This chapter refers to public health exclusions to indicate the time period an individual should not attend a setting to reduce the risk of transmission during the infectious stage. This is different to ‘exclusion’ as used in an educational sense.

Athlete’s foot is an infection caused by a fungus which affects the skin on the feet.

Table of Contents

Symptoms

The person affected may have scaling, peeling or cracking of the skin, especially between the toes and on soles of the feet, and it can sometimes be very itchy. They may also develop blisters. In some cases, it can cause toenails to become discoloured, thick and crumbly.

Spread

It is generally spread by direct or indirect contact with skin lesions of infected people. For example, when visiting places barefoot, such as contaminated floors in gyms (showers, locker room, around swimming pools). Spread can also occur when sharing socks, shoes or towels with a person who has the infection.

Exclusion

No exclusion is necessary.

Do

Advise the case to visit their local pharmacy or GP for advice and treatment.

Take care to dry between the toes after bathing. Use a fungicidal dusting powder, which can be bought over the counter at a pharmacy, on the feet, between the toes and in the socks and shoes.

Wear shoes that allow feet to breathe and change socks frequently.

Cover the affected foot with a rubber sock when going swimming.

Don’t

Do not allow people who have the infection to share socks, shoes, towels or bathmats.

Chickenpox (Varicella) and shingles

Chickenpox is a mild and common childhood illness that most children catch. Chickenpox is most common in children under the age of 10. Nine out of 10 adults are immune because they had chicken pox during childhood. Children usually catch chickenpox in winter and spring, particularly between March and May.

Symptoms

Chickenpox has a sudden onset with fever, runny nose, cough and a generalised rash. The spotty rash starts with fluid filled blisters which then scab over and eventually drop off. Some children have only a few spots, but other children can have spots that cover their entire body. In most children, the blisters crust up and fall off naturally within one to 2 weeks.

Chickenpox in children is considered a mild illness. There is no specific treatment for chickenpox, but there are pharmacy remedies that may alleviate symptoms. These include paracetamol to relieve fever, and calamine lotion and cooling gels to ease itching.

Some children may become more seriously ill and need to see a doctor.

Immediate medical advice should be sought if the child develops any abnormal symptoms such as:

Chickenpox tends to be more severe in adults and they tend to have a higher risk of developing complications.

Some children and adults are at higher risk of serious problems if they catch chickenpox.

They include:

These people should seek medical advice as soon as they are exposed to chickenpox or if they develop chickenpox symptoms. They may need a blood test to check if they are protected from (immune) chickenpox.

Shingles presents as a blistering rash in the area supplied by the affected nerve, usually only one side of the body. It can be very painful. Most people recover fully. There is often altered sensation before the rash appears, accompanied by ‘flu like’ symptoms.

Spread

Chickenpox is highly infectious and spreads by respiratory secretions or by direct contact with fluid from blisters.

Direct contact with fluid from the blisters of a person that has shingles can cause chickenpox in someone who has never had it before.

Exclusion

People with chickenpox are generally infectious from 2 days before the rash appears and until all blisters have crusted over (usually 5 to 6 days after the start of the rash). People with chickenpox should avoid contact with other people for at least 5 days from the onset of the rash and until all blisters have crusted over.

The same exclusion period applies to children and adults.

A person with shingles is infectious to those who have not had chickenpox and should be excluded from education/childcare setting if they have a weeping rash that cannot be covered or until the blisters are dry and crusted over.

Do

Any child with chicken pox should be sent home. Keep children and staff away from education or childcare settings until all blisters have crusted over. In cases of shingles, the decision to exclude a child or staff member will depend on whether the rash or blisters can be covered.

Keep any child or staff members away of they have a weeping shingles rash that cannot be covered.

Inform your UKHSA health protection team (HPT) if the education or childcare setting also has cases of scarlet fever circulating.

Ensure that anyone who is at higher risk (pregnant women, newborn babies, and people with a weakened immune system) seek medical advice as soon as they are exposed to chickenpox or if they develop chickenpox symptoms.

Don’t

Do not allow the child back to educational or childcare settings until all the blisters have dried and crusted over.

Cold sores

Cold sores are caused by a virus called herpes simplex and usually appear on and around the lips. They sometimes also appear on areas of the face and nose. It is estimated that more than half of us carry the virus but most of us do not develop cold sores.

It is usually a mild self-limiting virus. Most people who get cold sores will have been infected early in life.

Symptoms

The first signs are tingling, burning or itching in the area where the sore is going to appear. This phase may last for as little as 24 hours. There is reddening and swelling of the infected area resulting in fluid filled blisters which are usually clumped together in patches. Cold sores can be painful, and the blisters may form ulcers. They then dry up and crust over.

Cold sores may be triggered by factors such as having a cold, fever, other infection, stress, sunlight, or a weakened immune system.

Spread

The virus is spread by direct contact. People are at risk of getting a cold sore if they come in contact with the fluid of a cold sore or the saliva of someone who has the virus.

Exclusion

None needed.

Do

Advise children to try not to touch the cold sore or pick at the blisters to prevent spread.

Avoid contact with the sores and blisters such as kissing an affected person or sharing their food. Do not share eating and drinking utensils, towels, flannels, toothbrushes, and razors.

Don’t

Children and adults should not touch their eyes and adults should take extra care when applying or removing make-up.

Conjunctivitis

Conjunctivitis is an inflammation of the outer lining of the eye and eyelid causing a sore or itchy red eye(s) with a sticky or watery discharge. It can be caused by bacteria or viruses or allergies. Spread is by direct or indirect contact with the discharge from the eyes. Prompt treatment and good hand washing helps to prevent spread.

Symptoms

The eye(s) becomes reddened and swollen and there may be a sticky or watery discharge. Eyes usually feel sore or itchy and ‘gritty’. Topical ointment or eye drops can be obtained from a pharmacy to treat the infection.

Spread

Conjunctivitis is spread by contact with discharge from the eye such as when an affected person rubs their eyes with their hands, or a towel then handles another person’s face or towel.

Exclusion

None needed.

Do

Advise parents to seek advice from their local pharmacist. Encourage children not to rub their eyes and to wash their hands frequently. Affected persons should avoid sharing towels, flannels and pillows.

Contact your UKHSA HPT if an outbreak occurs.

Cryptosporidiosis

Cryptosporidiosis is an infection that causes diarrhoea.

Cryptosporidiosis is spread from those with the infection to others when the germ enters the gut by the mouth for example when contaminated hands or objects are put in the mouth or after eating or drinking contaminated food or drinks. It can also be spread by direct contact with farm animals particularly cattle and sheep. Spread by contaminated or untreated water and milk has also been reported.

Cryptosporidum’s high tolerance to chlorine enables it to survive for long periods of time in chlorinated drinking and swimming pool water. This means people swallowing contaminated water could get infected.

Symptoms

Symptoms include abdominal pain, diarrhoea and occasionally vomiting. The incubation period is between 7 to 10 days but can sometimes be as long as 28 days.

Exclusion

Cases should be excluded until 48 hours after symptoms have stopped and they are well enough to return back to education or childcare setting.

Do

Ensure the children and staff are excluded from the education or childcare setting until at least 48 hours after diarrhoeal symptoms have stopped, and they are well enough to return.

Do encourage staff and children to wash their hands regularly with soap and water.

Take care to wash hands with soap and water before handling food and after going to the toilet.

Clean kitchen and toilet areas regularly.

Inform your UKHSA HPT if there are 2 or more cases with cryptosporidium. Your UKHSA HPT or the local authority environmental health officer (EHO) will advise you if any actions need to be taken at the education/childcare setting.

Use personal protective equipment (PPE) when handling blood or body substances such as vomit or diarrhoea (For more details, see chapter 2.)

Don’t

People with cryptosporidium should not go to a swimming pool until 14 days after the last diarrhoeal episode.

Diarrhoea and vomiting (gastroenteritis)

Diarrhoea and/or vomiting may be due to a variety of causes including germs, toxins or non-infectious diseases. However, as a general principle, all cases of gastroenteritis should be regarded as potentially infectious unless there is good evidence to suggest otherwise.

A liquid stool is more likely to contaminate hands and the environment than a formed stool and is therefore a greater risk. Vomit, like liquid stool, may also be highly infectious such as when there is norovirus circulating in the education or childcare setting.

Symptoms

People affected by infectious gastrointestinal diseases may have diarrhoea and/or vomiting. Diarrhoea is defined as 3 or more liquid or semi-liquid stools within a 24-hour period.

Spread

These infections are spread when the germs enter the gut by the mouth or when contaminated hands or objects are put in the mouth or after eating or drinking contaminated food or drinks.

Infection can also be spread when the affected person vomits. This is because aerosols can spread the organism directly to others and contaminate the environment. A person will be infectious while symptoms remain.

Exclusion

Children and adults with diarrhoea and/or vomiting should be excluded until 48 hours after diarrhoea and/or vomiting symptoms have stopped, and they are well enough to return. If medication is prescribed, ensure that the full course is completed and there is no further diarrhoea and/or vomiting for 48 hours after the course is completed.

For some gastrointestinal infections, longer periods of exclusion from education or childcare setting are required and there may be a need to obtain faecal samples for microbiological clearance. For these groups, your UKHSA HPT, or the local authority EHO will advise you if any action is required by the education or childcare setting.

Do

Ensure the child or children and staff are excluded from the education or childcare setting until at least 48 hours after diarrhoea and/or vomiting symptoms have stopped, and they are well enough to return.

Do encourage staff and children to wash their hands regularly with soap and water.

Take care to wash hands with soap and water before handling food and after going to the toilet.

Clean kitchen and toilet areas regularly.

Use PPE when handling blood or body substances such as vomit or diarrhoea. (For more details, see chapter 2.)

Inform your UKHSA health protection team if there are a higher than previously experienced and/or rapidly increasing number of staff or student absences due to diarrhoea and vomiting.

E. coli STEC (Shiga Toxin-producing E.Coli)

Escherichia coli (E. coli) are bacteria that live in the guts of humans and animals, particularly cattle and sheep. There are several different types of E. Coli and most are harmless.

Some types, known as Shiga Toxin-producing E. coli (STEC), produce a toxin, which can cause illness. Symptoms range from mild diarrhoea through to severe inflammation of the gut. On rare occasions this can cause serious complications such as kidney failure.

Symptoms

Symptoms vary depending on the severity of the infection but include diarrhoea (which might be bloody), abdominal pain, and sometimes vomiting and fever. The incubation period is 1 to 10 days and cases are infectious as long as bacteria are present in the faeces.

Spread

Spread is mainly by eating contaminated food such as undercooked meat, unpasteurised milk and cheese, unwashed vegetables which may have been contaminated by manure from infected animals, contact with infected animals or their faeces.

Person to person spread is by direct contact with someone who has the infection particularly within families and childcare settings. Outbreaks and sporadic cases have also been linked with handling animals. Therefore, adults should supervise children while washing their hands during visits to petting zoos and farm centres. For more information, see chapter 6.

Exclusion

The standard exclusion period is until 48 hours after diarrhoea and/or vomiting symptoms have stopped. However, some people pose a greater risk to others and may be excluded until they have a negative stool sample(s) for example pre-school infants, food handlers, and care staff working with vulnerable people. The UKHSA HPT will advise you in these instances.

Do

Follow the UKHSA HPT’s exclusion advice. Promote good hand washing to children visiting farms or petting zoos, especially after handling animals and prior to eating or drinking. For more information, see chapter 6.

Use PPE when handling blood or body substances such as vomit or diarrhoea. (For more details, see chapter 2.)

Do encourage staff and children to wash their hands regularly with soap and water.

Take care to wash hands with soap and water before handling food and after going to the toilet.

Clean kitchen and toilet areas regularly.

Food poisoning

Food poisoning is a general term used for gastrointestinal (GI) infections caused by consuming contaminated food or drink or by person to person spread.

Symptoms

Symptoms of food poisoning usually begin within 1 to 2 days of eating contaminated food, although they may start at any point between a few hours and several weeks later depending on the type of germ. The main symptoms include feeling sick (nausea), vomiting, diarrhoea, abdominal pain and fever.

Spread

Gastrointestinal infections can be caused by a variety of bacteria, viruses or parasites; the most commonly reported bacterial infections are salmonella and campylobacter.

Outbreaks can occur when people eat the same contaminated food. Or if food is prepared by someone who has the infection and did not wash their hands properly before preparing the food.

Exclusion

Children and adults should be excluded until 48 hours after the diarrhoea and/or vomiting has stopped, and they are well enough to return.

For some infections, longer periods of exclusion from education and childcare settings are required and there may be a need to obtain further faecal samples for microbiological clearance. Your UKHSA HPT will advise you if any actions need to be taken by the education or childcare setting.

All outbreaks of food poisoning should be investigated, your UKHSA HPT will work with the education or childcare setting and EHOs from the local authority.

Do

Exclude the pupil or staff member until 48 hours after the diarrhoea and/or vomiting has stopped, and they well enough to return.

Do encourage staff and children to wash their hands regularly with soap and water.

Take care to wash hands with soap and water before handling food and after going to the toilet.

Clean kitchen and toilet areas regularly.

Use PPE when handling blood or body substances such as vomit or diarrhoea. (For more details, see chapter 2.)

Inform your UKHSA HPT if there are 2 or more cases with similar symptoms linked in time or place or a greater than expected rate of infection compared with the usual background rate.

Giardia

This parasitic disease is spread from those with the infection to others when the germ enters the gut by the mouth for example when contaminated hands or objects are put in the mouth or after eating or drinking contaminated food or drinks. Infection with giardia may not cause any symptoms. The incubation period is between 5 and 25 days.

When symptoms do occur, they may include abdominal pain, bloating, fatigue and pale, loose stools. Cases may need treatment.

Exclusion

Children and adults should be excluded until 48 hours after the diarrhoea and/or vomiting has stopped, and they are well enough to return. Your UKHSA HPT or the local authority EHO will advise you if any actions need to be taken at the education or childcare setting.

Do

Exclude the pupil or staff member until 48 hours after the diarrhoea and/or vomiting has stopped, and they are well enough to return. People with giardia should not go to a swimming pool until 14 days after the last diarrhoeal episode.

Do encourage staff and children to wash their hands regularly with soap and water.

Take care to wash hands with soap and water before handling food and after going to the toilet.

Clean kitchen and toilet areas regularly.

Use PPE when handling blood or body substances such as vomit or diarrhoea. (For more details, see chapter 2.)

Inform your UKHSA HPT if 2 or more cases with similar symptoms linked in time or place or a greater than expected rate of infection compared with the usual background rate.

Glandular fever

Glandular fever is a viral infection that mostly affects young adults, it is caused by the Epstein-Barr virus.

Symptoms

Symptoms present as fatigue, aching muscles, sore throat, high fever, swollen glands in the neck and occasionally jaundice (yellowing of the skin and eyes). In children, the disease is generally mild. The incubation period is about 4 to 6 weeks.

Symptoms of glandular fever can be unpleasant, but most pass within 2 to 3 weeks. Fatigue, however, can occasionally last longer.

Spread

The virus is found in the saliva of infected people and can be spread by direct contact with saliva such as kissing, being exposed to coughs and sneezes, sharing of eating and drinking utensils. It can also be spread by indirect contact via contaminated objects if hands are not washed adequately.

Exclusion

Exclusion is not required, and children and staff can return back to education or childcare setting when they feel well.

Do

Encourage staff and children to wash their hands regularly with soap and water to reduce the risk of spread and ensure that used tissues are disposed of straight away.

Hand, foot and mouth disease is a common viral illness in childhood. It is generally a mild illness caused by an enterovirus. In rare instances it can be more severe.

Symptoms

The child may develop a fever, reduced appetite and generally feel unwell. One or 2 days later a rash may develop with blisters, on hands, feet, insides of their cheeks, gums and on the sides of the tongue. Not all cases have symptoms. The incubation period is 3 to 5 days. Persons affected are most infectious during the first week of the illness.

The illness is usually mild and clears up by itself in 7 to 10 days. If the child or staff member develops the rare additional symptoms of high fever, headache, stiff neck, back pain, or other complications then they should seek prompt medical advice.

Spread

Spread is by direct contact with the secretions of the infected person (including faeces) or by aerosol spread such as coughing and sneezing. Younger children are more at risk because they tend to play closely with their peers.

There is a slight risk to pregnant staff, and they may wish to avoid close contact with an affected child. Women who develop any rash symptoms during pregnancy should seek advice from their general practitioner or midwife.

Promote good hand washing in both those affected and the staff who carry out nappy changing and/or assist with toileting to reduce the risk of transmission. This should continue even after the child is well because the virus can still be present in the faeces and saliva for a few weeks.

Exclusion

Exclusion of a well pupil is not required. If a child is feeling unwell, they can stay at home and return to education or childcare setting as soon as they are feeling better, there is no need to stay off until the blisters have all healed. Keeping your child off for longer periods is unlikely to stop the illness spreading.

Do

Care should be taken when handling contaminated articles such as tissues, nappies including when assisting with toileting, these contaminated articles should be disposed of immediately.

Staff who carry out nappy changing and/or assist with toileting should wear gloves and wash hands after removing the gloves. Gloves should be changed between each child.

Don’t

Do not confuse with foot and mouth disease which is found in animals. Children do not need to be excluded from education or childcare settings if they are well.

Head lice

Head lice and nits are common in young children and their families. They do not have anything to do with dirty hair and are picked up by head-to-head contact. They are tiny insects that only live on humans. The eggs are grey or brown and about the size of a pinhead which stick to the hair, close to the scalp. The eggs hatch in 7 to 10 days. Empty eggshells (nits) are white and shiny and are found further along the hair shaft as they grow out.

Spread

Head lice are spread by direct head-to-head contact and therefore tend to be more common in children because of the way they play. They cannot jump, fly or swim. Itching and scratching occurs 2 to 3 weeks after coming into contact with someone who has headlice.

Exclusion

No exclusion is needed.

Hepatitis A

Hepatitis A is a viral infection which affects the liver. The severity of the disease varies from a mild illness lasting 1 to 2 weeks to a more serious illness lasting several months. Young children may have mild infections without jaundice or other symptoms, and many may have no symptoms at all.

Symptoms

Symptoms include abdominal pain, loss of appetite, nausea, fever and fatigue, followed by jaundice (yellowing of the skin and eyes), dark urine and pale faeces.

Spread

The hepatitis A virus is caught by eating or drinking contaminated food or water. The infection can also be spread by close contact with an infected person. The virus is spread by poor personal or public hygiene. It can be caught where standards of hygiene are low either in this country and abroad.

People should be vaccinated against hepatitis A before travelling to countries where hepatitis A is common.

Exclusion

Exclude the child or staff member whist unwell or for 7 days after the onset of jaundice or from the onset of symptoms if no jaundice is present. Your UKHSA HPT or the local authority EHO will advise you if any actions need to be taken at the education or childcare setting.

Do

Do encourage staff and children to wash their hands regularly with soap and water.

Take care to wash hands with soap and water before handling food and after going to the toilet.

Clean kitchen and toilet areas regularly.

Household and other close contacts of cases will be offered a hepatitis A vaccine if they are not immune.

Hepatitis B

Hepatitis B (HBV) is a liver disease caused by the hepatitis B virus. There are several different viruses which affect the liver, primarily hepatitis A, B, C, D and E.

The main difference between the viruses is how they are spread; the way they cause liver damage and the effects they have on health. In the UK, hepatitis B infection is not a common viral infection in young children.

Hepatitis B can cause an acute or a chronic illness. An acute illness is one that gets better quickly, usually within weeks or at most a few months.

A chronic illness lasts much longer, sometimes waxing and waning. Chronic hepatitis B is when it lasts longer than 6 months.

Symptoms

Symptoms can vary and may include general fatigue, nausea and vomiting, loss of appetite, fever and dark urine. Older children and adults may develop jaundice (a yellowing of the eyes and skin).

Many people never have any symptoms, but they can pass on the infection. The incubation period can be between 4 weeks and 6 months.

Spread

Spread is by contact with infected blood and body fluids entering the bloodstream through broken skin or mucous membranes, for example through a bite which breaks the skin or if the skin is pierced by a contaminated object.

The virus can also be passed on via tattooing or from medical and dental treatment if equipment is not adequately sterilised.

All blood and body fluids should be considered potentially infectious and spills should be cleaned wearing protective clothing and using a spillage kit.

Exclusion

People with acute hepatitis B will typically be too ill to attend their education or childcare setting and their doctor will advise them when they can return. Do not exclude chronic cases of hepatitis B or restrict their activities. Similarly, do not exclude staff with chronic hepatitis B infection.

Contact your UKHSA HPT for more advice if required.

Do

Take a standard approach to cleaning all spillages of blood and body fluids, managing all as potentially infectious and wear appropriate protective clothing including gloves when cleaning up blood, urine, loose stools and vomit. More information is available in chapter 2.

Always complete the accident book with details of injuries or adverse events.

Don’ts

Individuals with chronic hepatitis B infection should not be excluded or have their activities restricted.

Hepatitis C

Hepatitis C is not a common infection in children.

Symptoms

Hepatitis C virus (HCV) is a blood borne virus affecting the liver. Symptoms of hepatitis C infection can often be vague and include loss of appetite, fatigue, nausea and abdominal pain. Jaundice (yellowing of the skin and eyes) occurs less commonly than in hepatitis B infection. Up to 80% of those infected may be carriers of the virus and can pass it on to others.

Spread

HCV is present in blood and other body fluids and tissues and is spread in the same way as hepatitis B virus. Hepatitis C, like Hepatitis B, cannot be spread through casual contact.

Exclusion

No exclusion is needed.

Do

Take a standard approach to cleaning all spillages of blood and body fluids, managing all blood and bodily fluids as potentially infectious and wear the appropriate protective clothing including gloves when cleaning up blood, urine, loose stools and vomit.

Always complete the accident book with details of injuries or adverse events.

Don’t

Individuals with chronic hepatitis C infection should not be excluded or have their activities restricted.

Impetigo

Impetigo is a bacterial skin infection which mainly affects infants and young children. It is very infectious and appears most commonly as reddish sores on the face. It may be a primary infection or a complication of an existing skin condition such as eczema, scabies or insect bites.

Symptoms

The sores can develop anywhere on the body but tend to occur as reddish sores on the face, especially around the nose and mouth and on the hands and feet. After about a week, the sores burst and leave golden brown crusts. It can sometimes be painful and itchy. The incubation period is between 4 to 10 days.

Spread

Impetigo can easily spread to other parts of the affected person’s body or to other people such as through direct physical contact, or by sharing towels, flannels or eating and drinking utensils.

Exclusion

The child should be excluded from education or childcare setting until all sores or blisters are crusted over or 48 hours after commencing antibiotic treatment.

Do

Encourage staff and children to wash their hands regularly with soap and water to reduce the risk of spread. Avoid touching or scratching the sores, or letting others touch them.

Towels, flannels and eating and drinking utensils should not be shared by others.

Ensure that toys and play equipment are thoroughly cleaned daily. Non-washable soft toys should be wiped or washed with a detergent using warm water and dried thoroughly.

Don’t

The child should be excluded from education or childcare setting until all sores or blisters the lesions are crusted over or 48 hours after commencing antibiotic treatment.

Influenza

Influenza, commonly known as flu, is caused by a virus, usually influenza A or B. The illness is very infectious and spreads easily in crowded populations and in enclosed spaces. Flu viruses are always changing so this winter’s flu strains will be slightly different from previous winters.

Flu can affect anyone but if people have a long-term health condition the effects of flu can make it worse even if the health condition is well managed and they normally feel well.

For further details see the UK national immunisation schedule.

Conditions which may increase your risk of serious influenza illness are detailed in the Green Book.

Symptoms

Influenza is a respiratory illness and commonly has a sudden onset. Symptoms include headache, high temperature, cough, sore throat, aching muscles and joints and fatigue.

Cases can be infectious 1 day before to 3 to 5 days after symptoms appear. Importantly, children may sometimes present differently with flu – for example, without fever but with diarrhoea.

Spread

By breathing in droplets coughed out into the air by infected people or by the droplets landing on mucous membranes. Transmission may also occur by direct or indirect contact with respiratory secretions for example via soiled tissues, surfaces.

Incubation period is between 1 to 3 days.

Exclusion

There is no precise exclusion period. Adults and children with symptoms of flu are advised to remain at home until they have recovered.

Do

Encourage those in eligible groups to have the flu vaccine .

Encourage children and staff with flu-like symptoms to stay at home until recovered.

Ask children to cover their noses and mouths with a tissue when coughing or sneezing and discard tissues after use.

Ensure regular hand washing with soap and water, especially after coughing or sneezing.

Measles

Measles is a highly infectious viral infection. The (measles, mumps and rubella) MMR vaccine is the safest and most effective way to protect against measles. People need 2 doses of MMR to be protected against measles, mumps and rubella.

During coronavirus (COVID-19), there has been a significant drop in children getting vaccinated with MMR and other childhood vaccines. Measles is highly contagious so even a small decline in MMR vaccine uptake can lead to significant increases in cases.

Symptoms

Symptoms include a runny nose; cough; conjunctivitis (sore, itchy, watery, red and sticky eyes); high fever and small white spots (Koplik spots) inside the cheeks. Around day 3 of the illness, a rash of flat red or brown blotches appear, beginning on the face, behind the ears and spreading over the body. The incubation period is between 10 to 12 days but can vary from 7 to 21 days.

Spread

Measles is highly infectious and transmitted via airborne or droplet spread, or direct contact with nasal or throat secretions of infected persons.

Exclusion

Cases are infectious from 4 days before onset of rash to 4 days after, where the date of the rash onset is day 0. It is important to ensure cases are excluded from education or childcare settings during this period.

Do

Encourage all children over the age of one year old to have the combined MMR (measles, mumps and rubella) vaccination as per the national immunisation schedule. More information is available in chapter 5.

Any staff who are unvaccinated or partially vaccinated with the MMR vaccination should be encouraged to seek advice from their general practitioner or practice nurse.

If a member of staff is pregnant and not sure of their immunity (have not either had measles previously or have not had 2 measles vaccines), they may wish to seek advice from their general practitioner. When contacting the GP or midwife they should inform them know that there has been exposure to a case of measles.

Don’t

Do not allow the child back to education or childcare settings until 4 days after the start of the rash where the date of the rash onset is day 0.

Children and adults with a weak immune system, pregnant staff and children under 12 months who come into contact with measles should seek prompt medical advice.

Meningitis

Meningitis is a general term that describes an inflammation of the membranes covering the brain and spinal cord. It can be caused by a range of germs including bacteria or viruses.

Bacterial meningitis is less common but more serious than viral meningitis and needs urgent medical attention. In some cases, bacterial meningitis can lead to septicaemia (blood poisoning).

Symptoms

Common signs and symptoms of meningitis and septicaemia include fever, severe headache, photophobia, neck stiffness, non-blanching rash (see glass test box below), vomiting, drowsiness.

The incubation period varies but for bacterial meningitis the incubation is between 2 and 10 days.

Glass test

If a glass tumbler is pressed firmly against a septicaemic rash, the rash will not fade. The rash will be visible through the glass. If this happens urgent medical attention should be sought. Note that the rash is a late symptom – if any of the other symptoms have already occurred seek medical advice immediately.

Immunisation

The routine childhood immunisation schedule provides protection against meningitis caused by mumps, polio, Haemophilus influenzae type b (Hib), pneumococcus and Neisseria meningitidis group A, B, C, W and Y. There is no vaccination for some types of meningitis. Pupils should be encouraged to be up to date with their vaccinations.

Viral

There is no effective medication for the treatment of viral meningitis, but symptoms are usually much milder.

Exclusion

Once the child has been treated (if necessary) and has recovered, they can return to their education or childcare setting. No exclusion is needed.

Meningitis is a notifiable disease. Inform the HPT if 2 cases of meningitis occur in the education/childcare setting within 4 weeks.

Meningococcal meningitis and septicaemia

Meningococcal meningitis and septicaemia require immediate medical attention.

The bacteria Neisseria meningitidis causes meningococcal meningitis and meningococcal septicaemia (known collectively as ‘meningococcal infection’).

There are 13 known groups of the bacteria, the most common worldwide are A, B, C, W and Y. In the UK, groups B and C are the most common. Meningococcal infection is a rare but serious disease and is fatal in around 1 in 10 people with the illness. About 15% of those that recover have long-term complications.

Symptoms

Symptoms include fever, severe headache, photophobia, drowsiness, non-blanching rash (see glass test box). Not all the symptoms will be present, and cases can have symptoms of meningitis and septicaemia.

Glass test

If a glass tumbler is pressed firmly against a septicaemic rash, the rash will not fade. The rash will be visible through the glass. If this happens urgent medical attention should be sought. Note that the rash is a late symptom – if any of the other symptoms have already occurred seek medical advice immediately.

Spread

Spread is from person to person through respiratory droplets and direct contact with nose and throat secretions. About 10% of us carry the bacteria harmlessly in our nose and throat.

Close and prolonged contact is needed to pass the bacteria to others (such as contacts in a household setting or intimate kissing) only a small proportion of people develop meningitis or septicaemia if they come into contact with it. For this reason, only people that have had significant close contact with the case in the previous 7 days will be offered antibiotics and immunisation later if applicable.

The case is considered non-infectious 24 hours after taking appropriate antibiotic treatment.

If a child (case) has been treated and has recovered, they can return to their education or childcare setting. The UKHSA HPT will have carried out a risk assessment and organised antibiotics for household and other close contacts.

Exclusion is not necessary for household or close contacts unless they have symptoms suggestive of meningococcal infection, they should see medical advice.

Do

Seek medical advice immediately if meningitis is suspected.

Inform your UKHSA HPT if you have a case of meningococcal disease in your education or childcare setting.

Inform your UKHSA HPT if 2 cases of meningitis occur in the education/childcare setting within 4 weeks.

Methicillin Resistant Staphylococcus Aureus (MRSA)

MRSA (Methicillin Resistant Staphylococcus Aureus) are bacteria that have developed resistance to methicillin (a type of penicillin) and/or other antibiotics.

Symptoms

Staphylococcus aureus (Staph aureus) are bacteria that live on healthy skin. One in 3 health people carry Staph aureus on their skin or in their nostrils without it causing any harm. Sometimes Staph aureus causes infections, mainly of the skin. It can occasionally cause serious infection.

Spread

Spread is mainly by direct contact with contaminated hands and objects.

Exclusion

None advised.

Do

Staff should ensure good infection control principles are in place, in particular good hand washing, to reduce the risk of transmission.

All infected wounds should be covered.

Mumps

Symptoms

Mumps is a viral infection. The first symptoms of mumps are usually a raised temperature, swelling and tenderness of salivary glands (parotid) accompanied by headaches, joint pain and general malaise. The swelling can be one sided or affect both sides.

Mumps is usually fairly mild in young children, but can cause swelling of the testicles and rarely, infertility in males over the age of puberty.

Spread

The mumps virus is highly infectious and can be spread by droplets from the nose and throat, and by saliva.

Exclusion

Infected children can return to education or childcare setting 5 days after the onset of swelling, if well.

Do

Encourage staff and children to wash their hands regularly with soap and water.

Send the child home if unwell.

Advise the parents to seek advice from a general practitioner.

Encourage all children over the age of 1 to have the combined MMR vaccination as per the national immunisation schedule.

Staff should be up to date with their MMR vaccinations.

Panton-Valentine Leukocidin Staphylococcus aureus (PVL-SA)

Staphylococcus aureus (Staph aureus) are bacteria that live on healthy skin. One in 3 health people carry Staph aureus on their skin or in their nostrils without it causing any harm. Sometimes Staph aureus causes infections, mainly of the skin.

PVL-SA are types of Staph aureus which produce a toxin and can cause recurrent boils, skin abscesses or cellulitis if it enters deeper layers of skin through a graze or wound. Occasionally it may enter the blood stream, causing more serious problems.

Risk factors for acquiring PVL-SA

  • close contact with someone who is already affected, for example household contacts or close contact sports
  • contact with contaminated surfaces or equipment, for example gym equipment
  • sharing towels, flannels and razors
  • chronic skin condition, for example eczema
  • living in closed communities, for example boarding school

Exclusion

Children and staff with a lesion or wound that cannot be covered should be excluded.

Do

Encourage staff and children to wash their hands regularly with soap and water after using toilets, before eating and drinking, before and after use of the gymnasium and other communal sports activities or outings, and whenever hands are contaminated or soiled.

Encourage covering of the nose and mouth with a tissue when coughing or sneezing. Tissues should be disposed, and hands washed with soap and water.

Infected areas should be covered with dressings that are changed regularly particularly when there is a visible discharge.

Affected persons should not share towels, flannels and pillows.

Contaminated surfaces should be cleaned promptly using detergent and water

Common areas in settings (for example toilets, locker rooms, dining room, and so on), should be kept clean by following regularly scheduled cleaning protocols.

If there are 2 or more cases at the setting, please contact the UKHSA HPT.

Don’t

Affected persons should not share towels or visit gyms or swimming pools until the wounds have healed.

Respiratory infections, including coronavirus (COVID-19)

Respiratory infections are common in children and young people, particularly during the winter months. Symptoms can be caused by [several respiratory infections]https://www.gov.uk/guidance/people-with-symptoms-of-a-respiratory-infection-including-covid-19) including the common cold, COVID-19, flu, and respiratory syncytial virus (RSV).

For most children these illnesses will not be serious, and they soon recover.

Symptoms

Children with respiratory infections can experience a range of symptoms including a runny nose, high temperature, cough and sore throat.

It is not possible to tell which germ someone is infected with based on symptoms alone.

Some children aged under 2 years, especially those with a heart condition or born prematurely, and very young infants, are at increased risk of hospitalisation from RSV.

Spread

Respiratory infections can spread easily between people. Sneezing, coughing, singing and talking may spread respiratory droplets from an infected person to someone close by.

Droplets from the mouth or nose may also contaminate hands, eating and drinking utensils, toys or other items and spread to those who may use or touch them, particularly if they then touch their nose or mouth.

Exclusion

Children with mild symptoms such as a runny nose, sore throat, or mild cough, who are otherwise well, can continue to attend their education or childcare setting.

Children and young people who are unwell and have a high temperature should stay at home and where possible avoid contact with other people. They can go back to education or childcare setting when they no longer have a high temperature and they are well enough.

If a child or young person has a positive COVID-19 test result they should try to stay at home and where possible avoid contact with other people for 3 days after the day, they took the test. The risk of passing the infection on to others is much lower after 3 days, if they feel well and do not have a high temperature.

Children and young people who usually attend an education or childcare setting and who live with someone who has a positive COVID-19 test result should continue to attend as normal.

Do

Ensure that any children and young people who have a high temperature and are unwell do not attend the education or childcare setting until they no longer have a high temperature and are well enough to attend.

Encourage all children with respiratory symptoms to cover their mouth and nose with a disposable tissue when coughing and sneezing and to wash their hands after using or disposing of tissues.

Advise children or young people with a positive COVID-19 test result try to stay at home for 3 days after the day they took their test.

Any staff who have a positive COVID-19 test result should try to stay at home for 5 days after the day they took the test .

Advise all staff and students to follow the ‘Living safely with COVID-19’ and other respiratory infections guidance.

You should contact your UKHSA HPT if there is:

  • a higher than previously experienced and/or rapidly increasing number of staff or student absences due to acute respiratory infection
  • evidence of severe disease due to respiratory infection, for example if a pupil, student, child or staff member is admitted to hospital

For more information on actions in the event of an outbreak or incident, see chapter 4.

Ringworm

Symptoms

Ringworm, also known as tinea, is a fungal infection of the skin, hair or nails. It is caused by various types of fungi and infections are named after the parts of the body that are affected, namely face, groin, foot, hand, scalp, beard area and nail.

The main symptom of ringworm is a rash. The rash may be scaly, dry, swollen or itchy and may appear red or darker than surrounding skin.

Scalp ringworm in children is becoming more common in the UK, particularly in urban areas. Until recently this was usually spread from infected animals but can spread within families and in education or childcare settings.

Ringworm of the scalp

Infection starts as a small red spot which spreads leaving a scaly bald patch. The hair becomes brittle and breaks easily.

The appearance of human scalp ringworm varies from lightly flaky areas, often indistinguishable from dandruff, to small patches of hair loss on the scalp. There may be affected areas on the face, neck and trunk.

Ringworm of the body

Infected areas are found on the trunk or legs and have a prominent red margin with a scaly central area.

Nail ringworm

Infection of the nails often with infection of the adjacent skin. There is thickening and discolouration of the nail.

Spread

Spread is by direct skin to skin contact with an infected person or animal and with athlete’s foot, by indirect contact with contaminated surfaces.

Exclusion

No exclusion needed. Once treatment has started children can return to their education or childcare setting. Scalp ringworm is treated with oral anti-fungal agents. An anti-fungal cream is used to treat ringworm of the skin and feet.

Do

Wash and dry feet well in cases of athlete’s foot.

Encourage staff and children to wash their hands regularly with soap and water.

Affected persons should not share towels, flannels, pillows, socks or shoes.

Ensure the child with ringworm of the feet is wearing socks and trainers. The child should have his or her feet covered for physical education.

Advise the parents to seek advice from a general practitioner for recommended treatment.

Don’t

Discourage scratching of the affected skin/area as it can spread to other parts of the body.

Affected persons should not share towels, flannels, pillows, socks or shoes.

Rotavirus

Symptoms

Rotavirus is a highly infectious virus that can cause severe diarrhoea, stomach cramps, vomiting, dehydration and mild fever. It is more common in the winter months. The symptoms usually last 3 to 8 days.

Most babies and children recover within a week, but in a small number of cases, rotavirus infection can become serious, with babies getting dehydrated (losing body fluids) and possibly needing hospital treatment.

Spread

Rotavirus is very infectious and spreads easily between people. The virus mostly spreads through hand to mouth contact and can be picked up by contact with contaminated surfaces such as toys, hands or dirty nappies. It can also be spread through the air by coughing and sneezing.

An oral vaccine against rotavirus infection is given to babies as part of their routine childhood vaccinations.

Apart from vaccination, good hygiene is the most important way of preventing the spread of rotavirus.

Exclusion

Until 48 hours after the symptoms have subsided.

Do

Encourage uptake of the rotavirus vaccination.

Encourage staff and children to wash their hands regularly with soap and water.

Send babies or children with diarrhoea and vomiting home and advise that they should not return until 48 hours after the diarrhoea and/or vomiting has stopped.

Keeping surfaces clean can help reduce the spread of the virus.

Use PPE when handling blood or body substances such as vomit or diarrhoea (see chapter 2 for more details)

Rubella (German measles)

Rubella is a viral infection that generally causes a mild, febrile rash-illness. Rubella can be serious during pregnancy. The MMR vaccine is the safest and most effective way to protect against rubella. People need 2 doses of MMR to be protected.

Recovery from rubella is usually rapid and complications rarely occur. Rubella does, however, have serious consequences for pregnant women who are not immune and for the unborn baby if acquired during the first 20 weeks of pregnancy.

Symptoms

The symptoms of rubella are mild. Usually the rash is the first indication of rubella infection. The main symptoms are:

  • swollen lymph glands around the ears and back of head 5 to 10 days before the onset of a rash

  • sore throat and runny nose 1 to 5 days before the rash appears

  • mild fever, headache, tiredness

  • conjunctivitis (sore, itchy, watery, red and/or sticky eyes)

  • red rash mostly seen behind the ears and on the face and neck

  • painful and swollen joints

If someone has had both doses of the MMR vaccination, they are very unlikely to have rubella.

Spread

Rubella is highly infectious. It is spread by respiratory droplets through coughing or sneezing, or by direct contact with the saliva of an infected individual.

Exclusion

Exclude from education or childcare setting or work for 5 days from the appearance of the rash.

Rubella is infectious from 1 week before the symptoms start and for 5 days after the rash first appears.

Do

Encourage all children over the age of one year old to have the combined MMR (measles, mumps and rubella) vaccination as per the national immunisation schedule. More information is available in chapter 5.

Any staff who are unvaccinated or partially vaccinated with the MMR vaccination should be encouraged to seek advice from their general practitioner or practice nurse.

If a member of staff is pregnant and not sure of their immunity, they should seek advice from their general practitioner or midwife. When contacting the GP or midwife they should inform them that there has been exposure to a case of rubella.

Scabies

Scabies is a skin infection caused by tiny mites that burrow in the skin. The pregnant female mite burrows into the top layer of the skin and lays about 2 to 3 eggs per day before dying after 4 to 5 weeks.

Symptoms

The appearance of the rash varies but most people have tiny pimples and nodules on their skin. Secondary infection can occur particularly if the rash has been scratched.

The scabies mites are attracted to folded skin such as the webs of the fingers. Burrows may also be seen on the wrists, palms elbows, genitalia and buttocks.

Spread

Spread is most commonly by direct contact with the affected skin. The rash usually spreads across the whole body, apart from the head. Scabies remains infectious until treated.

Occasionally if there is impaired immunity or altered skin sensation, large numbers of mites occur, and the skin thickens and becomes scaly.

Exclusion

The infected child or staff member should be excluded until after the first treatment been completed.

Do

The child can return after the first treatment has been completed.

It is important that the second treatment is not missed and should be carried out 1 week after the first.

All household contacts and any other very close contacts should have 1 treatment at the same time as the second treatment of the case.

Contact your UKHSA HPT if there is an outbreak of scabies within your setting.

Scarlet Fever

Scarlet fever (sometimes called scarlatina) is bacterial illness caused Streptococcus pyogenes, or group A streptococcus (GAS). It mostly affects young children.

A wide variety of bacteria and viruses can cause tonsillitis and other throat infections. Most are caused by viruses but streptococci bacteria account for 25 to 30% of cases. It produces toxins (poisons), which cause a rash.

Symptoms

Symptoms vary but in severe cases there may be high fever, difficulty swallowing and tender enlarged lymph nodes. The rash develops on the first day of fever, it is red, generalised, pinhead in size and gives the skin a sandpaper-like texture and the tongue has a strawberry-like appearance.

The scarlet fever rash may be confused with measles. The fever lasts 24 to 48 hours. Scarlet fever is usually a mild illness but is rarely complicated by ear infections, rheumatic fever which affects the heart, and kidney problems.

Spread

Scarlet fever is highly infectious and is spread by close contact with someone carrying the bacteria. The incubation period is 2 to 5 days.

Coughing, sneezing, singing and talking may spread respiratory droplets from an infected person to someone close by.

Droplets from the mouth or nose may also contaminate hands, eating and drinking utensils, toys or other items and spread to others that use or touch them, particularly if they then touch their nose or mouth.

Exclusion

Children can return to their education or childcare setting 24 hours after commencing appropriate antibiotic treatment. If no antibiotics have been administered the person will be infectious for 2 to 3 weeks.

If there is an outbreak of scarlet fever within the education/childcare setting, your UKHSA HPT should be informed.

Do

Encourage staff and children to wash their hands regularly with soap and water.

Encourage covering of the nose and mouth with a tissue when coughing or sneezing. Tissues should be disposed, and hands washed with soap and water.

Send the child home if unwell.

Advise parent or carer to seek advice from their general practitioner.

Inform your UKHSA HPT if there is an outbreak of scarlet fever and there is chickenpox co-circulating at the education or childcare setting

Don’t

Do not allow child to return to education or childcare setting until at least 24 hours after they start appropriate antibiotic treatment.

Slapped cheek syndrome (parvovirus B19)

Symptoms

Slapped check syndrome (also called fifth disease or parvovirus B19) is common in children and should get better on its own. It is rarer in adults but can be more serious.

The illness may only consist of a mild feverish illness which escapes notice but in others a rash appears after a few days.

The rose-red rash makes the cheeks appear bright red, hence the name ‘slapped cheek syndrome’. The rash may spread to the rest of the body but unlike many other rashes it rarely involves the palms and soles.

The child begins to feel better as the rash appears. The rash usually peaks after a week and then fades. The rash is unusual in that for some months afterwards, a warm bath, sunlight, heat or fever will trigger a recurrence of the bright red cheeks and the rash itself.

The virus can affect an unborn baby in the first 20 weeks of pregnancy. If a woman is exposed early in pregnancy (before 20 weeks) she should seek prompt advice from whoever is providing her antenatal care.

Spread

Spread is by the respiratory route and a person is infectious 3 to 5 days before the appearance of the rash. Children are no longer infectious once the rash appears. There is no specific treatment.

Exclusion

The child need not be excluded from their education or childcare setting because he or she is no longer infectious by the time the rash occurs.

Do

Do advise seeking advice from a general practitioner.

Do request that parents inform the education or childcare setting of a diagnosis of slapped cheek syndrome.

Threadworm

Threadworm infection is an intestinal infection and is very common in childhood. They are tiny worms in stools and can spread easily.

Symptoms

Worms may be seen in stools or around a child’s bottom. They look like pieces of white thread.

Symptoms include extreme itching around the anus or vagina, particularly at night. They can also cause children to be irritable and wake up during the night.

Pharmacies can advise on treatment.

Spread

Re-infection is common and infectious eggs are also spread to others directly on fingers or indirectly on bedding, clothing and environmental dust.

Regular hand washing, laundry and regular cleaning can help reduce the risk of infection and re-infection.

Exclusion

None needed.

Do

Encourage high standards of basic hygiene, including washing hands before eating, after using toilet or changing nappies.

Keep fingernails short

Encourage children to wash their hands regularly with soap and water.

Wash towels, flannels, sheets and sleepwear on a hot temperature

Do be aware that transmission is uncommon in education or childcare settings.

Don’t

Threadworm infection can lead to lack of sleep, irritability and loss of concentration.

Tuberculosis (TB)

TB is a bacterial infection that can affect any part of the body, including the lungs.

Symptoms

People with TB might have all or some of the following symptoms: weight loss, fever, night sweats, prolonged cough, loss of appetite, fatigue, breathlessness, pains in the chest and lumps or swellings.

Spread

Some people who develop TB of the lung (pulmonary TB) are infectious to others. Spread happens when these infectious cases breathe out droplets containing TB bacteria in the air which someone else then breathes in. This happens if the person had a lot of close contact with the case (especially if the case has been coughing). The incubation period is 4 to 12 weeks but can be longer.

Exclusion

People with infectious TB can usually return to their education or childcare setting or normal activities after 2 weeks of effective antibiotic treatment prescribed by specialist TB services, and if they are well enough.

Children, young people and staff with non-infectious TB do not require exclusion and can return to their education or childcare setting as soon as they are well enough. TB doctor or nurses or the UKHSA HPT will advise on exclusion for the child or staff member affected.

Do

Do inform and discuss with your UKHSA HPTTB nurses, school nurse or health advisor if you are informed of a suspected case of TB and before taking any action.

The HPT will carry out a risk assessment with the education or childcare setting and may advise and arrange screening for other pupils or staff.

Do exclude pupils whilst they are infectious, following advice from TB nurses or your UKHSA HPT.

Don’t

Don’t exclude children or staff with non-infectious TB or those with pulmonary TB who have completed 2 weeks of effective antibiotic treatment as confirmed by the TB nurses.

Don’t exclude siblings, friends or other contacts of TB cases, unless exclusion is advised by TB nurses or your HPT.

Typhoid and Paratyphoid fever

Typhoid and paratyphoid fever are uncommon but serious illnesses. They are spread by consuming food or water contaminated by the faeces or urine of someone with the illness or someone without symptoms who may be excreting the organism. These infections are most commonly acquired abroad.

Symptoms

Symptoms of typhoid fever are fatigue, fever and constipation, whereas those of paratyphoid fever are fever, diarrhoea and vomiting. The severity of the illness varies. The incubation periods are typically (typhoid) 1 to 3 weeks and (paratyphoid) 1 to 10 days.

Exclusion

Exclude the pupil or staff member until 48 hours after the diarrhoea and/or vomiting has stopped.

For some people, such as food handlers or young children, longer periods of exclusion from the education or childcare setting may be required and there may be a need to obtain further faecal samples. For these groups your UKHSA HPT will advise you if any actions need to be taken by the education or childcare setting.

All outbreaks of food poisoning should be investigated. In the event of an outbreak your HPT will work with the education or childcare setting and EHOs from the local authority.

The EHO or your UKHSA HPT will advise you if any actions need to be taken at the education or childcare setting.

Do

Do encourage staff and children to wash their hands regularly with soap and water.

Take care to wash hands with soap and water before handling food and after going to the toilet.

Clean kitchen and toilet areas regularly.

Report immediately to your UKHSA HPT.

Observe exclusion period or longer if advised by your UKHSA HPT or EHO.

Whooping cough (pertussis)

Whooping cough (pertussis) is an acute bacterial infection caused by Bordetella pertussis. The national immunisation schedule recommends that women 16 to 32 weeks pregnant should be immunised to maximise the likelihood that the baby will be protected from birth.

Infants receive 3 doses of vaccination by their 16th week and an additional pre-school booster.

Symptoms

The early stages of whooping cough, which may last a week or so, can be very like a heavy cold with a temperature and persistent cough.

The cough becomes worse and usually, the characteristic ‘whoop’ develops. Coughing spasms are frequently worse at night and may be associated with vomiting. It may last several months.

The disease is usually more serious in children of pre-school age. Antibiotics rarely affect the course of the illness but may reduce the period the child is infectious.

Spread

Whooping cough spreads by direct contact with airborne particles of discharges from the nose and throat of the affected person.

Exclusion

A child or staff member should not return to their education/childcare setting until they have had 48 hours of appropriate treatment with antibiotics and they feel well enough to do so or 21 days from onset of illness if they have not received antibiotic treatment.

Children should be immunised against whooping cough in their first year of life.

Do

Encourage staff and children to wash their hands regularly with soap and water.

Encourage covering of the nose and mouth with a tissue when coughing or sneezing. Tissues should be disposed, and hands washed with soap and water.

Send the child home if unwell.

Advise parent or carer to seek advice from their general practitioner.

Do allow the child to return to their education or childcare setting after exclusion period even if they are still coughing.

Do encourage parents to have their children immunised against whooping cough. The whooping cough vaccine is included in the national immunisation schedule. More information is available in chapter 5.

Don’t

Do not allow the child or staff member back to education/childcare setting until they have had at least 48 hours of the appropriate antibiotic or 21 days from the onset of the symptoms if no antibiotics have been taken.

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