COMMUNICABLE Disease in child care - clphs.health.mo.gov

COMMUNICABLE Disease in child care - clphs.health.mo.gov

Child Care Basics Series Module 3: Emergency Preparedness, Communicable Disease Control, and Immunizations in Child Care Settings Disaster and Emergency Preparedness in Child Care Planning Things we plan for Parties Holidays Vacations

First day of school/daycare Moving Family Reunions Things we cant plan for

Tornadoes Earthquakes Fires Intruders/Lockdown Hazardous spills Accidents/death JOPLIN MISSOURI 2011 Tornado Damage 13 child care facilities were completely destroyed Photo credit: Kathy Harris WHAT CAN OUR FACILITY DO TO

PREPARE??? WRITE AN EMERGENCY PLAN Purpose of an Emergency Plan To assist in protecting the health and safety of the children in its care should disaster or emergency, be in natural or deliberate, affect the facility, operation or its community The safety of the child and staff is the primary goal Types of Emergency Response Shelter in Place /

Lock Down Evacuation Staying inside a designated area, or a safe room, within your facility to secure children, staff, and visitors in a protected area (tornado, earthquake, severe storm) Evacuate a location to go to another location either nearby or far away to remain safe

(fire, flood, chemical exposure, bomb threat) Emergency Planning Considerations Post local emergency numbers by every phone in the building and in every room where staff/children may need them All staff should load emergency numbers into their cell phone Have emergency contact information for every child in every classroom Emergency Planning Considerations

Assign specific staff to be responsible for primary emergency functions: One staff is responsible for the following Communication with teachers in each class/head count Contacting parents Classrooms have adequate staff/item to keep children calm Contact local officials/communicate with emergency officials Emergency Supplies Emergency supplies should be stored in one location that is easily

accessible. Supplies should be easily transportable t o another location. Supplies should be checked/updated every 6 months. Supplies: Contact lists (children and staff) Weather radio First aid kit/Medications Flashlight/batteries Diapers/wipes Food/Water

Clothing /toys/equipment for Children Staff / Parent Education An emergency plan doesnt work if staff are not aware of and trained on it. DRILLS are critical, just as you practice CPR and other vital skills practice for emergencies can save lives. KNOW THE PLAN PRACTICE THE PLAN Next Steps For more information on Emergency Preparedness in Child Care watch the Ready in

3 video (25 minutes) Your Preparedness Plan If you dont have a personal and family preparedness plan you will be less likely to be able to help the children in your care during an emergency. Take the time to write a plan for your family. http://health.mo.gov/emergenc ies / COMMUNICABLE Disease in child care

Prepared by MISSOURI DEPARTMENT OF HEALTH AND SENIOR SERVICES CENTER FOR LOCAL PUBLIC HEALTH CHILD CARE HEALTH CONSULTATION PROGRAM INTRODUCTION TO COMMUNICABLE DISEASE PREVENTION YOUNG CHILDREN AND THE ADULTS WHO CARE FOR THEM ARE OFTEN AFFECTED BY COMMUNICABLE DISEASES GOOD INFORMATION AND

PRACTICES CAN HELP KEEP CHILDREN IN CHILD CARE HEALTHY THE SAME PRACTICES CAN HELP YOU AS A CARE GIVER STAY HEALTHY Illness in child care-why are children at risk? Childrens immunity is not fully developed Children in out-ofhome care often are sick more frequently and for longer (exposed to bugs they arent exposed to at home)

Larger numbers of children are in close contact for longer periods of time Their activities increase opportunity for disease transmission They are not reliable hand-washers Illness in child carewhy are children at risk? DISCUSSION: Talk with the person next to you for a few minutes. Come up with 3-4 examples of behaviors or activities you

have seen children do, that increase the sharing of germs. COMMUNICABLE DISEASES WHAT ARE THEY? Spread from one person to another by germs that are microscopic Only a few germs on a hand, sink or toy can cause disease HOW DO GERMS SPREAD? RESPIRATORY TRANSMISSION Coughing

Sneezing Runny noses RESPIRATORY TRANSMISSION When a germ passes from the lungs, throat, or nose of one person to another person The most common infections in child care Children in child care average 10-12 colds a year Examples: Common cold Influenza Many vaccine-preventable diseases (measles, mumps, chickenpox, pertussis) Tuberculosis

Strep throat How do germs spread from the intestinal tract Intestinal tract (germs are swallowed) Called fecal-oral transmission Germs pass in stool Hands are contaminated with stool Surfaces are contaminated Food is contaminated Happens when contaminated hands touch objects such as food, utensils, or toys that someone else puts into their mouth. Hands can be contaminated during toileting, or by touching objects contaminated by stool.

Examples of fecal-oral diseases Shigella Giardia Salmonella E. coli O157:H7 Hepatitis A How do germs spreadthrough secretions

Contact with infected secretions (urine, saliva, blood ) Can occur when secretions or other body fluid such as blood from an infected person enters open skin or mucous membranes, like a childs mouth, nose or eye. Examples of diseases transmitted by secretions or blood

Cytomegalovirus* Hand, foot and mouth disease* Hepatitis B Hepatitis C Herpes simplex* HIV Infection / AIDS * most common in childcare settings How do germs spread direct contact Direct contact

Germs are spread by direct contact with an infected persons skin or body fluids Examples of diseases spread by direct contact Chickenpox (varicella) Impetigo Head Lice (pediculosis)-Not a disease but an infestation. Ringworm Staph infections including MRSA (methicillin-resistant staph) You cant always tell Diseases are sneaky! Many people with a disease show symptoms

(coughing, sneezing, diarrhea) BUT People who dont show symptoms of being sick can still spread diseases. Some diseases are transmitted before the person has symptomsup to several days before they know they are sick Some who are infected never have symptoms, but they can still spread the disease People can pass on a disease even without getting it themselves (e.g., from unwashed hands or a dirty tissue) Disease prevention techniques: Always follow prevention procedures, not just when a person is sick. Here are the 5 most important ways to prevent disease:

Good handwashing is the most important thing (for you and the children) Use sanitary methods when diapering and toileting Teach and use the best procedure for containing coughs and sneezes Follow proper food preparation and handling procedures Maintain sanitary conditions in the child care home or center

In addition to the top 5 Understand the causes of diseases and how they spread Call for consultation when you have questions or need help Report certain significant diseases to your local public health department Take special measures (when recommended) to control outbreaks of disease references

Infection Control in the Child Care Center & Preschool, Edited by Leigh Grossman Donowitz Managing Infectious Diseases in Child Care & Schools, American Academy of Pediatrics, Editors Susan S. Aronson, MD, FAAP & Timothy R. Shope, MD, MPH, FAAP Immunizations and child care Missouri Department of Health and Senior Services Child Care Health Consultation Program Learning objectives

Understand the importance of immunizations Responsibility of child care facilities Ability to review immunization records for age appropriate compliance Identify reliable resources for immunization education Immunizations are important for everyone To prevent disease To protect health To eliminate contagious diseases To prevent further victims of preventable

diseases Immunization requirements for child care & preschool 2017-2018 DTaP Haemophlius Influenzae type B (Hib) Pneumococcal (PCV) Hepatitis B (Hep B)

Polio (IPV) Measles, Mumps, Rubella (MMR) Varicella (Chicken Pox) Diphteria, Tetanus & Acellular Pertussis (DTaP) Diphtheriabacteria lives in the mouth, throat, and nose of an infected person. Spread to others by coughing and sneezing Tetanus (Lockjaw) infection caused by a bacteria that lives in soil and in the intestines of many animals. The bacteria enters the body through cuts or wounds. Pertussis (Whooping Cough) Highly infectious bacteria that causes severe coughing

Dtap immunization schedule The recommended schedule for DTaP is 2 mo, 4 mo, 6 mo, 12-18 mo, and 4 to 6 years DTaP 2 months 4 months 6 months 12-15 months

DTaP Infants do not start the series until 2 months of age and may not be fully protected until they receive the 3rd and 4th dose There should be 6 months from the 3rd Haemophilus influenza type b ( hib) Most often strikes children under the age of 5 Before vaccine was developed, leading

cause of bacterial meningitis infections in this age group Germs are carried in the nose and throat Easily spread, life threatening Hib immunization schedule Recommended schedule: 2 mo, 4 mo, 6 mo, and 12-15 mo 2 months 4 months 6 months 12-15 months

HiB DTaP Depending on vaccine manufacturer, ACIP recommends 3-4 doses by age 2 years Catch up schedule requires attention (next slide) Hib catch up schedule VACCINE REQUIRED FOR PRESCHOO

L AND CHILD CARE # DOSES REQUIR ED BY AGE 3 MONTH S # DOSES REQUIRE D BY

AGE 5 MONTHS # DOSES REQUIR ED BY AGE 7 MONTH S # DOSES REQUIRED BY AGE

19 MONTHS & OLDER 3 2 HIB 1 1 2 1

SPACING REQUIRENENTS: IF VACC IS GIVEN 4 DAYS EARLY, CHILD IS CONSIDERED ADEQUATELY IMMUNIZED 3 DOSES WITH FINAL DOSE ON OR AFTER 12 MONTHS OF AGE; OR 2 DOSES WITH 1 DOSE ON OR AFTER 12 MONTHS OF AGE; OR

1 DOSE ON OR AFTER 12 MONTHS OF AGE; OR IF CURRENT AGE IS 5 YR OR OLDER, NO NEW OR ADDITIONAL DOSES Pneumococcal VACCINE REQUIRED FOR PRESCHOO L AND CHILD CARE

# DOSES REQUIR ED BY AGE 3 MONTH S # DOSES REQUIRE D BY AGE 5 MONTHS

# DOSES REQUIR ED BY AGE 7 MONTH S (pcv) # DOSES REQUIRED BY AGE 19 MONTHS

& OLDER 4 3 PCV (PNEUMOCOCCAL CONJUGATE, PREVNAR) 1 2 3 2

1 SPACING REQUIRENENTS: IF VACC IS GIVEN 4 DAYS EARLY, CHILD IS CONSIDERED ADEQUATELY IMMUNIZED 4 DOSES WITH 4TH DOSE ON OR AFTER 12 MONTHS OF AGE; OR 3 DOSES WITH 1 DOSE ON OR AFTER 12 MONTHS OF AGE;

OR 2 DOSES ON OR AFTER 12 MONTHS OF AGE; OR 1 DOSE ON OR AFTER 24 MONTHS OF AGE; OR IF CURRENT AGE IS 5 YR OR OLDER, NO Hepatitis b (hep b) Illness causes severe diarrhea and vomiting, fatigue, loss of appetite, and yellowing of skin

and mucous membranes (eyes) Leads to serious liver disease, including liver cancer (2nd most common cause worldwide) Newborns can be infected if mother is infected, or through contact with blood and other body fluids Completed vaccination will protect for life Hep B Immunization Schedule Birth 2 months 4 months 6 months 12-15 months

Hep B started at 2 months Hep B with Birth dose PCV HiB Dtap Hep B Dose spacing Dose 1 and 2 At least 4 weeks between Dose 2 and 3 At least 8 weeks between Dose 1 and 3 At least 16 weeks between. Dose 3 must be on or after child is 24 weeks (6 months) of age NOTE: DATE OF BIRTH DOSE MUST BE RECORDED. BIRTH IS NOT AN

ACCEPTABLE ENTRY ON THE RECORD PER STATE LAW. Polio (ipv) Caused by virus that lives in intestinal tract

Spread by contact with feces (ex: diapering, poor sanitation) No cure for the disease Appears as a mild cold-like illness, but is potentially crippling, can lead to paralysis and death In the 1940s nearly 35,000 people in the US contracted polio By 1979, the US was free of polio thanks to vaccination efforts Still present in many poorer countries outside the US President Franklin D. Roosevelt was paralyzed by polio Polio Immunization Schedule Birth** 2 months 4 months

6 months Polio Hep B ** If Birth dose given, 4 mo dose may be omitted PCV HiB DTaP 12-15 months Recommended schedule: 2 mo, 4 mo, 6-18 mo, and 4-6 years Child entering Kindergarten must have and IPV on or after their 4 th birthday

Measled, mumps, rubella (mmr) Measles: Highly contagious; caused by virus; 1 in 20 will get pneumonia; 1 or 2 in 1,000 will die high fever, rash, cough, runny nose, eye irritation Mumps: Also caused by virus fever, headache, swelling of jaw and salivary glands Rubella (German Measles): Viral; low fever, rash on face and neck for 2 or 3 days Causes birth defects if passed to pregnant women Mmr immunization

schedule Birth 2 months 4 months 6 months MMR Polio Hep B **if first dose at birth PCV HiB DTaP 12-15 months

Recommended schedule: 12-15 mo and 4-6 years MMR MUST be given on or after the childs 1st birthday with booster usually on or after 4th birthday Varicella (chicken pox) Produces skin rash of blister-like lesions normally seen on face and body The lesions (blisters) can develop in other parts of the body, such as lungs, esophagus Other complications can include skin infections, scarring, pneumonia, brain damage Before vaccine, about 11,000 people hospitalized and 100 deaths annually

Varicella (cont) RULE CHANGE: As of July 1, 2010, parental/guardian statements no longer accepted as satisfactory evidence of disease Must have signed statement from MD or DO with month and year of disease on file at facility Varicella immunization schedule Birth 2 months 4 months 6 months

Varicella MMR Polio Hep B**If first dose at birth PCV HiB DTaP 12-15 months Recommended: given at 12-15 months and at 4-6 years MUST be given on or after childs 1st birthday, booster USUALLY given on or after 4th birthday Immunizations recommended by

ACIP These vaccinations are recommended by the Advisory Committee on Immunization Practices (ACIP) but are not required: Rotavirus (RV) Hepatitis A (Hep A) Influenza (Flu) Not required, but still VERY IMPORTANT ROTAVIRUS (RV) Virus causes severe diarrhea, and sometimes vomiting and fever Transmitted by children who are infected to other children Leads to severe dehydration, often hospitalization

(70,000/year), and sometimes death Unimmunized children will probably have at least one infection by age 5 Occurs most often in winter and spring, with most infections occurring between November and May Rotavirus (rv) immunization schedule Birth 2 months 4 months 6 months RV MMR Hep B**If 1st dose

at birth HiB Varicella Polio PCV DTaP 12-15 months RV is given by mouth, not injection; 3 dose schedule completed before age 32 wks Recommended: 2 mo, 4 mo, & 6 mo Should not give RV after 32 weeks of age regardless of where they Hepatitis a (Hep A)

Virus causes an infection that damages the liver Causes stomach pain, fatigue, loss of appetite, jaundice (yellowing of skin/eyes) Can have/shed virus and not show signs of illness Spread through close contact or eating food, drinking contaminated water Hepatitis a (cont) Examples of how Hepatitis A is spread: Infected persons not practicing good hand washing after using bathroom Eating food prepared by infected person Drinking untreated water or eating food prepared with untreated water

Placing objects in mouth that have been in contact with virus Close personal contact with infected person (diapering, cleaning soiled linens) Hepatitis A immunization schedule Birth 2 mo 4 mo 6 mo Hep A Varicella Polio PCV

DTaP RV MMR Hep B**if 1st dose at birth HiB 12-15 mo 18 mo Recommended: dose at 12-23 months followed with booster dose 6 months after 1st dose Influenza (flu) Virus causes sudden onset of fever, chills, muscle

aches, cough, sore throat, and headache Can be mild, but usually severe, and can even lead to death (especially among most vulnerable) Complications include pneumonia Children under 5 years old often require medical care Severe complications most common in children under 2 years old Influenza (FLU) Immunization Vaccine is updated annually Take each year as soon as is available Vaccine takes 14-21 days to be fully protected Recommended for ALL persons age 6 months

and older Important that caregivers take annual vaccine Complete immunization schedule including acip recommended (RV, Hep A) Hep A Birth 2 mo RV Varicella MMR 4 mo

Polio 6 mo Hep B**If 1st dose at birth, omit dose at 4 mo 12-15 mo PCV HiB 18 mo DTaP

ANNUAL FLU SHOT RECOMMENDED EVERY YEAR 6 MO & OLDER Immunization schedule after age 18 months Age 4 6 years Age 11-12 years Every year DTaP Tdap

Flu shot (6 mo & older) Polio MCV MMR HPV Varicella Day care immunization rule

Daycare immunization rule 19 CSR 20-28.040 (1) As mandated by Missouri Revised Statutes section 210.003, the administrator of each public, private, or parochial day care center, preschool, or nursery school caring for ten (10) or more children shall have a record prepared showing the immunization status of every child enrolled in or attending a facility under the administrators jurisdiction. (2) No child shall enroll in or attend a public, private, or parochial day care center, preschool, or nursery school caring for ten (10) or more children unless the child has been adequately immunized according to this rule. Other citations

in rule 19 CSR Licensing Rules No child shall be permitted to 3062.192 (4) for Group Child Care Homes and Child Care Centers enroll in or attend any day care facility caring for ten (10) or more children unless the child has been immunized adequately

against vaccine preventable childhood illnesses specified by the department in accordance with recommendations of the Immunization Practices Advisory Committee (ACIP) 19 CSR 3061.185 (4) Licensing Rules Same as above for Family Day Care Homes

19 CSR 3060.060 License Exempt Child care facilities shall meet Child Care immunization Facilities requirements for children as Options / exemptions to immunization rule Medical exemption May be exempted for medical reason Must have on file Medical Exemption card

signed by licensed MD or DO (DHSS Form Imm.P.12) Does not have to be renewed annually Unimmunized children are subject to exclusion from child care facilities during outbreaks of vaccine-preventable diseases Parent / guardian exemption One parent may file written objection with day care administrator MUST be on DHSS Form Imm.P.11 & filed with immunization record MUST be renewed annually Unimmunized children are subject to exclusion from child care facilities during

outbreaks of vaccine-preventable disease In progress In Progress means vaccine series is begun and next dose appointment is scheduled Failing to keep appointments equals noncompliance with the law, and child shall be excluded immediately May enroll if satisfactory evidence shows child has begun immunizations May continue to attend so long as progress is according to DHSS requirements Properly completed & updated In Progress card MUST be on file Immunization record

review Annual child care survey Missouri Revised Statutes (RsMo) Section 210.003 requires ALL children (including any relatives of child care provider) attending public, private, parochial day care centers, preschools or nursery schools caring for ten (10) or more children to be adequately immunized, in the process of being immunized, or to have a parental or medical exemption card on file. Law also requires ALL public, private, parochial day care centers, preschools or nursery schools to submit an annual summary report providing information on the immunization status of attendees. Completed report due (to Mo Dept of Health & Senior ServicesBureau of Immunization Assessment and Assurance) by January 15. FAILURE TO SUBMIT THE ANNUAL SUMMARY REPORT IS A RULE VIOLATION PER THE SECTION FOR CHILD CARE REGULATIONS.

Aggregate data collected from the annual child care survey is reported to the CDC. Data from the report also helps DHSS prevent possible disease outbreaks The next slide will be n example of a childs immunization record. Lets interrupt the record and see if he is compliant Immunization Record review Immunization Record #14 Child's Name (Last, First, MI) Missouri Department of Health and Senior Services Date of Birth 5/1/2012 Evans, Sarah Elizabeth

Dates Given Dose DTaP 1 2 7/28/2012 10/3/2012 7/28/2012 10/3/2012

5/2/2012 7/28/2012 3 4 Hib Polio Hepatitis B 10/3/2012 MMR Varicella

Pneumococcal Hepatitis A Influenza Rotavirus Name of Physician or Recognized Health Facility (Please Print or Type:) Dr. Betty Cheerful 5 6 Contact your child care consultant with questions regarding immunization record interpretation, or if you need assistance filling out the state survey. resources

Child Care Health Consultants (local public health agency) DHSS Immunization program representatives http://www.dhss.mo.gov/living/wellness/immunizations www.cdc.gov/vaccines www.immunize.org www.aap.org www.pkids.org www.vaccinateyourbaby.org www.ecbt.org Show me vax Link: http://health.mo.gov/l

iving/wellness/immun izations/showmevax. php Child Care Providers may access with read only privileges [email protected] health.mo.gov . Thank you!

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