School exclusion for infections

Disease

Incubation

Infectivity

Exclude Until

Comments

Chickenpox

11-20 days

Up to 4 days before (usually only 1 day) to 5 days after.

Cases often transmit before appearance of rash.

5 days from the onset of rash.

Exclude until all lesions have crusted over and it is at least five days from the start of the rash.

Contacts with a weak immune system or who are pregnant should speak to their GP in case they need preventative treatment.

Cold sores

1-6 days

While lesions are moist.

None.

Highly infectious, especially amongst young children.

Avoid kissing.

Conjunctivitis

3-29 days

Mean = 8

While active (direct contact).

Infective up to 2 weeks.

None.

Transmission more likely in young children by direct contact - very few data.

Cryptosporidiosis*

1-12 days (usually 7 days)

12-14 days (may be as long as 1 month).

48 hours from last episode of diarrhoea.

Exclusion from swimming for 14 days after diarrhoea has settled.

Diarrhoea and vomiting

8-10 days

6-16 days.

48 hours from last episode of diarrhoea or vomiting.

Exclude for 48 hours after the last episode of diarrhoea or vomiting.

Glandular fever

33-49 days

At least 2 months.

None.

None.

Hand, foot and mouth disease

3-5 days

Up to 50% in homes and nurseries.

None.

Children can return to school once they feel better: they do not need to be excluded until blisters have healed.

Stool excretion continues for some weeks. Avoid infection in pregnant women. If large numbers of children in one setting are affected then public health should be contacted as they may consider exclusion.

Head lice

n/a

While harbouring lice.

None.

Treatment needed for cases and contacts shown to have live head lice.

Hepatitis A*

15-50 days

From 2 weeks before to 1-2 weeks after jaundice onset.

Exclude until 7 days after onset of jaundice (or 7 days after symptom onset if no jaundice).

Good hygiene needs emphasising.

Hepatitis B* Hepatitis C*

HIV

See comment.

None.

These are blood-borne viruses and are not infectious through casual contact. Settings should know what to do if there is an incident involving blood spillage.

Impetigo

Skin carriage 2-33 days before development of impetigo (streptococci)

High (streptococci).

Low (staphylococci).

Variable infectivity depending on causative bacteria.

Until lesions have healed or crusted or 48 hours after starting antibiotic treatment.

Antibiotics speed healing and shorten the infectious period.

Measles*

6-19 days

Highly contagious in the non-immune population.

A few days before to 6-18 days after onset of rash.

4 days from onset of rash.

Check immunisation.
Risk of serious infection in people with a weak immune system, who should see their GP to consider preventative treatment if exposed to measles, particularly if their medical condition means that they were not able to have the MMR vaccine.

Meningitis

2 - 10 days

Depends on which bacteria are causing it but can be highly infectious.

Until the child has recovered.

Public health will advise - in some cases school/nursery contacts may need preventative antibiotics. Siblings or household contacts do not need to be excluded.

MRSA

Skin carriage

Low.

None.

Good hygiene, in particular handwashing, is important.

Mumps*

15-24 days

10-29 days.

Moderately infective in the non-immunised population.

5 days from onset of swelling.

Preventable by vaccination.

Ringworm

Varies

Until lesions resolve.

Exclusion not usually required.

Good hygiene helps. Treatment is required and can usually be bought over the counter.

Rubella*

14-21 days

1 week before to approximately 4 days after onset of rash.

4 days from onset of rash.

Preventable by immunisation. Check all female contacts are immune - non-immune pregnant contacts should see their GP.

Scabies

Varies

Until mites and eggs are dead.

Can return after first treatment.

Risk of transmission is low in schools but outbreaks do occur.

Close contacts should also be treated.

Scarlet fever*

1-3 days

Moderate within families.

Low elsewhere.

Infective first 3 days of treatment.

24 hours after starting antibiotic treatment.

Moderate within families.
Low elsewhere.

If there is more than one case in a setting, public health should be informed.

Shingles

14-16 days

Reactivation of the virus that causes chickenpox but lower infectivity.

5 days from the onset of the rash.

If the rash can be covered, exclusion is not usually necessary. Contacts with a weak immune system or those who are pregnant should contact their GP to see if they need preventative treatment.

Slapped cheek disease

13-18 days

30% in families.

10-60% in schools.

None.

Avoid infection in pregnant women and people with a weak immune system.

Threadworms

n/a

Until all worms are dead.

None.

Good hygiene helps.

Case and family contacts should be treated.

Tonsillitis

n/a

Risk is similar to other colds and flu

None

Most cases are viral and do not need antibiotics.

Tuberculosis*

n/a

Until 14th day of treatment.

Variable. Always consult the local health protection unit.

Public health should always be contacted - spread is most likely where there is prolonged close contact.

Warts and verrucas

n/a

None.

None.

Care needed with verrucas in swimming pools, gymnasiums and changing rooms.

Whooping cough*

7-10 days

Mainly early catarrhal stage, but until 4 weeks after onset of cough paroxysms.

Shorten to 7 days if given antibiotics.

48 hours from commencing antibiotic treatment, or 21 days from onset of illness if no antibiotic treatment.

Preventable by vaccination. Check immunisation of contacts.
Highly infectious in non-immune populations. Children may cough for many weeks after the exclusion period has finished.