1. Infectious Diseases in Daycare Settings
My name is Libby Schmidt and I am the Disease Control Specialist for Olmsted County Public Health. My colleague is Leah Espinda-Brandt who is the Disease Prevention and Control Nurse Manager. I am here to talk to you today about infectious diseases in the childcare setting. There are notecards and writing utensils on the tables. These are for you to write questions you may have throughout the presentation. Leah will go around and collect the cards and I will do my best to answer them at the end of the presentation.
Infectious Diseases in Daycare Settings
Olmsted County Public Health Services
Family Child Care, Inc. Workshop
April 8th, 2019

2. Objectives Define Understand Identify
Identify resources for the prevention and control of infectious diseases in childcare settings
Understand
Understand the basic epidemiology, preventative measures, and exclusion policies for the most commonly transmitted diseases in childcare settings
Define
Define common infectious disease terminology
Identify the roles and responsibilities of State and Local Health Departments and Childcare Providers
Objectives
We are going to go through several diseases and there will be a lot of information for each. Keep in mind that we are not asking you to diagnose these diseases, but rather want to give you some basic knowledge on the various disease you may see and ways to prevent and control these diseases within your childcare.

3. Minnesota Department of Health
Surveillance
Prevention and Response
Enforcement—Minnesota Communicable Disease Reporting Rule and Minnesota Statutes
Surveillance—monitoring the occurrence of infectious diseases in Minnesota
Develop strategies for preventing and controlling diseases
Chapter 4605 and Minnesota State Statute subd.1(a) [1] Persons required to report include “any person in charge of any institution, school, child care facility, or camp”

4. Olmsted County Public Health Services
Disease Investigation
Pertussis
Varicella
Measles
Mumps
GI Outbreaks
Consultation
Disease specifics
Environmental cleaning
Preventative measures
Guidelines

5. Childcare Provider
Have a basic knowledge of the signs and symptoms of common diseases as well as how to prevent and control them
Report diseases to MDH or OCPHS via phone or fax
(OCPHS); (MDH)
Develop and enforce an exclusion policy
Sanitize and disinfect commonly touched surfaces
Encourage good handwashing

6. Before we jump into specific diseases, I want to do a little Epi 101
Before we jump into specific diseases, I want to do a little Epi 101. My role is as an epidemiologist. Epidemiology is the study of the distribution and determinants of diseases, both infectious and non-infectious. So we look for who is effected by the disease (age, gender, race, location) and what are the causes of the disease.
Epi 101

7. What is the cause of infectious diseases
What is the cause of infectious diseases? It all starts with some kind of germ whether it be a bacteria like E.coli or pertussis or a virus like chickenpox or norovirus or even a parasite or fungus.
Most germs need somewhere to live even if they aren’t causing illness, this is called the reservoir. The reservoir can be the environment (soil), food, water, people, or other animals.
The germs that we worry about in childcare settings are primarily traveling person-to-person in some way. This can be by direct contact with germ on hands, toys, and surfaces or through the air via droplets from sneezing, coughing, singing, or talking. This is called the mode of transmission or spread of a disease.

8. Infectious Disease Terminology
Germ—the thing that causes disease
Bacteria, Viruses, Parasites, Fungi
Transmission (Spread)—how the germs get from one person to another person
Incubation Period—the time from exposure to the germ/sick individual to the start of symptoms
Contagious (Infectious) Period—the timeframe in which a person can spread their illness
Incubation period refers to the time from exposure to an ill person until the development of symptoms. This is important as we think about ways to distinguish between diseases that show very similar symptoms.
The infectious period is the timeframe in which a person can spread the infection. Again this is really important as it can tell us who may have been exposed and who we need to notify. This is why we ask when symptoms began and what days kids were in school/daycare on our interview forms.

9. Disease Investigation
[Outbreak investigation initiated]
Exposure notifications made; interventions put in place
Case (or parent) interviewed
Case report initiated
Disease is reported to public health
Disease Investigation
So as I mentioned, these time periods are very important for us to know and a big portion of our disease investigation. The sooner we know about a case, the sooner we can act and notify those exposed. Once a disease is reported, we start a case report form and interview the parent of the case. This helps us to determine if there are any exposure notifications that need to be made and what interventions should be put into place.

10. Case Report—What do we collect?
Who?
Age
Sex/gender
Race/ethnicity
Where?
School, daycare, sports, church groups
When?
Symptom onset
Travel dates
Dates attended activities
What do we collect when we interview parents? We collect basic demographics as well as symptoms and onset dates. Additionally, we collect information about household contacts, visitors, school, daycare, sports, church groups, etc…

11. Calculating Infectious Period
From that information, we use the onset date to determine the infectious period. This can be tricky as it can be hard to remember exactly when a cough started as it may have been several weeks before they actually go into the doctor. We try to use holidays or big events to jog parent’s memories.

12. Exposure Notifications and Interventions
Phone calls and/or letters
Inform of exposure
Education about disease
Action steps
Exposure Notifications
Environmental cleaning
Exclusion/isolation
Prevention messaging
Interventions
Exposure Notifications and Interventions
After we determine who may have been exposed based on the infectious period, we notify parents or organizations of the potential exposure. For example, for pertussis (whooping cough) you may be familiar with our 7 day symptom monitoring letter. The letter contains basic information about the exposure and symptoms of the disease, information about the vaccine, and action steps—if you notice your child coughing for more than 7 days, bring them into their healthcare provider for testing and that the child be excluded from activities until the test comes back negative or they complete proper antibiotic treatment, if positive.
This is also where we advise both the parent and the school/daycare as to if and how long the child needs to be excluded.
Finally, we can consult with the providers about any additional cleaning that may need to be done.

13. Common Infectious Diseases in Child Care Settings
Okay, now lets get into some of the infectious diseases you may come across in your childcare.
Common Infectious Diseases in Child Care Settings

14. Conjunctivitis (Pink Eye)
Germ:
Viruses, bacteria, or allergens
Transmission:
Touching secretions from eyes, nose, or mouth
Incubation:
1-3 days usually (1-12 days)
Symptoms:
Pink/red color in white of the eye(s); swelling of eyelid; watery eye; itching, irritation, and/or burning; discharge; crusting of eyelid or lashes
Duration:
Viral (7-14 days); Bacterial (2-5 days); Allergen (once allergen removed)
Contagious Period:
While symptoms are present
The first one I want to talk about is pink eye. This has been on our radar recently due to some changes in the way Mayo is advising parents. I will get into that in a minute.

15. Conjunctivitis: What’s the Difference?
Viral
Watery discharge
Starts in one eye and can spread within days to other eye
Bacterial
Thicker, pus-like discharge
Eyelids stuck together
May occur with ear infection
Allergen
Both eyes
Intense itching, tearing, and swelling of eyes
May occur with itchy nose, sneezing, scratchy throat, or asthma
Conjunctivitis: What’s the Difference?

16. Conjunctivitis (Pink Eye)
Exclusions:
Until seen by doctor if bacterial with thick white or yellow discharge and eye pain
NO exclusion if clear, watery discharge without eye pain or fever
Prevention:
Cover nose and mouth when sneezing or coughing
Do not rub eyes
Do not share towels, eye drops, or other objects that come in contact with the eye
Handwashing
Clean and sanitize/disinfect objects such as toys, tables, door knobs
When to exclude children is where the changes in Mayo’s practices come into play. The advice has always been to exclude children until they have been seen by a doctor and told they can come back in. However, Mayo did some research and found treatment to be ineffective and unnecessary for most conjunctivitis cases as antibiotics can not be used on viral illnesses. For this reason, Mayo has changed their policy so that only those with eye pain or a thick white or yellow discharge that indicates a bacterial infection should come into the doctor. This means that if a child does not have those symptoms they should not be excluded from childcare.

17. Head Lice Germ: Transmission: Incubation: Symptoms: Duration:
Louse
Transmission:
Head-to-head contact  CANNOT jump or fly
Sharing personal products such as combs, brushes, hats, hair ties
Incubation:
7-10 days from eggs laid to hatch
Symptoms:
Itching of the head/neck, crawling lice, scratch marks on the head/back of neck
Duration:
2 weeks
Contagious Period:
Until treated with lice killing products
Only live off the head for 48 hours

18. Head Lice Exclusions: Prevention:
None, but recommended to wait until first complete treatment
DO NOT recommend a “No Nit” policy—all lice do not need to be gone
Prevention:
Do NOT share hair products, accessories, or towels
Vacuum carpets, furniture, mattresses, and car seats thoroughly
Wash clothes, pillow cases, towels in hot water and on a hot dryer cycle
Un-washables can be sealed in a plastic bag
Don’t be surprised if you need to do a second treatment 7-10 days later
Children with an active infestation are unlikely to spread the lice as they have already had the infestation for several weeks.
DO NOT need insecticide!!

19. Common Childhood Rashes: Name that Rash
Shifting gears we are now going to talk about a bigger category of diseases with one very common symptom—rash. As I mentioned earlier the goal is not to have you diagnose these diseases so there is no need to memorize all of this information. The goal is to recognize some common symptoms and advocate that parents take their child to their provider, but to also give you some of the basics when it comes to preventing and controlling these diseases. Alright for each disease I am going to talk about, I will start with a picture or pictures of the rash and want you to go ahead and shout out the disease out if you know what it is.
Common Childhood Rashes: Name that Rash

20. https://www.nhs.uk/conditions/rashes-babies-and-children/ (bottom left)
CDC (top left)
Courtesy of Varicella Active Surveillance Project (top and bottom right pictures)

21. Varicella (Chickenpox)*
Germ:
Virus
Transmission:
Contact with blister fluid or secretions from the nose or mouth; coughing or sneezing
Incubation:
10-21 days after exposure
Symptoms:
Red spots that turn into fluid-filled blisters; itchy; fever; tiredness; loss of appetite; headache
Duration:
4-7 days
Contagious Period:
1-2 days before rash onset until spots are dry and scabbed
I will put an Asterix next to all reportable diseases and color them purple.
MDH recommends that parents contact their medical provider for testing given the similarities between chickenpox and Hand, Foot, and Mouth Disease.
“Providers should do laboratory testing to confirm all cases of varicella. Varicella cases have become more difficult to clinically diagnose because of the effectiveness of the varicella vaccine. Classic presentation of the rash is less common, and breakthrough disease (disease after someone has been vaccinated) can be difficult to differentiate between hand, foot, and mouth disease (HFMD) and other rash illnesses. The exclusion periods for varicella and HFMD are different, and the post-exposure prophylaxis and public health recommendations differ as well. Testing children for varicella ensures they do not unnecessarily miss school and that their high-risk contacts, such as pregnant women or immunocompromised individuals, are cared for correctly.”

22. Varicella (Chicken Pox)*
Exclusion:
All blisters need to be dry and scabbed over (around 5 days after rash onset)
Prevention:
Cover nose and mouth when sneezing and coughing
Handwashing
Clean and disinfect objects and surfaces
Vaccination
Dose 1: months
Dose 2: 4-6 years

23. https://www.nhs.uk/conditions/rashes-babies-and-children/ (bottom left)
CDC/NIP/ Barbara Rice (right)
CDC/ Dr. Lyle Conrad (bottom middle)
CDC (top left)

24. Measles* Germ: Transmission: Incubation: Symptoms: Duration:
Virus
Transmission:
Airborne (can stay in air for 2 hours); touching secretions
Incubation:
10-21 days (rash usually starts around day 14)
Symptoms:
High fever, cough, runny nose, watery eyes, red/brown rash on 3rd-7th day
Duration:
4-7 days for rash
Contagious Period:
4 days prior to rash to 4 days after rash
Rash starts at the face and spreads downward

25. Measles* Exclusion: Prevention: Until 4 days after onset of rash
If exposed and unvaccinated, exclude for 21 days from LAST exposure.
Unless they received a vaccine within 72 hours or were given immune globulin within 6 days of exposure
Prevention:
Vaccine
Dose 1: 12 months
Dose 2: 4-6 years
Cover nose and mouth when coughing or sneezing
Handwashing
Clean and sanitize/disinfect surfaces and toys
Vaccine can be given at 6-12 months if traveling internationally
The measles vaccine is very effective—1 dose is 93% effective and 2 doses are 97% effective against measles

27. Hand, Foot, and Mouth Disease
Germ:
Virus
Transmission:
Fecal-oral—contact with stool from an infected person on hands, food, or objects; coughing/sneezing; contact with blisters (RARE)
Incubation:
3-6 days
Symptoms:
Fever; reduced appetite; sore throat; small red ulcers in mouth, small red fluid-filled bumps on palms of hands, and soles of feet (knees, elbows, buttocks, genital area)
Duration:
7-10 days
Contagious Period:
First week of illness most infectious, but can spread for several weeks after symptoms go away

28. Hand, Foot, and Mouth Disease
Exclusion:
Until 24 hours after fever is gone and can resume routine activity
NOTE: sores and rash may still be present
Prevention:
Cover nose/mouth when sneezing and coughing
Handwashing
Clean and sanitize/disinfect objects and surfaces (toys, diaper changing area, and potty chairs)
Since the virus can be shed for such a long period of time without symptoms, it can be hard to tell when children are no longer infectious. For that reason, we don’t require child to be out that entire time.

30. Ringworm Cause: Transmission: Incubation: Symptoms: Duration:
Fungi
Transmission:
Touching rash; sharing objects (hats, combs, towels, pillows, bedding)
Incubation:
7-21 days
Symptoms:
Flat, ring-shaped rash; as it spreads, the center becomes clear; itchy; “athletes foot”, patchy scaling or cracking skin on the foot
Duration:
2-4 weeks
Contagious Period:
24-48 hours after treatment

31. Ringworm Exclusion: Prevention: Until treatment started
No swimming, gym, or other close contact until lesions can be covered or 72 hours after treatment started
Prevention:
Do not share brushes, combs, towels, bedding, hats, etc..
Handwashing
Have separate bedding and pillows for each child and wash in hot soapy water daily when an individual is infected

33. Scabies Germ: Transmission: Incubation: Symptoms: Duration:
Mites
Transmission:
Skin-to-skin contact; sharing bedding and towels
Incubation:
2-6 weeks
Symptoms:
Tiny red bumps or blisters (usually between fingers, around wrist, elbows, and armpits); intense itching
Duration:
2-3 weeks
Contagious Period:
Rash onset until 24 hours after treatment
Mites can only survive for 3 days off body

34. Scabies Exclusion: Prevention: 24 hours after treatment
Wash bedding and towels in hot water and dry on high heat cycle
Vacuum furniture and carpeting

36. Impetigo Germ: Transmission: Incubation: Symptoms: Duration:
Bacteria
Transmission:
Direct contact with the sores; contact with contaminated objects (RARE)
Incubation:
1-10
Symptoms:
Red sores or blister with crusty brown discharge; itchy
Duration:
2-4 weeks
Contagious Period:
Until sores are healed or 24 hours after antibiotics started

37. Impetigo Exclusion: Prevention:
24 hours after antibiotics started and sores drying/improving
Prevention:
Handwashing
Cover sores
Wear gloves when applying medication to the sores
Do not share towels, washcloths, or clothing
Clean and sanitize/disinfect toys and surfaces

39. 5th Disease (Slapped Cheek Syndrome)
Cause:
Virus
Transmission:
Coughing or sneezing; touching secretions
Incubation:
4-21 days
Symptoms:
Bright red rash on cheeks; fever; sore throat
Duration:
3-7 days; may reoccur over several weeks
Contagious Period:
Just before rash onset until rash onset
Rash begins in cheeks and spreads to arms, body, buttocks, and legs

40. 5th Disease Exclusion: Prevention:
None—no longer infectious once rash begins
Prevention:
Handwashing
Cover nose and mouth when coughing or sneezing
Clean and sanitize/disinfect toys and surfaces

41. Respiratory: Name that Cough
Alright now we will take a 10 minute break. Moving onto a new disease category: Respiratory.
Respiratory: Name that Cough

42. Influenza vs. Cold vs. Pertussis

43. Influenza Germ: Transmission: Incubation: Symptoms: Duration:
Virus
Transmission:
Coughing or sneezing; touching secretions
Incubation:
1-4 days (usually 2)
Symptoms:
Rapid onset of fever, chills, body aches, cough, runny nose, sore throat
Duration:
3-7 days
Contagious Period:
1 day before symptoms until symptoms resolve

44. Influenza Exclusion: Prevention: 24 hours after fever resolves
Child is well enough to perform normal activities
Prevention:
Yearly influenza vaccine
Cover nose and mouth when coughing or sneezing
Handwashing
Clean and sanitize/disinfect toys and surfaces
Stay home when sick
Influenza is not something to underestimate. In Minnesota last season, there were over 6,000 (6,288) people hospitalized for influenza and there were 435 deaths, 5 of whom were children under the age of 18.
577 hospitalizations in Southeast Minnesota

45. Pertussis (Whooping Cough)*
Germ:
Bacteria
Transmission:
Coughing, sneezing, talking, and singing; touching secretions
Incubation Period:
4-21 days after exposure (usually days)
Symptoms:
Week 1-2: sneezing, runny nose, low- grade fever, cough
Symptoms Continued:
Week 2-6 (up to 10): Coughing in sudden, uncontrollable bursts, high- pitched whoop sound following coughing episode, gagging or vomiting after coughing episode, coughing often worse at night
Duration:
weeks to months  nicknamed the 100 day cough
Contagious Period:
Cough onset until either 3 weeks after cough onset or until 5 days of antibiotics taken

46. Pertussis (Whooping Cough)*
Exclusion Policy:
If treated, 5 days antibiotics completed.
If not treated, 3 weeks of coughing has passed.
If exposed AND symptomatic, negative swab or 3 weeks of coughing has passed.
Prevention:
2, 4, and 6 months, months, and 4-6 years
Cover nose and mouth when sneezing and coughing
Handwashing
Clean and sanitize/disinfect toys and surfaces

47. The last category of diseases I want to talk about is Stomach Bugs.

48. Norovirus Germ: Transmission: Incubation: Symptoms: Duration:
Fecal-oral
Incubation:
12-48 hours
Symptoms:
Watery diarrhea, vomiting, fever, headache, fatigue, stomach cramps
Duration:
1-3 days
Contagious Period:
Symptom onset to 72 hours after symptoms resolve
The first and most common cause of gastrointestinal issues is norovirus.

49. Norovirus Exclusion: Prevention:
24 hours after last bout of diarrhea or vomiting
Prevention:
Handwashing
Clean and sanitize/disinfect toys and surfaces

50. E.coli* Germ: Transmission: Incubation: Symptoms: Duration:
Bacteria
Transmission:
Fecal-oral
Incubation:
1-8 days (usually 3-4 days)
Symptoms:
Watery diarrhea, stomach cramps, low grade fever; bloody diarrhea (O157)
Duration:
5-10 days
Contagious Period:
Symptom onset until several weeks or months after symptom resolution
Keep in mind that E.coli normally lives in the intestines of people and animals. There are over 700 types of E.coli and most do not cause illness.
When we need to worry is when the E.coli is what is called a Shiga-toxin producing E.coli strain. Many of you have probably heard of E.coli O157:H7 which can cause a serious illness called Hemolytic Uremic Syndrome (HUS) in children under the age of 5 causing their kidneys to shut down.

51. E.coli* Exclusion: Prevention:
Shiga-toxin producing E.coli (STEC) O157 or other STEC that produce shiga toxin: Need 2 consecutive negative stool results at least 24 hours apart
Any other E.coli—24 hours after last bout of diarrhea
Prevention:
Handwashing
Clean and sanitize/disinfect toys and surfaces

52. C. diff Germ: Transmission: Incubation: Symptoms: Duration:
Bacteria
Transmission:
Fecal-oral
Incubation:
5-10 days
Symptoms:
Watery diarrhea, fever, loss of appetite, nausea, stomach cramps
Duration:
Varies
Contagious Period:
Unknown—less contagious after symptoms diminish and treatment taken
C.diff is typically seen in those over the age of 65, those recently hospitalized, or those on antibiotics. However, infants can become colonized with C.diff early in life and carry the bacteria until age 3 without symptoms. I have had a couple of calls in the past year and half in this position about c.diff and so I wanted to briefly mention it.

53. C. diff Exclusion: Prevention: 24 hours after last bout of diarrhea
Handwashing
Clean and sanitize/disinfect toys and surfaces
Wear gloves when changing diapers and disinfect changing area after each change
There is no need to notify parents, other teachers or the health dept. The child can use the public restroom as normal.

54. Prevention and Control

55. Cleaning, Sanitizing, and Disinfecting
Cleaning—using soap and water to remove dirt, debris, and many germs
Sanitizing—using a chemical to remove disease-causing germs from food contact surfaces or mouthed toys or objects (Bleach Solution 2)
Disinfecting—using a chemical of stronger concentrations to remove disease-causing germs from non-food contact surfaces (Bleach Solution 1)
See sheet in folder from Hennepin County Infectious Diseases in Childcares and Schools Manual
Bleach 1 Solution = 1 gallon water to 2.5 tablespoons of Bleach
Bleach 2 Solution = 1 gallon water to 1 teaspoon of Bleach
Make solutions fresh daily and label them with the date and contents
Mix in airtight, cloudy plastic container
Date bleach bottles with the date purchased (can keep unopened for 3 months) and the date the bottle was opened (can keep for 30 days once opened.
Keep out of reach of children!!
Other products can be used besides bleach. These should be: EPA-registered (labeled on product); Effective against Staph, Salmonella, and pseudomonas; effective with 10 minutes or less contact time; and clearly labeled with directions for mixing and use. If sanitizing mouthed objects or food surfaces, it also needs to say safe to use on food surfaces.

56. Food Safety Healthy food handlers
Cold foods cold (<41); Hot foods hot (>140)
When in doubt use 165 (cooking, reheating)
Consider a metal, tip sensing digital thermometer
Cool foods rapidly (or discard left-overs)
Keep raw and ready-to-eat foods separated

57. Handwashing
Handwashing is the single most effective way to prevent the spread of infection!
Young children have not yet learned healthy personal habits. They suck their fingers and/or thumbs, put things in their mouths, and rub their eyes. These habits can spread disease, but good handwashing can help reduce infection due to these habits. Caregivers who teach and model good handwashing techniques can reduce illness in childcare settings and schools. Gloves are not a substitute for handwashing.

59. Gloves Gloves are NOT a substitute for handwashing
Throw away single-use gloves after each use
Wash hands after removing gloves
Use gloves frequently
Food
Body fluids

60. Cover your Cough
These viruses can be spread to others when the ill person coughs or sneezes into their hands and then contaminates surfaces and objects.

61. Exclusion Policies Providers should have written exclusion policies
Exclusions vary by disease—refer to technical fact sheets from Hennepin Co
Basic exclusions include:
Fever, Diarrhea, and Vomiting AND 24 hours after
When the child cannot perform normal activities
When a serious contagious illness has been diagnosed
Just because a parent or provider says the child can be in childcare, does not necessarily mean they should be there!
Subp. 3.
Provider policies.
The provider shall have the following written information available for discussion with parents or the agency:
policies for the care of ill children, disease notification procedures, immunizations, and medicine permission policies;
C. The provider shall require that a child's parent notify the provider within 24 hours of the diagnosis of a serious contagious illness or parasitic infestation listed in item E so the provider may notify the parents of other children in care.
D. The provider shall inform a parent of each exposed child the same day the provider is notified a positive diagnosis has been made for any of the illnesses or parasitic infestations in item E.

62. Immunization Policies
Immunization records must be kept in accordance with Minnesota Statutes, section 121A.15
Children should be up to date on Measles, Rubella, Diptheria, Tetanus, Pertussis, Polio, Mumps Haemophilus influenzae type b, and Hepatitis B
OR have a medical or conscientious exemption
You have the responsibility and the right to enforce this State Statute. You can turn children away if not immunized.
Immunization records must be kept in accordance with Minnesota Statutes, section 121A.15. The provider shall request, update, and keep on file the dates of immunizations received by a child in regular attendance at the residence as follows:
§ (1)
for an infant, every six months;
§ (2)
for a toddler, annually;
§ (3)
for a preschool child, every 18 months; and
§ (4)
for a school-age child, every three years.

63. Emergency Preparedness Scenario
Okay in the last few minutes before we get to questions, I want to introduce a scenario to get you thinking a bit about emergency preparedness as it pertains to infectious diseases.
Emergency Preparedness Scenario

64. Emergency Preparedness Scenario
Day 1:
2 year old child comes in with a cough, sore throat, and runny nose
Parents say it started yesterday and think it is just a cold as she has not had a fever
Around noon, the child develops a fever and is sent home
Day 2:
Parents call you to let you know the child still has a fever and will not be in today

65. Emergency Preparedness Scenario
Day 3:
Parents call to let you know the child is still ill and they will be taking her into the doctor today
Day 4:
Olmsted County Public Health calls to notify you that the child was tested and positive for measles

66. What’s next?
What information do you as the childcare provider need to give to parents?
What do information do you need to give to public health?
What precautions are being implemented?
Are unvaccinated children being allowed to attend?
When would you shut down?
The reason I bring this up is because as you may know, Minnesota had its largest Measles outbreak since 1990 in 2017.
75 cases—32 cases transmitted in child care facilities
Median age was 2 years old (3 months – 57 years)
91% (68 cases) unvaccinated
21 cases hospitalized
Exposures occurred in 4 schools, 12 childcares, as well as several healthcare facilities for a total of 8,800 exposures
Exclusions: A total of 596 people were excluded including 530 from schools and childcares
This is a huge impact on families, health departments, schools and childcares.

67. OCPHS & Childcare Facility Work Together
Give a list of children who were exposed with vaccination records
Immune children okay to return
Excluded for 21 days (incubation period)
If still within 72 hours of INITIAL exposure, can receive a MMR vaccine and return to school. Still need to monitor for symptoms.
If still within 6 days of INITIAL exposure, can receive immunoglobulin (IG)
No evidence of immunity:
OCPHS & Childcare Facility Work Together

68. Resources
Hennepin County Infectious Diseases in Childcare Settings and Schools Manual
diseases
MDH
CDC
OCPHS
; General Line
; Disease Control Specialist
Hennepin County Infectious Diseases in Childcare Settings and School Manual is one of my go to resources. They have 47 fact sheets specifically for parents and 54 technical fact sheets for providers. This includes fact sheets for specific communicable diseases, information about reporting, control and management of communicable diseases, guidelines for prevention and control, guidelines for environmental cleaning, sanitizing, and disinfecting, and guidelines for staff and children surrounding exclusions and concerns for pregnant women.

69. Olmsted County Public Health Services
Libby Schmidt, Disease Control Specialist
Leah Espinda-Brandt, Disease Prevention & Control Nurse Manager
Stacy Sundve, Director of Health Assessment & Planning
Mike Melius, Environmental Health Manager
Olmsted County Public Health Services

70. Questions