>in</strong> breath<strong>in</strong>g that are the<br />
hallmarks of acute asthma. Severe attacks can be life threaten<strong>in</strong>g.<br />
Incubation period<br />
Nil.<br />
Infectious period<br />
Nil.<br />
Exclusion Period<br />
Nil.<br />
Responsibilities of child care providers/staff<br />
Ensure staff are aware of which children are known asthmatics <strong>and</strong> are aware of the<br />
centre’s ‘Asthma First Aid Plan’.<br />
Responsibilities of the parents<br />
Ensure staff of centre is aware of child’s asthma. Every child with asthma should have<br />
a written action plan so it is clear exactly what needs to be done dur<strong>in</strong>g an acute<br />
attack. This should be obta<strong>in</strong>ed from the child’s doctor by the parent <strong>and</strong> given to the<br />
centre when the child is enrolled, or diagnosed as asthmatic.<br />
Controll<strong>in</strong>g the spread of <strong>in</strong>fection<br />
Asthma is not an <strong>in</strong>fection, <strong>and</strong> is not a disease that other children can ‘catch’ from<br />
be<strong>in</strong>g near an asthmatic child.<br />
Treatment<br />
The first pr<strong>in</strong>ciple of treatment is to try <strong>and</strong> prevent attacks from occurr<strong>in</strong>g at all. If<br />
acute attacks do occur, or symptoms are present, then the aim is to limit both their<br />
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severity <strong>and</strong> duration. For many children, the most effective treatment of asthma is to<br />
take medications every day to prevent attacks – these are children who would<br />
otherwise have attacks relatively frequently. Most children have only occasional<br />
attacks <strong>and</strong> do not need to take preventative medication – they only take medication<br />
when they have symptoms. More children with asthma get <strong>in</strong>to trouble because they<br />
are undertreated than because they use medications too much.<br />
Medications used <strong>in</strong> asthma can be divided <strong>in</strong>to relievers <strong>and</strong> preventers 30 .<br />
Relievers are quick act<strong>in</strong>g <strong>and</strong> are used to treat the symptoms of an attack, so they are<br />
given when the child beg<strong>in</strong>s to cough <strong>and</strong> wheeze. They act on the smooth muscle<br />
surround<strong>in</strong>g the breath<strong>in</strong>g tubes to make them wider <strong>and</strong> so relieve the symptoms.<br />
They are usually given by <strong>in</strong>halation every three to four hours though, if the<br />
symptoms are severe, can be given safely more frequently. Relievers are also used<br />
before exercise or sport <strong>in</strong> those children who get symptoms such as cough, wheeze or<br />
shortness of breath when they exert themselves. The child takes a dose of medication<br />
just before the activity beg<strong>in</strong>s <strong>and</strong> aga<strong>in</strong> dur<strong>in</strong>g it if needed.<br />
Preventers are used to prevent attacks or daily symptoms. Some children take both<br />
preventers <strong>and</strong> relievers.<br />
Asthma medications are generally given by <strong>in</strong>halation. <strong>Child</strong>ren from about the age of<br />
7-8 years of age are able to use puffers. Younger children are able to use the puffers <strong>in</strong><br />
conjunction with a ‘spacer’, which is a plastic cyl<strong>in</strong>der. The puffer fits <strong>in</strong>to one end<br />
<strong>and</strong> the child then puts their lips over these devices which deliver the medication<br />
directly <strong>in</strong>to the lungs. Sometimes a nebuliser is used - this is an electrical pump <strong>and</strong><br />
the medication is turned <strong>in</strong>to a f<strong>in</strong>e mist via an air pump. This is especially useful <strong>in</strong><br />
an acute attack, though for most children medication delivered by a spacer device is<br />
likely to be just as effective.<br />
Asthma First Aid Plan 31<br />
1. Sit the person upright <strong>and</strong> rema<strong>in</strong> calm. Don’t leave them alone.<br />
2. Give 4 puffs of a blue reliever, (Airomir, Asmol, Bricanyl**, Epaq or<br />
Ventol<strong>in</strong>) one puff at a time, through a spacer*.<br />
(*Use a blue puffer on its own if there is no spacer. **Bricanyl is not used<br />
with a spacer)<br />
3. Wait for 4 m<strong>in</strong>utes.<br />
4. If there is little or no improvement, repeat steps 2 <strong>and</strong> 3.<br />
If there is still little or no improvement, call an ambulance immediately (Dial 000).<br />
Cont<strong>in</strong>ue to repeat steps 2 <strong>and</strong> 3 while wait<strong>in</strong>g for the ambulance.<br />
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Bronchiolitis<br />
Description<br />
Bronchiolitis is a chest condition caused by an <strong>in</strong>fection with a virus. This potentially<br />
serious <strong>in</strong>fection is common <strong>in</strong> <strong>in</strong>fants under 12 months of age <strong>and</strong> usually happens <strong>in</strong><br />
w<strong>in</strong>ter. The <strong>in</strong>fection beg<strong>in</strong>s like any common cold, but soon develops <strong>in</strong>to a cough,<br />
rapid breath<strong>in</strong>g <strong>and</strong> wheez<strong>in</strong>g to the extent that feed<strong>in</strong>g becomes difficult. Wheez<strong>in</strong>g<br />
when breath<strong>in</strong>g out is characteristic of bronchiolitis. This happens when <strong>in</strong>flammation<br />
causes the small airways (called the bronchioles) to become obstructed. Seek medical<br />
advice if the child develops these symptoms. The respiratory syncytial virus (RSV) is<br />
most often responsible for bronchiolitis, although other viruses may cause outbreaks.<br />
Most children with bronchiolitis get better with<strong>in</strong> a week to ten days. The wheez<strong>in</strong>g<br />
sound usually lasts for two to three days. As the wheez<strong>in</strong>g settles, the child gradually<br />
improves. However, the cough may last up to a month 32 .<br />
The disease is transmitted directly by oral contact or airborne droplets, or <strong>in</strong>directly<br />
by h<strong>and</strong>s, tissues, eat<strong>in</strong>g utensils, toys or other articles freshly soiled by the nose <strong>and</strong><br />
throat discharges of an <strong>in</strong>fected person.<br />
Incubation period<br />
Usually 48 hours 33 .<br />
Infectious period<br />
Shortly before the onset of symptoms <strong>and</strong> dur<strong>in</strong>g the active stage of the disease.<br />
Exclusion Period<br />
The child should stay at home until they are feel<strong>in</strong>g well.<br />
Responsibilities of child care providers/staff<br />
Report the <strong>in</strong>fection to the director.<br />
Advise the parent to keep the child away from other children until they are feel<strong>in</strong>g<br />
well.<br />
Responsibilities of the parents<br />
The child should stay at home until they are feel<strong>in</strong>g well.<br />
Controll<strong>in</strong>g the spread of <strong>in</strong>fection<br />
Teach children to cover the mouth when sneez<strong>in</strong>g or cough<strong>in</strong>g <strong>and</strong> to wash their<br />
h<strong>and</strong>s after blow<strong>in</strong>g their noses.<br />
Dispose of tissues soiled with nose <strong>and</strong> throat discharges.<br />
Ensure staff wash h<strong>and</strong>s after contact with soiled tissues or contact with nose <strong>and</strong><br />
throat discharges.<br />
Treatment<br />
Because this is a viral <strong>in</strong>fection there is no medic<strong>in</strong>e that will cure it <strong>and</strong> antibiotics<br />
will not help.<br />
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A child with mild bronchiolitis may be treated at home. The child may benefit from a<br />
warm, humid atmosphere (a humidifier or steam). Increase the child’s fluid <strong>in</strong>take.<br />
Paracetamol may be used to relieve a sore throat. Decongestant medication may help<br />
relieve symptoms.<br />
A child with acute bronchiolitis will need medical assessment. Some children with<br />
bronchiolitis may need to stay <strong>in</strong> hospital for a short time to receive specialised<br />
medical treatment.<br />
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Bronchitis<br />
Description<br />
Many children, when they get a cold, also develop a cough. This can be due to<br />
bronchitis, which is when the l<strong>in</strong><strong>in</strong>g of the trachea <strong>and</strong> bronchi (the tubes lead<strong>in</strong>g from<br />
the throat to the lungs) becomes reddened <strong>and</strong> swollen, <strong>and</strong> there is more mucus than<br />
normal.<br />
It is caused by viruses (especially <strong>in</strong>fluenza virus), bacteria (especially Streptococcus<br />
pneumoniae, see ‘strep throat’, page 68), <strong>and</strong> several other organisms.<br />
A child with bronchitis may have the usual signs of a cold <strong>in</strong>clud<strong>in</strong>g a runny nose,<br />
sore throat <strong>and</strong> mild fever, <strong>and</strong> then develop a cough. The cough is often dry at first,<br />
then moist after a couple of days. There may be a slight wheeze <strong>and</strong> a feel<strong>in</strong>g of<br />
shortness of breath.<br />
<strong>Child</strong>ren usually recover from an acute episode of bronchitis <strong>in</strong> 5 to 10 days. Some<br />
children keep gett<strong>in</strong>g attacks of bronchitis or can get chronic bronchitis. This can be<br />
due to allergies, someone smok<strong>in</strong>g around them or to other problems <strong>in</strong> the lungs.<br />
Note that asthma is often misdiagnosed as bronchitis. Therefore, bronchitis should<br />
only be diagnosed by a doctor.<br />
The disease is transmitted directly by oral contact or airborne droplets, or <strong>in</strong>directly<br />
by h<strong>and</strong>s, tissues, eat<strong>in</strong>g utensils, toys or other articles freshly soiled by the nose <strong>and</strong><br />
throat discharges of an <strong>in</strong>fected person.<br />
Incubation period<br />
1–3 days if caused by <strong>in</strong>fluenza virus or Streptococcus pneumoniae.<br />
Infectious period<br />
Shortly before the onset of symptoms <strong>and</strong> dur<strong>in</strong>g the active stage of the disease.<br />
Exclusion Period<br />
The child should stay at home until they are feel<strong>in</strong>g well.<br />
Responsibilities of child care providers/staff<br />
Report the <strong>in</strong>fection to the director.<br />
Advise the parent to keep the child home until they are feel<strong>in</strong>g well.<br />
Responsibilities of the parents<br />
The child should stay at home until they are feel<strong>in</strong>g well.<br />
Controll<strong>in</strong>g the spread of <strong>in</strong>fection<br />
Teach children to cover the mouth when sneez<strong>in</strong>g or cough<strong>in</strong>g <strong>and</strong> to wash their<br />
h<strong>and</strong>s after blow<strong>in</strong>g their noses.<br />
Dispose of tissues soiled with nose <strong>and</strong> throat discharges.<br />
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Ensure staff wash h<strong>and</strong>s after contact with soiled tissues or contact with nose <strong>and</strong><br />
throat discharges.<br />
Treatment<br />
Bronchitis <strong>in</strong> children is nearly always due to a virus <strong>and</strong> antibiotics don’t help 34 .<br />
In mild cases, bed rest <strong>in</strong> a warm environment for a few days, with a light diet <strong>and</strong><br />
nourish<strong>in</strong>g dr<strong>in</strong>ks, may be all that is needed. Cough medic<strong>in</strong>es may help relieve<br />
symptoms. From the onset of the attack, warmth to the chest may give relief. This can<br />
be <strong>in</strong> the form of a rubber hot water bottle filled with warm (not hot) water or a<br />
medic<strong>in</strong>al chest rub.<br />
In more serious cases where bronchitis may be due to a bacteria, the doctor may<br />
prescribe antibiotics.<br />
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Common cold<br />
Description<br />
The common cold is caused by many different viruses that affect the nose <strong>and</strong> throat.<br />
It is the most common <strong>in</strong>fectious illness, especially for young children. Young<br />
children may have 8 to 10 colds each year 35 , with the highest number usually be<strong>in</strong>g<br />
dur<strong>in</strong>g the first two years <strong>in</strong> child care, k<strong>in</strong>dergarten or school. A cold <strong>in</strong> itself is not<br />
serious but colds can sometimes lead to other <strong>in</strong>fections such as ear <strong>in</strong>fections <strong>and</strong><br />
tonsillitis.<br />
Symptoms <strong>in</strong>clude a runny, stuffed up nose, sneez<strong>in</strong>g, cough<strong>in</strong>g <strong>and</strong> a mild sore<br />
throat, with little or no fever. Nasal discharge is usually clear to start with, <strong>and</strong> then<br />
with<strong>in</strong> a day can become thicker, yellow <strong>and</strong> sometimes green. Up to a quarter of<br />
young children with a cold go on to have an ear <strong>in</strong>fection as well, but this happens<br />
less often as the child grows older 36 .<br />
Colds are spread directly by contact with airborne droplets (cough<strong>in</strong>g <strong>and</strong> sneez<strong>in</strong>g),<br />
or <strong>in</strong>directly by contam<strong>in</strong>ated h<strong>and</strong>s, tissues, eat<strong>in</strong>g utensils, toys or other articles<br />
freshly soiled by the nose <strong>and</strong> throat discharges of an <strong>in</strong>fected person.<br />
Incubation period<br />
About 1–3 days.<br />
Infectious period<br />
2-4 days after the cold starts.<br />
Exclusion Period<br />
There is no need to exclude a child with a common cold, unless the child is unwell.<br />
Responsibilities of child care providers/staff<br />
Report the <strong>in</strong>fection to the director.<br />
Advise the parent the child should stay at home until they are feel<strong>in</strong>g well.<br />
Responsibilities of the parent<br />
The child should stay at home until they are feel<strong>in</strong>g well.<br />
Controll<strong>in</strong>g the spread of <strong>in</strong>fection<br />
Teach children to cover the mouth when sneez<strong>in</strong>g or cough<strong>in</strong>g <strong>and</strong> to wash their<br />
h<strong>and</strong>s after blow<strong>in</strong>g their noses. See ‘Cover your cough <strong>and</strong> stop the spread of germs’<br />
(page 20).<br />
Dispose of tissues soiled with nose <strong>and</strong> throat discharges.<br />
Ensure staff wash h<strong>and</strong>s after contact with soiled tissues or contact with nose <strong>and</strong><br />
throat discharges.<br />
Treatment<br />
No specific treatment. Rest, extra dr<strong>in</strong>ks <strong>and</strong> comfort<strong>in</strong>g are important. Decongestants<br />
<strong>and</strong> other cold remedies are widely promoted for the relied of symptoms of colds <strong>and</strong><br />
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flu. However there is little evidence that any of these help 37 . In fact, there may be<br />
evidence that they can be harmful <strong>and</strong> may cause unpleasant side effects such as<br />
irritability, confusion <strong>and</strong> sleep<strong>in</strong>ess. Oral decongestants are not recommended for<br />
children under the age of 2 years. Cough medic<strong>in</strong>es are not effective <strong>in</strong> reduc<strong>in</strong>g the<br />
frequency, <strong>in</strong>tensity or duration of cough. Like fever, the cough is there for a reason –<br />
it serves a useful function <strong>in</strong> clear<strong>in</strong>g mucus from the child’s airways <strong>and</strong> prevent<strong>in</strong>g<br />
secondary <strong>in</strong>fection. If concerned, take children to the doctor. Do not give aspir<strong>in</strong> to<br />
any child with a fever.<br />
Comments<br />
Watch for new or more severe symptoms. They may <strong>in</strong>dicate other more serious<br />
<strong>in</strong>fections.<br />
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Croup<br />
Description<br />
Croup is caused by a virus <strong>in</strong>fection. It is any k<strong>in</strong>d of <strong>in</strong>flammation of the larynx or<br />
voice box that occurs <strong>in</strong> children. It is not a s<strong>in</strong>gle disorder <strong>in</strong> itself. A young child<br />
(usually under 5 years of age) becomes mildly unwell with what seems to be a normal<br />
‘cold’. The virus <strong>in</strong>fection causes the l<strong>in</strong><strong>in</strong>g of the airway <strong>in</strong> the child’s neck to swell,<br />
caus<strong>in</strong>g the airway to get narrower <strong>and</strong> mak<strong>in</strong>g it harder to breathe.<br />
The characteristic features of croup are a harsh, bark<strong>in</strong>g cough <strong>and</strong> a noisy, harsh<br />
sound when breath<strong>in</strong>g <strong>in</strong>. This noise is caused by air vibrat<strong>in</strong>g as it passes through the<br />
narrowed, <strong>in</strong>flamed larynx. This will usually happen dur<strong>in</strong>g the night. Dur<strong>in</strong>g the day<br />
the child is usually well apart from the cold. Seek medical advice if the child develops<br />
these symptoms.<br />
Several viruses may cause croup. These <strong>in</strong>clude para<strong>in</strong>fluenza, respiratory syncytial<br />
virus (RSV) <strong>and</strong> various <strong>in</strong>fluenza viruses.<br />
Incubation period<br />
Difficult to def<strong>in</strong>e, but about 2–4 days.<br />
Infectious period<br />
Shortly before the onset of symptoms <strong>and</strong> dur<strong>in</strong>g the active stage of the disease.<br />
Exclusion period<br />
The child should stay at home until they are feel<strong>in</strong>g well.<br />
Responsibilities of child care providers/staff<br />
Report the <strong>in</strong>fection to the director.<br />
Advise the parent to keep the child home until they are feel<strong>in</strong>g well.<br />
Responsibilities of parents<br />
The child should stay at home until they are feel<strong>in</strong>g well.<br />
Controll<strong>in</strong>g the spread of <strong>in</strong>fection<br />
Teach children to cover the mouth when sneez<strong>in</strong>g or cough<strong>in</strong>g <strong>and</strong> to wash their<br />
h<strong>and</strong>s after blow<strong>in</strong>g their noses.<br />
Dispose of tissues soiled with nose <strong>and</strong> throat discharges.<br />
Ensure staff wash h<strong>and</strong>s after contact with soiled tissues or contact with nose <strong>and</strong><br />
throat discharges.<br />
Treatment<br />
A child with croup will need medical assessment.<br />
The doctor may recommend that a child with mild croup be treated at home. Hav<strong>in</strong>g a<br />
croupy cough <strong>and</strong> noisy breath<strong>in</strong>g frightens children, <strong>and</strong> be<strong>in</strong>g scared makes the<br />
situation worse. Comfort<strong>in</strong>g is very important. Cuddl<strong>in</strong>g, sitt<strong>in</strong>g the child up 38 (<strong>in</strong><br />
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their parent’s arms or on pillows) <strong>and</strong> giv<strong>in</strong>g someth<strong>in</strong>g to dr<strong>in</strong>k (which helps with the<br />
sore throat) can all be important. The child may benefit from a warm, humid<br />
atmosphere (e.g. a humidifier). Increase their fluid <strong>in</strong>take. Paracetamol may be<br />
considered to relieve a sore throat.<br />
It is likely that a child with severe croup will need to stay <strong>in</strong> hospital for a short time<br />
to receive specialised medical treatment.<br />
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Ear <strong>in</strong>fections (otitis)<br />
Description<br />
An ear <strong>in</strong>fection is one of the most common health problems for young children 39 . It<br />
causes pa<strong>in</strong> <strong>and</strong> distress to children <strong>and</strong> is one of the reasons why they may wake at<br />
night. Up to 80% of children will have an ear <strong>in</strong>fection at least once 40 <strong>and</strong> many have<br />
them several times. Ear <strong>in</strong>fections can affect children’s hear<strong>in</strong>g.<br />
They may be middle ear <strong>in</strong>fections (otitis media) or outer ear <strong>in</strong>fections (otitis<br />
externa).<br />
Middle ear <strong>in</strong>fections occur on the <strong>in</strong>side of the ear drum. Because this is a small<br />
space, <strong>in</strong>fection leads to an <strong>in</strong>crease <strong>in</strong> pressure on the eardrum <strong>and</strong> pa<strong>in</strong>. A young<br />
child will not be able to tell you they have a sore ear. However, they may be pull<strong>in</strong>g<br />
or rubb<strong>in</strong>g their ear, have a fever or vomit. The child may be distressed. Cry<strong>in</strong>g that<br />
stops suddenly may mean that the ear drum has burst. Middle ear <strong>in</strong>fections can be<br />
caused by bacteria or viruses <strong>and</strong> often occurs a few days after a child gets a cold. The<br />
most common age for middle ear <strong>in</strong>fections is between 6 months <strong>and</strong> 2 years.<br />
Outer ear <strong>in</strong>fections occur on the outside of the ear drum or ear canal <strong>and</strong> are often<br />
associated with swimm<strong>in</strong>g.<br />
Incubation period<br />
A few days.<br />
Infectious period<br />
Ear <strong>in</strong>fections are not contagious, but the cold or other <strong>in</strong>fection which caused them<br />
is. Organisms can only be passed from one child to another if there is <strong>in</strong>fectious fluid<br />
dra<strong>in</strong><strong>in</strong>g out of the ear.<br />
Exclusion period<br />
A child should not attend the centre while there is any fluid com<strong>in</strong>g out of the ear.<br />
The child should stay at home until they are feel<strong>in</strong>g well.<br />
Responsibilities of child care providers/staff<br />
Report the <strong>in</strong>fection to the director.<br />
Advise the parent to keep the child home until they are feel<strong>in</strong>g well.<br />
Responsibilities of parents<br />
The child should stay at home until they are well.<br />
Control of spread<br />
Any discharge from an ear should be treated as <strong>in</strong>fectious. Wash h<strong>and</strong>s thoroughly.<br />
The child will often still need to be tak<strong>in</strong>g antibiotics after return<strong>in</strong>g to care.<br />
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Treatment<br />
Middle ear <strong>in</strong>fection - Most children will have healthy ears by about 2 weeks from<br />
when the middle ear <strong>in</strong>fection started, even if they do not take antibiotics. Antibiotics<br />
are usually prescribed when a child has a middle ear <strong>in</strong>fection. Antibiotics probably<br />
help the <strong>in</strong>fection to get better more quickly <strong>and</strong> they prevent some of the severe<br />
<strong>in</strong>fections which can develop from a middle ear <strong>in</strong>fection. The use of paracetamol<br />
may be considered to relieve pa<strong>in</strong>.<br />
Outer ear <strong>in</strong>fection – Usually treated with antibiotics, given as drops <strong>in</strong> the ear or<br />
placed <strong>in</strong> the ear canal with a wick.<br />
Comments<br />
As ear <strong>in</strong>fections are hard to detect <strong>in</strong> young children, suspect an ear <strong>in</strong>fection with all<br />
fevers <strong>and</strong> vomit<strong>in</strong>g. Watch the child for any signs of pull<strong>in</strong>g or rubb<strong>in</strong>g of ears.<br />
Rarely, a middle ear <strong>in</strong>fection may spread <strong>and</strong> the child may develop mastoiditis. The<br />
area beh<strong>in</strong>d the ear will be red <strong>and</strong> the ear lobe will stick out <strong>and</strong> down. A child with<br />
these symptoms should see a doctor as soon as possible.<br />
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Influenza<br />
Description<br />
Influenza is an acute viral disease of the respiratory tract characterised by fever, chills,<br />
headache, muscle pa<strong>in</strong>, a head cold <strong>and</strong> a mild sore throat. The cough is often severe.<br />
Usually the person will recover naturally with<strong>in</strong> 2–7 days.<br />
Incubation period<br />
Usually 1–3 days.<br />
Infectious period<br />
Probably 3-5 days from onset of symptoms <strong>in</strong> adults <strong>and</strong> up to 7 days <strong>in</strong> young<br />
children 41 .<br />
Exclusion period<br />
The child should stay at home until they are feel<strong>in</strong>g well.<br />
Responsibilities of child care providers/staff<br />
Report the <strong>in</strong>fection to the director.<br />
Advise the parent the child should stay at home until they are feel<strong>in</strong>g well.<br />
Responsibilities of parents<br />
The child should stay at home until they are feel<strong>in</strong>g well.<br />
Controll<strong>in</strong>g the spread of <strong>in</strong>fection<br />
A def<strong>in</strong>ite diagnosis of <strong>in</strong>fluenza requires a blood test or throat swab. Generally this<br />
test is not considered necessary by the general practitioner.<br />
Teach children to cover the mouth when sneez<strong>in</strong>g or cough<strong>in</strong>g <strong>and</strong> to wash their<br />
h<strong>and</strong>s after blow<strong>in</strong>g their noses. See ‘Cover your cough <strong>and</strong> stop the spread of germs’<br />
(page 20).<br />
Dispose of tissues soiled with nose <strong>and</strong> throat discharges.<br />
Wash h<strong>and</strong>s after contact with soiled tissues <strong>and</strong> articles <strong>and</strong> after contact with nose<br />
<strong>and</strong> throat discharges.<br />
Treatment<br />
No specific treatment. Antibiotics should be given for bacterial complications only.<br />
Decongestants <strong>and</strong> other cold remedies are widely promoted for the relief of<br />
symptoms of colds <strong>and</strong> flu. However there is little evidence that any of these help. In<br />
fact, there may be evidence that they can be harmful <strong>and</strong> may cause unpleasant side<br />
effects such as irritability, confusion <strong>and</strong> sleep<strong>in</strong>ess. Oral decongestants are not<br />
recommended for children under the age of 2 years. Cough medic<strong>in</strong>es are not<br />
effective <strong>in</strong> reduc<strong>in</strong>g the frequency, <strong>in</strong>tensity or duration of cough. Like fever, the<br />
cough is there for a reason – it serves a useful function <strong>in</strong> clear<strong>in</strong>g mucus from the<br />
child’s airways <strong>and</strong> prevent<strong>in</strong>g secondary <strong>in</strong>fection. If concerned, take children to the<br />
doctor. Do not give aspir<strong>in</strong> to any child with a fever.<br />
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Comments<br />
Watch for new or more severe symptoms. They may <strong>in</strong>dicate other, more serious<br />
<strong>in</strong>fections.<br />
Influenza vacc<strong>in</strong>e is available <strong>and</strong> may protect staff aga<strong>in</strong>st <strong>in</strong>fluenza. Staff wish<strong>in</strong>g to<br />
have the <strong>in</strong>fluenza vacc<strong>in</strong>e should consult their own doctor.<br />
Influenza vacc<strong>in</strong>e is not given rout<strong>in</strong>ely to children unless the child has a chronic,<br />
debilitat<strong>in</strong>g disease, for example, a chronic cardiac (heart) disorder, a pulmonary<br />
(lung) disorder, a renal (kidney) disorder or a metabolic disorder.<br />
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Pneumococcal disease<br />
Description<br />
Pneumococcal disease refers to a number of different types of <strong>in</strong>fection due to the<br />
bacteria called ‘the pneumococcus’ (also called Streptococcus pneumoniae). The<br />
bacteria are commonly found <strong>in</strong> the nose <strong>and</strong> throat of healthy people <strong>and</strong> usually live<br />
there harmlessly, especially <strong>in</strong> young children (up to 1 <strong>in</strong> 4 children <strong>in</strong> w<strong>in</strong>ter 42 ). It is<br />
not known why the bacteria cause disease <strong>in</strong> some people <strong>and</strong> not <strong>in</strong> others. The<br />
bacteria is spread <strong>in</strong> droplets shed from the mouth or nose through kiss<strong>in</strong>g or contact<br />
with articles that have been contam<strong>in</strong>ated with the <strong>in</strong>fected droplets.<br />
Pneumococcal disease occurs most commonly <strong>in</strong> children under the age of 2 years 43 .<br />
In children less than 5 years of age, Pneumococcus is the most common bacterial<br />
cause of otitis media (middle ear <strong>in</strong>fection), pneumonia (lung <strong>in</strong>fection), bacteraemia<br />
(<strong>in</strong>fection of the blood stream) <strong>and</strong> men<strong>in</strong>gitis (a life threaten<strong>in</strong>g <strong>in</strong>fection of the<br />
l<strong>in</strong><strong>in</strong>g of the bra<strong>in</strong>) 44 . In children, severe pneumococcal disease (men<strong>in</strong>gitis,<br />
septicaemia) peaks at around 12 months of age but cases of men<strong>in</strong>gitis may occur<br />
from about 2 months of age 45 .<br />
The symptoms of pneumococcal disease depend upon the site of the <strong>in</strong>fection. The<br />
symptoms are not exactly the same as men<strong>in</strong>gococcal disease <strong>and</strong> a sk<strong>in</strong> rash is not<br />
common with pneumococcal disease. When the bacteria <strong>in</strong>vade the blood stream the<br />
disease can become a life-threaten<strong>in</strong>g condition.<br />
Incubation period<br />
Not well determ<strong>in</strong>ed. It may be as short as 1-3 days 46 .<br />
Infectious period<br />
The person is <strong>in</strong>fectious whilst nasal <strong>and</strong> mouth secretions still conta<strong>in</strong> the<br />
pneumococcal bacteria. People are no longer <strong>in</strong>fectious 24-48 hours after<br />
commenc<strong>in</strong>g an appropriate antibiotic.<br />
Exclusion period<br />
The child needs to be excluded until 48 hours after the commencement of an<br />
appropriate antibiotic.<br />
Responsibilities of child care providers/staff<br />
Report the <strong>in</strong>fection to the director.<br />
Advise the parent the child needs to be excluded until 48 hours after the<br />
commencement of an appropriate antibiotic. Even after this period of time, the child<br />
should stay at home until they are feel<strong>in</strong>g well.<br />
Responsibilities of parents<br />
The child needs to be excluded until 48 hours after the commencement of an<br />
appropriate antibiotic. Even after this period of time, the child should stay at home<br />
until they are feel<strong>in</strong>g well.<br />
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Controll<strong>in</strong>g the spread<br />
Teach children to cover the mouth when sneez<strong>in</strong>g or cough<strong>in</strong>g <strong>and</strong> to wash their<br />
h<strong>and</strong>s after blow<strong>in</strong>g their noses. See ‘Cover your cough <strong>and</strong> stop the spread of germs’<br />
(page 20).<br />
Dispose of tissues soiled with nose <strong>and</strong> throat discharges.<br />
Rout<strong>in</strong>e pneumococcal immunisation is given at 2, 4 <strong>and</strong> 6 months of age. Some<br />
children may need another dose or two depend<strong>in</strong>g upon where <strong>in</strong> Australia they live,<br />
<strong>and</strong> if they have any risk factors which identify them as be<strong>in</strong>g at greater risk of<br />
pneumococcal disease.<br />
Ensure staff wash h<strong>and</strong>s after contact with soiled tissues or contact with nose <strong>and</strong><br />
throat discharges.<br />
Treatment<br />
Invasive pneumococcal disease can usually be treated with antibiotics if detected early<br />
enough; however the disease can develop very quickly.<br />
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Runny noses (with green or yellow discharge)<br />
Description<br />
When germs that cause colds (cold viruses) first <strong>in</strong>fect the nose <strong>and</strong> s<strong>in</strong>uses, the nose<br />
makes clear mucus. This helps wash the germs from the nose <strong>and</strong> s<strong>in</strong>uses. After two<br />
or three days, the body’s immune cells fight back, chang<strong>in</strong>g the mucus to a white or<br />
yellow colour 47 . As the bacteria that live <strong>in</strong> the nose grow back, they may also be<br />
found <strong>in</strong> the mucus, which changes to a greenish colour. This is normal <strong>and</strong> does not<br />
mean the child needs antibiotics.<br />
Incubation period<br />
2-3 days.<br />
Infectious period<br />
Nil.<br />
Exclusion period<br />
Nil.<br />
Responsibilities of child care providers/staff<br />
Report the discharge to the director.<br />
If the child is unwell, advise the parent that the child should stay at home until they<br />
are feel<strong>in</strong>g better (this is out of concern <strong>and</strong> consideration of the child – it is not an<br />
<strong>in</strong>fection control issue for the centre).<br />
Responsibilities of parents<br />
If the child is unwell, advise the parent the child should stay at home until they are<br />
feel<strong>in</strong>g better (this is out of concern <strong>and</strong> consideration of the child – not an <strong>in</strong>fection<br />
control issue for the centre).<br />
Controll<strong>in</strong>g the spread of <strong>in</strong>fection<br />
Teach children to cover their mouth when sneez<strong>in</strong>g or cough<strong>in</strong>g <strong>and</strong> to wash their<br />
h<strong>and</strong>s after blow<strong>in</strong>g their noses.<br />
Dispose of tissues soiled with nose <strong>and</strong> throat discharges.<br />
Ensure staff wash h<strong>and</strong>s after contact with soiled tissues or contact with nose <strong>and</strong><br />
throat discharges.<br />
Treatment<br />
No specific treatment. Antibiotics are not needed to treat a runny nose.<br />
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Sore throats <strong>and</strong> streptococcal sore throat (strep<br />
throat)<br />
Description<br />
Sore throats are caused by viruses or bacteria. <strong>Child</strong>ren do not commonly compla<strong>in</strong> of<br />
a sore throat. However, they may have a fever or be reluctant to eat or dr<strong>in</strong>k. <strong>Child</strong>ren<br />
with a sore throat should see a doctor to assess any need for antibiotics.<br />
A ‘strep sore throat’ is a bacterial <strong>in</strong>fection of the throat caused by Streptococcus<br />
pyogenes. Possible complications of a strep throat <strong>in</strong>clude:<br />
• Scarlet fever<br />
The child shall have all the symptoms of throat <strong>in</strong>fection plus a f<strong>in</strong>e red rash<br />
on the limbs <strong>and</strong> trunk <strong>and</strong> redden<strong>in</strong>g of the tongue (‘strawberry tongue’).<br />
Dur<strong>in</strong>g the recovery from the <strong>in</strong>fection, the sk<strong>in</strong> may peel off the f<strong>in</strong>gers <strong>and</strong><br />
toes 48 .<br />
• Qu<strong>in</strong>sy<br />
An abscess (collection of pus) next to a tonsil.<br />
• Rheumatic fever<br />
A rare complication. Fever, jo<strong>in</strong>t pa<strong>in</strong> <strong>and</strong> a sk<strong>in</strong> rash develop soon after a sore<br />
throat. Later, <strong>in</strong>flammation of the heart (rheumatic carditis) or shak<strong>in</strong>g <strong>and</strong><br />
unstead<strong>in</strong>ess (Sydenham’s chorea or St Vitus’ dance) may occur.<br />
• Inflammation <strong>and</strong> reduced function of the kidney<br />
A rare complication.<br />
Viral <strong>and</strong> bacterial throat <strong>in</strong>fections are spread directly by contact with airborne<br />
droplets (cough<strong>in</strong>g <strong>and</strong> sneez<strong>in</strong>g), or <strong>in</strong>directly by contam<strong>in</strong>ated h<strong>and</strong>s, tissues, eat<strong>in</strong>g<br />
utensils, toys or other articles freshly soiled by the nose <strong>and</strong> throat discharges of an<br />
<strong>in</strong>fected person.<br />
Incubation period<br />
Usually 1–3 days.<br />
Infectious period<br />
Bacterial sore throats: Untreated people rema<strong>in</strong> <strong>in</strong>fectious for 2 to 3 weeks after<br />
becom<strong>in</strong>g ill 49 . Treated people are <strong>in</strong>fectious for about 24 hours after appropriate<br />
antibiotic treatment beg<strong>in</strong>s.<br />
Viral sore throats: As long as organisms are be<strong>in</strong>g spread by cough<strong>in</strong>g, sneez<strong>in</strong>g,<br />
etc. Viral tonsillitis <strong>and</strong> sore throats may last several days.<br />
Exclusion period<br />
Exclude a child with a strep sore throat until the child has received antibiotic<br />
treatment for at least 24 hours <strong>and</strong> they feel well.<br />
Exclude a child with a viral sore throat until the child is feel<strong>in</strong>g well 50 .<br />
Responsibilities of child care providers/staff<br />
Report the <strong>in</strong>fection to the director.<br />
Advise the parent to keep the child home for the exclusion period.<br />
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Responsibilities of the parents<br />
Keep the child home for the exclusion period.<br />
Controll<strong>in</strong>g the spread of <strong>in</strong>fection<br />
Exclude the person until they have received antibiotic treatment for at least 24 hours<br />
<strong>and</strong> they feel well.<br />
Cover the nose <strong>and</strong> mouth when cough<strong>in</strong>g or sneez<strong>in</strong>g. See ‘Cover your cough <strong>and</strong><br />
stop the spread of germs’ (page 20).<br />
Always follow good h<strong>and</strong> wash<strong>in</strong>g procedures.<br />
Dispose of soiled tissues appropriately.<br />
Do not share eat<strong>in</strong>g utensils, food or dr<strong>in</strong>k<strong>in</strong>g cups. Thoroughly wash toys that <strong>in</strong>fants<br />
<strong>and</strong> toddlers put <strong>in</strong> their mouths.<br />
Treatment<br />
A bacterial sore throat is treated with penicill<strong>in</strong> or other antibiotics as prescribed by a<br />
doctor. To prevent potential complications such as rheumatic fever, the full course of<br />
antibiotics should be completed.<br />
Antibiotics are not appropriate for viral sore throats.<br />
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Tuberculosis (TB)<br />
Description<br />
Tuberculosis is a bacterial <strong>in</strong>fection that can affect almost any part of the body but is<br />
most common <strong>in</strong> the lungs.<br />
TB is spread by <strong>in</strong>hal<strong>in</strong>g TB germ-conta<strong>in</strong><strong>in</strong>g droplets expelled directly from the<br />
lungs of <strong>in</strong>fectious persons dur<strong>in</strong>g cough<strong>in</strong>g, sneez<strong>in</strong>g, laugh<strong>in</strong>g <strong>and</strong> speak<strong>in</strong>g 51 . It is<br />
not hereditary.<br />
The symptoms of TB <strong>in</strong>clude a cough that lasts longer than 3 weeks <strong>and</strong> doesn’t go<br />
away with normal treatment, fever, cough, loss of energy <strong>and</strong> be<strong>in</strong>g tired. There may<br />
also be sweats, particularly at night, <strong>and</strong> weight loss can also occur. The cough may<br />
produce phlegm <strong>and</strong> sometimes blood. TB can be suspected when there are changes<br />
seen on a chest x-ray.<br />
Incubation period<br />
About 2-10 weeks from <strong>in</strong>fection to positive tubercul<strong>in</strong> sk<strong>in</strong> test 52 . The risk of active<br />
disease is greatest with<strong>in</strong> the first year or two after <strong>in</strong>itial <strong>in</strong>fection, although the<br />
germs may lie <strong>in</strong>active for many years.<br />
Infectious period<br />
Young children with their <strong>in</strong>itial <strong>in</strong>fection rarely spread the disease. Adults who<br />
develop active TB are most <strong>in</strong>fectious when they are cough<strong>in</strong>g <strong>and</strong> have not received<br />
treatment or are <strong>in</strong> the first few weeks of treatment.<br />
Exclusion period<br />
People are excluded from child care until they have a written clearance from their<br />
treat<strong>in</strong>g medical practitioner.<br />
Responsibilities of child care providers/staff<br />
Advise the parent to keep the child home until they have proof of clearance from the<br />
treat<strong>in</strong>g medical practitioner.<br />
Responsibilities of parents<br />
Parents should <strong>in</strong>form the director if their child has TB or if the child is on TB<br />
medications.<br />
Keep child home until they have proof of clearance from the treat<strong>in</strong>g medical<br />
practitioner.<br />
Controll<strong>in</strong>g the spread of <strong>in</strong>fection<br />
The most important way to prevent TB is to reduce the source of the germs by<br />
diagnos<strong>in</strong>g people with TB <strong>and</strong> ensur<strong>in</strong>g they are fully treated. By reduc<strong>in</strong>g the<br />
number of people with <strong>in</strong>fectious TB <strong>in</strong> the community the chance of exposure to TB<br />
is reduced for the general population.<br />
Cover mouth while cough<strong>in</strong>g <strong>and</strong> sneez<strong>in</strong>g. Wash h<strong>and</strong>s.<br />
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Treatment<br />
People with TB require anti-TB drugs for a m<strong>in</strong>imum of 6 months cont<strong>in</strong>uous<br />
treatment. The exact length of time varies <strong>and</strong> depends upon many factors.<br />
Complet<strong>in</strong>g a full course of therapy is essential.<br />
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Whoop<strong>in</strong>g cough (pertussis)<br />
Description<br />
Whoop<strong>in</strong>g cough is a highly contagious bacterial disease which can affect <strong>in</strong>fants,<br />
children <strong>and</strong> adults. It may start with a runny nose, sneez<strong>in</strong>g <strong>and</strong> then develop <strong>in</strong>to<br />
cough<strong>in</strong>g bouts. These cough<strong>in</strong>g bouts can be very severe <strong>and</strong> frighten<strong>in</strong>g. They may<br />
end with a ‘crow<strong>in</strong>g’ noise (the whoop) as air is drawn back <strong>in</strong>to the chest. Vomit<strong>in</strong>g<br />
or gagg<strong>in</strong>g may follow the cough<strong>in</strong>g bouts.<br />
Young babies may hold their breath <strong>and</strong> may sometimes turn blue. Adolescents <strong>and</strong><br />
adults may just have a persistent cough. Young children are especially at risk of<br />
severe illness, which may result <strong>in</strong> hospitalisation. One <strong>in</strong> four children develops<br />
pneumonia 53 . Some have fits (convulsions) <strong>and</strong> some may develop <strong>in</strong>flammation of<br />
the bra<strong>in</strong> (encephalitis). Whoop<strong>in</strong>g cough is particularly serious <strong>in</strong> children under 2<br />
years of age <strong>and</strong> hospitalisation is usually necessary.<br />
Whoop<strong>in</strong>g cough is transmitted by direct contact with droplets from the nose <strong>and</strong><br />
throat of an <strong>in</strong>fected person.<br />
Incubation period<br />
Commonly 7–10 days <strong>and</strong> not more than 21 days.<br />
Infectious period<br />
A person is <strong>in</strong>fectious from the beg<strong>in</strong>n<strong>in</strong>g of the illness <strong>and</strong> may rema<strong>in</strong> <strong>in</strong>fectious for<br />
up to three weeks. This time frame can be shortened to 5 days when the person is<br />
treated with an appropriate antibiotic.<br />
Exclusion period<br />
Exclude for 21 54 days from the onset of cough<strong>in</strong>g or until the person has taken 5 days<br />
of an appropriate antibiotic.<br />
Responsibilities of child care providers/staff<br />
Inform the director. The director should <strong>in</strong>form parents immediately if their child<br />
exhibits symptoms. Parents should then consult their doctor or cl<strong>in</strong>ic immediately.<br />
Parents of friends <strong>and</strong> contacts of the <strong>in</strong>fected child should be notified that the child<br />
has been diagnosed as hav<strong>in</strong>g whoop<strong>in</strong>g cough <strong>and</strong> advised to contact their doctor.<br />
Advise the parent to keep the child home for 21 days from the onset of cough<strong>in</strong>g or<br />
until they have taken 5 days of an appropriate antibiotic.<br />
Responsibilities of parents<br />
Keep the child home for 21 days from the onset of cough<strong>in</strong>g or until they have taken 5<br />
days of an appropriate antibiotic.<br />
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Controll<strong>in</strong>g the spread of <strong>in</strong>fection<br />
Whoop<strong>in</strong>g cough can be prevented by immunisation. Fully immunised communities<br />
offer the best protection aga<strong>in</strong>st whoop<strong>in</strong>g cough. Erythromyc<strong>in</strong> may be given to<br />
family <strong>and</strong> people <strong>in</strong> close contact with the disease. Adults <strong>and</strong> teenagers are<br />
susceptible to the illness as well <strong>and</strong> may carry the bacteria while exhibit<strong>in</strong>g only mild<br />
symptoms.<br />
If there is a case of whoop<strong>in</strong>g cough with<strong>in</strong> the centre:<br />
Check the immunisation records for every child who has contact with the child with<br />
whoop<strong>in</strong>g cough. Look for evidence of vacc<strong>in</strong>ation with the DTP vacc<strong>in</strong>e at 2, 4 <strong>and</strong> 6<br />
months of age, <strong>and</strong> at 4 years of age. The ‘P’ <strong>in</strong> the vacc<strong>in</strong>e is for pertussis which is<br />
whoop<strong>in</strong>g cough. <strong>Child</strong>ren who have received CDT (diphtheria <strong>and</strong> tetanus for<br />
children) at any of these times have not been vacc<strong>in</strong>ated aga<strong>in</strong>st whoop<strong>in</strong>g cough.<br />
All child care contacts, who have received less than three doses of pertussis vacc<strong>in</strong>e,<br />
should be excluded from child care centres for fourteen days after the last exposure to<br />
the child with whoop<strong>in</strong>g cough, or until they have received five days of an appropriate<br />
course of antibiotics. If antibiotics have not been taken, these contacts must be<br />
excluded for 14 days after their last exposure to a case of whoop<strong>in</strong>g cough at the<br />
centre.<br />
Any child who lives <strong>in</strong> the same house as the case <strong>and</strong> also attends the centre <strong>and</strong> has<br />
received less than three doses of pertussis vacc<strong>in</strong>e is to be excluded from the centre<br />
until they have had 5 days of an appropriate course of antibiotics. If antibiotics have<br />
not been taken, these contacts must be excluded for 14 days after their last exposure to<br />
a case of whoop<strong>in</strong>g cough at home.<br />
Treatment<br />
Antibiotics may be given <strong>in</strong> the early stages to shorten the period of contagiousness of<br />
a child with whoop<strong>in</strong>g cough. However, these do not lessen the severity or duration of<br />
the illness.<br />
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Part 3 Gastro<strong>in</strong>test<strong>in</strong>al compla<strong>in</strong>ts<br />
Campylobacter<br />
Description<br />
Campylobacter <strong>in</strong>fection is a type of gastroenteritis caused by a bacteria known as<br />
Campylobacter. Symptoms may <strong>in</strong>clude diarrhoea (sometimes bloody), a low-grade<br />
fever, abdom<strong>in</strong>al cramp<strong>in</strong>g <strong>and</strong> nausea <strong>and</strong> vomit<strong>in</strong>g.<br />
Campylobacter bacteria are found <strong>in</strong> the faeces of many animals, <strong>in</strong>clud<strong>in</strong>g farm<br />
animals <strong>and</strong> household pets. People are <strong>in</strong>fected when bacteria are taken <strong>in</strong> by mouth<br />
<strong>and</strong> this can happen by:<br />
• Eat<strong>in</strong>g undercooked meat, especially chicken.<br />
• Dr<strong>in</strong>k<strong>in</strong>g unpasteurised milk or contam<strong>in</strong>ated dr<strong>in</strong>k<strong>in</strong>g water.<br />
• Eat<strong>in</strong>g cooked food which has been cross-contam<strong>in</strong>ated with campylobacter<br />
bacteria from raw food.<br />
• H<strong>and</strong>l<strong>in</strong>g <strong>in</strong>fected animals <strong>and</strong> not wash<strong>in</strong>g h<strong>and</strong>s afterwards.<br />
Infection can also be spread from person to person when:<br />
• People with campylobacter bacteria <strong>in</strong> the faeces do not wash their h<strong>and</strong>s<br />
effectively after go<strong>in</strong>g to the toilet. Contam<strong>in</strong>ated h<strong>and</strong>s can then contam<strong>in</strong>ate<br />
food which may be eaten by others.<br />
• H<strong>and</strong>s become <strong>in</strong>fected when chang<strong>in</strong>g the nappy of an <strong>in</strong>fected <strong>in</strong>fant. People<br />
<strong>and</strong> animals can carry <strong>and</strong> spread the <strong>in</strong>fection even if they don’t have<br />
symptoms.<br />
Incubation period<br />
Usually 2 - 5 days after com<strong>in</strong>g <strong>in</strong> contact with the bacteria, but may range from 1–10<br />
days.<br />
Infectious period<br />
For as long as the bacteria are <strong>in</strong> the person’s faeces. This may be for a few days or<br />
weeks after symptoms are gone.<br />
Exclusion period<br />
Exclude until diarrhoea has stopped for at least 24 hours.<br />
Responsibilities of child care providers/staff<br />
Report the <strong>in</strong>fection to the director.<br />
Contact your local health authority if several children <strong>in</strong> one group are ill. Public<br />
health workers may be able to help identify how the <strong>in</strong>fectious agent has spread<br />
through the centre <strong>and</strong> prevent further <strong>in</strong>fection.<br />
Responsibilities of parents<br />
Observe the exclusion period.<br />
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Controll<strong>in</strong>g the spread of <strong>in</strong>fection<br />
Exclude a person with <strong>in</strong>fectious diarrhoea from the centre until diarrhoea has stopped<br />
for at least 24 hours.<br />
Make sure that effective h<strong>and</strong> wash<strong>in</strong>g <strong>and</strong> clean<strong>in</strong>g procedures are be<strong>in</strong>g followed <strong>in</strong><br />
the centre <strong>and</strong> at home.<br />
Ensure s<strong>and</strong>pits are raked regularly <strong>and</strong> remove any animal faeces. Cover the s<strong>and</strong> pit<br />
when it is not <strong>in</strong> use 55 .<br />
Treatment<br />
Antibiotics are usually prescribed only when a child is not recover<strong>in</strong>g from the illness.<br />
Recovery usually occurs with<strong>in</strong> a few days of the onset of symptoms. Parents should<br />
consult their doctor about treatment.<br />
Make sure the child has plenty to dr<strong>in</strong>k, see ‘Safe dr<strong>in</strong>ks’ on page 79.<br />
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Cryptosporidiosis<br />
Description<br />
Cryptosporidiosis is a type of gastroenteritis caused by the parasite Cryptosporidium.<br />
The parasite <strong>in</strong>fects the <strong>in</strong>test<strong>in</strong>e. Often, the <strong>in</strong>fected person has no symptoms at all.<br />
The organism is usually identified by laboratory exam<strong>in</strong>ation of a faecal specimen.<br />
Symptoms <strong>in</strong>clude vomit<strong>in</strong>g, loss of appetite, stomach pa<strong>in</strong> <strong>and</strong> foul-smell<strong>in</strong>g<br />
diarrhoea. The faeces are often watery <strong>in</strong> appearance or may conta<strong>in</strong> mucus.<br />
In healthy young children the illness is self-limit<strong>in</strong>g <strong>and</strong> lasts only a few days 56 . In<br />
people with normal immune systems the symptoms often fluctuate but recovery is<br />
expected <strong>in</strong> less than 30 days.<br />
Cryptosporidium parasites live <strong>in</strong> the bowels of humans <strong>and</strong> <strong>in</strong> wild, pet <strong>and</strong> farm<br />
animals. People with cryptosporidiosis have the parasite <strong>in</strong> their faeces. The <strong>in</strong>fection<br />
spreads when:<br />
• Infected people do not wash their h<strong>and</strong>s effectively after go<strong>in</strong>g to the toilet.<br />
Contam<strong>in</strong>ated h<strong>and</strong>s can then spread the parasites to food that may be eaten by<br />
others <strong>and</strong> surfaces that may be touched by others.<br />
• H<strong>and</strong>s become contam<strong>in</strong>ated while h<strong>and</strong>l<strong>in</strong>g <strong>in</strong>fected animals or chang<strong>in</strong>g the<br />
nappy of an <strong>in</strong>fected <strong>in</strong>fant.<br />
• People who dr<strong>in</strong>k contam<strong>in</strong>ated water, unpasteurised milk or swallow<br />
contam<strong>in</strong>ated swimm<strong>in</strong>g pool water.<br />
Incubation period<br />
Uncerta<strong>in</strong>, probably an average of 7 days, with a range of 1-12 days 57 .<br />
Infectious period<br />
For as long as the organism is <strong>in</strong> the person’s faeces, whether or not the person has<br />
symptoms (usually 2–4 weeks).<br />
Exclusion period<br />
Exclude until diarrhoea has stopped for at least 24 hours.<br />
Responsibilities of child care providers/staff<br />
Report the <strong>in</strong>fection to the director.<br />
Contact your local health authority if several children <strong>in</strong> one group are ill. Public<br />
health workers may be able to help identify how the <strong>in</strong>fectious agent has spread<br />
through the centre <strong>and</strong> prevent further <strong>in</strong>fection.<br />
Responsibilities of parents<br />
Observe the exclusion period.<br />
Controll<strong>in</strong>g the spread of <strong>in</strong>fection<br />
Exclude a person with <strong>in</strong>fectious diarrhoea from the centre until diarrhoea has stopped<br />
for at least 24 hours.<br />
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Make sure that effective h<strong>and</strong> wash<strong>in</strong>g <strong>and</strong> clean<strong>in</strong>g procedures are be<strong>in</strong>g followed <strong>in</strong><br />
the centre <strong>and</strong> at home.<br />
As people with Cryptosporidium <strong>in</strong>fection can cont<strong>in</strong>ue shedd<strong>in</strong>g oocysts even after<br />
symptoms have settled, people should not go swimm<strong>in</strong>g while they have diarrhoea<br />
<strong>and</strong> for 2 weeks after diarrhoea stops 58 .<br />
Treatment<br />
No treatment is available but all children with diarrhoea should see a doctor.<br />
Make sure that the child has plenty to dr<strong>in</strong>k, see ‘Safe dr<strong>in</strong>ks’ on page 79.<br />
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Diarrhoea <strong>and</strong> vomit<strong>in</strong>g (gastroenteritis)<br />
Description<br />
Gastroenteritis is an illness triggered by the <strong>in</strong>fection <strong>and</strong> <strong>in</strong>flammation of the<br />
digestive system. Typical symptoms <strong>in</strong>clude abdom<strong>in</strong>al cramps, diarrhoea (an<br />
<strong>in</strong>crease <strong>in</strong> the frequency, runn<strong>in</strong>ess or volume of the faeces) <strong>and</strong> vomit<strong>in</strong>g. In many<br />
cases the condition is self-limit<strong>in</strong>g <strong>and</strong> resolves <strong>in</strong> a few days. The ma<strong>in</strong> complication<br />
of gastroenteritis is dehydration, but this can be prevented if the fluid lost <strong>in</strong> vomit<br />
<strong>and</strong> diarrhoea is replaced. A person suffer<strong>in</strong>g from severe gastroenteritis may need<br />
fluids <strong>in</strong>travenously. Some of the causes of gastroenteritis are:<br />
• Viruses – such as Norovirus, rotavirus <strong>and</strong> adenoviruses.<br />
• Bacteria – such as Campylobacter, Salmonella <strong>and</strong> Shigella.<br />
• Parasites – such as Giardia <strong>and</strong> Cryptosporidium.<br />
• Bacterial tox<strong>in</strong>s – the bacteria themselves don’t cause illness 59 , but their<br />
poisonous by-products can contam<strong>in</strong>ate food. For example some stra<strong>in</strong>s of<br />
staphylococcal bacteria produce tox<strong>in</strong>s that can cause gastroenteritis.<br />
• Chemicals – copper poison<strong>in</strong>g, for example, can cause gastroenteritis.<br />
• Drugs – certa<strong>in</strong> drugs, such as antibiotics, can cause gastroenteritis <strong>in</strong><br />
susceptible people.<br />
The exact cause of the diarrhoea can only be diagnosed by laboratory tests of faecal<br />
specimens. Sometimes multiple specimens must be tested.<br />
Incubation period<br />
Viral <strong>and</strong> bacterial <strong>in</strong>fections, usually 1–3 days.<br />
Parasitic <strong>in</strong>fections, 5–15 days.<br />
Infectious period<br />
People are <strong>in</strong>fectious for as long as the organisms are present <strong>in</strong> their faeces, whether<br />
or not they have symptoms.<br />
Exclusion period<br />
Exclude until diarrhoea has stopped for at least 24 hours.<br />
Responsibilities of child care providers/staff<br />
Inform the director, who can then <strong>in</strong>form parents that the illness is present <strong>in</strong> the<br />
centre.<br />
When several children <strong>in</strong> one group are ill with diarrhoea, your local public health<br />
authority should be contacted for advice <strong>and</strong> help <strong>in</strong> controll<strong>in</strong>g the outbreak.<br />
Responsibilities of parents<br />
Observe the exclusion period.<br />
Controll<strong>in</strong>g the spread of <strong>in</strong>fection<br />
A person with active diarrhoea is more likely to spread the disease than one who is<br />
well but has <strong>in</strong>fectious organisms <strong>in</strong> their faeces. For this reason, children <strong>and</strong> staff<br />
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with <strong>in</strong>fectious diarrhoea should not attend the centre until diarrhoea has stopped for<br />
at least 24 hours.<br />
Do not exclude children or staff with disease-caus<strong>in</strong>g organisms <strong>in</strong> their faeces but no<br />
diarrhoea.<br />
Staff with disease-caus<strong>in</strong>g organisms <strong>in</strong> their faeces but no diarrhoea should not be<br />
<strong>in</strong>volved <strong>in</strong> the preparation of food.<br />
Make sure that effective h<strong>and</strong> wash<strong>in</strong>g <strong>and</strong> clean<strong>in</strong>g procedures are be<strong>in</strong>g followed <strong>in</strong><br />
the centre <strong>and</strong> at home.<br />
Keep cold food cold (below 5°Celsius) <strong>and</strong> hot food hot (above 60°Celsius) to<br />
discourage the growth of bacteria. Reheat food <strong>and</strong> hold at 70°Celsius for 2 m<strong>in</strong>utes.<br />
Treatment<br />
Prevent<strong>in</strong>g dehydration <strong>in</strong> children with gastroenteritis<br />
<strong>Child</strong>ren with diarrhoea need extra fluid to replace what they lose. However, many<br />
fluids have too much sugar <strong>and</strong> the wrong amount of salt. Giv<strong>in</strong>g a sick child the<br />
wrong k<strong>in</strong>d of fluid can lead to more dehydration <strong>and</strong> illness.<br />
Safe dr<strong>in</strong>ks<br />
The best fluids to give conta<strong>in</strong> a mixture of special salts (electrolytes) <strong>and</strong> sugars. You<br />
can buy oral rehydration solution from the chemist. Mix the sachet of powder with<br />
water, not other k<strong>in</strong>ds of fluids. Mix solution accord<strong>in</strong>g to manufacturer’s<br />
<strong>in</strong>structions.<br />
If children refuse oral rehydration solution they may be given diluted soft dr<strong>in</strong>ks or<br />
fruit juice.<br />
Diluted cordial 10ml + 150ml water.<br />
Diluted soft dr<strong>in</strong>k (eg lemonade) 50ml + 150ml water<br />
Diluted fruit juices 50ml + 150ml water<br />
Unsafe dr<strong>in</strong>ks<br />
Do not give undiluted fruit juice, fizzy dr<strong>in</strong>ks, ‘sports dr<strong>in</strong>ks’ or ‘energy dr<strong>in</strong>ks 60 ’ or<br />
cordial to children with diarrhoea. They may <strong>in</strong>crease diarrhoea <strong>and</strong> dehydration.<br />
Breastfed children<br />
Breastfeed<strong>in</strong>g mothers should cont<strong>in</strong>ue to breastfeed <strong>and</strong> offer the breast more often.<br />
Offer water (boiled if the baby is under 6 months) between feeds.<br />
Bottle/Formula fed babies<br />
Cont<strong>in</strong>ue normal strength formula or milk if the child is hungry, <strong>and</strong> offer oral<br />
rehydration solution or safe dr<strong>in</strong>ks as recommended above.<br />
Remember that withhold<strong>in</strong>g formula for more than 24 hours may result <strong>in</strong> the baby<br />
los<strong>in</strong>g weight.<br />
Re-<strong>in</strong>troduc<strong>in</strong>g food<br />
Re-<strong>in</strong>troduce food with<strong>in</strong> 24 hours, even if the diarrhoea has not settled. Suitable<br />
foods to start off with <strong>in</strong>clude bread, pla<strong>in</strong> biscuits, potatoes, rice, noodles, vegetables,<br />
pla<strong>in</strong> meats, fish <strong>and</strong> eggs. Gradually re<strong>in</strong>troduce other foods, such as dairy foods <strong>and</strong><br />
sweet foods such as jelly, honey <strong>and</strong> jam.<br />
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Comments<br />
<strong>Child</strong>ren with diarrhoea, who vomit or who refuse extra fluids should see a doctor. In<br />
severe cases hospitalisation may be needed.<br />
The parent <strong>and</strong> doctor will need to know the details of the child’s illness while at the<br />
centre. Photocopy the letter on page 8 <strong>and</strong> fill <strong>in</strong> the details.<br />
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Giardiasis<br />
Description<br />
Giardiasis is a form of gastroenteritis caused by a parasite called Giardia lamblia<br />
which lives <strong>in</strong> the bowel. Giardia parasites are also found <strong>in</strong> wild animals, pets <strong>and</strong><br />
farm animals. Untreated water that comes directly from lakes <strong>and</strong> rivers may also<br />
conta<strong>in</strong> Giardia parasites.<br />
Symptoms <strong>in</strong>clude diarrhoea, foul-smell<strong>in</strong>g faeces, cramp<strong>in</strong>g, excessive gas or<br />
bloat<strong>in</strong>g, fatigue, nausea, <strong>and</strong> sometimes vomit<strong>in</strong>g or weight loss. Fever <strong>and</strong> bloody<br />
faeces are not usually symptoms of Giardia <strong>in</strong>fections. Many <strong>in</strong>fected people <strong>and</strong><br />
animals have no symptoms.<br />
In child care centres, children <strong>and</strong> adults may be well <strong>and</strong> not have diarrhoea but still<br />
be <strong>in</strong>fected with the parasite. This makes their faeces potentially <strong>in</strong>fectious to others.<br />
A person with active diarrhoea is more likely to spread the disease than one who<br />
doesn’t have diarrhoea but still has <strong>in</strong>fectious organisms <strong>in</strong> their faeces. Giardia<br />
<strong>in</strong>fections are spread when:<br />
• Infected people do not wash their h<strong>and</strong>s effectively after go<strong>in</strong>g to the toilet.<br />
Contam<strong>in</strong>ated h<strong>and</strong>s can then spread the parasites to food that may be eaten by<br />
others <strong>and</strong> surfaces that may be touched by others.<br />
• H<strong>and</strong>s become contam<strong>in</strong>ated while h<strong>and</strong>l<strong>in</strong>g <strong>in</strong>fected animals or chang<strong>in</strong>g the<br />
nappy of an <strong>in</strong>fected <strong>in</strong>fant.<br />
• People dr<strong>in</strong>k contam<strong>in</strong>ated water.<br />
Incubation period<br />
Commonly 6 – 9 days but may range from 5–15 days.<br />
Infectious period<br />
For as long as the organism is <strong>in</strong> the person’s faeces, whether or not the person has<br />
symptoms.<br />
Exclusion period<br />
Exclude until diarrhoea has stopped for at least 24 hours.<br />
Responsibilities of child care providers/staff<br />
Report the <strong>in</strong>fection to the director.<br />
Contact your local health authority if several children <strong>in</strong> one group are ill. Public<br />
health workers may be able to help identify how the <strong>in</strong>fectious agent has spread<br />
through the centre <strong>and</strong> prevent further <strong>in</strong>fection.<br />
Responsibilities of parents<br />
Observe the exclusion period.<br />
Controll<strong>in</strong>g the spread of <strong>in</strong>fection<br />
Exclude a person with <strong>in</strong>fectious diarrhoea from the centre until diarrhoea has stopped<br />
for at least 24 hours.<br />
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Be sure that effective h<strong>and</strong> wash<strong>in</strong>g <strong>and</strong> clean<strong>in</strong>g procedures are be<strong>in</strong>g followed <strong>in</strong> the<br />
centre <strong>and</strong> at home.<br />
Treatment<br />
The person will not usually be <strong>in</strong>fectious after be<strong>in</strong>g treated for several days. Ask<br />
parents to check with their doctor about treatment. It is not usually necessary to test or<br />
treat children who have no symptoms.<br />
Make sure the child has plenty to dr<strong>in</strong>k, see ‘Safe dr<strong>in</strong>ks’ on page 79.<br />
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Norovirus<br />
Description<br />
Norovirus is a form of gastroenteritis caused by a group of viruses. Vomit<strong>in</strong>g is<br />
usually the ma<strong>in</strong> symptom <strong>and</strong> can be violent <strong>and</strong> profuse. Other symptoms may<br />
<strong>in</strong>clude diarrhoea, nausea, stomach cramps, fever, headache <strong>and</strong> muscle aches.<br />
The illness is highly <strong>in</strong>fectious <strong>and</strong> often occurs <strong>in</strong> outbreaks. It is highly <strong>in</strong>fectious<br />
for several reasons. Vomit can conta<strong>in</strong> one million virus particles per millilitre. Faeces<br />
are also very <strong>in</strong>fectious. Because violent vomit<strong>in</strong>g can produce aerosolised particles<br />
(particles suspended <strong>in</strong> the air) or can contam<strong>in</strong>ate surfaces norovirus is easily spread.<br />
It only takes a small number of germs to cause an <strong>in</strong>fection <strong>and</strong> the germs are fairly<br />
resistant to dis<strong>in</strong>fectants.<br />
The viruses can spread <strong>in</strong> many different ways:<br />
• Person-to-person (eg. by germs from vomit or faeces gett<strong>in</strong>g on to h<strong>and</strong>s then<br />
<strong>in</strong>to someone else’s mouth).<br />
• Aerosols from projectile vomit<strong>in</strong>g.<br />
• Food (for example, an <strong>in</strong>fected person with germs on their h<strong>and</strong>s can<br />
contam<strong>in</strong>ate food, as can aerosols from vomit<strong>in</strong>g).<br />
• Surfaces that become contam<strong>in</strong>ated (eg. toilets).<br />
• Contam<strong>in</strong>ated water.<br />
Incubation period<br />
About 15 to 48 hours.<br />
Infectious period<br />
While they have symptoms, <strong>and</strong> usually for 48 hours after symptoms have stopped.<br />
Some people are still <strong>in</strong>fectious up to 10 days after symptoms have stopped.<br />
Exclusion period<br />
<strong>Child</strong>ren are to be excluded from the centre for at least 24 hours after symptoms have<br />
stopped.<br />
Staff who h<strong>and</strong>le food should be excluded from food preparation, food h<strong>and</strong>l<strong>in</strong>g <strong>and</strong><br />
assist<strong>in</strong>g others with feed<strong>in</strong>g until at least 48 hours after the symptoms have stopped.<br />
Large outbreaks have occurred when food h<strong>and</strong>lers have returned to prepar<strong>in</strong>g food<br />
while still <strong>in</strong>fectious 61 .<br />
Responsibilities of child care providers/staff<br />
Report the <strong>in</strong>fection to the director.<br />
Contact your local health authority if several children <strong>in</strong> one group are ill. Public<br />
health workers may be able to help identify how the <strong>in</strong>fectious agent has spread<br />
through the centre <strong>and</strong> will provide advice on how to prevent a large scale outbreak<br />
occurr<strong>in</strong>g.<br />
Responsibilities of parents<br />
Observe the exclusion period.<br />
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Controll<strong>in</strong>g the spread of <strong>in</strong>fection<br />
Do not prepare food for anyone until at least 48 hours after recovery.<br />
Ensure h<strong>and</strong>s are washed thoroughly, especially after go<strong>in</strong>g to the toilet, before eat<strong>in</strong>g,<br />
before prepar<strong>in</strong>g or h<strong>and</strong>l<strong>in</strong>g food, after chang<strong>in</strong>g <strong>in</strong>fants' nappies <strong>and</strong> after<br />
supervis<strong>in</strong>g children at the toilet.<br />
Make sure that effective h<strong>and</strong> wash<strong>in</strong>g <strong>and</strong> clean<strong>in</strong>g procedures are be<strong>in</strong>g followed <strong>in</strong><br />
the centre <strong>and</strong> at home.<br />
Surfaces that could have become contam<strong>in</strong>ated should be scrupulously cleaned, first<br />
with detergent <strong>and</strong> water to ensure no particles rema<strong>in</strong>, followed by dis<strong>in</strong>fectant (eg.<br />
bleach diluted 1 <strong>in</strong> 10). Make sure that all surfaces are kept clean <strong>in</strong>clud<strong>in</strong>g kitchens<br />
<strong>and</strong> bathrooms.<br />
Treatment<br />
Plenty of fluids (eg. water, dilute fruit juice or special oral rehydration solutions)<br />
should be consumed to prevent dehydration, see ‘Safe Dr<strong>in</strong>ks’ on page 79. Food can<br />
be eaten as tolerated. Antibiotics will not help as they do not kill viruses.<br />
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Rotavirus<br />
Description<br />
Rotavirus is a form of gastroenteritis caused by a virus. The people most at risk for<br />
rotavirus <strong>in</strong>fection are young children especially those under 2 years old 62 . Almost all<br />
people worldwide will have a rotavirus <strong>in</strong>fection before they are 5 years old. In<br />
Australia 20-40% of all admissions of young children to hospital with diarrhoea are<br />
due to rotavirus <strong>in</strong>fections. Rotavirus <strong>in</strong>fections occur mostly <strong>in</strong> late autumn <strong>and</strong> early<br />
w<strong>in</strong>ter 63 .<br />
Symptoms <strong>in</strong>clude vomit<strong>in</strong>g, fever <strong>and</strong> watery diarrhoea. Onset is usually sudden, <strong>and</strong><br />
the illness ma<strong>in</strong>ly affects <strong>in</strong>fants <strong>and</strong> young children up to 3 years of age.<br />
Rotaviruses are <strong>in</strong> the faeces of a person while they have diarrhoea <strong>and</strong> for several<br />
weeks after the diarrhoea stops (sometimes up to 2 months or longer). Rotavirus<br />
<strong>in</strong>fections are spread when:<br />
• Infected people do not wash their h<strong>and</strong>s effectively after go<strong>in</strong>g to the toilet.<br />
Contam<strong>in</strong>ated h<strong>and</strong>s can then spread the virus to other people <strong>and</strong> surfaces that<br />
may be touched by others.<br />
• H<strong>and</strong>s become contam<strong>in</strong>ated while chang<strong>in</strong>g the nappy of an <strong>in</strong>fected <strong>in</strong>fant.<br />
Incubation period<br />
Usually about 48 hours, but may range from 24 – 72 hours 64 .<br />
Infectious period<br />
The virus may be excreted <strong>in</strong> the faeces for 1–2 days before the illness <strong>and</strong> up to eight<br />
days after the illness.<br />
Exclusion period<br />
Exclude until diarrhoea has stopped for at least 24 hours.<br />
Responsibilities of child care providers/staff<br />
Report the <strong>in</strong>fection to the director.<br />
Contact your local health authority if several children <strong>in</strong> one group are ill. Public<br />
health workers may be able to help identify how the <strong>in</strong>fectious agent has spread<br />
through the centre <strong>and</strong> prevent further <strong>in</strong>fection.<br />
Responsibilities of parents<br />
Observe the exclusion period.<br />
Controll<strong>in</strong>g the spread of <strong>in</strong>fection<br />
Exclude a person with <strong>in</strong>fectious diarrhoea <strong>and</strong> vomit<strong>in</strong>g from the centre until<br />
vomit<strong>in</strong>g <strong>and</strong> diarrhoea has stopped for at least 24 hours.<br />
Make sure that effective h<strong>and</strong> wash<strong>in</strong>g <strong>and</strong> clean<strong>in</strong>g procedures are be<strong>in</strong>g followed <strong>in</strong><br />
the centre <strong>and</strong> at home.<br />
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Treatment<br />
Take a child with vomit<strong>in</strong>g <strong>and</strong> diarrhoea to the doctor. Drugs are usually not<br />
prescribed.<br />
Make sure the child has plenty to dr<strong>in</strong>k, see ‘Safe dr<strong>in</strong>ks’ on page 79.<br />
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Salmonellosis<br />
Description<br />
Salmonellosis is a form of gastroenteritis caused by Salmonella bacteria.<br />
Symptoms <strong>in</strong>clude diarrhoea, fever, abdom<strong>in</strong>al pa<strong>in</strong>, nausea <strong>and</strong> vomit<strong>in</strong>g, sometimes<br />
with blood or mucus <strong>in</strong> the faeces. The severity of symptoms depends upon the<br />
number of bacteria you swallow, your age <strong>and</strong> your general health.<br />
Salmonellosis occurs when Salmonella bacteria are taken <strong>in</strong> by mouth. This may<br />
happen <strong>in</strong> any of the follow<strong>in</strong>g ways:<br />
• Eat<strong>in</strong>g undercooked meat, especially poultry, <strong>and</strong> raw or undercooked eggs.<br />
• Eat<strong>in</strong>g cooked or ready to eat food that has been contam<strong>in</strong>ated with<br />
Salmonella bacteria from raw food, such as chicken. This is called cross<strong>in</strong>fection<br />
<strong>and</strong> can also happen when food comes <strong>in</strong>to contact with<br />
contam<strong>in</strong>ated kitchen surfaces, such as chopp<strong>in</strong>g boards <strong>and</strong> utensils that have<br />
been used with raw food.<br />
• People with salmonellosis have Salmonella bacteria <strong>in</strong> the faeces. If these<br />
people do not wash their h<strong>and</strong>s properly after go<strong>in</strong>g to the toilet, their<br />
contam<strong>in</strong>ated h<strong>and</strong>s can spread the bacteria to surfaces <strong>and</strong> objects that may be<br />
touched by others. H<strong>and</strong>s can also become contam<strong>in</strong>ated when chang<strong>in</strong>g the<br />
nappy of an <strong>in</strong>fected <strong>in</strong>fant.<br />
• Pets <strong>and</strong> farm animals may have salmonella bacteria <strong>in</strong> their faeces without<br />
hav<strong>in</strong>g any symptoms. People can get salmonellosis from these animals if they<br />
do not wash their h<strong>and</strong>s after h<strong>and</strong>l<strong>in</strong>g them.<br />
Incubation period<br />
6 hours to 3 days, usually 12–36 hours.<br />
Infectious period<br />
You may be <strong>in</strong>fectious for several weeks. Although the symptoms usually only last<br />
for a few days, the bacteria may be present <strong>in</strong> faeces for several weeks.<br />
Exclusion period<br />
Exclude until diarrhoea has stopped for at least 24 hours.<br />
Responsibilities of child care providers/staff<br />
Report the <strong>in</strong>fection to the director.<br />
Staff may resume h<strong>and</strong>l<strong>in</strong>g food 48 hours after diarrhoea has ceased.<br />
Contact your local health authority if several children <strong>in</strong> one group are ill. Public<br />
health workers may be able to help identify how the germ has spread through the<br />
centre <strong>and</strong> prevent further <strong>in</strong>fection.<br />
Responsibilities of parents<br />
Observe the exclusion period.<br />
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Controll<strong>in</strong>g the spread of <strong>in</strong>fection<br />
Exclude a person with <strong>in</strong>fectious diarrhoea from the centre until the diarrhoea has<br />
stopped for at least 24 hours.<br />
Do not exclude a person with organisms <strong>in</strong> their faeces but no diarrhoea.<br />
Make sure that effective h<strong>and</strong> wash<strong>in</strong>g <strong>and</strong> clean<strong>in</strong>g procedures are be<strong>in</strong>g followed <strong>in</strong><br />
the centre <strong>and</strong> at home.<br />
A person with Salmonella <strong>in</strong> their faeces must not be <strong>in</strong>volved <strong>in</strong> food preparation<br />
under diarrhoea has ceased for at least 48 hours 65 .<br />
Treatment<br />
Treatment with antibiotics is not usually recommended for Salmonella <strong>in</strong>fections. Use<br />
of antibiotics sometimes results <strong>in</strong> the person becom<strong>in</strong>g a carrier. The person then<br />
appears well but is <strong>in</strong>fectious to others.<br />
Recovery from Salmonella <strong>in</strong>fection usually occurs with<strong>in</strong> a few days of the onset of<br />
symptoms. Parents should consult a doctor about treatment.<br />
Make sure the child has plenty to dr<strong>in</strong>k, see ‘Safe dr<strong>in</strong>ks’ on page 79.<br />
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Shigellosis<br />
Description<br />
Shigellosis is a severe <strong>in</strong>test<strong>in</strong>al <strong>in</strong>fection caused by Shigella bacteria. The germ can<br />
be identified by a faecal culture. Symptoms <strong>in</strong>clude diarrhoea (sometimes conta<strong>in</strong><strong>in</strong>g<br />
blood or mucus), fever, vomit<strong>in</strong>g <strong>and</strong> cramps. Some <strong>in</strong>fected people have no<br />
symptoms. Shigella spreads when h<strong>and</strong>s, objects or food become contam<strong>in</strong>ated with<br />
the faeces of <strong>in</strong>fected people, <strong>and</strong> the bacteria are then taken <strong>in</strong> by mouth. Very small<br />
numbers of the bacteria are sufficient to cause an <strong>in</strong>fection. Str<strong>in</strong>gent control measures<br />
are needed.<br />
Incubation period<br />
1–7 days, usually 1–3 days.<br />
Infectious period<br />
While ill <strong>and</strong> for a few days afterwards.<br />
Exclusion period<br />
Exclude until diarrhoea has stopped for at least 24 hours.<br />
Responsibilities of child care providers/staff<br />
Report the <strong>in</strong>fection to the director.<br />
Staff may resume h<strong>and</strong>l<strong>in</strong>g food 48 hours after diarrhoea has ceased.<br />
Contact your local health authority if more than one child <strong>in</strong> one group is ill. Public<br />
health workers may be able to help identify how the germ has spread through the<br />
centre <strong>and</strong> prevent further <strong>in</strong>fection.<br />
Responsibilities of parents<br />
Observe the exclusion period.<br />
Controll<strong>in</strong>g the spread of <strong>in</strong>fection<br />
Exclude a person with <strong>in</strong>fectious diarrhoea from the centre until the diarrhoea has<br />
stopped for at least 24 hours.<br />
Make sure that effective h<strong>and</strong> wash<strong>in</strong>g <strong>and</strong> clean<strong>in</strong>g procedures are be<strong>in</strong>g followed <strong>in</strong><br />
the centre <strong>and</strong> at home.<br />
A person with Shigella <strong>in</strong> their faeces must not be <strong>in</strong>volved <strong>in</strong> food preparation until<br />
diarrhoea has ceased for at least 48 hours 66 .<br />
Treatment<br />
A child with this <strong>in</strong>fection may become seriously ill. The child may need<br />
hospitalisation. Seek medical advice on treatment <strong>and</strong> fluid replacement. The doctor<br />
may prescribe antibiotics.<br />
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Worms: Hydatid disease<br />
Description<br />
Hydatid disease is caused by a small tapeworm called Ech<strong>in</strong>ococcus granulosis. This<br />
is passed to humans from <strong>in</strong>fected dogs. The disease is transmitted when tapeworm<br />
eggs <strong>in</strong> dog faeces are transferred from h<strong>and</strong>s to mouths. This may happen when a<br />
person h<strong>and</strong>les dogs or objects soiled with dog faeces, or <strong>in</strong>gests contam<strong>in</strong>ated food or<br />
water. Hydatid disease is not transmitted directly from person to person.<br />
Hydatid disease causes cysts to grow <strong>in</strong> different parts of the body. Any organ may be<br />
affected. Sometimes these cysts cause no symptoms at all <strong>and</strong> are found dur<strong>in</strong>g<br />
rout<strong>in</strong>e chest X-rays. However, if the cysts grow <strong>in</strong> vital organs (such as the liver,<br />
lungs or bra<strong>in</strong>) they may cause disease. Hydatid disease is essentially a problem of the<br />
rural community, especially the sheep farmer.<br />
Incubation period<br />
Variable, from months to years, depend<strong>in</strong>g upon the number <strong>and</strong> location of cysts <strong>and</strong><br />
how rapidly they grow.<br />
Infectious period<br />
Dogs beg<strong>in</strong> to pass eggs of the parasite approximately seven weeks after becom<strong>in</strong>g<br />
<strong>in</strong>fected. Most <strong>in</strong>fections <strong>in</strong> dogs resolve with<strong>in</strong> 6 months, but some adult tapeworms<br />
may survive as long as 2–3 years. Dogs can become <strong>in</strong>fected repeatedly.<br />
Exclusion period<br />
Nil.<br />
Responsibilities of child care providers/staff<br />
Ensure rout<strong>in</strong>e de-worm<strong>in</strong>g of dogs <strong>in</strong> the community <strong>and</strong> particularly dogs that<br />
frequent the centre.<br />
Responsibilities of parents<br />
Ensure that adults <strong>and</strong> children wash their h<strong>and</strong>s before eat<strong>in</strong>g.<br />
Dispose of dog faeces regularly, wear<strong>in</strong>g gloves.<br />
Controll<strong>in</strong>g the spread of <strong>in</strong>fection<br />
Ensure that adults <strong>and</strong> children wash their h<strong>and</strong>s before eat<strong>in</strong>g.<br />
Dispose of dog faeces regularly, wear<strong>in</strong>g gloves.<br />
Treatment<br />
This may be drug therapy, or surgery to remove the cysts.<br />
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Worms: P<strong>in</strong>worms<br />
Description<br />
There are many worms that can <strong>in</strong>fest children. Most, however, need to live for a<br />
period <strong>in</strong> water, soil or animals before they become <strong>in</strong>fectious to humans. In<br />
Australia, with its temperate, dry climate <strong>and</strong> adequate town sewerage facilities, very<br />
few worms are transmitted.<br />
In child care centres, the most common worm is the p<strong>in</strong>worm (also called Enterobius<br />
vermicularis). Other names for a p<strong>in</strong>worm <strong>in</strong>fection are ‘seatworm <strong>in</strong>fection’,<br />
‘threadworm <strong>in</strong>fection’, ‘enterobiasis’ or ‘oxyuriasis’ 67 ’. People are <strong>in</strong>fected by<br />
unknow<strong>in</strong>gly eat<strong>in</strong>g microscopic p<strong>in</strong>worm eggs. The eggs pass <strong>in</strong>to the digestive<br />
system <strong>and</strong> hatch <strong>in</strong> the small <strong>in</strong>test<strong>in</strong>e. From the small <strong>in</strong>test<strong>in</strong>e, p<strong>in</strong>worm larvae<br />
cont<strong>in</strong>ue their journey to the large <strong>in</strong>test<strong>in</strong>e, where they live as parasites – their heads<br />
attached to the <strong>in</strong>side wall of the bowel. P<strong>in</strong>worms are spread when the person<br />
scratches or touches the anal area (where the p<strong>in</strong>worm lays its eggs) <strong>and</strong> then puts<br />
their h<strong>and</strong>s to their mouth. Occasionally eggs on <strong>in</strong>fected cloth<strong>in</strong>g may be breathed <strong>in</strong><br />
<strong>and</strong> then enter the gut (where the adult p<strong>in</strong>worm lives). P<strong>in</strong>worms do not <strong>in</strong>fect dogs<br />
<strong>and</strong> cats so domestic pets are not a source of <strong>in</strong>fection.<br />
Symptoms of p<strong>in</strong>worm <strong>in</strong>fection <strong>in</strong>clude itchy bottom, irritability <strong>and</strong> behavioural<br />
changes. Sometimes a th<strong>in</strong>, adult p<strong>in</strong>worm, about 1 cm long, is found on freshly<br />
passed faeces.<br />
Incubation period<br />
Approximately 2 to 4 weeks after eggs enter the <strong>in</strong>test<strong>in</strong>es, the female p<strong>in</strong>worm<br />
beg<strong>in</strong>s mov<strong>in</strong>g from the large <strong>in</strong>test<strong>in</strong>e to the area around the rectum.<br />
Infectious period<br />
P<strong>in</strong>worms can spread as long as worms live <strong>in</strong> the gut. Infection will cont<strong>in</strong>ue until<br />
the person is treated. Immunity does not occur. Both adults <strong>and</strong> children are<br />
susceptible.<br />
Exclusion period<br />
Nil.<br />
Responsibilities of child care providers/staff<br />
Signs of p<strong>in</strong>worm <strong>in</strong>fection should be reported to the director.<br />
Responsibilities of parents<br />
Seek medical treatment for <strong>in</strong>fected children. The child will be free of p<strong>in</strong>worm<br />
<strong>in</strong>fection with<strong>in</strong> a day if the child receives treatment <strong>and</strong> clothes <strong>and</strong> bed l<strong>in</strong>en are<br />
washed <strong>in</strong> hot water.<br />
Make sure that effective h<strong>and</strong> wash<strong>in</strong>g <strong>and</strong> clean<strong>in</strong>g procedures are be<strong>in</strong>g followed at<br />
home.<br />
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Controll<strong>in</strong>g the spread of <strong>in</strong>fection<br />
Make sure that effective h<strong>and</strong> wash<strong>in</strong>g <strong>and</strong> clean<strong>in</strong>g procedures are be<strong>in</strong>g followed <strong>in</strong><br />
the centre <strong>and</strong> at home.<br />
Treatment<br />
Treatment of p<strong>in</strong>worm is simple, safe <strong>and</strong> effective. The family doctor may wish to<br />
confirm the <strong>in</strong>fection with a simple laboratory test. In most cases, though, the doctor<br />
will prescribe treatment on symptoms alone. A s<strong>in</strong>gle-dose therapy is given to the<br />
child <strong>and</strong> each family member. This may be repeated after two weeks. Treatment of<br />
other children at the centre is not necessary.<br />
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Worms: Roundworm, hookworm <strong>and</strong> tapeworm<br />
Description<br />
Infection with roundworms, hookworms <strong>and</strong> tapeworms (<strong>in</strong>clud<strong>in</strong>g hydatid tapeworm<br />
page 90) is uncommon. However, it is still important to observe good personal<br />
cleanl<strong>in</strong>ess, as <strong>in</strong>fections with hydatid tapeworm or roundworms can have serious<br />
effects.<br />
Incubation period<br />
Eggs or larvae can beg<strong>in</strong> to be passed <strong>in</strong> the faeces several weeks after <strong>in</strong>fection,<br />
depend<strong>in</strong>g on the species of worm <strong>in</strong>volved. Symptoms may not be obvious until<br />
months or years after the <strong>in</strong>fection was acquired.<br />
Infectious period<br />
Transmission is possible throughout the period of <strong>in</strong>festation. Infection will cont<strong>in</strong>ue<br />
until the person is treated. Immunity does not occur. Both adults <strong>and</strong> children are<br />
susceptible.<br />
Exclusion period<br />
Nil.<br />
Responsibilities of child care providers/staff<br />
Signs of worm <strong>in</strong>fection should be reported to the director.<br />
Responsibilities of parents<br />
Observe the exclusion period.<br />
Controll<strong>in</strong>g the spread of <strong>in</strong>fection<br />
Make sure that effective h<strong>and</strong> wash<strong>in</strong>g <strong>and</strong> clean<strong>in</strong>g procedures are be<strong>in</strong>g followed <strong>in</strong><br />
the centre <strong>and</strong> at home.<br />
Dispose of animal faeces frequently (us<strong>in</strong>g gloves) <strong>and</strong> prevent children from eat<strong>in</strong>g<br />
dirt.<br />
Ensure that animals are wormed regularly with anti-parasitic preparations specific to<br />
the worms present <strong>in</strong> that area.<br />
Pregnant dogs should be treated for roundworms. Larvae which are dormant <strong>in</strong> the<br />
bitch’s body from a previous <strong>in</strong>fection may <strong>in</strong>fect the unborn puppies. Dogs should be<br />
re-treated 3–4 weeks after hav<strong>in</strong>g the puppies.<br />
Treatment<br />
Diagnos<strong>in</strong>g worm <strong>in</strong>fections requires laboratory tests. Seek medical advice. Treatment<br />
of worm <strong>in</strong>fections varies accord<strong>in</strong>g to the type of worm <strong>and</strong> the person’s symptoms.<br />
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Part 4 Sk<strong>in</strong> compla<strong>in</strong>ts<br />
General notes on rashes<br />
Rashes are common <strong>in</strong> children. They can be caused by many different viral<br />
<strong>in</strong>fections <strong>and</strong> may not be <strong>in</strong>fectious. It is important to be able to describe the rash as<br />
this may help with diagnosis.<br />
Some features to notice with rashes are:<br />
Illness<br />
Does the child look unwell? The rash may not affect the child’s well-be<strong>in</strong>g at all.<br />
Fever<br />
Take the child’s temperature with a thermometer.<br />
Appearance<br />
What colour is the rash? (Is it dark red like a blood blister? Red? P<strong>in</strong>k?)<br />
What does the rash look like?<br />
• small, red, p<strong>in</strong>-heads<br />
• f<strong>in</strong>e <strong>and</strong> lacy<br />
• large red blotches<br />
• solid red area all jo<strong>in</strong>ed together<br />
• blisters<br />
How does the rash feel to the touch?<br />
• raised slightly, with small lumps<br />
• swollen<br />
Is the rash itchy?<br />
Where on the body did the rash start (for example, head, neck)?<br />
Where is the rash now (for example, head, neck, abdomen, arms, legs)?<br />
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Chickenpox (varicella)<br />
Description<br />
Chickenpox is a viral illness that comes on suddenly <strong>and</strong> is highly contagious. The<br />
chickenpox virus is also called varicella virus. Chickenpox usually starts with one<br />
spot, but more quickly appear, with fever, headache, runny nose, a cough <strong>and</strong> feel<strong>in</strong>g<br />
very tired. The rash starts on the chest <strong>and</strong> back <strong>and</strong> spreads to the face, scalp, arms<br />
<strong>and</strong> legs. The rash can develop all over the body, <strong>in</strong>side the ears, on the eyelids, <strong>in</strong>side<br />
the nose <strong>and</strong> with<strong>in</strong> the vag<strong>in</strong>a, everywhere. The rash cont<strong>in</strong>ues to spread for three or<br />
four days. It is usually very itchy.<br />
With<strong>in</strong> a few hours after each spot appears, a blister forms. It may appear full of<br />
yellow fluid. After a day or so, the fluid turns cloudy. These spots are easily broken<br />
<strong>and</strong> form a scab. The spots heal at different stages, some faster than others, so it is<br />
possible the child may have the rash <strong>in</strong> several stages at once. Some children appear<br />
to ‘breeze’ through chickenpox with just a few spots. Others have a terrible time with<br />
hundred of itchy spots. In families with several children, outbreaks can last for weeks,<br />
because of the relatively long <strong>in</strong>cubation period.<br />
It is spread by cough<strong>in</strong>g <strong>and</strong> contact with the fluid from the blisters. One <strong>in</strong>fection<br />
gives long-last<strong>in</strong>g immunity. People rarely get chickenpox twice. Herpes zoster<br />
(sh<strong>in</strong>gles) is caused by the same virus. It is an eruption <strong>in</strong> someone who has<br />
previously had chickenpox. Direct contact with the moist sh<strong>in</strong>gles rash can cause<br />
chickenpox <strong>in</strong> a person who has not already had it.<br />
Incubation period<br />
The average <strong>in</strong>cubation period is 14 to 15 days, but may range from 10 to 21 days 68 .<br />
Infectious period<br />
From two days before the rash appears (that is, dur<strong>in</strong>g the cough<strong>in</strong>g, runny nose stage)<br />
<strong>and</strong> until all blisters have formed scales or crusts.<br />
Exclusion period<br />
Exclude until all blisters have dried. This is usually at least 5 days after the rash first<br />
appeared <strong>in</strong> unimmunised children <strong>and</strong> less <strong>in</strong> immunised children 69 .<br />
Responsibilities of child care providers/staff<br />
Report the <strong>in</strong>fection to the director.<br />
Rem<strong>in</strong>d parents that aspir<strong>in</strong> should not be given. (See below <strong>in</strong> treatment - Reye’s<br />
syndrome).<br />
Pregnant women should be advised to avoid contact with chickenpox. Vacc<strong>in</strong>ation for<br />
chickenpox dur<strong>in</strong>g pregnancy is not recommended <strong>and</strong> pregnancy should be avoided<br />
for one month follow<strong>in</strong>g chickenpox vacc<strong>in</strong>ation 70 . If pregnant staff members are<br />
concerned, refer them to their doctor.<br />
Responsibilities of the parents<br />
Keep the child home until all blisters have dried. This is usually at least 5 days after<br />
the rash first appeared <strong>in</strong> unimmunised children <strong>and</strong> less <strong>in</strong> immunised children. 71<br />
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Controll<strong>in</strong>g the spread of <strong>in</strong>fection<br />
Chickenpox can be prevented by immunisation. Fully immunised communities offer<br />
the best protection aga<strong>in</strong>st chickenpox. Chickenpox vacc<strong>in</strong>ation is part of the<br />
Australian St<strong>and</strong>ard Vacc<strong>in</strong>ation Schedule for all children at 18 months of age from<br />
1 st November 2005. Vacc<strong>in</strong>ation after exposure is usually successful <strong>in</strong> prevent<strong>in</strong>g<br />
chickenpox when given with<strong>in</strong> 3 days of exposure <strong>and</strong> may be successful when given<br />
up to 5 days after exposure.<br />
Varicella zoster immunoglobul<strong>in</strong> (VZIG) may be given to some contacts who are at<br />
very high risk of complications because of other medical problems. This is not<br />
recommended for normal healthy children.<br />
Cover the nose <strong>and</strong> mouth when cough<strong>in</strong>g or sneez<strong>in</strong>g.<br />
Dispose of soiled tissues after wip<strong>in</strong>g a runny nose or which are soiled with nose or<br />
throat discharges. Wash h<strong>and</strong>s carefully. Do not share eat<strong>in</strong>g utensils, food or dr<strong>in</strong>k<strong>in</strong>g<br />
cups.<br />
Thoroughly wash toys that <strong>in</strong>fants <strong>and</strong> toddlers put <strong>in</strong> their mouths.<br />
Treatment<br />
There is no specific treatment, but calam<strong>in</strong>e lotion or phenergan may soothe the itch.<br />
The use of a medic<strong>in</strong>e conta<strong>in</strong><strong>in</strong>g paracetamol may be considered to lower the child’s<br />
temperature or relieve discomfort. Never give aspir<strong>in</strong> to children who develop fever<br />
after exposure to chickenpox. Aspir<strong>in</strong> appears to <strong>in</strong>crease the risk of Reye’s<br />
syndrome, a rare but serious disorder characterised by sleep<strong>in</strong>ess <strong>and</strong> vomit<strong>in</strong>g.<br />
Reye’s syndrome can lead to coma <strong>and</strong> death.<br />
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Cold sores (herpes simplex)<br />
Description<br />
Cold sores are caused by herpes simplex virus (HSV). Cold sores are very common<br />
<strong>and</strong> most children will have had their first cold sore by the age of five years 72 . After<br />
the first <strong>in</strong>fection, the virus that causes them ‘hides’ <strong>in</strong> the nerves of the sk<strong>in</strong> <strong>and</strong> can<br />
cause new cold sores from time to time.<br />
The most common place for cold sores is on or next to the lips, less often on the nose,<br />
ch<strong>in</strong> <strong>and</strong> other parts of the face but they can occur on any part of the body. In babies,<br />
they often come on the ch<strong>in</strong> of a dribbl<strong>in</strong>g baby. The virus can (rarely) affect the eye<br />
if the virus is carried by the child’s h<strong>and</strong> from an active cold sore to the eye. Cold<br />
sores on the surface of the eye can affect eyesight <strong>and</strong> any child with a pa<strong>in</strong>ful red eye<br />
should be seen by a doctor.<br />
There is often an irritation or burn<strong>in</strong>g feel<strong>in</strong>g first, then one or two blisters form,<br />
which break, form a yellow scab <strong>and</strong> then heal. They usually don’t leave any scars.<br />
Cold sores usually last from 3 – 7 days 73 .<br />
Cold sores can be triggered by such th<strong>in</strong>gs as cold, sunburn, fever, illness or worries<br />
<strong>and</strong> stress.<br />
Incubation period<br />
2 – 12 days 74 .<br />
Infectious period<br />
Spread of <strong>in</strong>fection is most likely when there is fluid present <strong>in</strong> the blister. However,<br />
people with a history of cold sores may shed the virus <strong>in</strong> their saliva (<strong>and</strong> are capable<br />
of <strong>in</strong>fect<strong>in</strong>g others) even without a blister be<strong>in</strong>g present 75 .<br />
Exclusion period<br />
Exclusion is not necessary if the person is developmentally capable of ma<strong>in</strong>ta<strong>in</strong><strong>in</strong>g<br />
hygiene practices to m<strong>in</strong>imise the risk of transmission. If the person is unable to<br />
comply with these practices they should be excluded until the sores are dry. Sores<br />
should be covered by a waterproof dress<strong>in</strong>g where possible.<br />
Responsibilities of child care providers/staff<br />
Report the <strong>in</strong>fection to the director.<br />
Staff members with cold sores may need to be given duties <strong>in</strong>volv<strong>in</strong>g less direct<br />
contact with children.<br />
Responsibilities of parents<br />
If the child is unable to comply with good hygiene practices (ie not touch cold sores,<br />
not kiss other children, wash h<strong>and</strong>s thoroughly, dispose of tissues appropriately, etc)<br />
they should be kept at home until the blisters have dried completely.<br />
Cover the lesion with a waterproof dress<strong>in</strong>g if possible.<br />
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Controll<strong>in</strong>g the spread of <strong>in</strong>fection<br />
Anyone with a cold sore should avoid contact with newborn babies 76 .<br />
Follow good h<strong>and</strong> wash<strong>in</strong>g <strong>and</strong> clean<strong>in</strong>g procedures.<br />
Do not allow kiss<strong>in</strong>g on or near the <strong>in</strong>fected area or shar<strong>in</strong>g of food or dr<strong>in</strong>k<br />
conta<strong>in</strong>ers.<br />
Dispose of used tissues appropriately.<br />
Wash toys that children put <strong>in</strong> their mouths daily <strong>and</strong> store dummies separately. Do<br />
not allow children to dr<strong>in</strong>k from another child’s bottle.<br />
Treatment<br />
Us<strong>in</strong>g antiviral creams or lotions such as idoxurid<strong>in</strong>e or acyclovir at the very early<br />
stages may help keep the sore small <strong>and</strong> help it heal more quickly 77 .<br />
It is important to try to stop any other germs gett<strong>in</strong>g <strong>in</strong>to the cold sores, so try not to<br />
scratch them, <strong>and</strong> wash h<strong>and</strong>s thoroughly.<br />
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Parvovirus B19 (Erythema <strong>in</strong>fectiosum, slapped cheek<br />
syndrome, fifth disease)<br />
Description<br />
This is a mild viral illness. About 20% of <strong>in</strong>fected children will have no symptoms at<br />
all 78 . In others, early <strong>in</strong> the <strong>in</strong>fection there may be mild cold-like symptoms, then two<br />
to five days later, the child typically develops a ‘slapped cheek’ rash on the face <strong>and</strong> a<br />
lacy red rash on the trunk <strong>and</strong> limbs. The child is usually not very ill, though the rash<br />
occasionally can be itchy. The rash disappears after 7 to 10 days, although it may<br />
come <strong>and</strong> go for several weeks, often <strong>in</strong> response to heat. On recovery, the child<br />
develops last<strong>in</strong>g immunity, <strong>and</strong> is protected aga<strong>in</strong>st future <strong>in</strong>fection.<br />
Infection with parvovirus B19 generally only causes a mild illness. However, if a<br />
pregnant woman is <strong>in</strong>fected, the <strong>in</strong>fection may be transmitted to her unborn baby. In<br />
less than 5% of cases 79 , parvovirus B19 <strong>in</strong>fection may cause the unborn baby to have<br />
severe anaemia (low blood count), <strong>and</strong> the woman may have a miscarriage. This<br />
occurs more commonly if <strong>in</strong>fection occurs dur<strong>in</strong>g the first half of pregnancy.<br />
Malformations do not appear to occur <strong>in</strong> babies who survive this <strong>in</strong>fection <strong>in</strong> the<br />
mother.<br />
Parvovirus is spread by droplets or by secretions from the nose <strong>and</strong> throat.<br />
Incubation period<br />
Variable; 4-20 days 80 .<br />
Infectious period<br />
Not <strong>in</strong>fectious once the rash appears.<br />
Exclusion period<br />
Nil.<br />
Responsibilities of child care providers/staff<br />
Report the <strong>in</strong>fection to the director. The director should advise pregnant women to<br />
consult with their medical practitioner.<br />
Advise the parent the child should stay at home until they are feel<strong>in</strong>g well.<br />
Responsibilities of parents<br />
The child should stay at home until they are feel<strong>in</strong>g well.<br />
Controll<strong>in</strong>g the spread of <strong>in</strong>fection<br />
Follow good h<strong>and</strong> wash<strong>in</strong>g practices.<br />
Clean surfaces contam<strong>in</strong>ated by respiratory secretions.<br />
Dispose of soiled tissues appropriately.<br />
Treatment<br />
No specific treatment.<br />
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H<strong>and</strong>, foot <strong>and</strong> mouth disease<br />
Description<br />
This is a mild viral illness <strong>and</strong> has noth<strong>in</strong>g to do with animal diseases with similar<br />
names (eg foot <strong>and</strong> mouth disease <strong>in</strong> livestock).<br />
Symptoms <strong>in</strong>clude a slight fever, loss of appetite, blisters <strong>in</strong> the mouth <strong>and</strong> on the<br />
h<strong>and</strong>s <strong>and</strong> feet, <strong>and</strong> a sore mouth for a few days before the ulcers or blisters appear.<br />
Affected young children may refuse to eat or dr<strong>in</strong>k. Less commonly, blisters may be<br />
seen <strong>in</strong> the nappy area.<br />
H<strong>and</strong>, foot <strong>and</strong> mouth disease is spread through contact with the fluid <strong>in</strong> the blisters.<br />
This is most likely to occur when the virus becomes airborne dur<strong>in</strong>g cough<strong>in</strong>g,<br />
s<strong>in</strong>g<strong>in</strong>g, talk<strong>in</strong>g, etc. Contact with faeces can also spread the <strong>in</strong>fection.<br />
Incubation period<br />
Usually 3–5 days 81 .<br />
Infectious period<br />
As long as there is fluid <strong>in</strong> the blisters. The faeces can rema<strong>in</strong> <strong>in</strong>fectious for several<br />
weeks.<br />
Exclusion period<br />
Exclude until all blisters have dried.<br />
Responsibilities of child care providers/staff<br />
Report the illness to the director.<br />
Responsibilities of parents<br />
Observe exclusion period.<br />
Controll<strong>in</strong>g the spread of <strong>in</strong>fection<br />
Allow blisters to dry naturally. The blisters should not be deliberately pierced because<br />
the fluid with<strong>in</strong> the blisters is <strong>in</strong>fectious.<br />
Follow good h<strong>and</strong> wash<strong>in</strong>g <strong>and</strong> clean<strong>in</strong>g procedure.<br />
Treatment<br />
Usually none is required.<br />
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Head lice (Pediculosis capitis)<br />
Description<br />
Head lice are t<strong>in</strong>y <strong>in</strong>sects. They do not have w<strong>in</strong>gs, so they cannot fly. Head lice have<br />
strong claws <strong>and</strong> sw<strong>in</strong>g from hair to hair – they cannot jump. They live on the hair<br />
<strong>and</strong> suck blood from the scalp. Head lice can only be spread from one person to<br />
another by direct head-to-head contact.<br />
Anyone can get head lice – they have no preferences for cleanl<strong>in</strong>ess, hair colour, hair<br />
type, ethnicity or age. Head lice are a nuisance but they do not cause disease or<br />
illness. Itch<strong>in</strong>g is often the first th<strong>in</strong>g that raises concern about head lice, however it is<br />
not a reliable sign of head lice.<br />
Head lice need to spend their entire life on human heads to survive. Head lice will die<br />
from dehydration with<strong>in</strong> 6 – 24 hours when removed from the human head, depend<strong>in</strong>g<br />
upon humidity <strong>and</strong> when they last fed. Scientific research has shown<br />
• Shar<strong>in</strong>g hats presents no risk. It does not <strong>in</strong>crease the chance of gett<strong>in</strong>g head<br />
lice. Researchers exam<strong>in</strong>ed hats worn by 1000 school children <strong>and</strong> found no<br />
head lice even when many head lice were found on the children’s heads.<br />
• Plac<strong>in</strong>g hair groom<strong>in</strong>g implements <strong>in</strong> a conta<strong>in</strong>er of very hot water (just after<br />
boil<strong>in</strong>g) for at least 30 seconds will kill any head lice caught <strong>in</strong> the comb after<br />
groom<strong>in</strong>g.<br />
• Researchers exam<strong>in</strong>ed 118 carpeted classroom floors <strong>and</strong> found no head lice<br />
or eggs. When the students from those rooms were exam<strong>in</strong>ed, they had a total<br />
of 14 563 live head lice on their heads 1 .<br />
Incubation Period<br />
The head louse starts as a small egg about the size of a gra<strong>in</strong> of salt which the female<br />
louse glues to the base of the hair shaft. Most often these eggs (nits) are found <strong>in</strong> the<br />
hair beh<strong>in</strong>d the ears, at the back of the neck, or around the crown <strong>and</strong> under the fr<strong>in</strong>ge.<br />
The eggs hatch <strong>in</strong> 7–10 days. They mature <strong>in</strong>to an adult louse, which is a w<strong>in</strong>gless<br />
<strong>in</strong>sect 2–3 mm long with a flat body <strong>and</strong> six legs. The adult louse is capable of lay<strong>in</strong>g<br />
eggs after 6-10 days.<br />
Infectious Period<br />
As long as the eggs or lice are alive. Head lice can only survive on human heads <strong>and</strong><br />
they must feed every 6 hours or they will die from dehydration 82 .<br />
Exclusion Period<br />
Exclusion is necessary. The child may return to child care as soon as ‘effective<br />
treatment’ has commenced (see ‘Treatment’). An ‘effective treatment’ is when a<br />
treatment is used <strong>and</strong> all the lice are dead.<br />
Responsibilities of child care providers/staff<br />
Reduc<strong>in</strong>g head-to-head contact between all children dur<strong>in</strong>g activities when the centre<br />
is aware that someone <strong>in</strong> the centre has head lice.<br />
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Support parents <strong>and</strong> children who have head lice by provid<strong>in</strong>g factual <strong>in</strong>formation,<br />
reduc<strong>in</strong>g parental anxiety <strong>and</strong> by not <strong>in</strong>dicat<strong>in</strong>g <strong>in</strong>dividual children as hav<strong>in</strong>g head<br />
lice.<br />
Responsibilities of parents<br />
Check child’s head once a week for head lice. If head lice are found, beg<strong>in</strong> treatment<br />
immediately <strong>and</strong> check for effectiveness (see ‘Treatment’) <strong>and</strong> keep check<strong>in</strong>g every 2<br />
days until no lice are found for 10 consecutive days.<br />
You may send your child back to child care as soon as effective treatment has<br />
commenced. Your child is not a risk to others as long as treatment has commenced.<br />
Controll<strong>in</strong>g the spread of <strong>in</strong>fection<br />
Educate staff, children <strong>and</strong> parents about head lice.<br />
Keep families <strong>in</strong>formed if there is someone with<strong>in</strong> the centre with head lice.<br />
Recommend that staff <strong>and</strong> children tie back long hair to reduce the chance of<br />
transmission.<br />
Detection<br />
Itch<strong>in</strong>g is often the first th<strong>in</strong>g that raises concern about head lice; however it is not a<br />
reliable sign of head lice. Most children who itch do not have head lice. You can have<br />
head lice <strong>and</strong> not know. Lice move fast <strong>in</strong> dry hair <strong>and</strong> are easy to miss. If you f<strong>in</strong>d<br />
head lice early, they are easier to treat. Everyone (adults <strong>and</strong> children) <strong>in</strong> the family<br />
needs to be checked.<br />
Check everyone’s head once a week. If a close contact has head lice, keep check<strong>in</strong>g<br />
every 2 days until no lice are found for 10 consecutive days. If you f<strong>in</strong>d head lice, you<br />
need to decide on a treatment option.<br />
Us<strong>in</strong>g hair conditioner <strong>and</strong> comb<strong>in</strong>g is the most effective way of f<strong>in</strong>d<strong>in</strong>g, <strong>and</strong> treat<strong>in</strong>g,<br />
head lice 83 . Conditioner <strong>and</strong> comb<strong>in</strong>g can be used for detection <strong>and</strong>/or treatment. The<br />
conditioner stuns the lice for some m<strong>in</strong>utes so they can be easily removed.<br />
Conditioner <strong>and</strong> comb<strong>in</strong>g are reasonably <strong>in</strong>expensive. It also avoids the use of head<br />
lice chemicals (pesticides).<br />
Conditioner <strong>and</strong> comb<strong>in</strong>g technique<br />
1. Untangle dry hair with an ord<strong>in</strong>ary comb.<br />
2. Apply hair conditioner to dry hair (use white conditioner as it makes it easier<br />
to see the nits). Use enough conditioner to thoroughly cover the whole scalp<br />
<strong>and</strong> all hair from roots to tips.<br />
3. Use the ord<strong>in</strong>ary comb to evenly distribute conditioner <strong>and</strong> divide the hair <strong>in</strong>to<br />
four or more sections us<strong>in</strong>g hair clips. A mirror helps if comb<strong>in</strong>g yourself.<br />
4. Change to a head lice comb.<br />
5. Start with a section at the back of the head. Place the teeth of the head lice<br />
comb aga<strong>in</strong>st the scalp. Comb the hair from the roots through to the tips.<br />
6. Wipe the comb clean on a tissue after each stroke. In good light, check for<br />
head lice. Adult lice are easier to see – young lice are difficult to see. A<br />
magnify<strong>in</strong>g glass will help. You may see some eggs.<br />
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7. Comb each section twice until you have combed the whole head. If the comb<br />
becomes clogged, use an old toothbrush, dental floss or safety p<strong>in</strong> to remove<br />
the head lice or eggs.<br />
Treatment Options<br />
The two most important th<strong>in</strong>gs to th<strong>in</strong>k about when choos<strong>in</strong>g <strong>and</strong> us<strong>in</strong>g treatments are<br />
safety <strong>and</strong> effectiveness.<br />
Conditioner <strong>and</strong> Comb<strong>in</strong>g Treatment<br />
If you choose the conditioner <strong>and</strong> comb<strong>in</strong>g as a treatment, follow all the steps<br />
described <strong>in</strong> ‘Conditioner <strong>and</strong> comb<strong>in</strong>g technique’. Keep comb<strong>in</strong>g the whole head<br />
until all the hair conditioner is gone. Repeat the conditioner <strong>and</strong> comb<strong>in</strong>g daily 84 until<br />
you f<strong>in</strong>d no more head lice for 10 consecutive days. You will be remov<strong>in</strong>g all the<br />
adult lice <strong>and</strong> any young lice that hatch from the eggs.<br />
Chemical Treatment<br />
When choos<strong>in</strong>g a chemical treatment product, ensure you only choose chemical<br />
treatments that are designed specifically to treat head lice.<br />
Choose only chemical treatments which have an ‘Aust. L’ or ‘Aust. R’ number on the<br />
label. These products are licensed or registered with the Therapeutic Goods<br />
Adm<strong>in</strong>istration (TGA) <strong>in</strong> Australia. This means they are approved for safety. Be wary<br />
of chemical treatments with are not officially approved.<br />
Chemical treatments are divided <strong>in</strong>to 4 groups accord<strong>in</strong>g to the active <strong>in</strong>gredient.<br />
These groups are Pyrethr<strong>in</strong>s, Synthetic Pyrethroids, Organophosphates <strong>and</strong> Herbal <strong>and</strong><br />
Essential Oils.<br />
If you use a chemical treatment <strong>and</strong> it does not kill the head lice, choose a product<br />
with a different active <strong>in</strong>gredient from a different group.<br />
Products from the same group will probably not work as the active <strong>in</strong>gredient is likely<br />
to be the same. Your pharmacist can help you choose a product.<br />
There is no chemical treatment which will kill eggs 85 . The eggs will cont<strong>in</strong>ue to hatch<br />
after the treatment. Therefore it is essential to apply the second treatment one week<br />
later to kill any young lice that have hatched. The conditioner <strong>and</strong> comb<strong>in</strong>g treatment<br />
can be used <strong>in</strong> between to help remove the lice that are hatch<strong>in</strong>g.<br />
There is no chemical treatment that will work for everyone. Resistance to chemical<br />
treatments is a problem <strong>in</strong> Australia. Research <strong>in</strong>to this problem is cont<strong>in</strong>u<strong>in</strong>g. The<br />
only way of deal<strong>in</strong>g with resistance is to check for effectiveness every time you use a<br />
chemical treatment.<br />
Effectiveness of chemical treatments<br />
It is essential to check for effectiveness after each application of a chemical product<br />
(refer to <strong>in</strong>structions above). Some head lice are resistant to some chemical<br />
treatments. This means that this treatment will not be effective <strong>in</strong> kill<strong>in</strong>g head lice.<br />
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To check for effectiveness after treat<strong>in</strong>g for head lice, use a f<strong>in</strong>e tooth head lice comb<br />
(preferably a metal comb) to comb all of the hairs from roots to tips. After each<br />
sweep, wipe the comb<strong>in</strong>gs onto a tissue. Repeat until all the hair has been combed at<br />
least twice. Wait for 5 m<strong>in</strong>utes. Observe the lice for movement.<br />
Effective: If all the lice are dead the treatment has been effective.<br />
• Apply the same product every 7 days (maximum 3 times) to kill the lice<br />
hatch<strong>in</strong>g from the eggs. Use conditioner <strong>and</strong> comb<strong>in</strong>g every 2 days <strong>in</strong> between<br />
to improve the effectiveness of the treatment 86 .<br />
• After first application eggs will be present. In 7 days use conditioner <strong>and</strong><br />
comb<strong>in</strong>g to detect lice. If lice are found, apply product aga<strong>in</strong> <strong>in</strong> 7 days.<br />
• After third application, if lice are still present, cont<strong>in</strong>ue us<strong>in</strong>g conditioner <strong>and</strong><br />
comb<strong>in</strong>g only.<br />
Ineffective: If some lice run around or wave their legs <strong>and</strong> antennae, the treatment<br />
has not been effective.<br />
• If a treatment has not been effective, select a product with a different active<br />
<strong>in</strong>gredient. Show the pharmacist your current treatment <strong>and</strong> request advice on<br />
choos<strong>in</strong>g an alternative treatment or consider us<strong>in</strong>g the conditioner <strong>and</strong><br />
comb<strong>in</strong>g technique.<br />
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Measles<br />
Description<br />
Measles is a highly <strong>in</strong>fectious <strong>and</strong> serious viral illness. It beg<strong>in</strong>s with fever, tiredness,<br />
a cough, a runny nose <strong>and</strong> <strong>in</strong>flamed eyes. These symptoms usually worsen over 3<br />
days. The cough tends to be worse at night. The child may avoid light because the<br />
eyes are <strong>in</strong>flamed. At this stage, there may be small white spots on a red base present<br />
<strong>in</strong> the mouth on the <strong>in</strong>side of the cheek. Between days 3 <strong>and</strong> 7, a rash beg<strong>in</strong>s at the<br />
hair l<strong>in</strong>e. The fever will still be present when the rash beg<strong>in</strong>s. In 24–48 hours, this will<br />
spread over the entire body. When the rash reaches the legs, the rash on the head <strong>and</strong><br />
face beg<strong>in</strong>s to fade. The rash usually disappears after 6 days. Measles lasts about 10<br />
days. The cough may be the last symptom to disappear. A child with measles usually<br />
feels very ill.<br />
In a fairly high number of cases, the measles virus causes serious complications, such<br />
as pneumonia or <strong>in</strong>flammation of the bra<strong>in</strong>. That is why there is much concern about<br />
the disease. Measles is not a simple childhood disease.<br />
The number of cases <strong>in</strong> Australia has fallen dramatically over the past 10 years as a<br />
result of immunisation programmes <strong>and</strong> other public health measures.<br />
Incubation period<br />
8–14 days, usually 10 days.<br />
Infectious period<br />
About 4–5 days before the rash beg<strong>in</strong>s until the fourth day after the rash appears.<br />
Exclusion period<br />
Exclude for at least 4 days after the appearance of the rash.<br />
Responsibilities of child care providers/staff<br />
All children with a fever <strong>and</strong> a rash should see a doctor. Copy the letter on page 8 <strong>and</strong><br />
fill <strong>in</strong> the details. Ensure the parents realise that before tak<strong>in</strong>g a child to a doctor they<br />
must r<strong>in</strong>g <strong>and</strong> <strong>in</strong>form the health staff that they are br<strong>in</strong>g<strong>in</strong>g a child with suspected<br />
measles. Measles can spread very easily to others <strong>in</strong> a doctor’s wait<strong>in</strong>g room.<br />
Encourage the parents to ask the doctor for a blood test to confirm/exclude measles.<br />
Report the <strong>in</strong>fection to the director.<br />
Inform the local public health authority immediately. (One case of measles is<br />
considered an outbreak.)<br />
Responsibilities of parents<br />
Observe the exclusion period. If the child feels unwell, keep them home until they are<br />
feel<strong>in</strong>g better.<br />
Advise any friends, family or social contacts that your child has measles. These<br />
contacts may need to seek medical advice if they are pregnant, consider<strong>in</strong>g start<strong>in</strong>g a<br />
family, unimmunised or have a medical condition which compromises their immune<br />
system (such as cancers, HIV/AIDS, some medication).<br />
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Controll<strong>in</strong>g the spread of <strong>in</strong>fection <strong>in</strong> the centre<br />
Measles is best prevented through immunisation with the MMR vacc<strong>in</strong>e. <strong>Child</strong>ren<br />
should be vacc<strong>in</strong>ated at 12 months of age <strong>and</strong> aga<strong>in</strong> at 4 years of age. The vacc<strong>in</strong>e<br />
gives last<strong>in</strong>g immunity.<br />
If you have a suspected or def<strong>in</strong>ite case of measles the first th<strong>in</strong>g you must do is notify<br />
the local public health authority. Because measles is a serious disease, every effort is<br />
be<strong>in</strong>g made to elim<strong>in</strong>ate the <strong>in</strong>fection from Australia. The staff from the public health<br />
authority will assist your centre <strong>and</strong> local doctors to control the disease.<br />
Write down the dates that the child/adult with measles was <strong>in</strong> the centre over the last<br />
10 days.<br />
Discuss with the public health staff who <strong>in</strong> the centre might need preventive treatment<br />
<strong>and</strong> who should be excluded from care.<br />
• Exclude a person with measles for at least four days after the rash appears.<br />
• Exclude children over 6 months of age who have not had MMR vacc<strong>in</strong>e, this<br />
will be most babies between 6 <strong>and</strong> 12 months of age <strong>and</strong> some older children.<br />
Exclude these children quickly <strong>and</strong> give the parents the dates that the case of<br />
measles was <strong>in</strong> the centre. The unimmunised children may return after they<br />
have the appropriate preventive treatment. This treatment will depend on their<br />
age <strong>and</strong> when they were exposed to the case of measles. They may require<br />
MMR vacc<strong>in</strong>e or Immunoglobul<strong>in</strong> as advised by the public health authority.<br />
• Babies under 6 months of age probably still have immunity to measles from<br />
their mother <strong>and</strong> do not need immediate exclusion. The baby will only be<br />
immune if his/her mother is immune. Inform the parents of babies under 6<br />
months of age of a case of measles <strong>in</strong> the centre. Ask the mother to contact the<br />
public health authority to discuss whether her baby needs treatment.<br />
• Staff who were born after 1966 <strong>and</strong> who have no evidence of hav<strong>in</strong>g received<br />
2 doses of the vacc<strong>in</strong>e or hav<strong>in</strong>g had measles. These staff may return as soon<br />
as they are vacc<strong>in</strong>ated or have evidence from a blood test that they are<br />
immune. People born before 1966 are considered immune because of the<br />
measles virus they would have been exposed to <strong>in</strong> childhood.<br />
• Exclude children or staff whose immune system is compromised (such as<br />
children with some cancers, HIV/AIDS or specific treatments) regardless of<br />
their vacc<strong>in</strong>ation status. Discuss with the public health staff <strong>and</strong> local doctors<br />
when these people should return.<br />
• Inform any visitors to the centre, part-time staff, <strong>and</strong> parents of part-time<br />
children about a case of measles.<br />
Anyone who is not immune <strong>and</strong> has not received preventive treatment recommended<br />
by the public health authority must be excluded for 14 days after the appearance of the<br />
rash <strong>in</strong> the LAST case of measles <strong>in</strong> the centre.<br />
Treatment<br />
None.<br />
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Molluscum contagiosum<br />
Description<br />
A common sk<strong>in</strong> <strong>in</strong>fection caused by the Molluscipox virus.<br />
The virus causes small, usually 2-5mm, pa<strong>in</strong>less, p<strong>in</strong>k or pearly white lumps on the<br />
sk<strong>in</strong>. The top of the lump is <strong>in</strong>dented <strong>and</strong> conta<strong>in</strong>s a white core.<br />
The <strong>in</strong>fection is not serious, only affects the sk<strong>in</strong>, <strong>and</strong> will disappear without<br />
treatment, although this may take several months. Individual lumps often disappear<br />
after about two months, but often there will be more than one lump <strong>and</strong> they will not<br />
all disappear until 6-9 months. There are no long-term ill effects follow<strong>in</strong>g molluscum<br />
contagiosum. People who are immunosuppressed may have more lesions, <strong>and</strong> these<br />
may take longer to clear up.<br />
The virus is spread by direct sk<strong>in</strong>-to-sk<strong>in</strong> contact where there are m<strong>in</strong>or breaks <strong>in</strong> the<br />
sk<strong>in</strong>, <strong>and</strong> is most common <strong>in</strong> children.<br />
Incubation period<br />
2-7 weeks, sometimes longer 87 .<br />
Infectious period<br />
As long as the lumps are present. This may be for several months.<br />
Exclusion period<br />
Nil.<br />
Responsibilities of child care providers/staff<br />
Inform the director of the <strong>in</strong>fection.<br />
Responsibilities of parents<br />
Inform child care provider/staff of <strong>in</strong>fection.<br />
Controll<strong>in</strong>g the spread of <strong>in</strong>fection<br />
Direct contact with the lumps should be avoided.<br />
Cover<strong>in</strong>g lumps is not necessary.<br />
Treatment<br />
Lumps will disappear without treatment, although this may take several months.<br />
Various treatments such as laser therapy, freez<strong>in</strong>g <strong>and</strong> surgery are occasionally used<br />
for cosmetic reasons.<br />
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Fungal <strong>in</strong>fections of the scalp, sk<strong>in</strong> or nails (r<strong>in</strong>gworm,<br />
t<strong>in</strong>ea, athlete’s foot)<br />
Description<br />
These <strong>in</strong>fections are commonly called ‘r<strong>in</strong>gworm’ but are not caused by worms, but a<br />
spread<strong>in</strong>g area of fungal dermatitis. These <strong>in</strong>fections are passed on by direct sk<strong>in</strong><br />
contact or <strong>in</strong>directly by touch<strong>in</strong>g contam<strong>in</strong>ated articles, cloth<strong>in</strong>g <strong>and</strong> floors. While<br />
some of these <strong>in</strong>fections can be caught from animals, humans also have some species<br />
of fungal <strong>in</strong>fections that do not occur <strong>in</strong> animals at all. Different types of animals have<br />
different types of fungi that cause r<strong>in</strong>gworm. If a specimen from the <strong>in</strong>fected area is<br />
cultured <strong>in</strong> the laboratory, it is often possible to narrow down the source of <strong>in</strong>fection<br />
to humans, cats <strong>and</strong> dogs, cattle, horses, pigs, etc.<br />
Fungal <strong>in</strong>fections can be found <strong>in</strong> different areas of the body (scalp, sk<strong>in</strong> <strong>and</strong> nails).<br />
The condition looks different depend<strong>in</strong>g where it is located—on the scalp, the nails,<br />
the body or the foot.<br />
Sk<strong>in</strong> (other than of the scalp, bearded areas <strong>and</strong> feet)<br />
This appears as a flat, spread<strong>in</strong>g, r<strong>in</strong>g-shaped lesion. The outer edge is usually<br />
reddish. It often conta<strong>in</strong>s fluid or pus, but may also be dry <strong>and</strong> scaly or moist <strong>and</strong><br />
crusted. The centre of the patch may appear to be heal<strong>in</strong>g.<br />
Foot (commonly known as t<strong>in</strong>ea or athlete’s foot)<br />
The characteristics of this common condition are scal<strong>in</strong>g or crack<strong>in</strong>g of the sk<strong>in</strong>,<br />
especially between the toes, or blisters conta<strong>in</strong><strong>in</strong>g a th<strong>in</strong> watery fluid.<br />
Toenails <strong>and</strong> f<strong>in</strong>gernails<br />
This condition tends to be a long-term fungal disease. It is difficult to treat. It usually<br />
affects one or more nails of the h<strong>and</strong>s or feet. The nail gradually thickens <strong>and</strong><br />
becomes discoloured <strong>and</strong> brittle. Cheesy look<strong>in</strong>g material forms beneath the nail, or<br />
the nail becomes chalky <strong>and</strong> dis<strong>in</strong>tegrates.<br />
R<strong>in</strong>gworm of the scalp <strong>and</strong> beard<br />
This condition beg<strong>in</strong>s as a small pimple. It spreads outward leav<strong>in</strong>g f<strong>in</strong>e scaly patches<br />
of temporary baldness. Infected hairs become brittle <strong>and</strong> break off easily.<br />
Incubation period<br />
Varies with the site of <strong>in</strong>fection. The <strong>in</strong>cubation period for t<strong>in</strong>ea is unknown.<br />
Infectious period<br />
As long as the condition persists.<br />
Exclusion period<br />
Exclude until the day after appropriate treatment has been commenced.<br />
Responsibilities of child care providers/staff<br />
Report the <strong>in</strong>fection to the director.<br />
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Responsibilities of parents<br />
Observe exclusion period. Commence appropriate treatment. Others <strong>in</strong> the family<br />
should be <strong>in</strong>spected for signs of <strong>in</strong>fection.<br />
Follow good h<strong>and</strong> wash<strong>in</strong>g techniques.<br />
Controll<strong>in</strong>g the spread of <strong>in</strong>fection<br />
Seek appropriate treatment early. Follow good h<strong>and</strong> wash<strong>in</strong>g techniques.<br />
Treatment<br />
The condition first needs to be diagnosed correctly. It is treated by apply<strong>in</strong>g or tak<strong>in</strong>g<br />
anti-fungal medications. These may need to be used for a long time if the nails are<br />
<strong>in</strong>fected. Parents should seek medical advice.<br />
R<strong>in</strong>gworm <strong>in</strong> animals can be treated with anti-fungal preparations <strong>and</strong> tablets. These<br />
can be obta<strong>in</strong>ed from vets.<br />
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Roseola (exanthum subitum, sixth disease)<br />
Description<br />
This common contagious viral <strong>in</strong>fection is marked by the sudden onset of a high fever<br />
which lasts 3 – 5 days <strong>and</strong> then falls, at which time a rash appears. The rash may look<br />
similar to the measles rash, but appears first on the body. The high temperature can<br />
last from a few hours up to 3 – 5 days. The rash lasts from a few hours to 1 – 2 days.<br />
It usually affects children between the ages of 6 months <strong>and</strong> 3 years 88 . Although it can<br />
lead to febrile convulsions, roseola is usually a mild illness.<br />
Roseola is spread by airborne droplets from the nose <strong>and</strong> throat, <strong>and</strong> <strong>in</strong>directly by<br />
contact with h<strong>and</strong>s, tissues <strong>and</strong> other articles soiled by nose <strong>and</strong> throat discharges. The<br />
disease is also spread by direct contact with the saliva of an <strong>in</strong>fected person.<br />
Incubation period<br />
Around 10 days.<br />
Infectious period<br />
Saliva, nasal discharge <strong>and</strong> other respiratory secretions are most <strong>in</strong>fectious from a few<br />
days before until several days after the rash appears.<br />
Exclusion period<br />
Nil. If the child feels unwell they should not attend the centre until they are feel<strong>in</strong>g<br />
better.<br />
Responsibilities of child care providers/staff<br />
Report the <strong>in</strong>fection to the director.<br />
Responsibilities of parents<br />
Although there is no exclusion period for roseola, if the child feels unwell they should<br />
not attend the centre until they are feel<strong>in</strong>g better.<br />
Control of spread<br />
Follow good h<strong>and</strong> wash<strong>in</strong>g procedures. Dispose of soiled tissues appropriately.<br />
Treatment<br />
None.<br />
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Rubella (german measles)<br />
Description<br />
Rubella is a mild viral disease. The onset of rubella is rather like a mild cold, with a<br />
slight fever, sore throat <strong>and</strong> enlarged lymph gl<strong>and</strong>s <strong>in</strong> the neck. The characteristic rash<br />
appears 2-3 days later. It beg<strong>in</strong>s on the face <strong>and</strong> spreads to the trunk. The spots are at<br />
first pale p<strong>in</strong>k <strong>in</strong> colour <strong>and</strong> soon merge to form patches. The rash lasts only a few<br />
days <strong>and</strong> then disappears. Dur<strong>in</strong>g this time the child rema<strong>in</strong>s mildly unwell with<br />
swollen gl<strong>and</strong>s <strong>in</strong> the neck <strong>and</strong> back of the head.<br />
Rubella is spread through airborne droplets or direct contact with the nose or throat<br />
secretions of <strong>in</strong>fected persons.<br />
Rubella usually causes only mild illness <strong>in</strong> children. However, <strong>in</strong>fants born to mothers<br />
who had rubella dur<strong>in</strong>g the first 20 weeks of pregnancy may have severe birth defects.<br />
The risk is highest <strong>in</strong> early pregnancy.<br />
Incubation period<br />
14–21 days, usually 16-18 days.<br />
Infectious period<br />
Up to 7 days before <strong>and</strong> at least 4 days after appearance of the rash.<br />
Exclusion period<br />
Exclude for at least 4 days after the appearance of the rash <strong>and</strong> until the child feels<br />
well.<br />
Responsibilities of child care providers/staff<br />
Report the <strong>in</strong>fection to the director.<br />
Refer anyone with suspected rubella to a doctor.<br />
All staff members should be aware of their immune status <strong>and</strong> if not immune, they<br />
should be immunised.<br />
If pregnant staff members are concerned, refer them to their doctor. Immunisation<br />
dur<strong>in</strong>g pregnancy should be avoided 89 . Although immunisation for rubella dur<strong>in</strong>g<br />
pregnancy is not recommended, the <strong>in</strong>advertent adm<strong>in</strong>istration of the vacc<strong>in</strong>e dur<strong>in</strong>g<br />
early pregnancy is not cause for undue concern.<br />
Responsibilities of parents<br />
Observe the exclusion period.<br />
Advise any pregnant friends or family who may have been exposed to consult with<br />
their doctor.<br />
Controll<strong>in</strong>g the spread of <strong>in</strong>fection<br />
The affected child should rema<strong>in</strong> away from the centre for at least 4 days after onset<br />
of the rash <strong>and</strong> until fully recovered.<br />
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<strong>Child</strong>ren should be immunised twice aga<strong>in</strong>st rubella, at 12 months of age <strong>and</strong> aga<strong>in</strong> at<br />
4 years of age. The rubella vacc<strong>in</strong>e is part of the MMR (measles–mumps–rubella)<br />
immunisation.<br />
Anyone who works with children should be immunised or be certa<strong>in</strong> that they have<br />
had a blood test which demonstrates that they are immune to rubella.<br />
Treatment<br />
Nil.<br />
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Scabies <strong>and</strong> other mites caus<strong>in</strong>g sk<strong>in</strong> disease<br />
Description<br />
Scabies is an <strong>in</strong>fectious disease of the sk<strong>in</strong> caused by a mite. Scabies <strong>and</strong> other mites<br />
caus<strong>in</strong>g sk<strong>in</strong> disease are diagnosed by exam<strong>in</strong><strong>in</strong>g a sk<strong>in</strong> scrap<strong>in</strong>g under a microscope<br />
for mites or eggs. Scabies <strong>and</strong> other mites usually cause <strong>in</strong>tense itch<strong>in</strong>g. Scabies is<br />
usually found between the f<strong>in</strong>gers, on the front of the wrists, <strong>and</strong> <strong>in</strong> the folds of the<br />
elbows, wrists, armpits, buttocks <strong>and</strong> genitalia. Thread-like ‘tunnels’ (about 10 mm<br />
long) may be present <strong>in</strong> the sk<strong>in</strong>, but are often very difficult to see. When mites have<br />
been transmitted from animals to humans, the mites are commonly found on contact<br />
areas, such as the arms, chest <strong>and</strong> neck.<br />
Scabies is usually transmitted by sk<strong>in</strong>-to-sk<strong>in</strong> contact. Very rarely, it is spread on<br />
undercloth<strong>in</strong>g or bed clothes that have been freshly contam<strong>in</strong>ated by an <strong>in</strong>fested<br />
person. The mites only live for a few days off the human or animal body. Although<br />
scabies mites from animals can rema<strong>in</strong> alive on humans, they do not reproduce.<br />
Some forms of sk<strong>in</strong> disease <strong>in</strong> animals caused by mites (such as mange) can also be<br />
spread to humans. If an animal has mange, it is important to have a veter<strong>in</strong>arian<br />
diagnose which mite is caus<strong>in</strong>g the mange. Some mange mites on animals can spread<br />
to humans (for example, scabies <strong>and</strong> Cheyletiella), while others do not spread to<br />
humans (for example, Demodex). Sarcoptes (which causes scabies) can <strong>in</strong>fest a wide<br />
variety of animals (<strong>in</strong>clud<strong>in</strong>g cats <strong>and</strong> dogs), while Cheyletiella usually <strong>in</strong>fests rabbits<br />
but can also <strong>in</strong>fest cats <strong>and</strong> dogs.<br />
Scabies is not an <strong>in</strong>dication of poor cleanl<strong>in</strong>ess.<br />
Incubation period<br />
Itch<strong>in</strong>g beg<strong>in</strong>s 2–6 weeks after <strong>in</strong>festation <strong>in</strong> people not previously exposed to scabies<br />
<strong>and</strong> with<strong>in</strong> 1–4 days for people previously exposed. Itch<strong>in</strong>g due to Cheyletiella can<br />
develop with<strong>in</strong> hours of h<strong>and</strong>l<strong>in</strong>g the animal.<br />
Infectious period<br />
Until the mites <strong>and</strong> eggs are destroyed by treatment.<br />
Exclusion period<br />
The child is to be excluded <strong>and</strong> may return to the centre the day follow<strong>in</strong>g treatment.<br />
Responsibilities of child care providers/staff<br />
Report mite <strong>in</strong>festations to the director.<br />
Any animals <strong>in</strong> the child care centre with sk<strong>in</strong> disease caused by mites (mange)<br />
should be treated. A vet should exam<strong>in</strong>e a sk<strong>in</strong> scrap<strong>in</strong>g to confirm the presence of<br />
mites <strong>and</strong> identify whether the mite can spread to humans.<br />
Responsibilities of parents<br />
Observe exclusion period.<br />
See ‘controll<strong>in</strong>g the spread of <strong>in</strong>fection’ for further responsibilities.<br />
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Controll<strong>in</strong>g the spread of <strong>in</strong>fection<br />
All close (sk<strong>in</strong>-to-sk<strong>in</strong>) contacts <strong>and</strong> other people <strong>in</strong> the same household should be<br />
treated at the same time, even if no itch<strong>in</strong>g or other symptoms are present. By the time<br />
scabies is diagnosed <strong>in</strong> one person, many other people may have been <strong>in</strong>fested. If<br />
everyone is not treated at the same time, treatment is likely to be unsuccessful.<br />
Contam<strong>in</strong>ated underwear, bed l<strong>in</strong>en <strong>and</strong> other cloth<strong>in</strong>g worn by <strong>in</strong>fested people <strong>in</strong> the<br />
48 hours prior to treatment should be washed <strong>in</strong> hot water <strong>and</strong> detergent. All items<br />
such as toys which cannot be washed or dry-cleaned should be placed <strong>in</strong> a plastic bag<br />
for 4 days to kill any mites or eggs.<br />
It is not likely that scabies will be spread by furniture, carpets, mattresses, etc but they<br />
could be vacuumed or gently ironed.<br />
Treatment<br />
Sk<strong>in</strong> disease caused by mites can easily be confused with other sk<strong>in</strong> diseases.<br />
Treatment should not beg<strong>in</strong> until a doctor has confirmed the diagnosis follow<strong>in</strong>g<br />
exam<strong>in</strong>ation of a sk<strong>in</strong> scrap<strong>in</strong>g for mites. This is particularly important for babies,<br />
pregnant women or people who already have other forms of sk<strong>in</strong> disease.<br />
Treatment <strong>in</strong>volves application of <strong>in</strong>secticidal cream, lotion or solution as prescribed<br />
by a doctor. If the mite has spread with<strong>in</strong> the centre, all staff <strong>and</strong> children will need to<br />
be treated at the same time.<br />
Animals with sk<strong>in</strong> disease caused by mites (mange) should be treated. A vet should<br />
exam<strong>in</strong>e a sk<strong>in</strong> scrap<strong>in</strong>g to confirm the presence of mites <strong>and</strong> identify whether the<br />
mite can spread to humans. Animals <strong>and</strong> their bedd<strong>in</strong>g should then be treated with<br />
<strong>in</strong>secticidal washes, accord<strong>in</strong>g to the vet’s <strong>in</strong>structions.<br />
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Scarlet fever<br />
Description<br />
Scarlet fever beg<strong>in</strong>s suddenly, sometimes caus<strong>in</strong>g a convulsion <strong>in</strong> a very young child.<br />
It beg<strong>in</strong>s with a sore throat, high temperature <strong>and</strong> frequent vomit<strong>in</strong>g. This is followed<br />
with<strong>in</strong> 12–36 hours by a f<strong>in</strong>e red rash on the limbs <strong>and</strong> trunk <strong>and</strong> redden<strong>in</strong>g of the<br />
tongue (strawberry tongue). This appears first on the neck <strong>and</strong> chest, rapidly<br />
spread<strong>in</strong>g over the body, f<strong>in</strong>ally reach<strong>in</strong>g the legs. Dur<strong>in</strong>g the recovery from the<br />
<strong>in</strong>fection, the sk<strong>in</strong> may peel off the f<strong>in</strong>gers <strong>and</strong> toes 90 .<br />
Scarlet fever is caused by a streptococcal <strong>in</strong>fection (see ‘Sore throats <strong>and</strong> strep throat<br />
on page 68).<br />
It is spread directly by contact with airborne droplets (cough<strong>in</strong>g <strong>and</strong> sneez<strong>in</strong>g), or<br />
<strong>in</strong>directly by contam<strong>in</strong>ated h<strong>and</strong>s, tissues, eat<strong>in</strong>g utensils, toys or other articles freshly<br />
soiled by the nose <strong>and</strong> throat discharges of an <strong>in</strong>fected person.<br />
Incubation period<br />
Usually 1–3 days.<br />
Infectious period<br />
For about 24 hours after appropriate treatment beg<strong>in</strong>s. Untreated people rema<strong>in</strong><br />
<strong>in</strong>fectious as long as they are sick. This is usually 3–7 days.<br />
Exclusion period<br />
Exclude until the child has received antibiotic treatment for at least 24 hours <strong>and</strong> they<br />
feel well.<br />
Responsibilities of child care providers/staff<br />
Report the <strong>in</strong>fection to the director.<br />
Responsibilities of parents<br />
Observe the exclusion period.<br />
Controll<strong>in</strong>g the spread of <strong>in</strong>fection<br />
Follow good personal cleanl<strong>in</strong>ess practices. Cover the nose <strong>and</strong> mouth when cough<strong>in</strong>g<br />
or sneez<strong>in</strong>g. Dispose of soiled tissues appropriately. Always follow this with proper<br />
h<strong>and</strong> wash<strong>in</strong>g. Do not share eat<strong>in</strong>g utensils, food or dr<strong>in</strong>k<strong>in</strong>g cups. Wash toys that<br />
<strong>in</strong>fants <strong>and</strong> toddlers put <strong>in</strong> their mouths.<br />
Treatment<br />
Penicill<strong>in</strong> or other effective antibiotics as prescribed by a doctor. Take the full course<br />
of antibiotics.<br />
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School sores (impetigo)<br />
Description<br />
Impetigo is a bacterial sk<strong>in</strong> <strong>in</strong>fection caused by either the Staphylococcus or<br />
Streptococcus organism, or both. It is very common <strong>in</strong> children <strong>and</strong> is very easily<br />
spread, but with care spread can be reduced.<br />
Impetigo appears as a flat, yellow, crusty or moist patch on the sk<strong>in</strong>, usually on<br />
exposed parts of the body such as the face, arms <strong>and</strong> legs. The sores are often greater<br />
than 1cm <strong>in</strong> diameter. It usually starts with a blister or a group of blisters<br />
Dry, cracked sk<strong>in</strong> is an ideal area for growth of bacteria. This <strong>in</strong>fection spreads easily<br />
to other parts of the <strong>in</strong>fected person’s body. It is transferred to other people by direct<br />
contact with sores or contam<strong>in</strong>ated clothes.<br />
Incubation period<br />
1–3 days.<br />
Infectious period<br />
As long as there is fluid weep<strong>in</strong>g from the sores. Usually it has stopped be<strong>in</strong>g<br />
<strong>in</strong>fectious about 24 hours after treatment with an antibiotic has been started <strong>and</strong><br />
heal<strong>in</strong>g has begun.<br />
Exclusion period<br />
Exclude until the child has received antibiotic treatment for at least 24 hours.<br />
Responsibilities of child care providers <strong>and</strong> parents<br />
Report the <strong>in</strong>fection to the director.<br />
Responsibilities of parents<br />
Observe the exclusion period.<br />
Any sores on exposed sk<strong>in</strong> should be covered with a waterproof dress<strong>in</strong>g.<br />
Controll<strong>in</strong>g the spread of <strong>in</strong>fection<br />
Emphasise the importance of good h<strong>and</strong> wash<strong>in</strong>g procedures for all personnel <strong>and</strong><br />
children <strong>in</strong> the centre.<br />
Sores on exposed surfaces should be covered with a waterproof dress<strong>in</strong>g.<br />
Treatment<br />
The doctor may recommend the use of antibiotic o<strong>in</strong>tment or antibiotics taken by<br />
mouth. Refer the child back to the doctor if the condition does not improve.<br />
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Thrush (c<strong>and</strong>ida)<br />
Description<br />
Thrush is a common <strong>in</strong>fection <strong>in</strong> the mouth of babies, on rashes (especially nappy<br />
rashes <strong>and</strong> rashes <strong>in</strong> moist places such as under the ch<strong>in</strong> of a dribbl<strong>in</strong>g baby), on the<br />
nipples of breastfeed<strong>in</strong>g mothers <strong>and</strong> <strong>in</strong> the vag<strong>in</strong>a of women. It can be very irritat<strong>in</strong>g<br />
but it is treatable.<br />
Thrush is caused by a yeast (a very small liv<strong>in</strong>g cell) called c<strong>and</strong>ida. Most people<br />
have c<strong>and</strong>ida on their sk<strong>in</strong>, <strong>in</strong> their mouths <strong>and</strong> <strong>in</strong> their gut most of the time without<br />
hav<strong>in</strong>g any problems with it 91 . Sometimes the c<strong>and</strong>ida can start grow<strong>in</strong>g fast <strong>and</strong> can<br />
cause an <strong>in</strong>fection (thrush).<br />
Thrush is common <strong>in</strong> very young babies <strong>and</strong> <strong>in</strong>fants. They are susceptible at this time<br />
because their immune systems are still immature. Thrush is often found <strong>in</strong>side the<br />
mouth as white spots or flakes that cannot be removed by clean<strong>in</strong>g the mouth.<br />
Another site of <strong>in</strong>fection is the vulva <strong>and</strong> vag<strong>in</strong>a. Frequently thrush is a secondary<br />
<strong>in</strong>fection to nappy rash. Thrush is spread by direct contact with fungi liv<strong>in</strong>g <strong>in</strong> the<br />
mouth, vag<strong>in</strong>a <strong>and</strong> faeces <strong>and</strong> on the sk<strong>in</strong>. A mother can <strong>in</strong>fect her newborn baby<br />
dur<strong>in</strong>g the birth.<br />
Incubation period<br />
Variable, but 2–5 days <strong>in</strong> <strong>in</strong>fants.<br />
Infectious period<br />
As long as the white spots or flakes are present.<br />
Exclusion period<br />
Nil.<br />
Responsibilities of child care providers/staff<br />
Report the <strong>in</strong>fection to the director.<br />
Responsibilities of parents<br />
If bottle feed<strong>in</strong>g, clean <strong>and</strong> sterilise teats <strong>and</strong> dummies (or replace them) to prevent re<strong>in</strong>fection.<br />
Any nappy rash that is not clear<strong>in</strong>g after 3 days, or not respond<strong>in</strong>g to your usual<br />
cream, may be the result of thrush <strong>and</strong> needs treatment.<br />
Controll<strong>in</strong>g the spread of <strong>in</strong>fection<br />
Make sure effective h<strong>and</strong> wash<strong>in</strong>g <strong>and</strong> clean<strong>in</strong>g procedures are be<strong>in</strong>g practised.<br />
Treatment<br />
For moderate to severe <strong>in</strong>fection of the mouth or the vulva/vag<strong>in</strong>a the parent should<br />
take the child to a doctor. The doctor may prescribe anti-fungal medications. Wash the<br />
affected area with water, apply the prescribed cream, <strong>and</strong> expose the nappy area to air<br />
as much as possible.<br />
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Warts (common, plane <strong>and</strong> plantar)<br />
Description<br />
Warts are thicken<strong>in</strong>gs of the sk<strong>in</strong>, usually round or oval shaped, <strong>and</strong> clearly different<br />
from the surround<strong>in</strong>g sk<strong>in</strong>. Warts are caused by a virus <strong>in</strong>fection of the sk<strong>in</strong> (Human<br />
papillomavirus). The virus enters the sk<strong>in</strong> through scratches or other damage to the<br />
sk<strong>in</strong>. People cannot get warts from animals 92 . There are many types of warts.<br />
Common warts develop on the sk<strong>in</strong> of children <strong>and</strong> adolescents. They ma<strong>in</strong>ly occur<br />
on the knuckles, backs of h<strong>and</strong>s <strong>and</strong> knees. Occasionally, common warts come out <strong>in</strong><br />
a crop. They are usually raised <strong>and</strong> separate from each other. They are spread by sk<strong>in</strong>to-sk<strong>in</strong><br />
contact such as hold<strong>in</strong>g h<strong>and</strong>s.<br />
Plane warts are flat-topped. They are most commonly found on the face <strong>and</strong> on the<br />
back of the h<strong>and</strong>s. They occur <strong>in</strong> l<strong>in</strong>es where the virus has <strong>in</strong>fected a scratch.<br />
Plantar warts occur on the soles of the feet. They are found mostly <strong>in</strong> older children<br />
<strong>and</strong> adolescents. Infection can come from walk<strong>in</strong>g with bare feet on wet floors such as<br />
<strong>in</strong> school or swimm<strong>in</strong>g pool change rooms. Plantar warts can be quite pa<strong>in</strong>ful, unlike<br />
other warts.<br />
Incubation period<br />
2-3 months 93 , but ranges from 1–20 months.<br />
Infectious period<br />
Unknown, but if untreated probably as long as warts can be seen.<br />
Exclusion period<br />
Nil.<br />
Responsibilities of child care providers/staff<br />
Report the <strong>in</strong>fection to the director.<br />
Responsibilities of parents<br />
Advise children not to pick or scratch at warts. Wash h<strong>and</strong>s after any contact with<br />
warts.<br />
Controll<strong>in</strong>g the spread of <strong>in</strong>fection<br />
Avoid direct contact with warts.<br />
Make sure that effective h<strong>and</strong> wash<strong>in</strong>g <strong>and</strong> clean<strong>in</strong>g procedures are be<strong>in</strong>g practised.<br />
Treat warts if the affected area is exposed (for example, on the h<strong>and</strong>s or legs). After<br />
treatment the warts are not contagious.<br />
The wart virus may enter via moist sk<strong>in</strong> surfaces, such as abrasions <strong>and</strong> cuts.<br />
Therefore it is important to get children to:<br />
• dry h<strong>and</strong>s well after wash<strong>in</strong>g them;<br />
• cover abrasions <strong>and</strong> cuts with a clean dress<strong>in</strong>g; <strong>and</strong><br />
• wear shoes to protect the feet.<br />
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Treatment<br />
Warts will usually go away naturally, but this may take a long time. If treatment is<br />
necessary the follow<strong>in</strong>g may be used:<br />
• Liquid nitrogen<br />
• Chemical paste applications<br />
• Laser therapy.<br />
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Part 5 Other compla<strong>in</strong>ts<br />
Conjunctivitis<br />
Description<br />
Conjunctivitis is an <strong>in</strong>flammation of the conjunctiva, the clear membrane that covers<br />
the white part of the eye <strong>and</strong> l<strong>in</strong>es the <strong>in</strong>ner surface of the eyelids. The <strong>in</strong>flammation<br />
can have many causes, the commonest of which are <strong>in</strong>fection, allergy <strong>and</strong> irritation 94 .<br />
Infectious conjunctivitis is usually caused by either bacteria or viruses. If it is caused<br />
by a bacteria both eyes are almost always <strong>in</strong>fected, although it may start <strong>in</strong> one eye.<br />
There is likely to be a gritty feel<strong>in</strong>g <strong>and</strong> pus. Conjunctivitis from a virus may <strong>in</strong>volve<br />
one or both eyes, caus<strong>in</strong>g red, itchy eyes <strong>and</strong> water<strong>in</strong>g of the eyes.<br />
Allergic conjunctivitis occurs more frequently among children with allergic<br />
conditions such as hay fever. If it comes from an allergy, there are often other signs of<br />
allergy such as itchy nose <strong>and</strong> sneez<strong>in</strong>g, the eyes feel itchy <strong>and</strong> run a lot. 95 Allergic<br />
conjunctivitis typically affects both eyes at the same time.<br />
Irritant conjunctivitis can be caused by chemicals such as those <strong>in</strong> chlor<strong>in</strong>e <strong>and</strong><br />
soaps or air pollutants such as smoke <strong>and</strong> fumes.<br />
The different types of conjunctivitis can have different symptoms. In addition,<br />
symptoms can vary from child to child. One of the most common symptoms is<br />
discomfort or pa<strong>in</strong> <strong>in</strong> the eye, which may feel like hav<strong>in</strong>g s<strong>and</strong> <strong>in</strong> the eye. Many<br />
children have redness of the eye. They may also have swollen eyelids <strong>and</strong> be sensitive<br />
to bright lights.<br />
Discharge from the eye may accompany the other symptoms. In bacterial<br />
conjunctivitis, the discharge will be somewhat thick <strong>and</strong> coloured white, yellow or<br />
green. Sometimes the discharge will cause the eyelids to stick together when the child<br />
awakens <strong>in</strong> the morn<strong>in</strong>g. In viral or allergic conjunctivitis, the discharge may be<br />
th<strong>in</strong>ner <strong>and</strong> may be clear.<br />
Viral <strong>and</strong> bacterial conjunctivitis can be spread by direct contact with eye secretions<br />
or <strong>in</strong>directly by contact with towels, washcloths, tissues etc that have been<br />
contam<strong>in</strong>ated with eye secretions. In some cases it can be spread by <strong>in</strong>sects such as<br />
flies.<br />
Incubation period<br />
24–72 hours.<br />
Infectious period<br />
Viral <strong>and</strong> bacterial conjunctivitis are <strong>in</strong>fectious while there is discharge from the eye.<br />
Conjunctivitis caused by chemicals or allergies is not <strong>in</strong>fectious.<br />
Exclusion period<br />
Exclude until the discharge from the eyes has stopped.<br />
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Responsibilities of child care providers/staff<br />
Inform the director <strong>and</strong> the parents of the child.<br />
S<strong>in</strong>ce bacterial <strong>and</strong> viral conjunctivitis look the same, the child should see a doctor for<br />
proper diagnosis <strong>and</strong> treatment. Any child <strong>in</strong> the centre show<strong>in</strong>g signs of<br />
conjunctivitis should be isolated from the other children until the source of the<br />
irritation can be confirmed.<br />
Responsibilities of parents<br />
Observe the exclusion period. The child should see a doctor for proper diagnosis <strong>and</strong><br />
treatment.<br />
Controll<strong>in</strong>g the spread of <strong>in</strong>fection<br />
Effective h<strong>and</strong> wash<strong>in</strong>g is essential, especially before <strong>and</strong> after touch<strong>in</strong>g the eyes or<br />
face.<br />
Dispose of soiled tissues appropriately.<br />
Do not share towel, washcloths, etc.<br />
Treatment<br />
Antibiotic eye drops or o<strong>in</strong>tment may be prescribed by a doctor. Regular clean<strong>in</strong>g of<br />
the eyes may make the child feel better. It is important to use a separate cotton wool<br />
ball or tissue for each eye to avoid cross-<strong>in</strong>fection <strong>and</strong> use warm but not hot water.<br />
Wipe the closed eye gently but firmly to remove the excess pus – do not clean <strong>in</strong>side<br />
the eyelids as this may cause damage to the conjunctiva or the cornea (the clear front<br />
of the eye).<br />
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Cytomegalovirus (CMV)<br />
Description<br />
Cytomegalovirus (CMV) is a common virus worldwide. CMV is a member of the<br />
herpes virus group but it cannot cause other herpes <strong>in</strong>fections 96 . Most CMV <strong>in</strong>fections<br />
cause either no symptoms or only mild symptoms. Occasionally, symptoms similar to<br />
gl<strong>and</strong>ular fever can occur (see page 124). These <strong>in</strong>clude fever, sore throat <strong>and</strong> swollen<br />
gl<strong>and</strong>s.<br />
Once people are <strong>in</strong>fected with CMV they are thought to rema<strong>in</strong> <strong>in</strong>fected for the rest of<br />
their lives, even when they do not become ill. Sometimes the virus can be reactivated<br />
such as at times of other illnesses or stress, <strong>and</strong> may then cause symptoms 97 . Dur<strong>in</strong>g<br />
an <strong>in</strong>fection the virus can be spread <strong>in</strong> many ways, for example through cough<strong>in</strong>g,<br />
through contact with blood, faeces or saliva. Infection can also occur before birth, at<br />
birth, or early <strong>in</strong> life.<br />
Most women (50–60%) have been <strong>in</strong>fected with CMV <strong>in</strong> the past <strong>and</strong> cannot be<br />
<strong>in</strong>fected with the virus aga<strong>in</strong>. However, women who are <strong>in</strong>fected with CMV for the<br />
first time while pregnant may <strong>in</strong>fect the unborn baby. Infection of the unborn baby<br />
occasionally leads to eye disease, deafness, developmental delay or death. Therefore<br />
pregnant women who are car<strong>in</strong>g for young children need to be particularly careful.<br />
Incubation period<br />
Not accurately known. Probably 3–12 weeks.<br />
Infectious period<br />
The virus is often shed for months <strong>in</strong> ur<strong>in</strong>e or saliva. Infants can shed the virus for<br />
months to years follow<strong>in</strong>g <strong>in</strong>fection or reactivation of the virus 98 .<br />
Exclusion period<br />
Nil.<br />
Responsibilities of child care providers/staff<br />
Report the <strong>in</strong>fection to the director. The director may then need to review with staff<br />
the need for good personal cleanl<strong>in</strong>ess.<br />
Responsibilities of parents<br />
Good h<strong>and</strong> wash<strong>in</strong>g after h<strong>and</strong>l<strong>in</strong>g articles contam<strong>in</strong>ated with ur<strong>in</strong>e or saliva,<br />
particularly after chang<strong>in</strong>g nappies.<br />
Controll<strong>in</strong>g the spread of <strong>in</strong>fection<br />
Good h<strong>and</strong> wash<strong>in</strong>g, <strong>and</strong> wash<strong>in</strong>g of shared toys etc. should be done all the time, not<br />
only when a child is known to be unwell.<br />
Women of child bear<strong>in</strong>g age work<strong>in</strong>g with young children should always practise<br />
good personal cleanl<strong>in</strong>ess, especially:<br />
• good h<strong>and</strong> wash<strong>in</strong>g after contact with body secretions, <strong>and</strong> especially after<br />
chang<strong>in</strong>g nappies or assist<strong>in</strong>g <strong>in</strong> toilet care<br />
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• not kiss<strong>in</strong>g <strong>in</strong>fants on the mouth (hugg<strong>in</strong>g is acceptable).<br />
Treatment<br />
Usually none is required.<br />
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Gl<strong>and</strong>ular fever (Epste<strong>in</strong> Barr virus, Infectious<br />
Mononucleosis)<br />
Description<br />
An <strong>in</strong>fection caused by the Epste<strong>in</strong> Barr virus (EBV). Once a person catches Epste<strong>in</strong><br />
Barr virus, it is believed that the virus rema<strong>in</strong>s <strong>in</strong> their body for life, though it usually<br />
does not cause further illness. By adulthood, 90 – 95% of people have EBV 99 .<br />
Symptoms of acute gl<strong>and</strong>ular fever <strong>in</strong>clude fever, sore throat <strong>and</strong> swollen gl<strong>and</strong>s.<br />
Stomach pa<strong>in</strong> <strong>and</strong> jaundice (yellow<strong>in</strong>g of sk<strong>in</strong> <strong>and</strong> eyes) occur less frequently.<br />
Symptomatic <strong>in</strong>fection most often occurs <strong>in</strong> older children <strong>and</strong> young adults. When<br />
the <strong>in</strong>fection occurs <strong>in</strong> young children, symptoms are mild or absent. Fifty percent of<br />
people <strong>in</strong>fected have no symptoms of <strong>in</strong>fection at all. The illness can last between one<br />
<strong>and</strong> several weeks.<br />
The disease is spread from person-to-person through contact with saliva. Young<br />
children may be <strong>in</strong>fected by saliva on the h<strong>and</strong>s of care givers or by suck<strong>in</strong>g <strong>and</strong><br />
shar<strong>in</strong>g toys, but the virus doesn’t survive very well <strong>in</strong> the environment.<br />
Incubation period<br />
4 – 6 weeks.<br />
Infectious period<br />
Not accurately known. The virus is shed <strong>in</strong> the saliva for up to one year after illness<br />
<strong>and</strong> <strong>in</strong>termittently after that.<br />
Exclusion period<br />
Nil.<br />
Responsibilities of child care providers/staff<br />
Report the <strong>in</strong>fection to the director.<br />
If the child is unwell, advise the parent that the child should stay at home until they<br />
are feel<strong>in</strong>g better (this is out of concern <strong>and</strong> consideration of the child – it is not an<br />
<strong>in</strong>fection control issue for the centre.<br />
Responsibilities of parents<br />
If the child is unwell, the child should stay at home until they are feel<strong>in</strong>g better.<br />
Controll<strong>in</strong>g the spread of <strong>in</strong>fection<br />
Follow good h<strong>and</strong> wash<strong>in</strong>g techniques. M<strong>in</strong>imise contact with saliva where possible.<br />
Avoid shar<strong>in</strong>g cups.<br />
Treatment<br />
There is no effective antiviral medication available. Most people with gl<strong>and</strong>ular fever<br />
recover eventually.<br />
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Haemophilus <strong>in</strong>fluenzae type b (Hib)<br />
Description<br />
Before the <strong>in</strong>troduction of Hib immunisation <strong>in</strong> 1993, the bacterial <strong>in</strong>fection<br />
Haemophilus <strong>in</strong>fluenzae type B was one of the most common causes of men<strong>in</strong>gitis <strong>in</strong><br />
young children (usually under the age of 2 years), <strong>and</strong> it was also the cause of<br />
epiglottitis which causes breath<strong>in</strong>g difficulties 100 . It can also cause pneumonia, jo<strong>in</strong>t<br />
<strong>in</strong>fection or cellulitis (<strong>in</strong>fection of the tissue under the sk<strong>in</strong>). It is not related to the<br />
virus that causes <strong>in</strong>fluenza.<br />
Symptoms of men<strong>in</strong>gitis <strong>in</strong>clude severe headache, stiff neck, fits, severe drows<strong>in</strong>ess,<br />
difficulty wak<strong>in</strong>g up, <strong>and</strong> loss of consciousness 101 .<br />
The disease is spread directly from person-to-person, by contact with airborne<br />
droplets from the nose or throat, or <strong>in</strong>directly, by contact with articles contam<strong>in</strong>ated<br />
with discharges from nose or throat.<br />
Incubation period<br />
2–4 days.<br />
Infectious period<br />
Hib is <strong>in</strong>fectious as long as there are organisms present <strong>in</strong> the nose <strong>and</strong> throat. Hib is<br />
not able to be spread after 1-2 days of an appropriate antibiotic.<br />
Exclusion period<br />
Exclude until completion of appropriate antibiotics <strong>and</strong> a medical clearance certificate<br />
has been issued.<br />
Responsibilities of child care providers/staff<br />
Report the <strong>in</strong>fection to the director. Any child with the above symptoms should be<br />
seen by a doctor immediately. See ‘Controll<strong>in</strong>g the spread of <strong>in</strong>fection’ below.<br />
Responsibilities of parents<br />
Observe the exclusion period.<br />
Controll<strong>in</strong>g the spread of <strong>in</strong>fection<br />
Hib can be prevented by immunisation. Fully immunised communities offer the best<br />
protection aga<strong>in</strong>st Hib.<br />
Check the immunisation records of all children <strong>in</strong> contact with a child with Hib.<br />
Unimmunised children who have had close contact with the child with Hib will need<br />
special antibiotics.<br />
If needed, the public health authorities may help arrange for other children <strong>and</strong> staff to<br />
be given courses of the antibiotic rifampic<strong>in</strong> by mouth.<br />
Adults may also be given the antibiotic. They are not at risk of disease but may be<br />
carry<strong>in</strong>g the germ <strong>in</strong> their throat.<br />
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Treatment<br />
A child with Hib will be treated <strong>in</strong> hospital with antibiotics.<br />
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Hepatitis A<br />
Description<br />
Hepatitis A <strong>in</strong>fection is caused by the hepatitis A virus. The virus grows with<strong>in</strong> the<br />
liver, <strong>and</strong> passes <strong>in</strong>to the <strong>in</strong>test<strong>in</strong>es. The ma<strong>in</strong> way it is spread is through faeces, when<br />
the faeces gets onto the h<strong>and</strong>s of other people, <strong>and</strong> then moved from h<strong>and</strong>s to mouth.<br />
It can also be spread through contam<strong>in</strong>ated water or food (when faeces gets <strong>in</strong>to the<br />
water supply or onto food).<br />
<strong>Child</strong>ren under the age of 3 years rarely have symptoms 102 . Older children <strong>and</strong> adults<br />
are more likely to have symptoms last<strong>in</strong>g one to two weeks, or <strong>in</strong> severe cases, up to<br />
several months. Symptoms, when present, may <strong>in</strong>clude abdom<strong>in</strong>al discomfort, loss of<br />
appetite, nausea, low-grade fever <strong>and</strong> tiredness, sometimes followed by yellow sk<strong>in</strong><br />
<strong>and</strong> eyes, dark ur<strong>in</strong>e <strong>and</strong> pale faeces.<br />
Incubation period<br />
15–50 days, usually 28-30 days.<br />
Infectious period<br />
A person is most <strong>in</strong>fectious <strong>in</strong> the two weeks before yellow<strong>in</strong>g (jaundice) occurs, <strong>and</strong><br />
then slightly <strong>in</strong>fectious dur<strong>in</strong>g the first week of hav<strong>in</strong>g jaundice.<br />
Exclusion period<br />
Exclude until a medical certificate of recovery is received, but not before seven days<br />
after the onset of jaundice or illness.<br />
Responsibilities of child care providers/staff<br />
Report the <strong>in</strong>fection to the director.<br />
The first sign of a hepatitis A outbreak is likely to be an ill parent or employee, not an<br />
ill child. The director should immediately notify <strong>and</strong> seek help from the local public<br />
health unit.<br />
Responsibilities of parents<br />
Observe exclusion period. Follow good personal hygiene practices, especially<br />
effective h<strong>and</strong> wash<strong>in</strong>g.<br />
Controll<strong>in</strong>g the spread of <strong>in</strong>fection<br />
It is important for the <strong>in</strong>fected person to consult their doctor. The doctor may offer<br />
immunoglobul<strong>in</strong> to all people liv<strong>in</strong>g <strong>in</strong> the same house as the <strong>in</strong>fected person. If given<br />
with<strong>in</strong> 14 days after exposure, immunoglobul<strong>in</strong> may prevent hepatitis A or lessen the<br />
severity of the symptoms 103 .<br />
The staff from the local public health unit will advise on the need for immunoglobul<strong>in</strong><br />
for children <strong>and</strong> child care staff <strong>in</strong> the centre.<br />
Make sure that good h<strong>and</strong> wash<strong>in</strong>g <strong>and</strong> clean<strong>in</strong>g procedures are be<strong>in</strong>g followed <strong>in</strong> the<br />
centre <strong>and</strong> at home.<br />
Hepatitis A vacc<strong>in</strong>e is recommended for child care workers, particularly those who<br />
care for children who are not toilet tra<strong>in</strong>ed.<br />
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Hepatitis A vacc<strong>in</strong>e is not recommended for children because <strong>in</strong>fection <strong>in</strong> children is<br />
mild with little or no illness.<br />
Treatment<br />
There is no treatment for hepatitis A once symptoms develop.<br />
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Hepatitis B<br />
Description<br />
Hepatitis B <strong>in</strong>fection is caused by the hepatitis B virus. The virus is found ma<strong>in</strong>ly <strong>in</strong><br />
the blood of an <strong>in</strong>fected person <strong>and</strong>, to a lesser extent, <strong>in</strong> some other body fluids (for<br />
example, semen). It is not spread through food or water or through ord<strong>in</strong>ary social<br />
contact.<br />
Women who have this disease dur<strong>in</strong>g pregnancy may transmit it to their newborn<br />
babies. Many of these babies become long-term carriers of the virus.<br />
About 50% of adults <strong>and</strong> 90% of children do not develop any symptoms at the time of<br />
<strong>in</strong>fection 104 . Symptoms, if they occur, may <strong>in</strong>clude abdom<strong>in</strong>al discomfort, loss of<br />
appetite, nausea, fever, tiredness, jo<strong>in</strong>t pa<strong>in</strong>, dark ur<strong>in</strong>e <strong>and</strong> yellow sk<strong>in</strong> or eyes<br />
(jaundice).<br />
Incubation period<br />
2–6 months.<br />
Infectious period<br />
From about one month before jaundice occurs to the end of the time when they feel<br />
ill, (about 1–3 months after jaundice appears). People with chronic hepatitis B may<br />
carry the virus for life <strong>and</strong> always be able to <strong>in</strong>fect others.<br />
Exclusion period<br />
Nil.<br />
Responsibilities of child care providers/staff<br />
Report the <strong>in</strong>fection to the director.<br />
Responsibilities of parents<br />
If the child feels unwell, they should rema<strong>in</strong> at home until they feel better.<br />
Controll<strong>in</strong>g the spread of <strong>in</strong>fection<br />
Effective vacc<strong>in</strong>es are available, <strong>and</strong> are now rout<strong>in</strong>ely given at birth, 2, 4 <strong>and</strong> 6<br />
months of age. A course of 3 <strong>in</strong>jections over 6 months can be given at other ages for<br />
people who have not previously been vacc<strong>in</strong>ated. Completion of a full course of<br />
vacc<strong>in</strong>e will give protection aga<strong>in</strong>st hepatitis B <strong>in</strong>fection <strong>in</strong> over 90% of people 105 .<br />
Hepatitis B immunoglobul<strong>in</strong> is offered to non-immune people hav<strong>in</strong>g close contact<br />
with a person known to be <strong>in</strong>fected with hepatitis B <strong>in</strong> the follow<strong>in</strong>g situations:<br />
• after birth<br />
• after needle shar<strong>in</strong>g or needlestick <strong>in</strong>jury<br />
• after sexual exposure<br />
Take precautions when h<strong>and</strong>l<strong>in</strong>g blood-contam<strong>in</strong>ated items. More <strong>in</strong>formation on this<br />
subject is given on page 28.<br />
Re-emphasise good h<strong>and</strong> wash<strong>in</strong>g <strong>and</strong> clean<strong>in</strong>g practices.<br />
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Cover any open sores, cuts or abrasions that are weep<strong>in</strong>g or moist.<br />
Treatment<br />
There is no specific treatment for acute hepatitis B. Later, if the person starts to<br />
develop problems due to chronic hepatitis B, there are some medications which may<br />
make a difference (eg Interferon) 106 .<br />
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Hepatitis C<br />
Description<br />
Hepatitis C <strong>in</strong>fection is caused by the hepatitis C virus, which is carried <strong>in</strong> the blood<br />
<strong>and</strong> causes damage to the liver. The virus is found <strong>in</strong> the blood of an <strong>in</strong>fected person.<br />
Transmission of hepatitis C only occurs via blood to blood contact, where the blood of<br />
an <strong>in</strong>fected person comes <strong>in</strong>to contact with the blood of another person. People most<br />
at risk are those with a history of <strong>in</strong>ject<strong>in</strong>g drug use. About 2-5% 107 of <strong>in</strong>fected<br />
mothers will pass hepatitis C to their babies dur<strong>in</strong>g birth.<br />
Hepatitis C is not transmitted though air or water, the shar<strong>in</strong>g of plates, cups or<br />
cutlery, swimm<strong>in</strong>g pools or toilets, kiss<strong>in</strong>g, cough<strong>in</strong>g, sneez<strong>in</strong>g or spitt<strong>in</strong>g 108 .<br />
Out of 100 people found to be <strong>in</strong>fected with the hepatitis C virus:<br />
• about 25 people will elim<strong>in</strong>ate the virus from their bodies<br />
spontaneously with<strong>in</strong> two to six months of <strong>in</strong>fection<br />
• about 75 people will go on to develop chronic hepatitis C <strong>in</strong>fection;<br />
<strong>and</strong> of these people with chronic <strong>in</strong>fection 20 people do not develop<br />
liver damage or symptoms <strong>and</strong> approximately 50 – 60 people will<br />
develop some long-term symptoms or signs of liver damage. 5 – 20<br />
will have progressed to cirrhosis of the liver (on average 30 years after<br />
<strong>in</strong>fection) 109 .<br />
Symptoms of hepatitis C may <strong>in</strong>clude abdom<strong>in</strong>al discomfort, loss of appetite, nausea,<br />
fever, tiredness, jo<strong>in</strong>t pa<strong>in</strong>, dark ur<strong>in</strong>e, <strong>and</strong> yellow sk<strong>in</strong> or eyes (jaundice). The virus<br />
may be carried without symptoms.<br />
Incubation Period<br />
6-8 weeks.<br />
Infectious Period<br />
Indef<strong>in</strong>itely, keep<strong>in</strong>g <strong>in</strong> m<strong>in</strong>d that the blood of the <strong>in</strong>fected person must enter <strong>in</strong>to the<br />
blood stream of another person for the virus to be transmitted 110 .<br />
Exclusion Period<br />
Exclusion is not necessary.<br />
A child who is unwell may need to stay away until they are feel<strong>in</strong>g better.<br />
Responsibilities of child care providers/staff<br />
If the child care centre director is <strong>in</strong>formed that a child has hepatitis C, confidentiality<br />
must be ma<strong>in</strong>ta<strong>in</strong>ed 111 .<br />
Responsibilities of parents<br />
To protect the liver from further viral <strong>in</strong>fections, it is important that the child be<br />
vacc<strong>in</strong>ated aga<strong>in</strong>st hepatitis A <strong>and</strong> hepatitis B, if they are not already vacc<strong>in</strong>ated or<br />
immune 112 .<br />
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Controll<strong>in</strong>g the spread of <strong>in</strong>fection<br />
St<strong>and</strong>ard <strong>in</strong>fection control pr<strong>in</strong>ciples should be employed <strong>in</strong> all situations deal<strong>in</strong>g with<br />
blood-contam<strong>in</strong>ated items, regardless of whether or not it is known that a child has a<br />
blood borne virus 113 .<br />
Treatment<br />
Treatment aims to clear hepatitis C from the body <strong>and</strong> m<strong>in</strong>imise damage to the liver.<br />
Hepatitis C treatment has advanced rapidly <strong>in</strong> the past few years <strong>and</strong> around 80% of<br />
people with some genotypes (stra<strong>in</strong>s) <strong>and</strong> about 50 to 60% of all people treated with<br />
current therapy clear the virus 114 from their bodies.<br />
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HIV (Human immunodeficiency virus), AIDS<br />
Description<br />
HIV is a virus carried <strong>in</strong> blood <strong>and</strong> body fluids. It damages the immune system of the<br />
person <strong>in</strong>fected to the extent that the person becomes susceptible to a variety of<br />
common <strong>and</strong> rare diseases. HIV <strong>in</strong>fection is called AIDS (Acquired Immune<br />
Deficiency Syndrome) when it becomes fully developed <strong>in</strong> the body. People with<br />
AIDS contract repeated <strong>in</strong>fections with unusual organisms <strong>and</strong> cancers that do not<br />
normally affect people with healthy immune systems.<br />
There is no evidence that HIV is spread from child to child <strong>in</strong> schools or child care<br />
centres through normal social contact. HIV is not transmitted through air or water, the<br />
shar<strong>in</strong>g of plates, cups or cutlery, swimm<strong>in</strong>g pools or toilets, kiss<strong>in</strong>g, cough<strong>in</strong>g,<br />
sneez<strong>in</strong>g or spitt<strong>in</strong>g. There is no evidence that HIV can be spread by mosquitoes or<br />
other bit<strong>in</strong>g <strong>in</strong>sects, as the virus dies rapidly outside the human body.<br />
HIV can be spread by:<br />
• Unprotected sexual <strong>in</strong>tercourse (anal or vag<strong>in</strong>al) with an <strong>in</strong>fected person.<br />
• Shar<strong>in</strong>g of <strong>in</strong>ject<strong>in</strong>g drug equipment.<br />
• Infection pass<strong>in</strong>g from mother to child just before or dur<strong>in</strong>g birth, or through<br />
breast milk. Approximately 30% 115 of children born to <strong>in</strong>fected mothers will<br />
themselves become <strong>in</strong>fected due to transmission of HIV before, dur<strong>in</strong>g, or<br />
soon after birth. In a small number of cases, the disease is transmitted to the<br />
child through the mother’s breast milk.<br />
• Penetration of the sk<strong>in</strong> by <strong>in</strong>fected blood.<br />
Incubation period<br />
Variable. The time from <strong>in</strong>fection to development of detectable antibodies is generally<br />
1 – 3 months 116 . Symptoms of the disease may not be evident for months or even<br />
years after HIV <strong>in</strong>fection. In adults, an illness like gl<strong>and</strong>ular fever occurs a month or<br />
so after <strong>in</strong>fection <strong>in</strong> about 50% of people. Without treatment, most <strong>in</strong>dividuals<br />
develop severe immune deficiency with<strong>in</strong> 5 - 10 years. 117<br />
Infectious period<br />
People become <strong>in</strong>fectious about 2 - 4 weeks after pick<strong>in</strong>g up the HIV virus. A blood<br />
test for antibodies to the virus will show whether a person has been <strong>in</strong> contact with<br />
<strong>and</strong> become <strong>in</strong>fected by the HIV virus. At the moment HIV <strong>in</strong>fection is lifelong. To<br />
date, there have been no reported cases of <strong>in</strong>fection with the virus through ord<strong>in</strong>ary<br />
social contact, through <strong>in</strong>volvement with schools, pre-schools or child care centres, or<br />
through ord<strong>in</strong>ary nonsexual family contact.<br />
Exclusion Period<br />
Exclusion is not necessary.<br />
<strong>Child</strong>ren who have developed impairment of immunity should rema<strong>in</strong> away from<br />
school dur<strong>in</strong>g outbreaks of serious contagious diseases such as measles or<br />
chickenpox. <strong>Child</strong>ren with HIV are more susceptible to such <strong>in</strong>fections.<br />
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Responsibilities of child care providers/staff<br />
If the child care facility director is <strong>in</strong>formed that a child has HIV, confidentiality must<br />
be ma<strong>in</strong>ta<strong>in</strong>ed.<br />
Responsibilities of parents<br />
Follow<strong>in</strong>g medical advice, it can be expected that parents would consult with child<br />
care providers if their child has HIV <strong>in</strong>fection. Such children are more likely to have<br />
severe <strong>in</strong>fections than others, <strong>and</strong> more consideration <strong>and</strong> care must be given to their<br />
immunisation with common vacc<strong>in</strong>es.<br />
Controll<strong>in</strong>g the spread of <strong>in</strong>fection<br />
St<strong>and</strong>ard <strong>in</strong>fection control pr<strong>in</strong>ciples should be employed <strong>in</strong> all situations deal<strong>in</strong>g with<br />
blood-contam<strong>in</strong>ated items, regardless of whether or not it is known that a child has a<br />
blood borne virus.<br />
Treatment<br />
For patients with cl<strong>in</strong>ical AIDS, medical practitioners use specific drugs (for example,<br />
antibiotics <strong>and</strong> antiretroviral drugs) to overcome secondary <strong>in</strong>fections associated with<br />
the disease. Drugs that <strong>in</strong>terfere with the replication of HIV are available. These drugs<br />
do not cure AIDS.<br />
An enormous worldwide effort is be<strong>in</strong>g made to educate people about AIDS, to<br />
reduce the spread of HIV, to search for new antiviral drugs effective aga<strong>in</strong>st HIV, <strong>and</strong><br />
to develop a vacc<strong>in</strong>e. Australian authorities are monitor<strong>in</strong>g these developments<br />
closely.<br />
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Men<strong>in</strong>gococcal <strong>in</strong>fection<br />
Description<br />
A severe <strong>in</strong>fection caused by Neisseria men<strong>in</strong>gitidis bacteria, also commonly known<br />
as the ‘the men<strong>in</strong>gococcus’. There are 13 different groups of men<strong>in</strong>gococcus, but<br />
most <strong>in</strong>fections <strong>in</strong> Australia are caused by groups B <strong>and</strong> C. The men<strong>in</strong>gococcus is<br />
found <strong>in</strong> the nose <strong>and</strong> throat of up to 20% of people 118 , where it is generally carried<br />
harmlessly. In a small number of people, for uncerta<strong>in</strong> reasons, the men<strong>in</strong>gococcus<br />
will spread from the nose <strong>and</strong> throat <strong>in</strong>to the blood stream, <strong>and</strong> cause serious illness.<br />
Men<strong>in</strong>gococcal diseases can affect all age groups, but is most common <strong>in</strong> children<br />
under 5 years of age, <strong>and</strong> <strong>in</strong> the 15-24 years group. In Australia, 5 to 10% of people 119<br />
who have men<strong>in</strong>gococcal disease die with<strong>in</strong> a few hours of becom<strong>in</strong>g unwell despite<br />
rapid treatment.<br />
Symptoms <strong>in</strong> babies <strong>and</strong> young children <strong>in</strong>clude fever, refus<strong>in</strong>g feeds, fretfulness,<br />
vomit<strong>in</strong>g, rash of reddish purple spots or bruises, high-pitched or moan<strong>in</strong>g cry, pale or<br />
blotchy sk<strong>in</strong>. The child may be difficult to wake.<br />
The bacteria is spread <strong>in</strong> respiratory secretions by close <strong>and</strong> prolonged person-toperson<br />
contact such as occurs <strong>in</strong> a household. Men<strong>in</strong>gococcal disease can happen at<br />
any time of the year, but is most common <strong>in</strong> w<strong>in</strong>ter <strong>and</strong> spr<strong>in</strong>g.<br />
Incubation period<br />
Usually 3–4 days.<br />
Infectious period<br />
The child is <strong>in</strong>fectious as long as organisms are present <strong>in</strong> the nose <strong>and</strong> throat. This<br />
will be less than 24 hours after they are treated with effective antibiotics.<br />
Exclusion period<br />
Exclude until a course of an appropriate antibiotic 120 has been completed.<br />
Responsibilities of child care providers/staff<br />
A child with this <strong>in</strong>fection should see a doctor immediately. The director should<br />
immediately <strong>in</strong>form <strong>and</strong> seek help from the local public health unit.<br />
Responsibilities of parents<br />
Observe the exclusion period.<br />
Any very close contacts of someone with men<strong>in</strong>gococcal disease, such as family<br />
members, need a short course of antibiotics to kill any of the bacteria they may carry.<br />
All very close contacts are usually treated because there is no easy <strong>and</strong> quick way of<br />
f<strong>in</strong>d<strong>in</strong>g out who is the carrier.<br />
Controll<strong>in</strong>g the spread of <strong>in</strong>fection<br />
If appropriate, public health authorities will arrange for other children <strong>and</strong> staff of the<br />
centre to be given a course of rifampic<strong>in</strong> by mouth.<br />
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<strong>Care</strong>ful hygiene practices are important to prevent the spread of any <strong>in</strong>fection. These<br />
<strong>in</strong>clude effective h<strong>and</strong> wash<strong>in</strong>g <strong>and</strong> appropriate disposal of used tissues. The<br />
men<strong>in</strong>gococcus does not survive for long outside the human body.<br />
Men<strong>in</strong>gococcal C <strong>in</strong>fection can be prevented by immunisation. Fully immunised<br />
communities offer the best protection aga<strong>in</strong>st men<strong>in</strong>gococcal C <strong>in</strong>fection.<br />
Men<strong>in</strong>gococcal C vacc<strong>in</strong>ation does not protect aga<strong>in</strong>st men<strong>in</strong>gococcal B <strong>in</strong>fection.<br />
Treatment<br />
A child with men<strong>in</strong>gococcal <strong>in</strong>fection will be treated <strong>in</strong> hospital with antibiotics.<br />
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Mumps<br />
Description<br />
Mumps is an <strong>in</strong>fection caused by a virus. Mumps is now uncommon, s<strong>in</strong>ce children<br />
are immunised aga<strong>in</strong>st it, but before the days of immunisation, most people had<br />
mumps when they were children (most often between 5 <strong>and</strong> 9 years of age).<br />
Symptoms, when present, <strong>in</strong>clude swell<strong>in</strong>g of one or more of the salivary gl<strong>and</strong>s, high<br />
fever <strong>and</strong> headache. About 30% of people with mumps will have only mild symptoms<br />
or no symptoms at all. In males, tenderness <strong>in</strong> the testicles may occur. Females may<br />
have some lower abdom<strong>in</strong>al pa<strong>in</strong>.<br />
Complications can occur, <strong>in</strong>clud<strong>in</strong>g <strong>in</strong>flammation of the sp<strong>in</strong>al cord <strong>and</strong> bra<strong>in</strong>, hear<strong>in</strong>g<br />
loss, sterility (very rare) or death (extremely rare).<br />
Spread is by direct contact with droplets from the sneeze or cough of an <strong>in</strong>fected<br />
person.<br />
Incubation period<br />
12–25 days, usually 16–18 days.<br />
Infectious period<br />
Up to six days before swell<strong>in</strong>g of the gl<strong>and</strong>s beg<strong>in</strong>s <strong>and</strong> up to n<strong>in</strong>e days after the onset<br />
of swell<strong>in</strong>g.<br />
Exclusion period<br />
Exclude the child from the centre for n<strong>in</strong>e days after onset of swell<strong>in</strong>g.<br />
Responsibilities of child care providers/staff<br />
Report the <strong>in</strong>fection to the director.<br />
Responsibilities of parents<br />
Observe the exclusion period.<br />
Controll<strong>in</strong>g the spread of <strong>in</strong>fection<br />
Mumps can be prevented by immunisation. Fully immunised communities offer the<br />
best protection aga<strong>in</strong>st mumps. <strong>Child</strong>ren should be immunised aga<strong>in</strong>st mumps at 12<br />
months of age <strong>and</strong> aga<strong>in</strong> at 4 years with the measles–mumps–rubella (MMR) vacc<strong>in</strong>e.<br />
The vacc<strong>in</strong>e provides long-term immunity. Illness provides lifelong immunity.<br />
<strong>Care</strong>ful hygiene practices are important to prevent the spread of any <strong>in</strong>fection. These<br />
<strong>in</strong>clude effective h<strong>and</strong> wash<strong>in</strong>g <strong>and</strong> appropriate disposal of used tissues.<br />
Treatment<br />
None.<br />
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Toxoplasmosis<br />
Description<br />
Toxoplasmosis is a protozoan <strong>in</strong>fection. It is contracted by eat<strong>in</strong>g raw or undercooked<br />
meat, or through contact with cat faeces. Apart from transmission from mother to<br />
unborn child, person-to-person spread does not occur. Toxoplasmosis <strong>in</strong> pregnant<br />
women can affect the unborn child. It may cause rashes, damage to the child’s<br />
nervous system, liver or other organs or, rarely, death. Usually, though, the newborn<br />
baby is not affected at all. In Australia, very few cases of affected newborn children<br />
have occurred.<br />
Toxoplasmosis acquired after birth usually results <strong>in</strong> either no symptoms or mild<br />
illness. When mild illness occurs, common symptoms are enlarged lymph nodes,<br />
muscle pa<strong>in</strong>, <strong>in</strong>termittent fever <strong>and</strong> generally feel<strong>in</strong>g ill. Toxoplasmosis <strong>in</strong>fection is<br />
confirmed by a doctor’s exam<strong>in</strong>ation <strong>and</strong> blood tests. No immunisation is available.<br />
Incubation period<br />
Uncerta<strong>in</strong>, but probably from several days to months.<br />
Infectious period<br />
Infected meat is not safe until cooked properly. Freez<strong>in</strong>g meat does not necessarily<br />
make it safe. Cat faeces conta<strong>in</strong><strong>in</strong>g toxoplasma can become <strong>in</strong>fectious 24 hours after<br />
be<strong>in</strong>g passed.<br />
Exclusion period<br />
Nil.<br />
Responsibilities of child care providers/staff<br />
Report a diagnosed case to the director.<br />
Responsibilities of parents<br />
See ‘Control the spread of <strong>in</strong>fection’.<br />
Controll<strong>in</strong>g the spread of <strong>in</strong>fection<br />
Cook meat adequately. H<strong>and</strong>s, knives <strong>and</strong> other kitchen utensils should be thoroughly<br />
washed after be<strong>in</strong>g <strong>in</strong> contact with raw meat.<br />
Dispose of cat faeces <strong>and</strong> litter daily (as it can become <strong>in</strong>fectious after 24 hours).<br />
Wear gloves when h<strong>and</strong>l<strong>in</strong>g cat faeces or litter trays. Dis<strong>in</strong>fect litter trays daily by<br />
scald<strong>in</strong>g with boil<strong>in</strong>g water.<br />
Pregnant women without antibodies to toxoplasma should avoid clean<strong>in</strong>g litter trays<br />
<strong>and</strong> avoid contact with cats of unknown feed<strong>in</strong>g history.<br />
Cover children’s s<strong>and</strong>pits when not <strong>in</strong> use <strong>and</strong> keep stray cats away from the s<strong>and</strong>pit.<br />
Feed cats dry, canned or boiled food. Discourage them from hunt<strong>in</strong>g <strong>and</strong> scaveng<strong>in</strong>g.<br />
Treatment<br />
Medication is available for significant <strong>in</strong>fections. In most people, <strong>in</strong>fection passes<br />
unnoticed.<br />
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Viral Men<strong>in</strong>gitis<br />
Description<br />
Viral men<strong>in</strong>gitis is an <strong>in</strong>fection of the cover<strong>in</strong>g of the sp<strong>in</strong>al cord or bra<strong>in</strong> caused by a<br />
variety of viruses, most commonly those associated with gastroenteritis 121<br />
(<strong>in</strong>flammation of the stomach <strong>and</strong> <strong>in</strong>test<strong>in</strong>es). Other examples of viruses that can<br />
cause men<strong>in</strong>gitis are measles, mumps, chickenpox <strong>and</strong> herpes 122 . Viral men<strong>in</strong>gitis is<br />
relatively common, but rarely serious, though symptoms may be severe. Recovery is<br />
usually complete.<br />
Symptoms may <strong>in</strong>clude headache, fever, vomit<strong>in</strong>g, neck stiffness <strong>and</strong> jo<strong>in</strong>t pa<strong>in</strong>,<br />
drows<strong>in</strong>ess or confusion <strong>and</strong> photophobia (discomfort when look<strong>in</strong>g at bright lights).<br />
Spread is by direct or <strong>in</strong>direct contact with droplets from the nose or throat of <strong>in</strong>fected<br />
people, or by contact with <strong>in</strong>fected faeces or contam<strong>in</strong>ated surfaces.<br />
Incubation period<br />
Varies accord<strong>in</strong>g to the specific <strong>in</strong>fectious virus.<br />
Infectious period<br />
Varies accord<strong>in</strong>g to the specific <strong>in</strong>fectious virus.<br />
Exclusion period<br />
Exclude until well.<br />
Responsibilities of child care providers/staff<br />
<strong>Child</strong> care workers should <strong>in</strong>form the parents immediately if their child has<br />
symptoms. Parents should then seek medical help.<br />
Responsibilities of parents<br />
The child should stay at home until they are feel<strong>in</strong>g well.<br />
Controll<strong>in</strong>g the spread of <strong>in</strong>fection<br />
Make sure effective h<strong>and</strong> wash<strong>in</strong>g procedures are be<strong>in</strong>g followed.<br />
Treatment<br />
Unless it is very clear what the cause is (eg obvious mumps) a lumbar puncture may<br />
be needed to tell whether or not there is a bacterial <strong>in</strong>fection. A lumbar puncture is<br />
when a needle is put <strong>in</strong>to the sp<strong>in</strong>e <strong>in</strong> the lower back to collect some of the fluid from<br />
around the bra<strong>in</strong> <strong>and</strong> sp<strong>in</strong>al cord. Antibiotics may be started ‘just <strong>in</strong> case’ but these<br />
will not treat the virus. Once it is certa<strong>in</strong> that it is a viral <strong>in</strong>fection, no special<br />
treatment is needed.<br />
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Glossary of terms<br />
Bacteria A group of small micro-organisms (larger than viruses) that<br />
live <strong>in</strong> the soil, plants <strong>and</strong> animals as well as <strong>in</strong> the body.<br />
Not all bacteria are harmful, although some may cause<br />
illness or produce a poison known as a tox<strong>in</strong>.<br />
Clean<strong>in</strong>g Remov<strong>in</strong>g <strong>in</strong>fectious agents <strong>and</strong> matter from surfaces.<br />
Clean<strong>in</strong>g by wash<strong>in</strong>g or scrubb<strong>in</strong>g with warm water <strong>and</strong><br />
soap or detergent, followed by r<strong>in</strong>s<strong>in</strong>g <strong>and</strong> dry<strong>in</strong>g removes<br />
the bulk of germs from surfaces. Germs are unable to<br />
multiply on clean, dry surfaces.<br />
Contagious disease A disease that can be passed from one person to another. It<br />
is the same as an <strong>in</strong>fectious disease.<br />
Dermatitis Any condition of the sk<strong>in</strong> where there is <strong>in</strong>flammation.<br />
Inflammation is usually marked by redness <strong>and</strong> swell<strong>in</strong>g.<br />
Dis<strong>in</strong>fection Kill<strong>in</strong>g <strong>in</strong>fectious agents that are outside the body by<br />
chemical or physical means.<br />
Endemic A disease or <strong>in</strong>fectious agent present <strong>in</strong> a community or<br />
region at all times.<br />
Epidemic An illness or disease which attacks many people <strong>in</strong> a<br />
community or region at the same time. It may spread rapidly<br />
over a wide area.<br />
Febrile convulsion Convulsion (fit) when a child has a fever or high<br />
temperature.<br />
Germ A micro-organism that may cause disease.<br />
Immune <strong>in</strong>dividual A person who is highly resistant to a disease. A person<br />
becomes immune as a result of immunisation or from<br />
previous <strong>in</strong>fection.<br />
Immunisation The process of mak<strong>in</strong>g a person immune by use of oral or<br />
<strong>in</strong>jected vacc<strong>in</strong>es.<br />
Immunity Resistance to an <strong>in</strong>fection. A person acquires immunity after<br />
hav<strong>in</strong>g an <strong>in</strong>fection or by be<strong>in</strong>g immunised. The person’s<br />
body can then recognise <strong>and</strong> destroy the micro-organisms<br />
that cause that <strong>in</strong>fection or vacc<strong>in</strong>e-preventable disease.<br />
Immunoglobul<strong>in</strong>s Prote<strong>in</strong>s which protect the body aga<strong>in</strong>st <strong>in</strong>fectious microorganisms.<br />
They do this by carry<strong>in</strong>g antibodies that can kill<br />
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the <strong>in</strong>vad<strong>in</strong>g organisms. Immunoglobul<strong>in</strong>s can be <strong>in</strong>jected to<br />
give immediate protection aga<strong>in</strong>st diseases such as hepatitis<br />
A, hepatitis B, tetanus, measles, etc. This protection is<br />
temporary.<br />
Incubation period The time between an <strong>in</strong>fectious agent enter<strong>in</strong>g a person’s<br />
body <strong>and</strong> the appearance of a symptom of the disease.<br />
Incubation periods may range from a few hours to several<br />
years depend<strong>in</strong>g on the disease.<br />
Infection The entry <strong>and</strong> development or multiplication of an <strong>in</strong>fectious<br />
agent <strong>in</strong> the body of a human be<strong>in</strong>g or animal. In many<br />
cases, <strong>in</strong>fections can occur without lead<strong>in</strong>g to illness or<br />
<strong>in</strong>fectious disease.<br />
Infectious agent An organism (virus, bacteria, fungus, protozoa or parasitic<br />
worm) that is capable of produc<strong>in</strong>g <strong>in</strong>fection or <strong>in</strong>fectious<br />
disease.<br />
Infectious disease A disease that is caused by an <strong>in</strong>fectious agent or that can be<br />
passed on (transmitted) by an <strong>in</strong>fectious agent. It may affect<br />
humans <strong>and</strong>/or animals.<br />
Infectious period The length of time a person who is <strong>in</strong>fectious can pass the<br />
<strong>in</strong>fection on to others.<br />
Mucous membrane The th<strong>in</strong> l<strong>in</strong><strong>in</strong>g of body passages <strong>and</strong> cavities such as the<br />
mouth, respiratory tract, genitour<strong>in</strong>ary tract <strong>and</strong> eye. Its<br />
gl<strong>and</strong>s produce mucus.<br />
Oocysts ‘Egg’ cells.<br />
Phlegm Thick mucus secreted <strong>in</strong> the respiratory tract. (Pronounced<br />
‘flem’).<br />
Protozoa Microscopic organism. Some are parasites which can cause<br />
<strong>in</strong>fections such as giardiasis <strong>and</strong> toxoplasmosis.<br />
Pustular Conta<strong>in</strong><strong>in</strong>g pus.<br />
Replication Process of duplicat<strong>in</strong>g or reproduc<strong>in</strong>g an exact copy.<br />
Vacc<strong>in</strong>ation See ‘Immunisation’.<br />
Vacc<strong>in</strong>e Vacc<strong>in</strong>es cause resistance to specific <strong>in</strong>fections. They may<br />
conta<strong>in</strong> live or dead organisms, or parts or products of<br />
organisms.<br />
Virus A group of <strong>in</strong>fectious agents that is much smaller than<br />
bacteria. They can only multiply <strong>in</strong> liv<strong>in</strong>g cells. They are<br />
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esponsible for some of the most important diseases<br />
affect<strong>in</strong>g human be<strong>in</strong>gs, for example, most childhood<br />
illnesses with rashes, such as measles, chicken pox <strong>and</strong><br />
rubella.<br />
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Useful Web Sites<br />
(Taken from <strong>Health</strong> <strong>in</strong> Early <strong>Child</strong>hood Sett<strong>in</strong>gs by Professor Frank Oberklaid.<br />
Published by Pademelon Press (2004), Sydney, Australia).<br />
Parent <strong>in</strong>formation (general)<br />
www.rais<strong>in</strong>gchildren.net.au (This is funded by the Australian government <strong>and</strong> is<br />
designed to be a comprehensive resource for parents)<br />
http://www.cyh.com (A comprehensive site ma<strong>in</strong>ta<strong>in</strong>ed by the South Australian<br />
government – has <strong>in</strong>formation on a long list of topics <strong>in</strong> child health <strong>and</strong> behaviour)<br />
http://www.dh.sa.gov.au/pehs/You’ve-got-what/ (A comprehensive site ma<strong>in</strong>ta<strong>in</strong>ed by<br />
the South Australian government – has <strong>in</strong>formation on common conditions dur<strong>in</strong>g<br />
childhood)<br />
http://www.rch.org.au (A comprehensive site ma<strong>in</strong>ta<strong>in</strong>ed by Centre for Community<br />
<strong>Child</strong> <strong>Health</strong>, Royal <strong>Child</strong>ren’s Hospital, Melbourne - has <strong>in</strong>formation on a long list<br />
of topics <strong>in</strong> child health <strong>and</strong> behaviour).<br />
First aid:<br />
http://www.stjohn.org.au/guide.htm (St. Johns Ambulance Australia - a<br />
comprehensive resource on all aspects of first aid, <strong>in</strong>clud<strong>in</strong>g tra<strong>in</strong><strong>in</strong>g courses)<br />
Poisons <strong>in</strong>formation:<br />
http://www.health.qld.gov.au/PoisonsInformationCentre/homepage.htm (Queensl<strong>and</strong><br />
<strong>Health</strong> Poisons Information centre which <strong>in</strong>cludes <strong>in</strong>formation about bites <strong>and</strong> st<strong>in</strong>gs,<br />
poisonous plants, <strong>and</strong> poisons prevention as well as what to do <strong>in</strong> an emergency)<br />
Injuries <strong>and</strong> <strong>in</strong>jury prevention:<br />
http://www.kidsafe.com.au/ (A national organization which also has state branches.<br />
Offers useful <strong>and</strong> easily accessible <strong>in</strong>formation on all aspects on <strong>in</strong>jury prevention <strong>in</strong><br />
children of all ages)<br />
Immunisation:<br />
http://immunise.health.gov.au/ (The official Australian Government site that covers<br />
all aspects of immunisation – check this to f<strong>in</strong>d out the latest <strong>and</strong> most up to date<br />
immunisation schedules)<br />
<strong>Child</strong> care<br />
http://www.ncac.gov.au/ (The official site of the <strong>Child</strong> <strong>Care</strong> Accreditation Council –<br />
<strong>in</strong>cludes <strong>in</strong>formation for parents about quality <strong>in</strong> child care <strong>and</strong> choos<strong>in</strong>g a child care<br />
centre)<br />
Family day care<br />
http://www.familydaycare.com.au/ (Official site of the <strong>National</strong> Family Day <strong>Care</strong><br />
Association of Australia)<br />
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Early literacy <strong>and</strong> read<strong>in</strong>g to young children:<br />
http://www.rch.org.au/ccch/research/<strong>in</strong>dex.cfm?doc_id=5821 (A program of the<br />
Centre for Community <strong>Child</strong> <strong>Health</strong> at the Royal <strong>Child</strong>ren’s Hospital Melbourne)<br />
<strong>Child</strong>ren <strong>and</strong> television:<br />
http://www.racp.edu.au/hpu/paed/media (A comprehensive review of the subject<br />
undertaken by the organization represent<strong>in</strong>g all paediatricians <strong>in</strong> Australia - <strong>in</strong>cludes<br />
recommendations.<br />
Divorce <strong>and</strong> children:<br />
http://divorce<strong>and</strong>children.com/ (A useful American site)<br />
Sudden Infant Death Syndrome (SIDS):<br />
http://www.sids<strong>and</strong>kids.org (The Australian organization represent<strong>in</strong>g SIDS groups <strong>in</strong><br />
each state)<br />
Smok<strong>in</strong>g <strong>and</strong> health:<br />
http://www.quit.org.au/ (Has <strong>in</strong>formation on the health hazards of smok<strong>in</strong>g, as well as<br />
helpful resources on how to quit)<br />
Attention Deficit Hyperactivity Disorder (ADHD):<br />
http://www.chadd.org/ (This is the web site of an American organization which<br />
provides <strong>in</strong>formation about ADHD to parents <strong>and</strong> professionals)<br />
http://www.nhmrc.gov.au/publications/adhd/contents.htm (A report on ADHD from<br />
the <strong>National</strong> <strong>Health</strong> <strong>and</strong> <strong>Medical</strong> Research Council – written <strong>in</strong> 1997 but still relevant)<br />
<strong>Child</strong> abuse:<br />
http://www.napcan.org.au/home.php (<strong>National</strong> Prevention of <strong>Child</strong> Abuse <strong>and</strong><br />
Neglect (NAPCAN))<br />
http://www.aaca.com.au/ (Web site of the Australian <strong>Child</strong>hood Association)<br />
Head lice:<br />
www.health.qld.gov.au/germbusters (Queensl<strong>and</strong> <strong>Health</strong>)<br />
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References<br />
1 You’ve got what? 2004. The ways <strong>in</strong>fectious diseases spread, viewed 22 March 2005,<br />
< http://www.dh.sa.gov.au/pehs/You’ve-got-what/stop-disease-spread.htm><br />
2 The Royal <strong>Child</strong>ren’s Hospital Department of Emergency Medic<strong>in</strong>e, 2004. Fever <strong>in</strong> <strong>Child</strong>ren, viewed<br />
22 March 2005, < http://qheps.health.qld.gov.au/rch/04 Cl<strong>in</strong>cal/04docs/Parent Info – Febrile<br />
Convulsions.pdf ><br />
3<br />
Medication management <strong>in</strong> children’s services, <strong>Child</strong>care <strong>and</strong> children’s <strong>Health</strong> ,Vol 8 No 2 April<br />
2005, viewed 21 June 2005,<br />
http://www.rch.org.au/emplibrary/ecconnections/CCH_Vol8_No2_April2005.pdf<br />
4 You’ve got what? 2004. The ways <strong>in</strong>fectious diseases spread, viewed 7 April 2005,<br />
< http://www.dh.sa.gov.au/pehs/You’ve-got-what/exclusion-from-school.htm><br />
5 Food St<strong>and</strong>ards Australia New Zeal<strong>and</strong> (FSANZ). Safe Food Australia. 2 nd edition, January 2001.<br />
Viewed 6 April 2005, <br />
6 Varicella. In: Heymann DL, editor. Control of communicable diseases manual. 18 th ed. Wash<strong>in</strong>gton<br />
DC: America Public <strong>Health</strong> Association; 2004: 98<br />
7 Qheps.health.qld.gov.au/PHS/CDPM/<strong>in</strong>dex/HIB.htm<br />
8 Measles, Public <strong>Health</strong> Fact Sheets, Queensl<strong>and</strong> <strong>Health</strong> 2002 viewed 26 May 2005,<br />
<br />
9 Pertussis. In: Heymann DL, editor. Control of communicable diseases manual. 18 th ed. Wash<strong>in</strong>gton<br />
DC: America Public <strong>Health</strong> Association; 2004: 403<br />
10 Guidel<strong>in</strong>es for the Control of Infection <strong>and</strong> Communicable Disease <strong>in</strong> Nurseries <strong>and</strong> Other<br />
Institutional Early Years Sett<strong>in</strong>gs <strong>in</strong> South West London Sector, 2003. South West London <strong>Health</strong><br />
Protection Unit. Viewed 5 April 2005,<br />
<br />
11 You’ve got what? 2004. H<strong>and</strong> wash<strong>in</strong>g, viewed 11 April 2005,<br />
< http://www.dh.sa.gov.au/pehs/You’ve-got-what/h<strong>and</strong>-wash<strong>in</strong>g.htm><br />
12 Guidel<strong>in</strong>es for the Control of Infection <strong>and</strong> Communicable Disease <strong>in</strong> Nurseries <strong>and</strong> Other<br />
Institutional Early Years Sett<strong>in</strong>gs <strong>in</strong> South West London Sector, 2003. South West London <strong>Health</strong><br />
Protection Unit. Viewed 5 April 2005,<br />
<br />
13 Infection Control Guidel<strong>in</strong>es, Queensl<strong>and</strong> <strong>Health</strong> 2001, p53<br />
14 Infection Control Guidel<strong>in</strong>es, Queensl<strong>and</strong> <strong>Health</strong> 2001, p54<br />
15 <strong>Child</strong>care <strong>and</strong> children’s health, Centre for Community <strong>Child</strong> <strong>Health</strong>, Royal <strong>Child</strong>ren’s Hospital,<br />
Melbourne. Vol 6 No 2 June 2003, viewed 5 April 2005,<br />
<br />
16 The Australian Immunisation H<strong>and</strong>book, 8 th ed 2003, <strong>National</strong> <strong>Health</strong> & <strong>Medical</strong> Research Council,<br />
Australian Government Department of <strong>Health</strong> <strong>and</strong> Age<strong>in</strong>g, p235<br />
17 The Australian Immunisation H<strong>and</strong>book, 8 th ed 2003, <strong>National</strong> <strong>Health</strong> & <strong>Medical</strong> Research Council,<br />
Australian Government Department of <strong>Health</strong> <strong>and</strong> Age<strong>in</strong>g, p133<br />
18 Immunise Australia Program 2004, Australian Government Department of <strong>Health</strong> <strong>and</strong> Age<strong>in</strong>g.<br />
Viewed 4 May 2005, <br />
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