Infectious Disease in Out of Home Child Care Jonathan B. Kotch, MD, MPH, Director National Training Institute for Child Care Health Consultants The University of North Carolina at Chapel Hill Part III: Illnesses transmitted skin-to-skin, by body fluids and by insects

Objectives for Part III At the end of this training learners will be able to: Describe the causes and consequences of the infectious diseases in child care transmitted skin- to-skin, by body fluids and by insects, and Identify modes of transmission and prevention of infectious diseases transmitted skin-to-skin, by body fluids and by insects.

Skin-to-Skin Infections (Churchill and Pickering, 1997) Viruses Herpes simplex Varicella-zoster Molluscum contagiosum HPV (warts) Bacteria Group A strep Staphylococcus aureus Parasites Pediculosis (lice) Sarcoptes scabiei (scabies) Tinea capitus (scalp ringworm) Tinea corporis (body ringworm)

New Issue - MRSA Methicillin-resistant Staph aureus Child care cases rare More common in health care settings Hospitals Nursing homes Associated with contact sports, and sharing clothes and towels in locker rooms Also associated with compromised skin integrity (cuts, abrasions, boils)

Blood, Urine, Saliva Saliva Cytomegalovirus (CMV) Epstein-Barr virus (EBV) Herpes simplex virus Blood Hepatitis B (HBV) Human Immunodeficiency Virus (HIV) Cytomegalovirus (CMV) Epstein-Barr virus (EBV)

Prevention Immunization HBV Varicella-zoster Standard precautions Bloodborne pathogens (OSHA)

Indications for Exclusion 1 Mouth sores with drooling Rash with fever or behavior change Impetigo Draining boils or skin lesions not contained by a dressing (i.e., lesions on hands or face) Purulent conjunctivitis (pink eye) Scabies Shingles (usually affects caregivers, not children) if the lesions cannot be contained under a bandage that is under clothes (i.e., lesions on hands or face) 1 Courtesy of Steve Shuman

Head Lice 2 Unlike exclusion for other conditions, children with head lice don ’ t have to be sent home until the end of the day. Parents of affected children shall be notified and informed that their child must be treated properly before returning to the child care facility the next day. 2 Courtesy of Steve Shuman

Arthropod borne Tickborne Lyme disease Rocky Mountain spotted fever Ehrlichiosis Mosquitoborne West Nile Virus (WNV) Other arboviruses such as Eastern Equine encephalitis

Risks WNV: 4,269 cases reported in 2006 (CDC) Lyme disease: 23,305 cases reported in 2005 (CDC)

2007 West Nile Virus Activity in the U.S. (Reported to CDC as of December 11, 2007)

All About WNV (CDC, 2003) Relatively few children have been reported with severe West Nile Virus disease. By contrast, most of the deaths due to WNV are among people over 50 years old. Half of those deaths were among people over 77 years old. Fight the Bite © logo used with permission.

N,N-diethyl-3- methylbenzamide (DEET) Repellent with DEET is safe when used according to directions, according to the EPA and the AAP. No serious illness has been linked to the use of DEET in children However, no definitive studies exist in the scientific literature about what concentration of DEET is safe for children. Products with different strengths of DEET are available. The AAP recommends that concentrations up to 30% may be used for children (but do not use DEET in children younger than 2 months of age).

New recommendations from the CDC (2005) Picaridin (KBR 2023), along with DEET, is considered to have demonstrated “ a higher degree of efficacy ” Oil of lemon eucalyptus is comparable to low concentrations of DEET (but not recommended for children under 3)

Take it Outside Sunscreen – use liberally Insect repellent - use sparingly Other precautions Proper clothing (ideally long sleeves and long pants) Separate playground from wooded areas Tick-checks Eliminate standing water Keep outdoor sand boxes and sand tables covered

Acknowledgement Supported by Grant #U93-MC00003 from the Maternal and Child Health Bureau of the Health Resources and Services Administration, U.S. Department of Health and Human Services. END OF PART III