NEW JERSEY DEPARTMENT OF HEALTH COMMUNICABLE DISEASE SERVICE GENERAL GUIDELINES FOR THE PREVENTION AND CONTROL OF OUTBREAKS IN CAMP SETTINGS Intrductin New Jersey Administrative Cde, 8:25-5, Title 6A, Chapter 16-2, and N.J.A.C.10:122 (Manual f Requirements fr Child Care Centers) mandate that each schl district/child care center, and yuth camp shall immediately reprt any cmmunicable diseases that are identified as reprtable pursuant t N.J.A.C. 8:57-1, whether cnfirmed r presumed, by telephne t the health fficer f the jurisdictin in which the schl/camp is lcated. These regulatins pertain t day and resident yuth camps, child care centers, preschls, schls and institutins f higher educatin. Additinally, facilities that serve fd are subject t the requirements f NJAC 8:24-1, Chapter 24 Sanitatin in Retail Fd Establishments and Fd and Beverage Vending Machines. This dcument has been prepared t guide in preventin, identificatin and respnse t utbreaks ccurring in the camp setting. In additin t the guidance belw, specific guidance fr residential camps can be fund n page 6. An utbreak is defined as an ccurrence f disease greater than wuld therwise be expected at a particular time and place and further defined belw. Reprting Reprting cmmunicable disease utbreaks in camps serves many purpses. The immediate gal is t cntrl further spread f the disease. Beynd that, infrmatin gained frm utbreak investigatins can help camps and public health agencies identify and eliminate surces f infectin such as cntaminated prducts, learn abut emerging prblems, identify carriers t mitigate their rle in disease transmissin, and implement new strategies fr preventin within the camp setting. Often in the camp setting it is difficult t determine whether r nt an utbreak exists. Fllwing are sme examples f cnfirmed r suspected utbreaks which shuld be reprted by the camp t their lcal health department (LHD). This is nt a cmprehensive list. If the situatin des nt fit any f these criteria but yu think an utbreak might be ccurring, it is always a gd idea t cntact yur LHD fr guidance. An utbreak may be ccurring if: 1. Several children wh exhibit similar symptms are in the same sectin r grup, the same wing f a facility r they attended a cmmn event. 2. There is an increase in camp absences with many parents reprting similar symptms as the reasn why their child is nt attending camp. 3. Tw r mre campers r staff members are diagnsed with the same reprtable disease (e.g. salmnellsis).
4. A single case f a highly infectius disease (e.g., measles r pertussis) exists, r is suspected t exist. D nt wait fr cnfirmatin in these instances as the ptential fr an utbreak exists. Reprting refers nt nly t the initial utbreak ntificatin, but als t the prvisin f rutine updates n the status f the utbreak. The camp and the LHD shall be in daily cntact regarding case numbers, cntrl measures taken, and ther pertinent infrmatin. Upn receiving the initial reprt, the LHD shall immediately infrm the New Jersey Department f Health Cmmunicable Disease Service (NJDOH CDS) f the situatin. The camp shall: Immediately ntify the LHD f the jurisdictin in which the camp is lcated. A directry f lcal health departments can be fund at http://lcalhealth.nj.gv. Ntificatin MUST be made by phne. It is imprtant t nte that reprts shall NOT be made via vice mail, fax, email, text message, etc. Fr immediately reprtable diseases, LHDs have smene available 24/7 wh can take the reprt. If the LHD staff cannt be immediately reached and it is an emergency, make the reprt directly t the Cmmunicable Disease Service at NJDOH. The Cmmunicable Disease Service is reachable at 609-826-5964 (business hurs) and 609-392- 2020 (after hurs and hlidays) Ntify the NJDOH Public Health, Sanitatin and Safety Prgram (PHSSP) at 609-826-4941 within 24 hurs. The LHD shall: Ntify the NJDOH CDS (609-826-5964 -business hurs, 609-392-2020 after hurs and hlidays). Nte that reprting an utbreak t the NJDOH PHSSP des nt negate yur requirement t call NJDOH CDS. Case Investigatin Upn ntificatin, NJDOH CDS will assess the reprt and, if apprpriate, assign an E number. Clearly mark all crrespndence, dcumentatin and lab samples with this number. The LHD, in cnsultatin with the NJDOH CDS epidemilgist, shall lead the investigatin by prviding the schl with guidance, supprt and assistance. The LHD shuld cnsider making an n-site visit fr initial evaluatin and nging assessment. The LHD, with cperatin f the camp nurse/directr r designee, will fllw the basic steps listed belw. These steps may ccur sequentially and/r simultaneusly during the curse f the investigatin. 1. Gather infrmatin t cnfirm an utbreak prvide as much f the fllwing as pssible: Prvide ttal number f children and staff in camp. NJDOH-CDS September 2018 2
Start a line list that includes all ill children and staff. Fr an example f infrmatin that shuld be included in the line list see http://www.state.nj.us/health/frms/cds-33.dt (Frm CDS-33). Fr any gastrintestinal illnesses cmpile a list f fd handlers wh have been ill, alng with their specific duties. A fd handler is any persn directly preparing r handling fd. Fd handlers may range frm staff prviding a snack t a cafeteria wrker. Cmpile a list f extracurricular activities and special events held during the 2 weeks prir t the first illness nset. Examples f extracurricular activities r events might include sprts, scial events, clubs, etc. 2. Verify the diagnsis: There are a variety f ways t determine what is causing an utbreak. Occasinally, when an utbreak is reprted, labratry testing has already been cnducted and a diagnsis has been made. Fr mst utbreaks, hwever, this is nt the case. Als, sme diseases must be diagnsed clinically there is n specific test that can be dne. The LHD can assist with ensuring that the disease under investigatin has either already been prperly diagnsed r that apprpriate testing is carried ut t reach a diagnsis. This is dne by review f clinical findings and/r labratry results fr the case. It may als be necessary t interview the patient, parent r dctr. Based n the assessment f the LHD, cnfirmatin f the diagnsis with a labratry test may be necessary. Lab testing may be dne thrugh a private physician and labratry, at the state Public Health and Envirnmental Labratry (PHEL), r at the Centers fr Disease Cntrl and Preventin (CDC). The LHD r NJDOH CDS epidemilgist shall facilitate lab testing and/r specimen transprt. At least tw labratry-cnfirmed cases (e.g., Nrvirus) r 2 physician-cnfirmed cases in which labratry cnfirmatin is nt available (e.g., Cxsackie virus) are needed t cnfirm an utbreak s etilgy (i.e., the germ that is respnsible fr the disease). 3. Develp an utbreak case definitin: An utbreak case definitin describes the criteria that an individual must meet t be cunted as an utbreak case. This includes clinical signs & symptms, physical lcatin and specific time perid. Every utbreak will have a unique utbreak case definitin. This differs frm a clinical case definitin, which is a criterin f symptms used t make a diagnsis (e.g., diagnsis f a case f scarlet fever may include symptms f a rash, reddened sre thrat, fever, swllen glands). Examples f utbreak case definitins assciated with a camp setting are: 1. Fever, nausea, and abdminal discmfrt n r after mm/dd/yy plus tw r mre episdes f vmiting and/r lse r watery stls in cabin r drm XYZ. 2. Child r staff f cabin r drm XYZ experiencing an illness characterized by fever and at least tw f the fllwing n r after mm/dd/yy: Rhinrrhea, nasal cngestin, sre thrat, cugh (prductive r nn-prductive), change in appetite, change in mental status, headache, lethargy, myalgia, respiratry distress, pleuritic chest pain, radigraphic evidence f a pulmnary infiltrate. NJDOH-CDS September 2018 3
The utbreak case definitin will be develped by the LHD r NJDOH CDS epidemilgist with cperatin frm the camp based n the current situatin. The NJDOH CDS epidemilgist is available fr cnsultatin as needed. 4. Perfrm active surveillance: Seek ut additinal cases amng campers and staff. Be alert fr new-nset illness amng expsed persns, and review camper and staff histries t identify previus nsets f illness that may nt have been crrectly recgnized as being part f the utbreak. When a camper is absent, ask parents t prvide the reasn fr the child s absence in rder t determine if the camper is part f the utbreak and in need f further fllw up by public health. It may be necessary t cllect additinal specimens frm newly ill cases if a diagnsis has nt yet been established. 5. Dcument and cunt cases: The camp shall maintain a daily lg (line list) f the number f campers and staff absent due t illness. See (Frm CDS-33) fr a sample line list. The LHD investigatr shall review the line list with the camp and the NJDOH CDS epidemilgist t assess the status f the utbreak and make recmmendatins regarding cntrl measures. 6. Identify and eliminate pssible transmissin surces: The camp, LHD and NJDOH CDS epidemilgist shuld cllabrate t determine the utbreak surce. The surce f an utbreak is the persn r item respnsible fr transmissin f illness t thers (where it riginated). It can be a: 1. Single sick child. 2. Cntaminated surface r prduct in the camp. 3. Cntaminated water supply. 4. Pet r animal. Occasinally, even with thrugh investigatin, the surce might nt be identified. 7. Institute cntrl measures: Cntrl measures are the tls that can end the utbreak by halting transmissin. The LHD, in cnsultatin with the NJDOH CDS epidemilgist, shall prvide recmmendatins and guidance t the camp regarding cntrl measures. The camp shuld make every effrt t institute and maintain adequate cntrl measures until the utbreak is declared ver. See Camp Outbreak Cntrl Measures fr a list f cmmn cntrl measures that a camp may be asked t initiate. 8. Evaluate the effectiveness f cntrl measures and mdify as needed: Generally, the utbreak is cnsidered t be ver when tw incubatin perids have passed withut a new case being identified. An incubatin perid is defined as the time between expsure t an rganism and when symptms and signs are first apparent. NJDOH-CDS September 2018 4
Waiting tw incubatin perids allws fr recgnitin f ptential secndary casepatients that are still asymptmatic but in whm the disease may be incubating. Evaluate and enfrce adherence t infectin cntrl precautins by all staff, campers and visitrs. Cntinue cntrl measures until n new cases are identified fr tw incubatin perids. When n new cases are identified after tw incubatin perids, cntrl measures may be ceased unless therwise indicated by lcal health r the NJDOH CDS epidemilgist. 9. Camp Clsure: NJDOH CDS des nt recmmend camp clsure fr utbreaks f infectius disease. The decisin t clse a camp is an administrative decisin and ne that shuld be made nly after cnsultatin with public health fficials and the camp medical persnnel. Based n the situatin ccurring at the time f the utbreak, the licensing authrity (NJDOH PHSSP) des have the authrity t clse a camp. Camps shuld wrk with lcal health departments t ensure that recmmended cntrl measures (e.g., exclusins, increased cleaning) are being fllwed. In additin, the lcal health department in cnjunctin with NJDOH CDS may recmmend enhanced surveillance be cnducted in a camp in rder t mnitr the prgressin and ultimate decline f an utbreak. If abslutely necessary, camp clsure shuld be utilized n a limited basis t prevent spread f infectin when: 1. Infectins are expected t affect large number f susceptible individuals. 2. Recmmended cntrl measures are inadequate. 3. The camp is unable t functin due t increased illness affecting campers and staff. 4. The health department declares an epidemic r cause f ill health t be injurius r hazardus. 10. Summarize the investigatin in a written reprt: Unless therwise instructed by the NJDOH CDS, the LHD shall cllabrate with the directr/camp nurse and ther public health partners invlved in the investigatin n a final reprt and submit it t NJDOH within 30 days f cmpletin f the investigatin. See the NJDOH website fr the reprt frmat, available at http://www.state.nj.us/health/frms/cds-38.dt (frm CDS-38). NJDOH-CDS September 2018 5
Resident Camps Camps can be especially vulnerable t the rapid spread f gastrintestinal (GI), respiratry and ther illnesses. Campers ften reside in clse living quarters like tents r drmitries and participate in a many grup activities, which can allw fr easy transmissin f rganisms frm persn t persn. There is ften ptential fr decreased persnal hygiene amng campers, especially in rustic camp settings where there is little r n running water fr tilets, shwers r handwashing. In additin t the guidance in the main dcument, the fllwing infrmatin is prvided t specifically address preventin measures and challenges that may ccur when experiencing an illness utbreak in a residential camp setting. Camp Administratin At the beginning f camp seasn, all staff shuld be trained n basic illness preventin measures and plicies. Camps shuld establish an illness plicy fr emplyees. The plicy shuld address reprting f illness, by staff t management; exclusin and/r mdifying the duties f ill staff; and mnitring well staff fr symptms. Establishing an ill emplyee plicy is especially imprtant fr fd handlers. Camps shuld establish a cntingency plan that addresses illness utbreaks. This plan shuld include measures t exclude, huse, mnitr, and care fr large numbers f ill campers and staff. Ensure that the designated areas fr ill campers and staff have adequate ventilatin and climate cntrls; beds, cts, r mats and linens fr large numbers f ill persns; and access t tilets and lavatry facilities. In an utbreak situatin, meet with all staff t review the situatin and utbreak cntrl measures. If an utbreak ccurs, ntify parents f the utbreak. The LHD in cnjunctin with the NJDOH CDS epidemilgist can assist in develping letters and/r fact sheets depending n the circumstances f the utbreak. Health Center Management Immunizatin recrds r exemptins are required t be nsite fr all campers. Camps shuld have a plicy in place t track campers allergies, medicatins, and special needs. Medicatins are required t be prperly stred and labeled as required by the health regulatins. A nurse, health directr r designated persn is required t administer medicatins. This persn must be prperly trained t administer the medicatins. The administratin f all medicatin shuld be dcumented. It is recmmended that the camp shuld maintain incident and health center visit lgs t dcument and mnitr illnesses and injuries. Lgs shuld include at a minimum the date, time, name, living unit, and the nature f the visit. In the event f an utbreak r a suspect utbreak (when an utbreak has nt been cnfirmed but there is suspicin that ne may be ging n), develp and maintain a list f NJDOH-CDS September 2018 6
ill campers and staff. This list shuld include the fllwing infrmatin (a sample list is included in these guidelines): Identificatin Camps shuld have a plicy fr daily surveillance f campers and staff fr illness. Check health center illness lgs daily fr cmmn cmplaints and/r increased cases f illness with similar symptms. Preventin and Cntrl Handwashing Handwashing is the single mst effective means f cntrlling the spread f cmmunicable disease. Handwashing must ccur frequently and nt just during utbreaks. Adequate supplies f hand washing sap and dispsable twels must be available at all times in fd service and dining areas, bathrms and ther areas where tileting r fd service may ccur. Encurage all campers and staff t practice prper handwashing especially befre meals and after using the restrm. Staff shuld mnitr campers handwashing and supervise and/r help yung children wash their hands thrughly and prperly. Husekeeping Pst handwashing signs thrughut the camp. If handwashing facilities are limited, cnsider adding temprary facilities, staggering grups f campers at available facilities, r set a handwashing schedule t ensure all campers have an pprtunity t wash their hands. If temprary facilities are added, they must prvide a cntinuus flw f water. Sap and paper twels must be prvided at temprary facilities. Using buckets f standing water t dip hands int is NOT an acceptable temprary handwashing facility. Alchl-based hand sanitizers shuld be used if sap and water is nt available. Cnsider making alchl-based hand sanitizers available thrughut the camp. Exercise cautin and ensure prper supervisin f yung children using alchl-based sanitizers. When hands are visibly siled, after tileting, and after cleaning vmitus r ther ptentially cntaminated bdy fluids, alchl-based sanitizers shuld nt substitute fr sap and water when pssible. These prducts are nt as effective against sme GI viruses as prper handwashing, s prper handwashing shuld ccur when pssible. Staff shuld be educated n and wear persnal prtective equipment (glves and masks) and use dispsable cleaning prducts when cleaning bdy fluids (e.g. vmitus, feces). In additin, staff shuld practice thrugh handwashing, NJDOH-CDS September 2018 7
and be encuraged t change t clean clthing prir t resuming ther activities. Mattresses, mats, and pads are required t be cvered with impervius, easily cleanable materials. Cts must be cnstructed f easily cleanable materials. Cvers fr mats and mattresses and bedding are required t be laundered between uses by different children r at least nce per week if used by the same camper. Mattress and ct cvers that cannt be laundered shall be cleaned and sanitized between uses by different children r at least nce per week if used by the same camper. Vmit and Fecal Accident Clean Up The fllwing prcedure shuld be used t clean a vmit r fecal accident. Ideally, camps shuld maintain separate supplies (such as buckets) fr cleaning these types f accidents, and refrain frm using supplies that are used fr rutine cleaning. Clean areas siled with vmit r feces prmptly after the accident ccurs. Crdn ff the area where the accident ccurred until it is cleaned. At a minimum, the persn cleaning shuld wear dispsable single-use glves. Dispsable masks, aprns, and eye shields may als be wrn if they are available. Begin by spraying the siled area with a freshly prepared 10% husehld bleach slutin. This slutin can be made by mixing 1 2/3 cup (abut 13 unces) f bleach per galln f water. It shuld be made fresh daily. This is strnger than the cncentratin used fr rutine disinfectin. An EPA registered prduct effective against nrvirus accrding t manufacturer s instructins may als be used. See cleaning and disinfecting sectin in Camp Outbreak Cntrl Measures sectin. Spray the entire area within a 10-ft range f the vmiting r fecal incident. If the incident ccurs in the kitchen, cnsider the area within 25 feet f the vmit t be cntaminated. Use dispsable clths, paper twels, r an absrbent material t sak up the vmit r feces. Transfer the clths, paper twels, r absrbent material alng with any slid material int a plastic trash bag. Using a dispsable clth, clean the siled area with warm sapy water. Once clean, spray the affected area again, with a 10% husehld bleach slutin and allw the area t air-dry. After the affected area has been cleaned, supplies used t clean the accident (such as buckets) shuld be sprayed with a 10% husehld bleach slutin and allwed t air-dry. Place the glves, aprn, mask, cleaning clths, and paper twels in the trash bag and dispse f the bag in a trash receptacle. The persn cleaning the affected area shuld thrughly wash his/her hands when finished. If the accident ccurs utdrs r in an area that is nt easily cleaned, attempt t remve as much vmit r feces as pssible by the methd NJDOH-CDS September 2018 8
described abve. When utdrs, the affected area can be cvered with sil r grund cver after remving as much vmit r feces as pssible. If a persn vmits r has a fecal accident in the dining hall, clean the affected area as indicated abve. Fd cntact surfaces and dining tables near the accident shuld be sprayed with a 10% husehld bleach slutin and then rinsed with clean water. Fd that was in the area when the accident ccurred shuld be thrwn away. Mattress cvers siled with vmitus r feces shuld be remved and prmptly cleaned and disinfected r discarded. Handle linens, sleeping bags, and clthing siled with vmit r feces as little as pssible. These items shuld be laundered with detergent in ht water at the maximum cycle length and then machine dried n the highest heat setting. If there are n laundry facilities nsite capable f reaching a suitable temperature, siled items shuld be duble bagged (using plastic bags) and taken ffsite fr prper washing and drying. If siled items are sent hme, instruct parents r caregivers f the prper washing and drying prcedures. Fd Service Child care facilities, including children s camps that serve fd are subject t the requirements f the N.J.A.C. 8:24 the NJDOH Retail Fd Establishment Rules and Regulatins. The menu shuld nt be cmprised f fds r preparatin steps that pse greater risk f fdbrne illness transmissin. Fr example, fds cntaining raw r undercked animal prducts shuld nt be served. Fd preparatin areas shall be restricted t authrized persnnel. Campers shuld be restricted frm entering fd preparatin areas unless they are authrized t d s. Whenever pssible, fds shuld be prepared just befre service, handled minimally, and prtected during strage, preparatin, and service. Fd service shall be designed s that fds and utensils are handled by a minimal number f individuals. Fd plated by trained, authrized fd handlers is the best way t cntrl the spread f fdbrne illness. If a buffet line is used, fds shall be prtected with sneeze guards and dispensed with utensils. Family-style service (where a large batch f fd is placed n dining tables and campers serve themselves) shuld be mnitred by staff, limited t small grups f campers, and fd shuld be dispensed with a serving utensil. Dn't allw use f cmmn r unclean eating utensils, drinking cups, etc. Dining areas, including tables, shuld be wiped dwn after each use using a bleach slutin f 1-part husehld bleach per 50 parts water (2% slutin). Ensure that all fd service staff (including campers wh ccasinally handle fds) washes their hands thrughly befre fd handling and immediately after tilet visits. NJDOH-CDS September 2018 9
Exclude fd handlers and cafeteria staff ill with GI symptms accrding t exclusin criteria in the Schl Exclusin List. Fd handled r prepared by an ill persn must be thrwn away immediately. In the event f an utbreak, discntinue family-style service and selfservice bars such as salad and sandwich bars where campers serve themselves. This includes activities that allw children t assist with meal preparatin such as table setting and serving fd. Drinking Water and Waste Water Camps are required t prvide adequate, safe, and ptable drinking water. Camps that rely n well water are required t adequately and cntinuusly treat the water and verify thrugh bacterilgical samples taken at a frequency determined by the NJDOH PHSSP that the water is safe and ptable. Ensure prper treatment and nly use apprved surces. Camps that are nt cnnected t a municipal sewer system, and that rely n nsite wastewater treatment, must maintain their wastewater systems and mnitr fr signs f failure. Ill Campers and Staff Upn arrival at camp, all campers shuld be screened fr recent r current symptms f illness, such as fever, vmiting, and diarrhea. Campers with symptms f a cmmunicable illness, especially GI illness, shall be excluded frm well campers until they can be assessed by the health center. Campers ill with diarrhea and/r vmiting shuld nt return t their unit and shuld be excluded frm well campers until their symptms have reslved fr 48 hurs unless therwise specified in the schl exclusin list. Parents/guardians shuld be called t pick up ill campers if pssible. Campers shuld be islated in a hlding area until pick up. If pssible, ill campers shuld avid eating in the dining rm with well campers. If pssible, ill campers shuld use restrm facilities separate frm thse used by well campers. Ill campers shuld nt participate in grup activities with well campers until their symptms have reslved fr 48 hurs. It is recmmended that the camp have alternative activities available fr ill campers. Emplyees shall be in gd health and free frm cmmunicable disease while caring fr children, preparing fd fr campers and staff, r emplyed in any capacity where there is a likelihd f disease transmissin t thers at the facility. Staff ill with diarrhea and/r vmiting shuld limit cntact with campers until their symptms have been reslved fr 48 hurs. Exclude fd handlers and cafeteria staff ill with diarrhea and/r vmiting frm wrk until at least 48 hurs after diarrhea and vmiting have ceased unless therwise specified in the schl exclusin list, even if they are feeling well sner. NJDOH-CDS September 2018 10
Staff shuld use single-use glves when caring fr peple wh are sick with vmiting and/r diarrhea. Glves shuld be changed, and hands shuld be washed befre caring fr each persn. Camps shuld have an adequate supply f glves available thrughut the camp fr staff t use in the event f an utbreak. Depending n the situatin, the NJDOH CDS r the lcal public health agency may recmmend cllecting stl r vmit specimens frm ill campers and staff fr labratry testing t try t determine the rganism causing f the illness. Ill campers and staff shuld nt wade r swim in recreatinal waters r swimming pls until their symptms have reslved fr 48 hurs r therwise advised by lcal public health. New arrivals shuld nt be hused with sick r recvering campers and staff. At resident camps, campers r staff members must be islated frm ther campers in the infirmary r a lcatin separate frm uninfected campers and staff. Depending n the camp cntext and duratin, camp directrs may want t cnsider sending hme campers and staff with illness. Limit entry/exit frm camp; pstpne r restrict activities invlving visitrs, including ther camps n a case by case basis after cnsultatin with public health. NJDOH-CDS September 2018 11
GENERAL GUIDELINES FOR THE CONTROL OF OUTBREAKS IN CAMP SETTINGS CONTROL MEASURES The fllwing is a list f sme cmmn cntrl measures that may be requested f the camp. This list is t serve as a guide, nt all cntrl measures are charted belw and nt all are apprpriate in every situatin. The LHD can help the camp determine which cntrl measures are apprpriate. Descriptin f Cntrl Measure t be Implemented Recmmended Date Instituted Date Reinfrced Date Suspended Exclude sick staff and campers. Specific exclusin guidelines can be fund in the Schl Exclusin List. Ill children/staff shuld be immediately islated frm well students/staff; Have a designated area fr ill campers t stay until they can be picked up At resident camps, ill campers r staff members must be islated frm ther campers in the infirmary r a lcatin separate frm uninfected campers and staff Campers/staff ill with diarrhea and/r vmiting shuld nt return t their unit and shuld be excluded frm well campers until their symptms have reslved fr 48 hurs Ill campers shuld nt participate in grup activities with well campers until their symptms have reslved fr 48 hurs If pssible, ill campers shuld avid eating in the dining rm with well campers Review plicies; Illness Cleaning and disinfecting Sanitizing utensils, cups Handwashing Diaper changing If pl n site assure cmpliance by fllwing public recreatinal bathing rules NJDOH-CDS September 2018
Descriptin f Cntrl Measure t be Implemented Recmmended Date Instituted Date Reinfrced Date Suspended Educate parents, staff and campers; Prvide in-service t educate campers and staff regarding preventin, transmissin and prper hand hygiene During an utbreak meet with staff t review situatin and cntrl measures Cntact LHD fr fact sheets r ther pertinent educatinal materials Have a plicy in place regarding ntificatin t parents/guardians. This may be accmplished by sending ntificatin hme. Cnsult the lcal health department fr recmmendatins regarding ntificatin when a cmmunicable disease f public health imprtance r an utbreak f illness is reprted in a camp. Frequent hand washing with sap and water especially; Befre and after handling fd r eating Befre giving medicatin After using the bathrm Adults shuld supervise children during hand washing After cntact with animals After cleaning spills r bjects cntaminated with bdy fluids Befre and after giving first aid Befre dnning and after remving glves If handwashing facilities are limited, cnsider adding temprary facilities stagger grups f campers set a handwashing schedule prvide sap and paper twels Nte: Hand sanitizers shuld nt be substituted fr sap and water hand washing during a GI utbreak. Alchl based sanitizers have been shwn t be ineffective against spre frming bacteria such as C. difficile, r viruses such as Nrvirus. NJDOH-CDS September 2018
Descriptin f Cntrl Measure t be Implemented Recmmended Date Instituted Date Reinfrced Date Suspended Glves shuld be wrn; During cntact with bld, feces r bdy fluids Nte: Remve and dispse f glves after cmpleting tasks, befre tuching anything else. Reinfrce respiratry etiquette t campers and staff; Cughing and sneezing int a tissue r elbw Prperly dispsing f tissues http://www.cdc.gv/flu/prtect/cvercugh.htm If applicable, suspend cmmunity dining r recreatinal activities where ill and well campers wuld therwise mingle. Staff assigned t affected sectins f camp r cabins shuld nt rtate t unaffected sectins r cabins Cleaning and disinfecting; Increase frequency during an utbreak Immediately after spills f bdy fluids Discard fluid cntaminated material in a plastic bag that has been securely sealed Mps shuld be cleaned, rinsed with a disinfecting slutin, wrung as dry as pssible and hung t dry cmpletely Change mp heads when a new bucket f cleaning slutin is prepared, r after cleaning large spills f emesis r fecal material. Frequently tuched surfaces including recreatin equipment, tables, lavatry surfaces, mats, blankets/sheets, keybards, kitchen prep areas, phnes, handrails, drknbs and equipment in the immediate vicinity f children. Cmmn areas such as gym, cafeteria, restrms Prper technique Educate staff n and instruct staff t wear persnal prtective equipment when cleaning NJDOH-CDS September 2018
Descriptin f Cntrl Measure t be Implemented Recmmended Date Instituted vmitus Use dispsable cleaning prducts when cleaning vmitus Mattress and ct cvers must be laundered between uses by different children r at least nce a week if used by the same camper Date Reinfrced Date Suspended Cvers that cannt be laundered must be cleaned and sanitized between uses by different children r at least nce a week if used by the same camper Use a brad spectrum prduct registered with the EPA as being tuberculcidal r effective against Nrvirus http://www.epa.gv/ppad001/chemregindex.htm accrding t manufacturer s instructins r a self-made bleach slutin prepared daily; labeled and sealed ¼ cup bleach per galln f cl water r 1 Tbsp. bleach per quart f cl water Use f a bleach wipe with a 6% cncentratin f sdium hypchlrite fr a 2 ½ minute cntact time fllwed by air drying may be substituted NJDOH-CDS September 2018 Fr fecal accident r vmitus clean up use 1 2/3 cup f bleach per galln n water D nt use a cmmn clth fr cleaning/disinfecting; use paper twels and dispse f them immediately after use Facilities serving r sharing fd shuld; Discntinue family-style Stp using self-service bars Discntinue activities that allw children t assist with meal preparatin such as table setting and serving fd Restrict campers frm sharing f any cmmunal fd items Fd preparatin areas shall be restricted t
Descriptin f Cntrl Measure t be Implemented Recmmended Date Instituted authrized persnnel D nt allw use f cmmn r unclean eating utensils, drinking cups, etc. Hand ut items t be shared D nt let children serve themselves in any manner which might prmte direct hand cntact with shared fds Exclude ill fd handlers with GI illness accrding t exclusin list Drinking and recreatinal water Ensure prper treatment f water Use nly apprved surces Ill campers and staff shuld nt wade r swim in recreatinal waters r swimming pls until their symptms have reslved fr 48 hurs r therwise advised by lcal public health Date Reinfrced Date Suspended Limit entry/exit frm camp Pstpne r restrict activities invlving visitrs, including ther camps NJDOH-CDS September 2018
General Guidelines fr the Cntrl f Outbreaks in Schl and Child Care Settings Schl Exclusin List This chart prvides infrmatin abut sme cmmunicable disease that may ccur in schls, day care centers, summer camps and ther grup settings fr children. It is meant as a guide t answer questins frequently asked f persns respnsible fr grups f children. This is nt an all inclusive list f significant diseases r a cmprehensive guide t all infrmatin abut each disease r cnditin. Mre specific infrmatin abut these and ther diseases may be btained by cntacting yur lcal health department r the New Jersey Department f Health, Cmmunicable Disease Service. Infectin r Cnditin Cmmn Symptms Exclusin fr Schl/Daycare Children Acute Respiratry Illness (ARI) Fever (ral temperature 100 F r equivalent) and rhinrrhea, nasal cngestin, sre thrat, cugh in absence f a knwn cause (e.g., seasnal allergies). Until fever free fr 24 hurs withut fever reducing medicatin Exclusin fr Child Care Prvider and/r Fd Handler Nte Reprtable t Health Department Cnjunctivitis, purulent Pink r red cnjunctivae with white r yellw discharge, ften with matted eyelids after sleep and eye pain r redness f the eyelids r skin surrunding the eye. Until examined by a medical prvider and apprved fr return Cnjunctivitis, nnpurulent Pink cnjunctivae with a clear, watery eye discharge withut fever, eye pain, r eyelid redness. N exclusin E. cli Shiga txin prducing E. cli (STEC) Nausea, vmiting, bldy diarrhea, abdminal cramps. Daycare: Symptm free and 2 negative stls2 Schl: Symptm free Excluded frm cking, preparing and tuching fd until symptm free and have tw negative stl tests.2 Stls f all child care staff, attendees and husehld cntacts with diarrhea, shuld be tested in utbreak situatins. Yes, individual cases and utbreaks3 NJDOH-CDS September 2018 1
Infectin r Cnditin Cmmn Symptms Exclusin fr Schl/Daycare Children Fever (nly) Oral temperatures >101 F (38 C), rectal temperatures >102 F (38.9 C), r axillary temperatures > 100 F (37.8 C) usually are cnsidered t be abve nrmal. Fever free fr 24 hurs withut fever reducing medicatin. When fever abve nrmal is assciated with behavir change r ther signs f illness r the child is unable t participate, and staff cannt care fr child withut cmprmising ability t care fr the ther children in the grup. Exclusin fr Child Care Prvider and/r Fd Handler Nte Signs f illness are anything (ther than fever) that indicates that the child s cnditin is different frm what is usual when the child is healthy. Reprtable t Health Department Fifth Disease (Erythema infectisum) Gastrintestinal Illness (rganism/cause nt identified r nt yet determined) Mild cld symptms fllwed by rash, characterized by "slapped face" appearance. Frequent lse r watery stls, (2 abve nrmal fr that child), abdminal cramps/tenderness, and fever. Vmiting mre than 2 times in 24 hurs. N exclusin unless the child has an underlying bld disrder r a cmprmised immune system Diarrhea: until stls are cntained in the diaper r tilettrained children n lnger have accidents using the tilet and when stl frequency becmes less than 2 stls abve nrmal frequency fr that child. Vmiting: until symptms have reslved Excluded frm fd handling r feeding until 24 hrs. after symptms reslve. Pregnant wmen and immun- cmprmised persns shuld seek medical advice. Medical evaluatin fr stls with bld r mucus. Exclude unless vmiting is determined t be caused by a nn-cmmunicable cnditin (i.e. reflux) and child is able t remain hydrated and participate in activities. Outbreaks1 and individual cases f diarrheal disease (child in daycare center and fdhandler) Hand Ft and Muth (cxsackievirus) Fever, sre thrat, malaise, ulcers in the muth and blisters n hands and feet. Daycare: Fever free and n lnger drling steadily due t muth sres Schl: Fever free fr 24 hurs withut fever reducing medicatin Head Lice Head scratching While NJDOH des nt recmmend exclusin after treatment, individual schls may have different plicies. Refer t schl plicy Mst ften seen in summer and early fall. Recmmendatin: Refer fr treatment at the end f prgram day. Readmissin n cmpletin f treatment. Hepatitis A Jaundice 1 week after nset f jaundice r illness and fever free (if symptms are mild) Fd handlers - 1 week after nset f jaundice r illness and fever free (if symptms are mild) Yes, Immediately 3 NJDOH-CDS September 2018 2
Infectin r Cnditin Cmmn Symptms Exclusin fr Schl/Daycare Children Herpes Gladiatrum ( Wrestlers Herpes ) Cluster f blisters typically head, neck and shulders. Fever, sre thrat, swllen lymph ndes, burning r tingling skin. Wrestlers: All lesins healed with well adhered scabs 5 Exclusin fr Child Care Prvider and/r Fd Handler Nte Reprtable t Health Department Impetig Small, red pimples r fluid-filled blisters with crusted yellw scabs. 24 hurs after treatment initiated Sprts: Exclude if lesins cannt be adequately cvered until deemed nn-infectius and adequately treated by HCP 5 Wrestlers 5 Fund mst ften n the face but may be anywhere n the bdy. Lesins shuld be cvered until dry. Influenza-like Illness (ILI) Fever (ral temperature 100 F r equivalent) and cugh and/r sre thrat in absence f a knwn cause (e.g., strep thrat). Fever free fr 24 hurs withut fever reducing medicatin Outbreaks Only1 Measles Meningitis, Bacterial (including Haemphilus influenzae) Initially characterized by fever, reddened eyes, runny nse, cugh, fllwed by maculpapular rash that starts n the head and spreads dwn and ut. High fever, headache and stiff neck. Thrugh 4 days frm rash nset Rash nset = day 0 Yes, Immediately 3 Until adequately treated, 24 hurs after initiatin f effective antimicrbial therapy Meningitis, Viral High fever, headache and stiff neck. Fever free fr 24 hurs withut fever reducing medicatin Yes, Immediately 3 Mnnuclesis Fever, sre thrat, swllen lymph ndes. Fever free fr 24 hurs withut fever reducing medicatin Medical nte t resume physical activities. MRSA (methicillinresistant staphylcccus aureus) Red bumps that prgress t pus-filled bils r abscesses. If lesins cannt be adequately cvered Sprts: If lesins cannt be adequately cvered r drainage cannt be cntained by the bandage 5 Wrestlers 5 Tw r mre nnhusehld, culturecnfirmed cases f MRSA that ccur within a 14-day perid and may be linked. Mumps Fever with swelling and tenderness f ne r bth partid glands lcated belw and in frnt f ears. 5 days after nset f partid swelling Partitis = day 0 Yes, individual cases and utbreaks 3 NJDOH-CDS September 2018 3
Infectin r Cnditin Cmmn Symptms Exclusin fr Schl/Daycare Children Nrvirus Nausea, vmiting, diarrhea, abdminal cramps. May als have lw grade fever, chills, bdy aches, headache. Exclusin fr Child Care Prvider and/r Fd Handler 24-48 hrs. after symptms reslve 48-72 hrs. after symptms reslve. Staff may perfrm duties nt assciated with fd preparatin 24 hrs. after symptms reslve Nte Exclusin time n a case by case basis after cnsultatin with the lcal health department. Reprtable t Health Department Pertussis Initial stage begins with URI symptms and increasingly irritating cugh. Parxysmal stage is characterized by repeated episdes f vilent cugh brken by high pitched inspiratry whp. Older children may nt have whp. After 5 days f apprpriate antibitic therapy cmpleted. If untreated, thrugh 21 days frm cugh nset. Yes, Immediately 3 Rubella (German measles) Slight fever, rash f variable character lasting abut 3 days; enlarged head and neck lymph ndes. Jint pain may ccur. 6 days after nset f rash Yes, Immediately 3 Salmnella Typhi (typhid fever) Fever, anrexia, lethargy, malaise, headache. Daycare: Symptm free and three negative stl tests 2 Schl: Symptm free Excluded frm cking, preparing and tuching fd until symptm free and three negative stl tests. 2 Stls f all child care staff, attendees and husehld cntacts with diarrhea, shuld be tested in utbreak situatins. Yes, individual cases and utbreaks 3 Salmnella nntyphid Fever, nausea, vmiting, nn-bldy diarrhea, abdminal cramps. Symptm free 4 Excluded frm cking, preparing and tuching fd until symptm free and have tw negative stl tests. 2 Yes, individual cases and utbreaks 3 Scabies Itchy raised areas arund finger webs, wrists, elbws, armpits, beltline, and/r genitalia. Extensive scratching. Until after treatment has been given Wrestlers 5 Refer fr treatment at the end f schl day and exclude until treatment has been started. Shigella Nausea, vmiting, diarrhea (may be bldy, and abdminal cramps. Daycare: Symptm free and 2 negative stls 2 Schl: Symptm free Excluded frm cking, preparing and tuching fd until symptm free and have tw negative stl tests. 2 Stls f all child care staff, attendees and husehld cntacts with diarrhea, shuld be tested in utbreak situatins. Yes, individual cases and utbreaks 3 NJDOH-CDS September 2018 4
Infectin r Cnditin Cmmn Symptms Exclusin fr Schl/Daycare Children Staphylcccal r streptcccal skin infectins (nt including MRSA & Impetig) Hney crusted draining lesins, skin lesins with a reddened base. If lesins cannt be adequately cvered Sprts: If lesins cannt be adequately cvered r drainage cannt be cntained by the bandage 5 Wrestlers 5 Exclusin fr Child Care Prvider and/r Fd Handler Nte Reprtable t Health Department Streptcccal pharyngitis (strep thrat) Fever, sre thrat, exudative tnsillitis r pharyngitis, enlarged lymph ndes. May als have a sandpaper-like rash. 24 hrs. after treatment has been initiated and child able t participate in activities Tinea capitis (Ringwrm f the scalp) Hair lss in area f lesins Until after treatment has been started. Wrestlers 5 Refer fr treatment at the end f schl day and exclude until treatment has been started. Tinea crpris (Ringwrm f the bdy) Circular well demarcated lesin that can invlve the face, trunk, r limbs. Itching is cmmn Until after treatment has been started. Wrestlers 5 Refer fr treatment at the end f schl day and exclude until treatment has been started. Tuberculsis Cugh, chest pain, fever, night sweats, fatigue, and weight lss Until LHD and physician state the student is nn-infectius Yes, individual cases and utbreaks 3 Varicella (Chickenpx) Slight fever with eruptins which becme vesicular. Lesins ccur in successive crps with several stages f maturity at the same time Until all lesins have dried and crusted usually 6 days after nset f rash Yes, individual cases and utbreaks 3 Varicella-Herpes Zster (Shingles) Lcalized vesicular lesins Until all lesins have dried and crusted unless lesins can be cvered Wrestlers 5 Cnditins Requiring Temprary Exclusin Temprary exclusin is recmmended when the illness prevents the child frm participating cmfrtably in activities as determined by the staff f the schl r prgram; the illness results in a greater need fr care than the staff f the prgram determine they can prvide withut cmprmising their ability t care fr ther children; the child NJDOH-CDS September 2018 5
has any f the fllwing cnditins, unless a health prfessinal determines the child s cnditin des nt require exclusin: appears t be severely ill (this culd include lethargy/lack f respnsiveness, irritability, persistent crying, difficult breathing, r having a quickly spreading rash, fever (as defined abve) and behavir change r ther signs and symptms (e.g. sre thrat, rash, vmiting, and diarrhea). 1 An utbreak may be ccurring if: several children wh exhibit similar symptms are in the same classrm, same wing r attended a cmmn event. There is an increase in schl absences with reprt f similar symptms. Tw r mre students diagnsed with the same reprtable disease. A single case f a highly infectius disease exists r is suspected t exist. 2 Negative stl specimens taken at least 24 apart and at least 48 hurs after cessatin f antibitic treatment 3 Fr specific reprting requirements refer t NJDOH Reprting Requirements http://nj.gv/health/cd/reprting 4 During an utbreak negative stl specimens may be required befre return t schl and/r fd handling 5 Wrestling and ther cntact sprts refer t http://www.ncaapublicatins.cm (search sprts medicine handbk ) fr exclusin guidance Surces: A. American Academy f Pediatrics. Red Bk 30 th Editin B. NJDOH http://nj.gv/health/cd/tpics Cmmunicable Disease Chapters C. Centers fr Disease Cntrl and Preventin http://www.cdc.gv D. Natinal Cllegiate Athletic Assciatin. NCAA 2014-15 Sprts Medicine Handbk http://www.ncaapublicatins.cm F. American Academy f Pediatrics. Managing Infectius Diseases in Child Care and Schls a Quick Reference Guide, 3rd Editin NJDOH-CDS September 2018 6
Sample Letter t Families abut Expsure t Cmmunicable Disease Name f Prgram Date Telephne # Dear Parent r Legal Guardian: A child in ur prgram has r is suspected f having: Infrmatin abut this disease: The disease is spread by: The symptms are: It can be prevented by: What the prgram is ding: What yu can d at hme: Where yu can get additinal infrmatin: If yur child has any symptms f this disease, call yur dctr r ther healthcare prvider t find ut what t d. Be sure t tell him r her abut this ntice. If yu d nt have a regular prvider t care fr yur child, cntact yur lcal health department fr instructins n hw t find a dctr, r ask ther parents fr names f their children s prviders. If yu have any questins, please cntact: at Schl Nurse/Caregiver s name Phne number NJDOH-CDS September 2018