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Table 2.6. Disease- or Condition-Specific Recommendations for Exclusion of Children in Out-Of-Home Child Care

Table 2-6

ConditionManagement of CaseManagement of Contacts
Hepatitis A virus (HAV) infectionSerologic testing to confirm HAV infection in suspected cases. Exclusion until 1 week after onset of jaundice.If ≥1 case confirmed in child or staff attendees or =2 cases in households of staff or attendees, HAV vaccine or Immune Globulin (IG) should be administered within 14 days of exposure to unimmunized staff and attendees. In centers without diapered children, HAV vaccine or IG should be given to unimmunized classroom contacts of index case. Asymptomatic IG recipients may return after receipt of IG (see Hepatitis A).
ImpetigoExclusion until 24 hours after Treatment has been initiated. Lesions on exposed skin covered with watertight dressing.No intervention unless additional lesions develop.
MeaslesExclusion until 4 days after beginning of rash and when the child is able to participate.Immunize exposed children without evidence of immunity within 72 hours of exposure. Children who do not receive vaccine within 72 hours or who remain unimmunized after exposure should be excluded until at least 2 weeks after onset of rash in the last case of measles. For use of IG, (see Measles).
MumpsExclusion until 5 days after onset of parotid gland swelling.In outbreak setting, people without documentation of immunity should be immunized or excluded. Immediate readmission may occur following immunization. Unimmunized people should be excluded for =26 days following onset of parotitis in last case.
Pediculosis capitis (head lice)Treatment at end of program day and readmission on completion of first Treatment.Household and close contacts should be examined and treated if infested. No exclusion necessary.
PertussisExclusion until 5 days of appropriate antimicrobial therapy course have been completed (see Pertussis).Immunization and chemoprophylaxis should be administered as recommended for household contacts. Symptomatic children and staff should be excluded until completion of 5 days of antimicrobial therapy course. Untreated adults should be excluded until 21 days after onset of cough (see Pertussis Infections).
RubellaExclusion until 6 days after onset of rash for postnatal infection.Pregnant contacts should be evaluated (see Rubella).
Salmonella serotype Typhi infectionExclusion until diarrhea resolves. Three negative stool culture results required before readmission.Stool cultures should be performed for attendees and staff; infected people should be excluded on the basis of age (see Salmonella Infections).
Non-serotype Typhi Salmonella infectionExclusion until diarrhea resolves. Negative stool culture results not required for non-serotype Typhi Salmonella species.Symptomatic contacts should be excluded until symptoms resolve. Stool cultures are not required for asymptomatic contacts. Antimicrobial therapy is not recommended for asymptomatic infection or uncomplicated diarrhea or for contacts.
ScabiesExclusion until after Treatment given.Close contacts with prolonged skin-to-skin contact should have prophylactic therapy. Bedding and clothing in contact with skin of infected people should be laundered (see Scabies).
Shiga toxin-producing Escherichia coli (STEC), including E coli O157:H7, or Shigella infectionExclusion until diarrhea resolves and results of 2 stool cultures are negative for these organisms, depending on state regulations.Meticulous hand hygiene; stool cultures should be performed for contacts. Center(s) with cases should be closed to new admissions during E coli O157:H7 outbreak (see Escherichia coli diarrhea, and Shigella infections).
Staphylococcus aureus skin infectionsExclusion only if skin lesions are draining and cannot be covered with a watertight dressing.Meticulous hand hygiene; cultures of contacts are not recommended.
Streptococcal pharyngitisExclusion until 24 hours after Treatment has been initiated and the child is able to participate in activities.Symptomatic contacts of documented cases of group A streptococcal infection should be tested and treated if test results are positive.
TuberculosisFor active disease, exclusion until determined to be noninfectious by physician or health department authority. May return to activities after therapy is instituted, symptoms have diminished, and adherence to therapy is documented. No exclusion for latent tuberculosis infection (LTBI).Local health department personnel should be informed for contact investigation (see Tuberculosis).
Varicella (see Varicella-Zoster Infections)Exclusion until all lesions have dried and crusted (usually 6 days after onset of rash in immunocompetent people; may be longer in immunocompromised people).Varicella vaccine should be administered by 3 to 5 days after exposure, and Varicella-Zoster Immune Globulin should be administered up to 96 hours after exposure when indicated.

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Table 2.6. Disease- or Condition-Specific Recommendations for Exclusion of Children in Out-Of-Home Child Care
Table 2-6
Last updated: July 12, 2012
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